2,621 research outputs found
Recommended from our members
#MeToo in EM: A Multicenter Survey of Academic Emergency Medicine Faculty on Their Experiences with Gender Discrimination and Sexual Harassment
Introduction: Gender-based discrimination and sexual harassment of female physicians are well documented. The #MeToo movement has brought renewed attention to these problems. This study examined academic emergency physicians’ experiences with workplace gender discrimination and sexual harassment.Methods: We conducted a cross-sectional survey of a convenience sample of emergency medicine (EM) faculty across six programs. Survey items included the following: the Overt Gender Discrimination at Work (OGDW) Scale; the frequency and source of experienced and observed discrimination; and whether subjects had encountered unwanted sexual behaviors by a work superior or colleague in their careers. For the latter question, we asked subjects to characterize the behaviors and whether those experiences had a negative effect on their self-confidence and career advancement. We made group comparisons using t-tests or chi-square analyses, and evaluated relationships between gender and physicians’ experiences using correlation analyses.Results: A total of 141 out of 352 (40.1%) subjects completed at least a portion of the survey. Women reported higher mean OGDW scores than men (15.4 vs 10.2; 95% confidence interval [CI], 3.6–6.8). Female faculty were also more likely to report having experienced gender-based discriminatory treatment than male faculty (62.7% vs 12.5%; 95% CI, 35.1%-65.4%), although male and female faculty were equally likely to report having observed gender-based discriminatory treatment of another physician (64.7% vs 56.3%; 95% CI, 8.6%-25.5%). The three most frequent sources of experienced or observed gender-based discriminatory treatment were patients, consulting or admitting physicians, and nursing staff. The majority of women reported having encountered unwanted sexual behaviors in their careers, with a significantly greater proportion of women reporting them compared to men (52.9% vs 26.2%, 95% CI, 9.9%-43.4%). The majority of unwanted behaviors were sexist remarks and sexual advances. Of those respondents who encountered these unwanted behaviors, 22.9% and 12.5% reported at least somewhat negative effects on their self-confidence and career advancement.Conclusion: Female EM faculty perceived more gender-based discrimination in their workplaces than their male counterparts. The majority of female and approximately a quarter of male EM faculty encountered unwanted sexual behaviors in their careers.
Adaptation of EPEC-EM™ Curriculum in a Residency with Asynchronous Learning
Objective: The Education in Palliative and End-of-life Care for Emergency Medicine Project (EPEC™-EM) is a comprehensive curriculum in palliative and end-of-life care for emergency providers. We assessed the adaptation of this course to an EM residency program using synchronous and asynchronous learning.Methods: Curriculum adaptation followed Kern’s standardized six-step curriculum design process. Post-graduate year (PGY) 1-4 residents were taught all EPEC™-EM cognitive domains, divided as seven synchronous and seven asynchronous modules. All synchronous modules featured large group didactic lectures and review of EPEC™-EM course materials. Asynchronous modules use only EPEC™-EM electronic course media for resident self-study. Targeted evaluation for EPEC™-EM knowledge objectives was conducted by a prospective case-control crossover study, with synchronous learning serving as the quasi-control, using validated exam tools. We compared de-identified test scores for effectiveness of learning method, using aggregate group performance means for each learning strategy.Results: Of 45 eligible residents 55% participated in a pre-test for local needs analysis, and 78% completed a post-test to measure teaching method effect. Post-test scores improved across all EPEC™-EM domains, with a mean improvement for synchronous modules of +28% (SD=9) and a mean improvement for asynchronous modules of +30% (SD=18). The aggregate mean difference between learning methods was 1.9% (95% CI -15.3, +19.0). Mean test scores of the residents who completed the post-test were: synchronous modules 77% (SD=12); asynchronous modules 83% (SD=13); all modules 80% (SD=12).Conclusion: EPEC™-EM adapted materials can improve resident knowledge of palliative medicine domains, as assessed through validated testing of course objectives. Synchronous and asynchronous learning methods appear to result in similar knowledge transfer, feasibly allowing some course content to be effectively delivered outside of large group lectures. [West J Emerg Med. 2010; 11(5):491-498.
