Determinants of indoor carbonaceous aerosols in homes in the Northeast United States.

BACKGROUND: Little is known about sources of residential exposure to carbonaceous aerosols, which include black carbon (BC), the elemental carbon core of combustion particles, and organic compounds from biomass combustion (delta carbon). OBJECTIVE: Assess the impact of residential characteristics on indoor BC and delta carbon when known sources of combustion (e.g., smoking) are minimized. METHODS: Between November 2012-December 2014, 125 subjects (129 homes) in Northeast USA were recruited and completed a residential characteristics questionnaire. Every 3 months, participants received an automated sampler to measure fine particulate matter (PM2.5) in their home during a weeklong period (N = 371 indoor air samples) and were also questioned about indoor exposures. The samples were analyzed using a transmissometer at 880 nm (reflecting BC) and at 370 nm. The difference between the two wavelengths estimates delta carbon. Outdoor BC and delta carbon were measured using a central site aethalometer. RESULTS: Geometric mean indoor concentrations of BC and delta carbon (0.65 µg/m³ and 0.19 µg/m³, respectively), were greater than central site concentrations (0.53 µg/m³ and 0.02 µg/m³, respectively). Multivariable analysis showed that greater indoor concentrations of BC were associated with infrequent candle use, multi-family homes, winter season, lack of air conditioning, and central site BC. For delta carbon, greater indoor concentrations were associated with apartments, spring season, and central site concentrations. SIGNIFICANCE: In addition to outdoor central site concentrations, factors related to the type of housing, season, and home exposures are associated with indoor exposure to carbonaceous aerosols. Recognition of these characteristics should enable greater understanding of indoor exposures and their sources.

Support, technology and mental health: correlates of trainee workplace satisfaction.

INTRODUCTION: Low physician workplace satisfaction may negatively impact patient care. Dissatisfaction may begin during residency training, where trainees face lower autonomy and less control over work conditions. The theoretical and empirical literature on trainees is couched mainly in terms of burnout. Theories of satisfaction, a different construct, are derived from studies of independent physicians. Identifying specific correlates of trainee satisfaction may be a clearer path to preparing a sustainable physician workforce. METHODS: We surveyed 3300 residents and fellows (response rate of 7.2% to 46,574 surveys sent) across multiple specialties and institutions in the US. The instrument was adapted from a previous large-scale survey of physician satisfaction, with changes reflecting factors theorized to specifically affect trainee satisfaction. We applied generalized linear regression to identify correlates of higher satisfaction. RESULTS: A total of 1444 (44%) residents/fellows reported they were very satisfied and 1311 (40%) reported being somewhat satisfied. Factors associated with satisfaction included positive perceptions of supporting clinical staff, the electronic health record, and stability of personal mental health. Surprisingly, a strong negative perception of completing insurance and/or disability forms was also associated with higher satisfaction. Factors often presumed to correlate with satisfaction, such as duty hours, debt load, and specialty, did not show significant associations. DISCUSSION: Multiple workplace factors are correlated with trainee satisfaction, but they are not the factors (such as financial debt) that we initially hypothesized. The factors we identified, including clinical staff support and personal mental health, may be targets for further study and/or pilot interventions aimed at improving satisfaction.

Residents as Mentors: The Development of Resident Mentorship Milestones.

BACKGROUND: Mentorship of residents by more senior colleagues has been identified as important for stress management and creating an ideal learning environment. OBJECTIVE: We set out to define the attributes of an ideal resident mentor and explore ways to develop these attributes during residency training. METHODS: A 28-member, multi-specialty counsel of residents and fellows used 2 phases of a small group exercise. In the first phase, the group developed desirable attributes of resident mentors and explored means of developing these attributes. In the second phase, the group identified trends in the results, and in a second small group exercise with participants at a major national conference, refined these trends into Resident Mentorship Milestones. RESULTS: The exercises identified 3 common themes: availability, competence, and support of the mentee. We defined milestones for mentorship in each of these areas. CONCLUSIONS: The Resident Mentorship Milestones, developed by a national panel of residents, describe 3 key dimensions of mentorship: availability, defined as making time for mentorship; competence for and success in mentoring; and support of the mentee. These milestones may serve as a novel tool to develop and assess successful resident mentorship models.