Development and Use of a Survey Tool to Prioritize and Catalyze Change Surrounding Faculty Wellness in a Department of Pediatrics

Introduction: Physician wellness is an important factor in the delivery of safe, effective and humanistic patient care. There is compelling data describing the widespread prevalence of physician burnout and its subsequent adverse impact on patient care, healthcare costs, and relationships. Initiatives to improve wellness are necessary to maintain the healthcare work force as well as to ensure high-quality care. This project investigated faculty physicians’ attitudes and priorities regarding physician wellness within the department of Pediatrics at a single-center academic institution. Methods: A survey was created and distributed via e-mail to all faculty physicians employed within the Department of Pediatrics in 2019. Participants were asked to rate their agreement with statements regarding workplace wellness and to prioritize the potential allocation of resources designed to improve their satisfaction and wellness at work. Data were analyzed using Excel™ for quantitative and descriptive statistics. Results: 87 (74%) faculty members responded to the survey, with respondents representing all faculty tracks and ranks, male and female gender identities, and a wide range of years of employment. Sixty-eight percent of physicians (n=59) identified physician wellness as a problem. Faculty overwhelmingly identified “time,” “EMR” (electronic medical record) and “overworked” as the greatest impediments to workplace wellness. Thirty-nine percent (n=34) wrote “colleagues” to describe the single most positive contributing factor to their workplace wellness; and 72% (n=63) of docs indicated that resources should go to improve efficiency of practice. There was a correlation with feeling respected in the workplace and having the resources needed (R=0.28, p \u3c 0.001), as well as feeling recognized by leaders (R=0.38, p \u3c 0.001). Weak correlation was also identified between perceptions of wellness as a priority in the department and agreement with feeling respected (R=0.1, p \u3c 0.001). Conclusion: This study reveals the priorities for allocation of resources that best support Pediatric faculty wellness. Overall, the majority of respondents (72%) strongly preferred interventions that improve efficiency of practice over those that improve the culture of wellness or personal resilience. The emphasis on expanding clinical resources available to faculty members offers important insight into effective practice change for academic institutions. While improving personal resilience has become a hallmark of ‘wellness’ in the medical field, this data suggests that improving workplace efficiency is more representative of physician needs and priorities

Observing Galaxy Evolution in the Context of Large-Scale Structure

Galaxies form and evolve in the context of their local and large-scale environments. Their baryonic content that we observe with imaging and spectroscopy is intimately connected to the properties of their dark matter halos, and to their location in the "cosmic web" of large-scale structure. Very large spectroscopic surveys of the local universe (e.g., SDSS and GAMA) measure galaxy positions (location within large-scale structure), statistical clustering (a direct constraint on dark matter halo masses), and spectral features (measuring physical conditions of the gas and stars within the galaxies, as well as internal velocities). Deep surveys with the James Webb Space Telescope (JWST) will revolutionize spectroscopic measurements of redshifts and spectral properties for galaxies out to the epoch of reionization, but with numerical statistics and over cosmic volumes that are too small to map large-scale structure and to constrain halo properties via clustering. Here, we consider advances in understanding galaxy evolution that would be enabled by very large spectroscopic surveys at high redshifts: very large numbers of galaxies (outstanding statistics) over large co-moving volumes (large-scale structure on all scales) over broad redshift ranges (evolution over most of cosmic history). The required observational facility can be established as part of the probe portfolio by NASA within the next decade.Comment: 8 pages (including cover page and references), 3 figures. Science white paper submitted to Astro2020. arXiv admin note: substantial text overlap with arXiv:1802.0153

Girls' brain structural connectivity in late adolescence relates to history of depression symptoms

