To stay or go? A mixed methods study of psychiatry trainees’ intentions to leave training

This mixed methods research study aimed to test a tailored version of the job demands-resources (JD-R) model to uncover what factors contribute to psychiatry trainees’ intentions to leave their training and how. A Web-based survey measured psychiatry trainees’ work conditions, well-being, occupational commitment, and intentions to leave training. The results were analyzed using structural equation modeling featuring validated constructs. Narrative interviews were analyzed using thematic analysis following the tailored JD-R model. Of 159 current London trainees who completed the questionnaire, 22.1% were thinking a lot about leaving training. Trainees with higher job demands, fewer resources, and less ability to detach from their work experienced higher burnout levels. More engaged and less burned-out trainees were more committed to their occupation and less inclined to leave training. The interviews identified that trainees’ decision to leave was not linear and took time to make. Trainees found their work environment challenging and reported reduced well-being and rethinking their career paths. The JD-R model is a useful tool to understand how medical trainees’ job demands and resources need to be balanced to maintain their well-being and, in turn, how this affects their commitment to the occupation and training

Industrial scale high-throughput screening delivers multiple fast acting macrofilaricides.

Nematodes causing lymphatic filariasis and onchocerciasis rely on their bacterial endosymbiont, Wolbachia, for survival and fecundity, making Wolbachia a promising therapeutic target. Here we perform a high-throughput screen of AstraZeneca's 1.3 million in-house compound library and identify 5 novel chemotypes with faster in vitro kill rates (<2 days) than existing anti-Wolbachia drugs that cure onchocerciasis and lymphatic filariasis. This industrial scale anthelmintic neglected tropical disease (NTD) screening campaign is the result of a partnership between the Anti-Wolbachia consortium (A∙WOL) and AstraZeneca. The campaign was informed throughout by rational prioritisation and triage of compounds using cheminformatics to balance chemical diversity and drug like properties reducing the chance of attrition from the outset. Ongoing development of these multiple chemotypes, all with superior time-kill kinetics than registered antibiotics with anti-Wolbachia activity, has the potential to improve upon the current therapeutic options and deliver improved, safer and more selective macrofilaricidal drugs

Matrix metalloproteinases in asthma: the role of mast cells and basophils

Matrix metalloproteinases (MMPs) have important roles in the migration of leukocytes between endothelial cells and through the tissue, matrix deposition and airway remodelling observed in asthma. Mast cells and basophils are major effector cells in asthma and, as they are known to migrate during this disorder, the release of MMPs from these cells was investigated. Both mast cells and basophils were found to contain significant amounts of both the gelatinases MMP 9 and the stromelysin MMP 3. Mast cells and basophils were also found to contain and release the physiological inhibitor of MMP 9 and MMP 3, tissue inhibitor of matrix metalloproteinases-1 (TIMP 1).Leukocytes and lung cells were found to release MMP 9 and MMP 3 following challenge of basophils and mast cells respectively, with anti-IgE or A23187. Stimulation of lung cells and mixed leukocytes with concentrations of anti-IgE too low to induce measurable histamine release, resulted in the optimal liberation of MMPs. There was found to be cross-talk between basophils activated with low concentrations of anti-IgE and neutrophils, resulting in significant neutrophil MMP release. PAF was isolated as one of the candidate mediators of neutrophil-basophil cross-talk and was found to induce significant MMP release from neutrophils. Pure populations of mast cells and basophils released MMP 3 and MMP 9 on stimulation with both anti-IgE and A23187. Stimulation of cells with 0.1 &mu;g/ml of anti-IgE resulted in the rapid liberation of stored MMPs from mast cells and basophils. Lower concentrations of anti-IgE (0.1 ng/ml) produced maximal MMP release after 5 hours, suggesting that small concentrations of anti-IgE promote the de novo synthesis inhibitor cyclohexamide.</p

To stay or go? A mixed methods study of psychiatry trainees’ intentions to leave training

This mixed methods research study aimed to test a tailored version of the job demands-resources (JD-R) model to uncover what factors contribute to psychiatry trainees’ intentions to leave their training and how. A Web-based survey measured psychiatry trainees’ work conditions, well-being, occupational commitment, and intentions to leave training. The results were analyzed using structural equation modeling featuring validated constructs. Narrative interviews were analyzed using thematic analysis following the tailored JD-R model. Of 159 current London trainees who completed the questionnaire, 22.1% were thinking a lot about leaving training. Trainees with higher job demands, fewer resources, and less ability to detach from their work experienced higher burnout levels. More engaged and less burned-out trainees were more committed to their occupation and less inclined to leave training. The interviews identified that trainees’ decision to leave was not linear and took time to make. Trainees found their work environment challenging and reported reduced well-being and rethinking their career paths. The JD-R model is a useful tool to understand how medical trainees’ job demands and resources need to be balanced to maintain their well-being and, in turn, how this affects their commitment to the occupation and training

‘We thought if it’s going to take two years then we need to start that now’: Age, infertility risk and the timing of pregnancy in older first-time mothers

Over the past few decades, the number of women having their first babies over the age of thirty-five in most developed societies has steadily increased. Concerns have been raised over this trend amidst warnings of both the increased risk of fertility problems and health risks to mother and child. Despite this, research into the timing of pregnancy in the context of decreasing fertility has been somewhat neglected, with research typically framed in biomedical rather than social terms. However, this area merits closer attention given the contradictory nature of societal messages that simultaneously encourage women to pursue careers and enhance lifestyle, whilst warning of ‘risks’ of infertility and problems in ‘delaying’ motherhood. This article is based on a small-scale qualitative study that uses data drawn from eleven in-depth interviews with ‘older mothers’ about their transition to motherhood. The data was thematically analysed. We found that the women drew upon risk discourses around decreasing fertility and advancing maternal age, and that these discourses impacted on their decisions about the timing of their pregnancies. Some mothers felt that they started trying to conceive at ‘non-ideal’ times, owing to expectations they held about decreasing fertility. We suggest that the impact of contradictory societal messages around the timing of motherhood need to be more clearly considered for their potential effects on the timing of pregnancy and note how this topic brings the personal, and, by implication, the societal, into conflict with the (narrated) biological