Large-scale structure in the Lyman-alpha forest II: analysis of a group of ten QSOs
The spatial distribution of Ly-alpha forest absorption systems towards ten
QSOs has been analysed to search for large-scale structure over the redshift
range 2.2 < z < 3.4. The QSOs form a closely spaced group on the sky and are
concentrated within a 1 deg^2 field. We have employed a technique based on the
first and second moments of the transmission probability density function which
is capable of identifying and assessing the significance of regions of over- or
underdense Ly-alpha absorption. We find evidence for large-scale structure in
the distribution of Ly-alpha forest absorption at the > 99 per cent confidence
level. In individual spectra we find overdense Ly-alpha absorption on scales of
up to 1200 km s^-1. There is also strong evidence for correlated absorption
across line of sight pairs separated by < 3 h^-1 proper Mpc (q_0 = 0.5). For
larger separations the cross-correlation signal becomes progressively less
significant.Comment: 15 pages, LaTeX, 6 Postscript figures, accepted for publication in
MNRA
Optimizing Wellness in Academic Emergency Medicine
Introduction
Academic Emergency Physicians (EPs) face additional unique challenges in optimizing wellness compared to community EPs.
Objective
Our objective was to explore specific individual and systems challenges that academic EPs encounter that affect their wellbeing and professional fulfillment in emergency medicine (EM).
Methods
An expert group of academic EPs convened in 2019 at the annual meeting of the Society of Academic Emergency Medicine to investigate the overall causes of burnout in healthcare providers, the effects of burnout on the healthcare system, specific causes of burnout in EM, and the distinct challenges facing academic emergency physicians.
Results
We outline specific causes of burnout in EM and the effects of burnout on the healthcare system. Scholarly productivity pressures, variable reimbursement gaps, time allotment, and work-life balance are challenges facing academic EPs.
Conclusion
Understanding the unique challenges of academic EPs in optimizing wellness is vital to inform future research and effective interventions
Book Reviews
With the observation of high-energy astrophysical neutrinos by the IceCube Neutrino Observatory, interest has risen in models of PeV-mass decaying dark matter particles to explain the observed flux. We present two dedicated experimental analyses to test this hypothesis. One analysis uses 6 years of IceCube data focusing on muon neutrino ‘track’ events from the Northern Hemisphere, while the second analysis uses 2 years of ‘cascade’ events from the full sky. Known background components and the hypothetical flux from unstable dark matter are fitted to the experimental data. Since no significant excess is observed in either analysis, lower limits on the lifetime of dark matter particles are derived: we obtain the strongest constraint to date, excluding lifetimes shorter than s at 90% CL for dark matter masses above 10 TeV
Differential limit on the extremely-high-energy cosmic neutrino flux in the presence of astrophysical background from nine years of IceCube data
We report a quasi-differential upper limit on the extremely-high-energy (EHE)
neutrino flux above GeV based on an analysis of nine years of
IceCube data. The astrophysical neutrino flux measured by IceCube extends to
PeV energies, and it is a background flux when searching for an independent
signal flux at higher energies, such as the cosmogenic neutrino signal. We have
developed a new method to place robust limits on the EHE neutrino flux in the
presence of an astrophysical background, whose spectrum has yet to be
understood with high precision at PeV energies. A distinct event with a
deposited energy above GeV was found in the new two-year sample, in
addition to the one event previously found in the seven-year EHE neutrino
search. These two events represent a neutrino flux that is incompatible with
predictions for a cosmogenic neutrino flux and are considered to be an
astrophysical background in the current study. The obtained limit is the most
stringent to date in the energy range between and GeV. This result constrains neutrino models predicting a three-flavor
neutrino flux of $E_\nu^2\phi_{\nu_e+\nu_\mu+\nu_\tau}\simeq2\times 10^{-8}\
{\rm GeV}/{\rm cm}^2\ \sec\ {\rm sr}10^9\ {\rm GeV}$. A significant part
of the parameter-space for EHE neutrino production scenarios assuming a
proton-dominated composition of ultra-high-energy cosmic rays is excluded.Comment: The version accepted for publication in Physical Review
Neutrinos below 100 TeV from the southern sky employing refined veto techniques to IceCube data
Many Galactic sources of gamma rays, such as supernova remnants, are expected
to produce neutrinos with a typical energy cutoff well below 100 TeV. For the
IceCube Neutrino Observatory located at the South Pole, the southern sky,
containing the inner part of the Galactic plane and the Galactic Center, is a
particularly challenging region at these energies, because of the large
background of atmospheric muons. In this paper, we present recent advancements
in data selection strategies for track-like muon neutrino events with energies
below 100 TeV from the southern sky. The strategies utilize the outer detector
regions as veto and features of the signal pattern to reduce the background of
atmospheric muons to a level which, for the first time, allows IceCube
searching for point-like sources of neutrinos in the southern sky at energies
between 100 GeV and several TeV in the muon neutrino charged current channel.
No significant clustering of neutrinos above background expectation was
observed in four years of data recorded with the completed IceCube detector.
