Burnout and psychiatric morbidity in new medical graduates

OBJECTIVE: To determine the prevalence of psychiatric morbidity and burnout in final-year medical students, and changes in these measures during the intern year. DESIGN: Prospective longitudinal cohort study over 18 months, with assessment of psychiatric morbidity and burnout on six occasions. PARTICIPANTS: All 117 students in the first graduating cohort of the University of Sydney Graduate Medical Program were invited to participate in the study; 110 consented. OUTCOME MEASURES: Psychiatric morbidity assessed with the 28-item General Health Questionnaire and burnout assessed with the Maslach Burnout Inventory. RESULTS: The point prevalence of participants meeting criteria for psychiatric morbidity and burnout rose steadily throughout the study period. CONCLUSIONS: Internship remains a stressful time for medical graduates, despite initiatives to better support them during this period. The implications for the doctors themselves and for the communities they serve warrant further attention, including programs specifically aimed at reducing the rate of psychological morbidity and burnout during internship.NHMR

Treatment of iron deficiency in patients scheduled for pancreatic surgery:implications for daily prehabilitation practice in pancreatic surgery

BACKGROUND: Preoperative anemia is a frequent complication in pancreatic surgical patients, and it adversely affects morbidity, mortality, and postoperative red blood cell (RBC) transfusion rates. Iron deficiency (ID) is often the underlying cause of anemia and constitutes a modifiable risk factor.METHODS: Single-center, longitudinal prospective cohort study conducted between May 2019 and August 2022 at the University Medical Center Groningen in the Netherlands. Patients scheduled for pancreatic surgery were referred to the outpatient prehabilitation clinic for preoperative optimization of patient-related risk factors. Patients were screened for anemia (&lt; 12.0 g/dL in women and &lt; 13.0 g/dL in men) and ID (either absolute [ferritin &lt; 30 µg/L] or functional [ferritin ≥ 30 µg/L + transferrin saturation &lt; 20% + C-reactive protein &gt; 5 mg/L]). Intravenous iron supplementation (IVIS) (1,000 mg ferric carboxymaltose) was administered to patients with ID at the discretion of the consulting internist. Pre- and postoperative hemoglobin (Hb) levels were assessed, and perioperative outcomes were compared between patients receiving IVIS (IVIS-group) or standard care (SC-group).RESULTS: From 164 screened patients, preoperative anemia was observed in 55 (33.5%) patients, and in 23 (41.8%) of these patients, ID was the underlying cause. In 21 patients, ID was present without concomitant anemia. Preoperative IVIS was administered to 25 patients, out of 44 patients with ID. Initial differences in mean Hb levels (g/dL) between the IVIS-group and SC-group at the outpatient clinic and one day prior to surgery (10.8 versus 13.2, p &lt; 0.001, and 11.8 versus 13.4, p &lt; 0.001, respectively) did not exist at discharge (10.6 versus 11.1, p = 0.13). Preoperative IVIS led to a significant increase in mean Hb levels (from 10.8 to 11.8, p = 0.03). Fewer SSI were observed in the IVIS-group (4% versus 25.9% in the SC-group, p = 0.02), which remained significant in multivariable regression analysis (OR 7.01 (1.68 - 49.75), p = 0.02).CONCLUSION: ID is prevalent in patients scheduled for pancreatic surgery and is amendable to preoperative correction. Preoperative IVIS increased Hb levels effectively and reduced postoperative SSI. Screening and correction of ID is an important element of preoperative care and should be a standard item in daily prehabilitation practice.</p

Review: The Newsletter of the Literary Managers and Dramaturgs of the Americas, volume 14, issue 1

