Implementation and Outcomes of an Academic Peer Coaching Program for Pediatric Residents.

Introduction Academic coaching fosters self-directed learning and is growing in popularity within residency programs. Implementation is often limited by available faculty time and funding. Peer coaching is an emerging alternative but is not well studied. This study aims to demonstrate the acceptability, feasibility, and efficacy of a resident peer coaching program. Methodology In the 2021-2022 academic year, within a large pediatric residency program, we selected and trained senior residents as coaches and interns who opted in as coachees. Coaching dyads began meeting in the fall and worked toward individualized goals throughout the year; control interns participated in routine didactics. Outcomes included Accreditation Council for Graduate Medical Education (ACGME) milestone scores and a self-assessment survey (SAS). Results We enrolled 15/42 (36%) interns as coachees, with the remaining 27 (64%) as controls. Narrative feedback from coaches and coachees was overall positive, and time commitment was feasible for program staff (10-12 hours/month), coaches (three to four hours/month), and coachees (one to two hours/month) with minimal financial needs. Post-intervention, more coachees than controls scored ≥4.0 on ACGME milestones systems-based practice 3 (SBP3; 3/15, 20%, vs. 2/27, 7%), SBP4 (4/15, 27%, vs. 5/27, 19%), and practice-based learning and improvement 1 (4/15, 27%, vs. 3/27, 11%). SAS response rate was 8/15 (53%) for coachees and 5/27 (19%) for controls. More coachees than controls reported baseline difficulty with time management often (3/8, 38%, vs. 1/5, 20%); only coachees improved post-intervention, with 0/8 (0%) having difficulty often versus 2/5 (40%) of controls. Conclusions Resident peer coaching is acceptable and feasible to implement. Coachees reported more improvement in time management than controls, and ACGME milestone scores suggest improved use of evidence-based medicine and interprofessional care coordination among coachees.

A Survey Study of Motivators for Pediatric Hospitalists to Work in the Community.

BACKGROUND AND OBJECTIVE: The loss of pediatric beds in the community has contributed to decreased access to pediatric inpatient and emergency services. Community pediatric hospitalist programs could reduce the overhead of inpatient care, promoting the financial feasibility of caring for hospitalized children closer to home. This study aims to determine which career motivators are the most important for pediatric hospitalists to begin working in, remain in, and leave the community setting. METHODS: A survey was sent to a convenience sample of 269 community hospitalists from 31 different sites. Sites were invited if the program director was known to the authors. Responses were evaluated and χ-square or Fisher's exact test were used to compare the differences. RESULTS: One hundred twenty six community pediatric hospitalists completed the survey (response rate 49.1%). The 3 most important motivators for pediatric hospitalists to begin working in the community were work-life integration (80%), geographic location (75%), and flexible hours (71%). Pediatric hospitalists who planned to leave the community setting were more likely to cite mentoring and teaching opportunities (76% vs 32%, P = .0002), opportunities for research and quality improvement (29% vs 10%, P = .021), and paid time for nonclinical interests (52% vs 26%, P = .02) as very important. CONCLUSIONS: This study demonstrates key motivators for pediatric hospitalists to work in the community and elucidates motivators for transitioning to larger pediatric centers. This knowledge may be used to guide community pediatric hospital medicine recruitment and program development that could lead to improved retention.

Impact of COVID-19 on the Sense of Job Security Among Community Pediatric Hospitalists.

OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic offers a prime opportunity to examine the ability of community pediatric hospital medicine programs to respond to external stressors. This study aims to characterize the impact of the COVID-19 pandemic on compensation and furlough among community pediatric hospitalists, as well as self-reported sense of job security. METHODS: This study was part of a larger quantitative project investigating community pediatric hospitalists' career motivators. The survey was drafted through an iterative process by the authors. It was disseminated via e-mail to a convenience sample of community pediatric hospitalists obtained through direct contact with community pediatric hospital medicine programs. Data were collected on changes in compensation and furlough because of COVID-19, as well as worry about job security measured as self-reported worry about one's job being permanently terminated on a 5-point Likert scale. RESULTS: Data were collected from 31 hospitals across the United States with 126 completed surveys. Because of COVID-19, many community pediatric hospitalists experienced reduced base pay and benefits and a minority experienced furlough. Nearly two-thirds (64%) reported some worry about job security. Initial base pay reduction, working in suburban areas compared with rural areas, and affiliation with a university-based center or free-standing children's hospital were significantly associated with greater worry about job security. CONCLUSIONS: The initial response to the COVID-19 pandemic resulted in changes in compensation and furlough for some community pediatric hospitalists and many expressed concerns about job security. Future studies should identify protective factors for community pediatric hospitalists' job security.

