Contract Negotiation Skills: A Workshop for Women in Medicine

© 2020 Simone et al. Introduction: Contract negotiation is a high-stakes interaction, yet most physicians are never taught negotiation skills. Studies suggest that women, as compared with men, display a lower propensity to initiate negotiations and negotiate less competitively, highlighting a need for training to help level the playing field for female physicians. Methods: We devised a learner-centered workshop for female physicians that included a mini-didactic on negotiation principles, a question-and-answer time with a lawyer, an interactive role-play on contract negotiation style, and guided reflection. The workshop was intended for women in medicine from the level of medical student to full professor. The workshop was evaluated by pre- and postworkshop surveys with quantitative questions assessing perceived comfort with and knowledge of negotiation skills and strategies, as well as qualitative questions assessing lessons learned and areas for improvement. Results: After the workshop, participants (n = 34) reported significantly improved comfort with contract negotiation (p \u3c .01) and with negotiation skills and strategies (p \u3c .01). Through qualitative evaluation, we discovered that participants gained an appreciation for the self-advocacy in negotiation, as well as a better understanding of negotiation logistics. We also received positive feedback from participant comments, with most learners reporting that the topic was useful and worthwhile. Discussion: We believe that this workshop fills a gap in the literature regarding contract negotiation training for physicians while also helping to level the playing field with regard to female physicians and the gender pay gap

Liberty Bell Hospital: A Case Study In Employee Information Systems Fraud

Information systems provide an attractive opportunity for dishonest employees in sensitive job positions to develop and implement a fraudulent scheme. Many different types of technical information systems controls help prevent these situations from occurring and can also detect occurrences after they have happened. However, in some cases, employees are able to circumvent critical segregation of duties. In addition, management of a company may override traditional internal controls in order to achieve business objectives. Overriding internal controls can produce an environment that is conducive to fraud.Internal auditors with an information systems specialty can often identify red flags prior to fraudulent acts taking place in the organization. This allows an organization to utilize preventive measures to reduce the likelihood of a fraud occurring. In a specific situation where an information system fraud is suspected, internal auditors are often charged with leading the investigation. This case analyzes an employee fraud involving a breakdown of internal information technology and management controls, falsification of business records, and a lack of segregation of duties. This case is designed for use in either an undergraduate auditing, information systems security, accounting ethics, internal auditing, computer ethics or other related class. Its primary purpose is to introduce students to a very common type of employee fraud and to illustrate how professional guidance can be applied in such a situation. While the case is based on a true situation, all identities have been modified to protect each individuals right to privacy

Differential Indicators of Diabetes-Induced Oxidative Stress in New Zealand White Rabbits: Role of Dietary Vitamin E Supplementation

Determination of reliable bioindicators of diabetes-induced oxidative stress and the role of dietary vitamin E supplementation were investigated. Blood (plasma) chemistries, lipid peroxidation (LPO), and antioxidant enzyme activities were measured over 12 weeks in New Zealand White rabbits (control, diabetic, and diabetic + vitamin E). Cholesterol and triglyceride levels did not correlate with diabetic state. PlasmaLPOwas influenced by diabetes and positively correlated with glucose concentration only, not cholesterol or triglycerides. Liver glutathione peroxidase (GPX) activity negatively correlated with glucose and triglyceride levels. Plasma and erythrocyte GPX activities positively correlated with glucose, cholesterol, and triglyceride concentrations. Liver superoxide dismutase activity positively correlated with glucose and cholesterol concentration. Vitamin E reduced plasma LPO, but did not affect the diabetic state. Thus, plasmaLPOwas the most reliable indicator of diabetes-induced oxidative stress. Antioxidant enzyme activities and types of reactive oxygen species generated were tissue dependent. Diabetes-induced oxidative stress is diminished by vitamin E supplementation

A Model for the Voltage Steps in the Breakdown of the Integer Quantum Hall Effect

In samples used to maintain the US resistance standard the breakdown of the dissipationless integer quantum Hall effect occurs as a series of dissipative voltage steps. A mechanism for this type of breakdown is proposed, based on the generation of magneto-excitons when the quantum Hall fluid flows past an ionised impurity above a critical velocity. The calculated generation rate gives a voltage step height in good agreement with measurements on both electron and hole gases. We also compare this model to a hydrodynamic description of breakdown.Comment: 4 pages including 3 figure