Contents include: Far From Inundated, A Word form the President, BHAGS Words of Welcome, Remarks from Conference Co-Chair Ed Sobel, Keynote Speech Given by Chuck Smith Introduced by Michele Volansky, The Telephone Monologues: Five Monologues Written for the 2003 LMDA Conference introduced by Janet Allard, Telephone, Billy, The Visitors, A Drag Queen, Choice, Don\u27t Know Much About Holly-turgy Outline, Reflections on Conference 2003, Elect Better Actors, Neo-Romantic Manifesto, Pullet Surprise-Call for Nominations, and Regional News-Know Your Regional Vice Presidents. Issue editors: D.J. Hopkins, Shelley Orr, Liz Engelman, Madeleine Oldham, Jacob Zimmerhttps://soundideas.pugetsound.edu/lmdareview/1028/thumbnail.jp

Discovery and characterisation of detached M-dwarf eclipsing binaries in the WFCAM Transit Survey

We report the discovery of 16 detached M-dwarf eclipsing binaries with J<16 mag and provide a detailed characterisation of three of them, using high-precision infrared light curves from the WFCAM Transit Survey (WTS). Such systems provide the most accurate and model-independent method for measuring the fundamental parameters of these poorly understood yet numerous stars, which currently lack sufficient observations to precisely calibrate stellar evolution models. We fully solve for the masses and radii of three of the systems, finding orbital periods in the range 1.5<P<4.9 days, with masses spanning 0.35-0.50 Msun and radii between 0.38-0.50 Rsun, with uncertainties of ~3.5-6.4% in mass and ~2.7-5.5% in radius. Close-companions in short-period binaries are expected to be tidally-locked into fast rotational velocities, resulting in high levels of magnetic activity. This is predicted to inflate their radii by inhibiting convective flow and increasing star spot coverage. The radii of the WTS systems are inflated above model predictions by ~3-12%, in agreement with the observed trend, despite an expected lower systematic contribution from star spots signals at infrared wavelengths. We searched for correlation between the orbital period and radius inflation by combining our results with all existing M-dwarf radius measurements of comparable precision, but we found no statistically significant evidence for a decrease in radius inflation for longer period, less active systems. Radius inflation continues to exists in non-synchronised systems indicating that the problem remains even for very low activity M-dwarfs. Resolving this issue is vital not only for understanding the most populous stars in the Universe, but also for characterising their planetary companions, which hold the best prospects for finding Earth-like planets in the traditional habitable zone.Comment: 30 pages, 14 figures, 16 tables, Accepted for publication in MNRA

Characterising brown dwarf companions with IRDIS long-slit spectroscopy: HD 1160 B and HD 19467 B

The determination of the fundamental properties (mass, separation, age, gravity and atmospheric properties) of brown dwarf companions allows us to infer crucial informations on their formation and evolution mechanisms. Spectroscopy of substellar companions is available to date only for a limited number of objects (and mostly at very low resolution, R<50) because of technical limitations, i.e., contrast and angular resolution. We present medium resolution (R=350), coronagraphic long-slit spectroscopic observations with SPHERE of two substellar companions, HD 1160 B and HD 19467 B. We found that HD 1160 B has a peculiar spectrum that cannot be fitted by spectra in current spectral libraries. A good fit is possible only considering separately the Y+J and the H spectral band. The spectral type is between M5 and M7. We also estimated a T_eff of 2800-2900 K and a log(g) of 3.5-4.0 dex. The low surface gravity seems to favour young age (10-20 Myr) and low mass (~20 M Jup ) for this object. HD 19467 B is instead a fully evolved object with a T_eff of ~1000 K and log g of ~5.0 dex. Its spectral type is T6+/-1.Comment: 14 pages, 14 Figures. Accepted for publication on MNRA

Nowhere to go: How stigma limits the options of female drug users after release from jail

