Effects of 2- vs 4- Week Attending Physician Inpatient Rotations on Unplanned Patient Revisits, Evaluations by Trainees, and Attending Physician Burnout: A Randomized Trial

Colin West and the Mayo team recently published a meta-analysis of Interventions to Prevent and Reduce Physician Burnout (Lancet 2016; 388: 2272-81) and found that only three randomized studies of structural or organizational interventions have been reported in the literature. Brian Lucas et al. examined the Effects of 2- vs 4- Week Attending Physician Inpatient Rotations on Unplanned Patient Revisits, Evaluations by Trainees, and Attending Physician Burnout (JAMA 2012). The second organizational intervention was the Healthy Work Place (HWP) study by Mark Linzer et al: Interventions to Improve Work Conditions and Clinician Burnout in Primary Care (J Gen Intern Med 2015). Third, Christopher Parshuram et al studied Patient Safety, Resident Well-Being and Continuity of Care with Different Residents Duty Schedules in the Intensive Care Unit (CMAJ 2015). The panel will discuss the findings of these four studies and what further research is needed to determine the most effective interventions for preventing and reducing physician burnout.https://openworks.mdanderson.org/hrc_burnout_presentations/1008/thumbnail.jp

Human milk feeding and cognitive outcome in preterm infants: the role of infection and NEC reduction

BACKGROUND: Breast milk has been associated with lower risk of infection and necrotising enterocolitis (NEC) and improved long-term cognitive outcomes in preterm infants but, if unsupplemented, does not meet the nutritional requirements of preterm infants. METHODS: Preterm infants were randomised to receive a high nutrient intervention diet: preterm formula (PTF) or the standard diet: term formula (TF) or banked donor breast milk (BBM), either as their sole diet or as supplement to maternal breast milk (MBM). IQ tests were performed at ages 7, 15, 20, and 30 years. RESULTS: An increase in MBM and BBM intake was associated with a lower chance of neonatal infection/NEC. Neonatal infection/NEC was associated with lower Full Scale IQ (FSIQ) and Performance IQ (PIQ) score at ages 7 and 30 years. The relationship between higher intake of MBM and PIQ at age 7 years was partly mediated by neonatal infection/NEC. The intervention diet was associated with higher Verbal IQ (VIQ) scores compared to the standard diet. There was no evidence that these effects changed from childhood through to adulthood. CONCLUSIONS: Neonatal diet is an important modifiable factor that can affect long-term cognitive outcome through a 'human milk' factor, protecting against infection/NEC, and a 'nutrient content' factor. IMPACT: This is the first study to demonstrate the effects of neonatal infection/necrotising enterocolitis (NEC) on IQ in the same cohort in childhood and adulthood. Diet can be a key factor in long-term cognitive outcome in people born preterm by preventing neonatal infection/NEC and providing adequate nutrients. Human milk, whether MBM or BBM, is associated with a reduced risk of infection/NEC. A higher nutrient diet is associated with better cognitive outcome in childhood. Performance IQ is particularly vulnerable to the effects of infection/NEC and verbal IQ to the quantity of (macro)nutrients in the diet

Randomized Trial Comparing the Effectiveness of 2 Electric Breast Pumps in the NICU.

Background:Mothers with preterm infants may need to express milk for considerable periods. Research to improve breast pump design has focused on compression stimuli, frequencies, and vacuums.Objective:This study aimed to compare the effectiveness of 2 electric pumps: Medela Symphony (pump S) and a novel pump (Philips AVENT Twin electronic pump; pump A). Both offer flexibility of rate and suction; pump A also incorporates petal compression cushions. Primary outcomes were (1) milk weight expressed during 10-day study period and (2) weight of milk expressed in a 15-minute test.Methods:Seventy-one mothers with preterm infants < 34 weeks were randomized. Mothers completed 10-day diaries including weight of milk expressed. Milk weight expressed during a single 15-minute test period and data on pumping mode, skin-to-skin contact, breastfeeding at infant discharge, and mothers' opinions of the pump were recorded.Results:There was no significant difference in milk expressed during the first 10 days between groups. Pump S mothers expressed significantly more milk during a fixed 15-minute period. Mothers using pump A awarded higher scores for certain characteristics of the pump, notably location of control button and ease of use. Similar proportions of infants received breast milk at discharge, but pump A mothers were more likely to be directly breastfeeding (odds ratio, 4.27 [95% confidence interval, 1.29, 14.1]).Conclusion:The breast pumps showed similar effectiveness in terms of milk expression and maternal opinions. The finding that breast pump design may influence breastfeeding at infant discharge merits further investigation

A Time Series Analysis of Air Pollution and Preterm Birth in Pennsylvania, 1997–2001

Preterm delivery can lead to serious infant health outcomes, including death and lifelong disability. Small increases in preterm delivery risk in relation to spatial gradients of air pollution have been reported, but previous studies may have controlled inadequately for individual factors. Using a time-series analysis, which eliminates potential confounding by individual risk factors that do not change over short periods of time, we investigated the effect of ambient outdoor particulate matter with diameter ≤10 μm (PM(10)) and sulfur dioxide on risk for preterm delivery. Daily counts of preterm births were obtained from birth records in four Pennsylvania counties from 1997 through 2001. We observed increased risk for preterm delivery with exposure to average PM(10) and SO(2) in the 6 weeks before birth [respectively, relative risk (RR) = 1.07; 95% confidence interval (CI), 0.98–1.18 per 50 μg/m(3) increase; RR = 1.15; 95% CI, 1.00–1. 32 per 15 ppb increase], adjusting for long-term preterm delivery trends, co-pollutants, and offsetting by the number of gestations at risk. We also examined lags up to 7 days before the birth and found an acute effect of exposure to PM(10) 2 days and 5 days before birth (respectively, RR = 1.10; 95% CI, 1.00–1.21; RR = 1.07; 95% CI, 0.98–1.18) and SO(2) 3 days before birth (RR = 1.07; 95% CI, 0.99–1.15), adjusting for covariates, including temperature, dew point temperature, and day of the week. The results from this time-series analysis, which provides evidence of an increase in preterm birth risk with exposure to PM(10) and SO(2), are consistent with prior investigations of spatial contrasts