BackgroundGirls' depressive symptoms typically increase in adolescence, with individual differences in course and severity being key risk factors for impaired emotional functioning in young adulthood. Given the continued brain white matter (WM) maturation that occurs in adolescence, the present study tested whether structural connectivity patterns in late adolescence are associated with variation in the course of depression symptom severity throughout adolescence.MethodParticipants were girls (N = 115) enrolled in a multiyear prospective cohort study of risk for depression. Initial depression severity (intercept) at age 10 and change in severity (linear slope) across ages 10-19 were examined in relation to WM tractography collected at age 19. Network-based statistic analyses were used to identify clusters showing variation in structural connectivity in association with depressive symptom intercept, slope, and their interaction.ResultsHigher initial depressive severity and steeper positive slope (separately) were associated with greater structural connectivity between temporal, subcortical socioaffective, and occipital regions. Intercept showed more connectivity associations than slope. The interaction effect indicated that higher initial symptom severity and a steeper negative slope (i.e., alleviating symptoms) were related to greater connectivity between cognitive control regions. Moderately severe symptoms that worsened over time were followed by greater connectivity between self-referential and cognitive regions (e.g., posterior cingulate and frontal gyrus).ConclusionsHigher depressive symptom severity in early adolescence and increasing symptom severity over time may forecast structural connectivity differences in late adolescence, particularly in pathways involving cognitive and emotion-processing regions. Understanding how clinical course relates to neurobiological correlates may inform new treatment approaches to adolescent depression

Direct replication of task-dependent neural activation patterns during sadness introspection in two independent adolescent samples.

Functional neuroimaging results need to replicate to inform sound models of human social cognition and its neural correlates. Introspection, the capacity to reflect on one's thoughts and feelings, is one process required for normative social cognition and emotional functioning. Engaging in introspection draws on a network of brain regions including medial prefrontal cortex (mPFC), posterior cingulate cortex (PCC), middle temporal gyri (MTG), and temporoparietal junction (TPJ). Maturation of these regions during adolescence mirrors the behavioral advances seen in adolescent social cognition, but the neural correlates of introspection in adolescence need to replicate to confirm their generalizability and role as a possible mechanism. The current study investigated whether reflecting upon one's own feelings of sadness would activate and replicate similar brain regions in two independent samples of adolescents. Participants included 156 adolescents (50% female) from the California Families Project and 119 adolescent girls from the Pittsburgh Girls Study of Emotion. All participants completed the Emotion Regulation Questionnaire (ERQ) and underwent a functional magnetic resonance imaging scan while completing the same facial emotion-processing task at age 16-17 years. Both samples showed similar whole-brain activation patterns when engaged in sadness introspection and when judging a nonemotional facial feature. Whole-brain activation was unrelated to ERQ scores in both samples. Neural responsivity to task manipulations replicated in regions recruited for socio-emotional (mPFC, PCC, MTG, TPJ) and attention (dorsolateral PFC, precentral gyri, superior occipital gyrus, superior parietal lobule) processing. These findings demonstrate robust replication of neural engagement during sadness introspection in two independent adolescent samples

Direct replication of task-dependent neural activation patterns during sadness introspection in two independent adolescent samples.

Functional neuroimaging results need to replicate to inform sound models of human social cognition and its neural correlates. Introspection, the capacity to reflect on one's thoughts and feelings, is one process required for normative social cognition and emotional functioning. Engaging in introspection draws on a network of brain regions including medial prefrontal cortex (mPFC), posterior cingulate cortex (PCC), middle temporal gyri (MTG), and temporoparietal junction (TPJ). Maturation of these regions during adolescence mirrors the behavioral advances seen in adolescent social cognition, but the neural correlates of introspection in adolescence need to replicate to confirm their generalizability and role as a possible mechanism. The current study investigated whether reflecting upon one's own feelings of sadness would activate and replicate similar brain regions in two independent samples of adolescents. Participants included 156 adolescents (50% female) from the California Families Project and 119 adolescent girls from the Pittsburgh Girls Study of Emotion. All participants completed the Emotion Regulation Questionnaire (ERQ) and underwent a functional magnetic resonance imaging scan while completing the same facial emotion-processing task at age 16-17 years. Both samples showed similar whole-brain activation patterns when engaged in sadness introspection and when judging a nonemotional facial feature. Whole-brain activation was unrelated to ERQ scores in both samples. Neural responsivity to task manipulations replicated in regions recruited for socio-emotional (mPFC, PCC, MTG, TPJ) and attention (dorsolateral PFC, precentral gyri, superior occipital gyrus, superior parietal lobule) processing. These findings demonstrate robust replication of neural engagement during sadness introspection in two independent adolescent samples