Control of Peptide Amphiphile Supramolecular Nanostructures by Isosteric Replacements.

Supramolecular nanostructures with tunable properties can have applications in medicine, pharmacy, and biotechnology. In this work, we show that the self-assembly behavior of peptide amphiphiles (PAs) can be effectively tuned by replacing the carboxylic acids exposed to the aqueous media with isosteres, functionalities that share key physical or chemical properties with another chemical group. Transmission electron microscopy, atomic force microscopy, and small-angle X-ray scattering studies indicated that the nanostructure's morphologies are responsive to the ionization states of the side chains, which are related to their pKa values. Circular dichroism studies revealed the effect of the isosteres on the internal arrangement of the nanostructures. The interactions between diverse surfaces and the nanostructures and the effect of salt concentration and temperature were assessed to further understand the properties of these self-assembled systems. These results indicate that isosteric replacements allow the pH control of supramolecular morphology by manipulating the pKa of the charged groups located on the nanostructure's surface. Theoretical studies were performed to understand the morphological transitions that the nanostructures underwent in response to pH changes, suggesting that the transitions result from alterations in the Coulomb forces between PA molecules. This work provides a strategy for designing biomaterials that can maintain or change behaviors based on the pH differences found within cells and tissues.

Caucasian Infants' Attentional Orienting to Own- and Other-Race Faces.

Infants show preferential attention toward faces and detect faces embedded within complex naturalistic scenes. Newborn infants are insensitive to race, but rapidly develop differential processing of own- and other-race faces. In the present study, we investigated the development of attentional orienting toward own- and other-race faces embedded within naturalistic scenes. Infants aged six-, nine- and twelve-months did not show differences in the speed of orienting to own- and other race faces, but other-race faces held infants' visual attention for longer. We also found a clear developmental progression in attentional capture and holding, with older infants orienting to faces faster and fixating them for longer. Results are interpreted within the context of the two-process model of face processing.

Career Motivators for Community Pediatric Hospitalists.

BACKGROUND AND OBJECTIVES: Within the field of pediatric hospital medicine, physicians can choose to work at community-based or university-based centers. The factors that motivate pediatric hospitalists to work specifically at community sites have not yet been fully explored. Our objective with this study was to elucidate the motivators for pediatric hospitalists to begin and continue work at community sites. METHODS: A qualitative study was performed via phone-based focus groups. Physicians were included if they were able to attend 1 of the offered group sessions and they self-identified as spending the majority of their time working as community-based pediatric hospitalists. Data were analyzed through a constant comparative analysis. RESULTS: Five themes emerged regarding factors that motivate pediatricians to begin and continue their careers as hospitalists in the community. The themes were (1) professional impact, (2) scope of practice, (3) personal and professional satisfaction, (4) community involvement, and (5) job availability. CONCLUSIONS: This study reveals the key factors that motivate community pediatric hospitalists to begin and continue working in the community.

Face recognition accuracy of forensic examiners, superrecognizers, and face recognition algorithms.

Achieving the upper limits of face identification accuracy in forensic applications can minimize errors that have profound social and personal consequences. Although forensic examiners identify faces in these applications, systematic tests of their accuracy are rare. How can we achieve the most accurate face identification: using people and/or machines working alone or in collaboration? In a comprehensive comparison of face identification by humans and computers, we found that forensic facial examiners, facial reviewers, and superrecognizers were more accurate than fingerprint examiners and students on a challenging face identification test. Individual performance on the test varied widely. On the same test, four deep convolutional neural networks (DCNNs), developed between 2015 and 2017, identified faces within the range of human accuracy. Accuracy of the algorithms increased steadily over time, with the most recent DCNN scoring above the median of the forensic facial examiners. Using crowd-sourcing methods, we fused the judgments of multiple forensic facial examiners by averaging their rating-based identity judgments. Accuracy was substantially better for fused judgments than for individuals working alone. Fusion also served to stabilize performance, boosting the scores of lower-performing individuals and decreasing variability. Single forensic facial examiners fused with the best algorithm were more accurate than the combination of two examiners. Therefore, collaboration among humans and between humans and machines offers tangible benefits to face identification accuracy in important applications. These results offer an evidence-based roadmap for achieving the most accurate face identification possible.