<p>Abstract</p> <p>Background</p> <p>Drug and alcohol using women leaving prison or jail face many challenges to successful re-integration in the community and are severely hampered in their efforts by the stigma of drug or alcohol use compounded by the stigma of incarceration.</p> <p>Methods</p> <p>This qualitative study is based on individual semi-structured interviews and focus groups with 17 women who had recently left jail about the challenges they faced on reentry.</p> <p>Results</p> <p>Our analysis identified three major themes, which are related by the overarching influence of stigma: survival (jobs and housing), access to treatment services, and family and community reintegration.</p> <p>Conclusion</p> <p>Stigma based on drug use and incarceration works to increase the needs of women for health and social services and at the same time, restricts their access to these services. These specific forms of stigma may amplify gender and race-based stigma. Punitive drug and social policies related to employment, housing, education, welfare, and mental health and substance abuse treatment make it extremely difficult for women to succeed.</p

2020 WSES guidelines for the detection and management of bile duct injury during cholecystectomy.

Bile duct injury (BDI) is a dangerous complication of cholecystectomy, with significant postoperative sequelae for the patient in terms of morbidity, mortality, and long-term quality of life. BDIs have an estimated incidence of 0.4-1.5%, but considering the number of cholecystectomies performed worldwide, mostly by laparoscopy, surgeons must be prepared to manage this surgical challenge. Most BDIs are recognized either during the procedure or in the immediate postoperative period. However, some BDIs may be discovered later during the postoperative period, and this may translate to delayed or inappropriate treatments. Providing a specific diagnosis and a precise description of the BDI will expedite the decision-making process and increase the chance of treatment success. Subsequently, the choice and timing of the appropriate reconstructive strategy have a critical role in long-term prognosis. Currently, a wide spectrum of multidisciplinary interventions with different degrees of invasiveness is indicated for BDI management. These World Society of Emergency Surgery (WSES) guidelines have been produced following an exhaustive review of the current literature and an international expert panel discussion with the aim of providing evidence-based recommendations to facilitate and standardize the detection and management of BDIs during cholecystectomy. In particular, the 2020 WSES guidelines cover the following key aspects: (1) strategies to minimize the risk of BDI during cholecystectomy; (2) BDI rates in general surgery units and review of surgical practice; (3) how to classify, stage, and report BDI once detected; (4) how to manage an intraoperatively detected BDI; (5) indications for antibiotic treatment; (6) indications for clinical, biochemical, and imaging investigations for suspected BDI; and (7) how to manage a postoperatively detected BDI

Terrestrial Very-Long-Baseline Atom Interferometry:Workshop Summary

This document presents a summary of the 2023 Terrestrial Very-Long-Baseline Atom Interferometry Workshop hosted by CERN. The workshop brought together experts from around the world to discuss the exciting developments in large-scale atom interferometer (AI) prototypes and their potential for detecting ultralight dark matter and gravitational waves. The primary objective of the workshop was to lay the groundwork for an international TVLBAI proto-collaboration. This collaboration aims to unite researchers from different institutions to strategize and secure funding for terrestrial large-scale AI projects. The ultimate goal is to create a roadmap detailing the design and technology choices for one or more km-scale detectors, which will be operational in the mid-2030s. The key sections of this report present the physics case and technical challenges, together with a comprehensive overview of the discussions at the workshop together with the main conclusions

The genetic architecture of the human cerebral cortex

The cerebral cortex underlies our complex cognitive capabilities, yet little is known about the specific genetic loci that influence human cortical structure. To identify genetic variants that affect cortical structure, we conducted a genome-wide association meta-analysis of brain magnetic resonance imaging data from 51,665 individuals. We analyzed the surface area and average thickness of the whole cortex and 34 regions with known functional specializations. We identified 199 significant loci and found significant enrichment for loci influencing total surface area within regulatory elements that are active during prenatal cortical development, supporting the radial unit hypothesis. Loci that affect regional surface area cluster near genes in Wnt signaling pathways, which influence progenitor expansion and areal identity. Variation in cortical structure is genetically correlated with cognitive function, Parkinson's disease, insomnia, depression, neuroticism, and attention deficit hyperactivity disorder