Girls' brain structural connectivity in late adolescence relates to history of depression symptoms

BACKGROUND: Girls’ depressive symptoms typically increase in adolescence, with individual differences in course and severity being key risk factors for impaired emotional functioning in young adulthood. Given the continued brain white matter (WM) maturation that occurs in adolescence, the present study tested whether structural connectivity patterns in late adolescence are associated with variation in the course of depression symptom severity throughout adolescence. METHOD: Participants were girls (N=115) enrolled in a multi-year prospective cohort study of risk for depression. Initial depression severity (intercept) at age 10 and change in severity (linear slope) across ages 10-19 were examined in relation to WM tractography collected at age 19. Network-based statistical analysis was used to identify clusters showing variation in structural connectivity in association with depressive intercept, slope, and their interaction. RESULTS: Higher initial depressive severity and steeper positive slope (separately) were associated with greater structural connectivity between temporal, subcortical socio-affective, and occipital regions. Intercept showed more connectivity associations than slope. The interaction effect indicated that higher initial symptom severity and a steeper negative slope (i.e., alleviating symptoms) was related to greater connectivity between cognitive control regions. Moderately severe symptoms that worsened over time were followed by greater connectivity between self-referential and cognitive regions (e.g., posterior cingulate and frontal gyrus). CONCLUSIONS: Higher depressive severity in early adolescence and increasing symptom severity over time may forecast structural connectivity differences in late adolescence, particularly in pathways involving cognitive and emotion-processing regions. Understanding how clinical course relates to neurobiological correlates may inform new treatment approaches to adolescent depression

A simple solid media assay for detection of synergy between bacteriophages and antibiotics.

The emergence of antibiotic-resistant bacteria (ARB) has necessitated the development of alternative therapies to deal with this global threat. Bacteriophages (viruses that target bacteria) that kill ARB are one such alternative. Although phages have been used clinically for decades with inconsistent results, a number of recent advances in phage selection, propagation, and purification have enabled a reevaluation of their utility in contemporary clinical medicine. In most phage therapy cases, phages are administered in combination with antibiotics to ensure that patients receive the standard-of-care treatment. Some phages may work cooperatively with antibiotics to eradicate ARB, as often determined using non-standardized broth assays. We sought to develop a solid media-based assay to assess cooperativity between antibiotics and phages to offer a standardized platform for such testing. We modeled the interactions that occur between antibiotics and phages on solid medium to measure additive, antagonistic, and synergistic interactions. We then tested the method using different bacterial isolates and identified a number of isolates where synergistic interactions were identified. These interactions were not dependent on the specific organism, phage family, or antibiotic used. A priori susceptibility to the antibiotic or the specific phage were not requirements to observe synergistic interactions. Our data also confirm the potential for the restoration of vancomycin to treat vancomycin-resistant Enterococcus (VRE) when used in combination with phages. Solid media assays for the detection of cooperative interactions between antibiotics and phages can be an accessible technique adopted by clinical laboratories to evaluate antibiotic and phage choices in phage therapy.IMPORTANCEBacteriophages have become an important alternative treatment for individuals with life-threatening antibiotic-resistant bacteria (ARB) infections. Because antibiotics represent the standard-of-care for treatment of ARB, antibiotics and phages often are delivered together without evidence that they work cooperatively. Testing for cooperativity can be difficult due to the equipment necessary and a lack of standardized means for performing the testing in liquid medium. We developed an assay using solid medium to identify interactions between antibiotics and phages for gram-positive and gram-negative bacteria. We modeled the interactions between antibiotics and phages on solid medium, and then tested multiple replicates of vancomycin-resistant Enterococcus (VRE) and Stenotrophomonas in the assay. For each organism, we identified synergy between different phage and antibiotic combinations. The development of this solid media assay for assessing synergy between phages and antibiotics will better inform the use of these combinations in the treatment of ARB infections