Web Resources for Physician Wellness

A current listing of websites, TED talks, and podcasts related to physician wellness and resiliency

Are New Hampshire’s Winters Warming? Yes, But Fewer Than Half of State Residents Recognize the Trend

In this brief, authors Elizabeth Burakowski and Lawrence Hamilton review some basic evidence about winter warming in New Hampshire, explore to what extent state residents are aware of this trend, and ask who is aware, in terms of characteristics such as age, education, or participation in winter sports. Results from two statewide surveys find limited awareness of the trend overall, and no significant differences by age, education, or winter sports participation. Instead, perceptions of this winter trend depend on political identity: conservatives are much less likely than other groups to recognize that warming has occurred

Physical Activity in Matriculating and Senior Medical Students

BACKGROUND: Physical Activity (PA) has been correlated to lower burnout rates and higher quality of life in medical students. This study looks to assess PA during certain phases of medical education and its correlation to burnout, quality of life and self-care. METHODS: The University of New Mexico School of Medicine (UNM SOM) Medical Student Wellness Survey is administered to all medical students at matriculation, at the end of year 1 and at the end of year 3. This survey includes information on PA, burnout, quality of life, and self-care. PA was assessed in accordance with the Center for Disease Control and Prevention (CDC) recommendations for both strength and aerobic components. Independent T-tests were performed to test the hypotheses that increased PA was associated with lower burnout, improved quality of life, and more self-care. RESULTS: At matriculation, 63% of students met either the strength or aerobic component of CDC PA recommendations. This is compared to 68% of students at end of year 1 and 49% of students at end of year 3. Compared to their non-compliant counterparts, 3rd year students who met CDC PA recommendations had statistically significant lower rates of burnout (4.3 vs. 5.0, P \u3c .01), higher quality of life (6.5 vs. 5.4, P \u3c .0001), and were more likely to engage in self-care activities (4.1 vs. 3.4, P \u3c .0001). CONCLUSION: Students who meet CDC recommendations during 3rd year have lower rates of burnout, higher quality of life and more frequent self-care than their less active counterparts. 3rd year medical students engage in less PA than their matriculating and 1st year counterparts. This data supports the need to longitudinally study exercise habits in medical students, identify barriers to meeting CDC PA guidelines, and design intervention to encourage physical activity

Desmin common mutation is associated with multi-systemic disease manifestations and depletion of mitochondria and mitochondrial DNA.

Desmin (DES) is a major muscle scaffolding protein that also functions to anchor mitochondria. Pathogenic DES mutations, however, have not previously been recognized as a cause of multi-systemic mitochondrial disease. Here, we describe a 45-year-old man who presented to The Children\u27s Hospital of Philadelphia Mitochondrial-Genetics Diagnostic Clinic for evaluation of progressive cardiac, neuromuscular, gastrointestinal, and mood disorders. Muscle biopsy at age 45 was remarkable for cytoplasmic bodies, as well as ragged red fibers and SDH positive/COX negative fibers that were suggestive of a mitochondrial myopathy. Muscle also showed significant reductions in mitochondrial content (16% of control mean for citrate synthase activity) and mitochondrial DNA (35% of control mean). His family history was significant for cardiac conduction defects and myopathy in multiple maternal relatives. Multiple single gene and panel-based sequencing studies were unrevealing. Whole exome sequencing identified a known pathogenic p.S13F mutation in DES that had previously been associated with desmin-related myopathy. Desmin-related myopathy is an autosomal dominant disorder characterized by right ventricular hypertrophic cardiomyopathy, myopathy, and arrhythmias. However, neuropathy, gastrointestinal dysfunction, and depletion of both mitochondria and mitochondrial DNA have not previously been widely recognized in this disorder. Recognition that mitochondrial dysfunction occurs in desmin-related myopathy clarifies the basis for the multi-systemic manifestations, as are typical of primary mitochondrial disorders. Understanding the mitochondrial pathophysiology of desmin-related myopathy highlights the possibility of new therapies for this otherwise untreatable and often fatal class of disease. We postulate that drug treatments aimed at improving mitochondrial biogenesis or reducing oxidative stress may be effective therapies to ameliorate the effects of desmin-related disease