Upper limits on the neutrino flux for a number of spectral hypotheses are
reported for a list of astrophysical objects in the southern hemisphere.Comment: 19 pages, 17 figures, 2 table
A Search for Neutrino Emission from Fast Radio Bursts with Six Years of IceCube Data
We present a search for coincidence between IceCube TeV neutrinos and fast
radio bursts (FRBs). During the search period from 2010 May 31 to 2016 May 12,
a total of 29 FRBs with 13 unique locations have been detected in the whole
sky. An unbinned maximum likelihood method was used to search for spatial and
temporal coincidence between neutrinos and FRBs in expanding time windows, in
both the northern and southern hemispheres. No significant correlation was
found in six years of IceCube data. Therefore, we set upper limits on neutrino
fluence emitted by FRBs as a function of time window duration. We set the most
stringent limit obtained to date on neutrino fluence from FRBs with an
energy spectrum assumed, which is 0.0021 GeV cm per burst for emission
timescales up to \textasciitilde10 seconds from the northern hemisphere
stacking search.Comment: 15 pages, 9 figure
Search for transient optical counterparts to high-energy IceCube neutrinos with Pan-STARRS1
In order to identify the sources of the observed diffuse high-energy neutrino
flux, it is crucial to discover their electromagnetic counterparts. IceCube
began releasing alerts for single high-energy ( TeV) neutrino
detections with sky localisation regions of order 1 deg radius in 2016. We used
Pan-STARRS1 to follow-up five of these alerts during 2016-2017 to search for
any optical transients that may be related to the neutrinos. Typically 10-20
faint ( mag) extragalactic transients are found within the
Pan-STARRS1 footprints and are generally consistent with being unrelated field
supernovae (SNe) and AGN. We looked for unusual properties of the detected
transients, such as temporal coincidence of explosion epoch with the IceCube
timestamp. We found only one transient that had properties worthy of a specific
follow-up. In the Pan-STARRS1 imaging for IceCube-160427A (probability to be of
astrophysical origin of 50 %), we found a SN PS16cgx, located at 10.0'
from the nominal IceCube direction. Spectroscopic observations of PS16cgx
showed that it was an H-poor SN at z = 0.2895. The spectra and light curve
resemble some high-energy Type Ic SNe, raising the possibility of a jet driven
SN with an explosion epoch temporally coincident with the neutrino detection.
However, distinguishing Type Ia and Type Ic SNe at this redshift is notoriously
difficult. Based on all available data we conclude that the transient is more
likely to be a Type Ia with relatively weak SiII absorption and a fairly normal
rest-frame r-band light curve. If, as predicted, there is no high-energy
neutrino emission from Type Ia SNe, then PS16cgx must be a random coincidence,
and unrelated to the IceCube-160427A. We find no other plausible optical
transient for any of the five IceCube events observed down to a 5
limiting magnitude of mag, between 1 day and 25 days after
detection.Comment: 20 pages, 6 figures, accepted to A&
Adenylyl Cyclases 1 and 8 Initiate a Presynaptic Homeostatic Response to Ethanol Treatment
BACKGROUND:Although ethanol exerts widespread action in the brain, only recently has progress been made in understanding the specific events occurring at the synapse during ethanol exposure. Mice deficient in the calcium-stimulated adenylyl cyclases, AC1 and AC8 (DKO), demonstrate increased sedation duration and impaired phosphorylation by protein kinase A (PKA) following acute ethanol treatment. While not direct targets for ethanol, we hypothesize that these cyclases initiate a homeostatic presynaptic response by PKA to reactivate neurons from ethanol-mediated inhibition. METHODOLOGY/PRINCIPAL FINDINGS:Here, we have used phosphoproteomic techniques and identified several presynaptic proteins that are phosphorylated in the brains of wild type mice (WT) after ethanol exposure, including synapsin, a known PKA target. Phosphorylation of synapsins I and II, as well as phosphorylation of non-PKA targets, such as, eukaryotic elongation factor-2 (eEF-2) and dynamin is significantly impaired in the brains of DKO mice. This deficit is primarily driven by AC1, as AC1-deficient, but not AC8-deficient mice also demonstrate significant reductions in phosphorylation of synapsin and eEF-2 in cortical and hippocampal tissues. DKO mice have a reduced pool of functional recycling vesicles and fewer active terminals as measured by FM1-43 uptake compared to WT controls, which may be a contributing factor to the impaired presynaptic response to ethanol treatment. CONCLUSIONS/SIGNIFICANCE:These data demonstrate that calcium-stimulated AC-dependent PKA activation in the presynaptic terminal, primarily driven by AC1, is a critical event in the reactivation of neurons following ethanol-induced activity blockade
- …