α1b-Adrenergic Receptor Localization and Relationship to the D1-Dopamine Receptor in the Rat Nucleus Accumbens.

The α1-adrenergic receptors (α1ARs) have been implicated in numerous actions of the brain, including attention and wakefulness. Additionally, they have been identified as contributing to disorders of the brain, such as drug addiction, and recent work has shown a role of these receptors in relapse to psychostimulants. While some functionality is known, the actual subcellular localization of the subtypes of the α1ARs remains to be elucidated. Further, their anatomical relationship to receptors for other neurotransmitters, such as dopamine (DA), remains unclear. Therefore, using immunohistochemistry and electron microscopy techniques, this study describes the subcellular localization of the α1b-adrenergic receptor (α1bAR), the subtype most tied to relapse behaviors, as well as its relationship to the D1-dopamine receptor (D1R) in both the shell and core of the rat nucleus accumbens (NAc). Overall, α1bARs were found in unmyelinated axons and axon terminals with some labeling in dendrites. In accordance with other studies of the striatum, the D1R was found mainly in dendrites and spines; therefore, colocalization of the D1R with the α1bAR was rare postsynaptically. However, in the NAc shell, when the receptors were co-expressed in the same neuronal elements there was a trend for both receptors to be found on the plasma membrane, as opposed to the intracellular compartment. This study provides valuable anatomical information about the α1bAR and its relationship to the D1R and the regulation of DA and norepinephrine (NE) neurotransmission in the brain which have been examined previously.

Once is too much: Early development of the opponent process in taste reactivity behavior is associated with later escalation of cocaine self-administration in rats.

Evidence suggests that the addiction process may begin immediately in some vulnerable subjects. Specifically, some rats have been shown to exhibit aversive taste reactivity (gapes) following the intraoral delivery of a cocaine-predictive taste cue after as few as 1-2 taste-drug pairings. After only 3-4 trials, the number of gapes becomes a reliable predictor of later cocaine self-administration. Given that escalation of drug-taking behavior over time is recognized as a key feature of substance use disorder (SUD) and addiction, the present study examined the relationship between early aversion to the cocaine-predictive flavor cue and later escalation of cocaine self-administration in an extended-access paradigm. The data show that rats who exhibit the greatest conditioned aversion early in training to the intraorally delivered cocaine-paired cue exhibit the greatest escalation of cocaine self-administration over 15 extended-access trials. This finding suggests that early onset of the conditioned opponent process (i.e., the near immediate shift from ingestion to rejection of the drug-paired cue) is a reliable predictor of future vulnerability and resilience to cocaine addiction-like behavior. Future studies must determine the underlying neural mechanisms associated with this early transition and, hence, with early vulnerability to the later development of SUD and addiction. In so doing, we shall be in position to discover novel diagnostics and novel avenues of prevention and treatment.

Prevalence of compounding in independent community pharmacy practice.

OBJECTIVES: To determine the extent of prescription compounding in independent community pharmacies and identify factors that influence the decision of independent pharmacists whether to provide compounding services. DESIGN: Cross-sectional survey. SETTING: Illinois, Missouri, Kansas, and Iowa. PARTICIPANTS: 370 pharmacists in charge. INTERVENTION: Anonymous questionnaire mailed in January 2005. MAIN OUTCOME MEASURES: Percentage of pharmacies that provide compounding; percentage of dispensed prescriptions that require compounding; factors contributing to decisions whether to provide compounding service. RESULTS: Overall, 94% of respondent pharmacies provided compounding services at the time of this survey. Prescriptions that required compounding represented less than 1% of total prescriptions for the majority (58.3%) of respondents. The main reasons for the decision to provide compounding service were wanting to provide full pharmaceutical care to patients (73.8% of compounders) and responding to requests by prescribers (48.7%). Pharmacies that did not provide compounding service cited the main reason as not receiving prescriptions that required compounding (63.6% of noncompounders). CONCLUSION: Compounding remains a component of pharmacy practice in the independent community setting. Prescriptions that required compounding represented 2.3% of all prescriptions dispensed by compounding pharmacies.