The Genetics of Axonal Transport and Axonal Transport Disorders

Neurons are specialized cells with a complex architecture that includes elaborate dendritic branches and a long, narrow axon that extends from the cell body to the synaptic terminal. The organized transport of essential biological materials throughout the neuron is required to support its growth, function, and viability. In this review, we focus on insights that have emerged from the genetic analysis of long-distance axonal transport between the cell body and the synaptic terminal. We also discuss recent genetic evidence that supports the hypothesis that disruptions in axonal transport may cause or dramatically contribute to neurodegenerative diseases

Health Reform Reconstruction

This Article connects the failed, inequitable U.S. coronavirus pandemic response to conceptual and structural constraints that have held back U.S health reform for decades and calls for reconstruction. For more than a half-century, a cramped “iron triangle” ethos has constrained health reform conceptually. Reforms aimed to balance individual interests in cost, quality, and access to health care, while marginalizing equity, solidarity, and public health. In the iron triangle era, reforms unquestioningly accommodated four legally and logistically entrenched fixtures — individualism, fiscal fragmentation, privatization, and federalism — that distort and diffuse any reach toward social justice. The profound racial disparities and public health failures of the U.S. pandemic response have agonizingly manifested the limitations of pre-2020 health reform and demand a reconstruction. Health reform reconstruction begins with a new conceptual framework that aims to realize health justice. Health justice requires commitments to anti-racism, equitable distribution of the burdens and benefits of public investments in health care and public health (for which health care access, quality, and cost are useful, but not exhaustive, metrics), and community empowerment. These commitments put health justice on a collision course with the fixtures of individualism, fiscal fragmentation, privatization, and federalism. Thus, incremental reforms must be measured by the extent to which they confront these fixtures. This Article describes how health reform reconstruction can chart the path for legal change and proposes “confrontational incrementalism” as a method for recognizing the necessity of reconstructive reform, along with its near impossibility

An Assessment of the Law School Climate for GLBT Students

Nationwide empirical research has assessed the law school climate for gay, lesbian, bisexual, and transgender (GLBT) students. The research shows that the climate for GBLT students at most law schools in the United States, particularly those in urban areas, has improved. The research also shows, however, that this group still encounters substantial discrimination on law school campuses and in law school class¬rooms. This discrimination may result from overt acts, thoughtlessness, and/or neglect on the part of various actors in law school communities. Whatever the cause, the result is that many GLBT students feel disenfranchised from their broader law school communities. Nowhere is this result more telling than in stories of students who do not feel safe “coming out” on law school campuses and, in particular, in the stories of students who go back into the closet in law school. This article addresses the complex and sometimes sub¬tle discrimination faced by GLBT students, and provides proposals for law schools to address this discrimination

In vivo clonal expansion and phenotypes of hypocretin-specific CD4(+) T cells in narcolepsy patients and controls

Individuals with narcolepsy suffer from abnormal sleep patterns due to loss of neurons that uniquely supply hypocretin (HCRT). Previous studies found associations of narcolepsy with the human leukocyte antigen (HLA)-DQ6 allele and T-cell receptor alpha (TRA) J24 gene segment and also suggested that in vitro-stimulated T cells can target HCRT. Here, we present evidence of in vivo expansion of DQ6-HCRT tetramer(+)/TRAJ24(+)/CD4(+) T cells in DQ6(+) individuals with and without narcolepsy. We identify related TRAJ24(+) TCRalphabeta clonotypes encoded by identical alpha/beta gene regions from two patients and two controls. TRAJ24-G allele(+) clonotypes only expand in the two patients, whereas a TRAJ24-C allele(+) clonotype expands in a control. A representative tetramer(+)/G-allele(+) TCR shows signaling reactivity to the epitope HCRT87-97. Clonally expanded G-allele(+) T cells exhibit an unconventional effector phenotype. Our analysis of in vivo expansion of HCRT-reactive TRAJ24(+) cells opens an avenue for further investigation of the autoimmune contribution to narcolepsy development