Physician burnout among West Virginia primary care providers

TITLE: Physician burnout among West Virginia primary care providers INTRODUCTION: Work related burnout is highly prevalent in US physicians and linked to adverse effects on patients, providers and organizations. This study measures burnout in West Virginia (WV) primary care providers, allowing for comparison of results to a similar, recent study of US physicians. METHODS: Anonymous survey through email that included Maslach Burnout Inventory, demographic, workload, and practice characteristics. Responses were analyzed using JMP Pro 13. Analysis used JMP Pro 13 for descriptive statistics, chi-square and regression modeling. RESULTS: Subjects = 110, female/male ratio 1.4, all primary care physicians (PCP), or advanced practice registered nurses or physician assistants (APRN/PA). PCP and APRN/PA differed on sex ratio (p /= 65 vs under 0.178 (p 0.032). Severe burnout in WV PCP was 57.6% and in all US physicians 43.9% (p 0.015). The OR for severe burnout in PCP versus APRN/PA was 2.89 (p 0.039). Burnout in PCP \u3e APRN in rural (p 0.046) but not urban. Private practice 17.6% in our population, 48% US physicians (p 0.0003). Burnout increased linearly with work hours (p 0.003). Self-estimate of burnout correlated with MBI results (p \u3c0.0001). DISCUSSION/CONCLUSION: Severe burnout was highly prevalent in this high risk specialty serving a patient population at risk in regards to poverty, age and medical complexity. This community had a low rate of private practice, fewer providers over age 65, a higher rate of burnout in physicians compared to APRN/PA, and a linear association of burnout to work hours. There was also validation of a single question burnout screening tool. High risk community systems could be a reservoir for burnout research and improvement there could reduce costs and improve outcomes

Revising Ecological Assumptions About Human Papillomavirus Interactions And Type Replacement

The final publication is available at Elsevier via http://dx.doi.org/10.1016/j.jtbi.2013.12.028 © 2014. This manuscript version is made available under the CC-BY-NC-ND 4.0 license https://creativecommons.org/licenses/by-nc-nd/4.0/The controversy over whether vaccine-targeted HPV types will be replaced by other oncogenic, non-vaccine-targeted types remains unresolved. This is in part because little is known about the ecology of HPV types. Patient data has been interpreted to suggest independence or facilitative interactions between types and therefore replacement is believed to be unlikely. With a novel mathematical model, we investigated which HPV type interactions and their immune responses gave qualitatively similar patterns frequently observed in patients. To assess the possibility of type replacement, vaccination was added to see if non-vaccine-targeted types increased their 'niche'. Our model predicts that independence and facilitation are not necessary for the coexistence of types inside hosts, especially given the patchy nature of HPV infection. In fact, independence and facilitation inadequately represented co-infected patients. We found that some form of competition is likely in natural co-infections. Hence, non-vaccine-targeted types that are not cross-reactive with the vaccine could spread to more patches and can increase their viral load in vaccinated hosts. The degree to which this happens will depend on replication and patch colonization rates. Our results suggest that independence between types could be a fallacy, and so without conclusively untangling HPV within-host ecology, type replacement remains theoretically viable. More ecological thinking is needed in future studies.Canadian Institutes of Health Researc

Temperature Triggers a Non-Linear Response in Resource–Consumer Interaction Strength

Although temperature is recognized as a major determinant of many ecological processes, it is still not clear whether temperature increase caused by climate change will strengthen or weaken species interactions. One hypothesis is that interactions will respond non‐monotonically to temperature because thermal performance curves, which determine the strength of these interactions, are also non‐monotonic. To evaluate this hypothesis, we developed a temperature‐dependent consumer–resource model and tested predictions from this model in large freshwater mesocosms populated with green algae (Chlorella vulgaris) and herbivorous zooplankton (Daphnia magna). We found both in the model simulations and empirical investigations that the suppressive effect of the consumer depended non‐monotonically on the temperature. As predicted by the model, Daphnia suppressed the algal maximum per capita growth rate at the temperature that maximized algal growth rate but had little effect on resource growth at either lower or higher temperatures. This finding could help explain why effects of temperature variation on species interaction are variable in the literature and suggests that predicting the effects of temperature on the strength of food web interactions requires knowledge of the thermal performance curves for multiple traits, for multiple species and over a range of temperatures

Environmental weakening of trophic interactions drives stability in stochastic food webs

Peer reviewe

Silver(I) complexes of 9-anthracenecarboxylic acid and imidazoles: synthesis, structure and antimicrobial activity

[Ag2(9-aca)2] (1) (9-acaH = 9-anthracenecarboxylic acid) reacts with a series of imidazoles to give [Ag(imidH)2.3(CH3CN)0.7](9-aca) (3), [Ag6(imidH)4(9-aca)6(MeOH)2] (4), {[Ag(1-Me-imid)2]2[Ag4(9- aca)6]} (5), {[Ag(1-Bu-imid)2]2[Ag4(9-aca)6]} (6) and [Ag(apim)](9-aca)·H2O (7) (imidH = imidazole; 1-Me-imid = 1-methylimidazole; 1-Bu-imid = 1-butylimidazole; apim = 1-(3-aminopropyl)imidazole). The mononuclear complex 3, hexanuclear 4–6, and polymeric 7, were all characterised using X-ray crystallography. While many of the complexes possess excellent in vitro antifungal and antibacterial activities they are, unanimously, more effective against fungal cells. The insect, Galleria mellonella, can survive high doses of the Ag(I) complexes administered in vivo, and a number of the complexes offer significant protection to larvae infected with a lethal dose of pathogenic Candida albicans cells

Context-dependent interactions and the regulation of species richness in freshwater fish

Species richness is regulated by a complex network of scale-dependent processes. This complexity can obscure the influence of limiting species interactions,

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

Barcoding a Quantified Food Web: Crypsis, Concepts, Ecology and Hypotheses

The efficient and effective monitoring of individuals and populations is critically dependent on correct species identification. While this point may seem obvious, identifying the majority of the more than 100 natural enemies involved in the spruce budworm (Choristoneura fumiferana – SBW) food web remains a non-trivial endeavor. Insect parasitoids play a major role in the processes governing the population dynamics of SBW throughout eastern North America. However, these species are at the leading edge of the taxonomic impediment and integrating standardized identification capacity into existing field programs would provide clear benefits. We asked to what extent DNA barcoding the SBW food web would alter our understanding of the diversity and connectence of the food web and the frequency of generalists vs. specialists in different forest habitats. We DNA barcoded over 10% of the insects collected from the SBW food web in three New Brunswick forest plots from 1983 to 1993. For 30% of these specimens, we amplified at least one additional nuclear region. When the nodes of the food web were estimated based on barcode divergences (using molecular operational taxonomic units (MOTU) or phylogenetic diversity (PD) – the food web became much more diverse and connectence was reduced. We tested one measure of food web structure (the “bird feeder effect”) and found no difference compared to the morphologically based predictions. Many, but not all, of the presumably polyphagous parasitoids now appear to be morphologically-cryptic host-specialists. To our knowledge, this project is the first to barcode a food web in which interactions have already been well-documented and described in space, time and abundance. It is poised to be a system in which field-based methods permit the identification capacity required by forestry scientists. Food web barcoding provided an effective tool for the accurate identification of all species involved in the cascading effects of future budworm outbreaks. Integrating standardized barcodes within food webs may ultimately change the face of community ecology. This will be most poignantly felt in food webs that have not yet been quantified. Here, more accurate and precise connections will be within the grasp of any researcher for the first time