Soil respiration in a northeastern US temperate forest: a 22‐year synthesis

To better understand how forest management, phenology, vegetation type, and actual and simulated climatic change affect seasonal and inter‐annual variations in soil respiration (Rs), we analyzed more than 100,000 individual measurements of soil respiration from 23 studies conducted over 22 years at the Harvard Forest in Petersham, Massachusetts, USA. We also used 24 site‐years of eddy‐covariance measurements from two Harvard Forest sites to examine the relationship between soil and ecosystem respiration (Re). Rs was highly variable at all spatial (respiration collar to forest stand) and temporal (minutes to years) scales of measurement. The response of Rs to experimental manipulations mimicking aspects of global change or aimed at partitioning Rs into component fluxes ranged from −70% to +52%. The response appears to arise from variations in substrate availability induced by changes in the size of soil C pools and of belowground C fluxes or in environmental conditions. In some cases (e.g., logging, warming), the effect of experimental manipulations on Rs was transient, but in other cases the time series were not long enough to rule out long‐term changes in respiration rates. Inter‐annual variations in weather and phenology induced variation among annual Rs estimates of a magnitude similar to that of other drivers of global change (i.e., invasive insects, forest management practices, N deposition). At both eddy‐covariance sites, aboveground respiration dominated Re early in the growing season, whereas belowground respiration dominated later. Unusual aboveground respiration patterns—high apparent rates of respiration during winter and very low rates in mid‐to‐late summer—at the Environmental Measurement Site suggest either bias in Rs and Re estimates caused by differences in the spatial scale of processes influencing fluxes, or that additional research on the hard‐to‐measure fluxes (e.g., wintertime Rs, unaccounted losses of CO2 from eddy covariance sites), daytime and nighttime canopy respiration and its impacts on estimates of Re, and independent measurements of flux partitioning (e.g., aboveground plant respiration, isotopic partitioning) may yield insight into the unusually high and low fluxes. Overall, however, this data‐rich analysis identifies important seasonal and experimental variations in Rs and Re and in the partitioning of Re above‐ vs. belowground

Necrotic myocardial cells release damage-associated molecular patterns that provoke fibroblast activation in vitro and trigger myocardial inflammation and fibrosis in vivo

BACKGROUND: Tissue injury triggers inflammatory responses that promote tissue fibrosis; however, the mechanisms that couple tissue injury, inflammation, and fibroblast activation are not known. Given that dying cells release proinflammatory “damage-associated molecular patterns” (DAMPs), we asked whether proteins released by necrotic myocardial cells (NMCs) were sufficient to activate fibroblasts in vitro by examining fibroblast activation after stimulation with proteins released by necrotic myocardial tissue, as well as in vivo by injecting proteins released by necrotic myocardial tissue into the hearts of mice and determining the extent of myocardial inflammation and fibrosis at 72 hours. METHODS AND RESULTS: The freeze–thaw technique was used to induce myocardial necrosis in freshly excised mouse hearts. Supernatants from NMCs contained multiple DAMPs, including high mobility group box-1 (HMGB1), galectin-3, S100β, S100A8, S100A9, and interleukin-1α. NMCs provoked a significant increase in fibroblast proliferation, α–smooth muscle actin activation, and collagen 1A1 and 3A1 mRNA expression and significantly increased fibroblast motility in a cell-wounding assay in a Toll-like receptor 4 (TLR4)- and receptor for advanced glycation end products–dependent manner. NMC stimulation resulted in a significant 3- to 4-fold activation of Akt and Erk, whereas pretreatment with Akt (A6730) and Erk (U0126) inhibitors decreased NMC-induced fibroblast proliferation dose-dependently. The effects of NMCs on cell proliferation and collagen gene expression were mimicked by several recombinant DAMPs, including HMGB1 and galectin-3. Moreover, immunodepletion of HMGB1 in NMC supernatants abrogated NMC-induced cell proliferation. Finally, injection of NMC supernatants or recombinant HMGB1 into the heart provoked increased myocardial inflammation and fibrosis in wild-type mice but not in TLR4-deficient mice. CONCLUSIONS: These studies constitute the initial demonstration that DAMPs released by NMCs induce fibroblast activation in vitro, as well as myocardial inflammation and fibrosis in vivo, at least in part, through TLR4-dependent signaling

Soil respiration in a northeastern US temperate forest: a 22‐year synthesis

To better understand how forest management, phenology, vegetation type, and actual and simulated climatic change affect seasonal and inter‐annual variations in soil respiration (Rs), we analyzed more than 100,000 individual measurements of soil respiration from 23 studies conducted over 22 years at the Harvard Forest in Petersham, Massachusetts, USA. We also used 24 site‐years of eddy‐covariance measurements from two Harvard Forest sites to examine the relationship between soil and ecosystem respiration (Re). Rs was highly variable at all spatial (respiration collar to forest stand) and temporal (minutes to years) scales of measurement. The response of Rs to experimental manipulations mimicking aspects of global change or aimed at partitioning Rs into component fluxes ranged from −70% to +52%. The response appears to arise from variations in substrate availability induced by changes in the size of soil C pools and of belowground C fluxes or in environmental conditions. In some cases (e.g., logging, warming), the effect of experimental manipulations on Rs was transient, but in other cases the time series were not long enough to rule out long‐term changes in respiration rates. Inter‐annual variations in weather and phenology induced variation among annual Rs estimates of a magnitude similar to that of other drivers of global change (i.e., invasive insects, forest management practices, N deposition). At both eddy‐covariance sites, aboveground respiration dominated Re early in the growing season, whereas belowground respiration dominated later. Unusual aboveground respiration patterns—high apparent rates of respiration during winter and very low rates in mid‐to‐late summer—at the Environmental Measurement Site suggest either bias in Rs and Re estimates caused by differences in the spatial scale of processes influencing fluxes, or that additional research on the hard‐to‐measure fluxes (e.g., wintertime Rs, unaccounted losses of CO2 from eddy covariance sites), daytime and nighttime canopy respiration and its impacts on estimates of Re, and independent measurements of flux partitioning (e.g., aboveground plant respiration, isotopic partitioning) may yield insight into the unusually high and low fluxes. Overall, however, this data‐rich analysis identifies important seasonal and experimental variations in Rs and Re and in the partitioning of Re above‐ vs. belowground