Infant feeding bottle design, growth and behaviour: results from a randomised trial

BACKGROUND: Whether the design of an anti-vacuum infant feeding bottle influences infant milk intake, growth or behavior is unknown, and was the subject of this randomized trial. METHODS: SUBJECTS: 63 (36 male) healthy, exclusively formula-fed term infants. INTERVENTION: Randomisation to use Bottle A (n = 31), one-way air valve: Philips Avent) versus Bottle B (n = 32), internal venting system: Dr Browns). 74 breast-fed reference infants were recruited, with randomisation (n = 24) to bottle A (n = 11) or B (n = 13) if bottle-feeding was subsequently introduced. Randomisation: stratified by gender and parity; computer-based telephone randomisation by independent clinical trials unit. SETTING: Infant home. PRIMARY OUTCOME MEASURE: infant weight gain to 4 weeks. SECONDARY OUTCOMES: (i) milk intake (ii) infant behaviour measured at 2 weeks (validated 3-day diary); (iii) risk of infection; (iv) continuation of breastfeeding following introduction of mixed feeding. RESULTS: Number analysed for primary outcome: Bottle A n = 29, Bottle B n = 25. PRIMARY OUTCOME: There was no significant difference in weight gain between randomised groups (0-4 weeks Bottle A 0.74 (SD 1.2) SDS versus bottle B 0.51 (0.39), mean difference 0.23 (95% CI -0.31 to 0.77). SECONDARY OUTCOMES: Infants using bottle A had significantly less reported fussing (mean 46 versus 74 minutes/day, p < 0.05) than those using bottle B. There was no significant difference in any other outcome measure. Breast-fed reference group: There were no significant differences in primary or secondary outcomes between breast-fed and formula fed infants. The likelyhood of breastfeeding at 3 months was not significantly different in infants subsequently randomised to bottle A or B. CONCLUSION: Bottle design may have short-term effects on infant behaviour which merit further investigation. No significant effects were seen on milk intake or growth; confidence in these findings is limited by the small sample size and this needs confirmation in a larger study. TRIAL REGISTRATION: Clinical Trials.gov NCT00325208

Addressing the Poor Reading Performance of Filipino Learners: Beyond Curricular and Instructional Interventions

In the 2018 Programme for International Student Assessment (PISA), 15-year old Filipino students ranked last in reading proficiency among all countries/territories, with only 19% meeting the minimum (Level 2) standard. It is important to understand the different factors that contribute to the low reading performance and proficiency of these students, specifically the interventions that may help address this learning problem. Based on the result of a study using machine learning approaches, specifically binary classification methods, to identify the variables that best predict low (Level 1b and lower) vs. higher (Level 1a or better) reading proficiency using the Philippine PISA data, 20 variables that discriminated low reading proficiency students were identified. The results reflect aspects of the students’ psychosocial experiences at home, the classroom, and in the schools that relate to their poor reading proficiency. The results point to how interventions to address poor reading proficiency need to go beyond the curriculum and instructional interventions. What is needed are localized interventions that try to improve the psychosocial experiences of students in school, and that involve stakeholders from the local communities

Physical mapping integrated with syntenic analysis to characterize the gene space of the long arm of wheat chromosome 1A

Background: Bread wheat (Triticum aestivum L.) is one of the most important crops worldwide and its production faces pressing challenges, the solution of which demands genome information. However, the large, highly repetitive hexaploid wheat genome has been considered intractable to standard sequencing approaches. Therefore the International Wheat Genome Sequencing Consortium (IWGSC) proposes to map and sequence the genome on a chromosome-by-chromosome basis. Methodology/Principal Findings: We have constructed a physical map of the long arm of bread wheat chromosome 1A using chromosome-specific BAC libraries by High Information Content Fingerprinting (HICF). Two alternative methods (FPC and LTC) were used to assemble the fingerprints into a high-resolution physical map of the chromosome arm. A total of 365 molecular markers were added to the map, in addition to 1122 putative unique transcripts that were identified by microarray hybridization. The final map consists of 1180 FPC based or 583 LTC based contigs. Conclusions/Significance: The physical map presented here marks an important step forward in mapping of hexaploid bread wheat. The map is orders of magnitude more detailed than previously available maps of this chromosome, and the assignment of over a thousand putative expressed gene sequences to specific map locations will greatly assist future functional studies. This map will be an essential tool for future sequencing of and positional cloning within chromosome 1A

Research productivity and academics’ conceptions of research

This paper asks the question: do people with different levels of research productivity and identification as a researcher think of research differently? It discusses a study that differentiated levels of research productivity among English and Australian academics working in research-intensive environments in three broad discipline areas: science, engineering and technology; social science and humanities; and medicine and health sciences. The paper explores the different conceptions of research held by these academics in terms of their levels of research productivity, their levels of research training, whether they considered themselves an active researcher and a member of a research team, and their disciplinary differences