Formulas and equations for finding scattering data from the Dirichlet-to-Neumann map with nonzero background potential

For the Schrodinger equation at fixed energy with a potential supported in a bounded domain we give formulas and equations for finding scattering data from the Dirichlet-to-Neumann map with nonzero background potential. For the case of zero background potential these results were obtained in [R.G.Novikov, Multidimensional inverse spectral problem for the equation -\Delta\psi+(v(x)-Eu(x))\psi=0, Funkt. Anal. i Ego Prilozhen 22(4), pp.11-22, (1988)]

Infrared Observations of the Candidate LBV 1806-20 & Nearby Cluster Stars

We report near-infrared photometry, spectroscopy, and speckle imaging of the hot, luminous star we identify as candidate LBV 1806-20. We also present photometry and spectroscopy of 3 nearby stars, which are members of the same star cluster containing LBV 1806-20 and SGR 1806-20. The spectroscopy and photometry show that LBV 1806-20 is similar in many respects to the luminous ``Pistol Star'', albeit with some important differences. They also provide estimates of the effective temperature and reddening of LBV 1806-20, and confirm distance estimates, leading to a best estimate for the luminosity of this star of $> 5 \times 10^6 L_{\odot}$. The nearby cluster stars have spectral types and inferred absolute magnitudes which confirm the distance (and thus luminosity) estimate for LBV 1806-20. If we drop kinematic measurements of the distance ($15.1 ^{+1.8}_{-1.3}$ kpc), we have a lower limit on the distance of $>9.5$ kpc, and on the luminosity of $>2 \times 10^6 L_{\odot}$, based on the cluster stars. If we drop both the kinematic and cluster star indicators for distance, an ammonia absorption feature sets yet another lower limit to the distance of $>5.7$ kpc, with a corresponding luminosity estimate of $>7 \times 10^5 L_{\odot}$ for the candidate LBV 1806-20. Furthermore, based on very high angular-resolution speckle images, we determine that LBV 1806-20 is not a cluster of stars, but is rather a single star or binary system. Simple arguments based on the Eddington luminosity lead to an estimate of the total mass of LBV 1806-20 (single or binary) exceeding $190 M_{\odot}$. We discuss the possible uncertainties in these results, and their implications for the star formation history of this cluster.Comment: 36 pages, including 8 figures (Figures 1 and 7 in JPG format due to space); Accepted for publication in Ap

Evaluating remote sensing of deciduous forest phenology at multiple spatial scales using PhenoCam imagery

Plant phenology regulates ecosystem services at local and global scales and is a sensitive indicator of global change. Estimates of phenophase transition dates, such as the start of spring or end of autumn, can be derived from sensor-based time series data at the near-surface and remote scales, but must be interpreted in terms of biologically relevant events. We use the PhenoCam archive of digital repeat photography to implement a consistent protocol for visual assessment of canopy phenology at 13 temperate deciduous forest sites throughout eastern North America, as well as to perform digital image analysis for time series-based estimates of phenology dates. We then compare these near-surface results to remote sensing metrics of phenology at the landscape scale, derived from the Moderate Resolution Imaging Spectroradiometer (MODIS) and Advanced Very High Resolution Radiometer (AVHRR) sensors. We present a new type of curve fit, using a generalized sigmoid, to estimate phenology dates. We quantify the statistical uncertainty of phenophase transition dates estimated using this method and show that the generalized sigmoid results in less statistical uncertainty than other curve-fitting methods. Additionally, we find that dates derived from analysis of high-frequency PhenoCam imagery have smaller uncertainties than remote sensing metrics of phenology, and that dates derived from the remotely-sensed enhanced vegetation index (EVI) have smaller uncertainty than those derived from the normalized difference vegetation index (NDVI). Near-surface time series estimates for the start of spring are found to closely match visual assessment of leaf out, as well as remote sensing-derived estimates of the start of spring. However late spring and autumn phenology exhibit larger differences between near-surface and remote scales. Differences in late spring phenology between near-surface and remote scales are found to correlate with a landscape metric of deciduous forest cover. These results quantify the effect of landscape heterogeneity when aggregating to the coarser spatial scales of remote sensing, and demonstrate the importance of accurate curve fitting and vegetation index selection when analyzing and interpreting phenology time series.Organismic and Evolutionary Biolog