Benzene-1,2,4,5-tetrol.

The crystal structure of the title compound was determined at 120 K. It crystallizes in the triclinic space group P with four independent mol-ecules in the asymmetric unit. In the crystal, each symmetry-unique mol-ecule forms π-π stacks on itself, giving four unique π-π stacking inter-actions. Inter-molecular hydrogen bonding is observed between each pair of independent mol-ecules, where each hy-droxy group can act as a hydrogen-bond donor and acceptor.

Sensing the Spin State of Room-Temperature Switchable Cyanometallate Frameworks with Nitrogen-Vacancy Centers in Nanodiamonds.

Room-temperature magnetically switchable materials play a vital role in current and upcoming quantum technologies, such as spintronics, molecular switches, and data storage devices. The increasing miniaturization of device architectures produces a need to develop analytical tools capable of precisely probing spin information at the single-particle level. In this work, we demonstrate a methodology using negatively charged nitrogen vacancies (NV-) in fluorescent nanodiamond (FND) particles to probe the magnetic switching of a spin crossover (SCO) metal-organic framework (MOF), [Fe(1,6-naphthyridine)2(Ag(CN)2)2] material (1), and a single-molecule photomagnet [X(18-crown-6)(H2O)3]Fe(CN)6·2H2O, where X = Eu and Dy (materials 2a and 2b, respectively), in response to heat, light, and electron beam exposure. We employ correlative light-electron microscopy using transmission electron microscopy (TEM) finder grids to accurately image and sense spin-spin interacting particles down to the single-particle level. We used surface-sensitive optically detected magnetic resonance (ODMR) and magnetic modulation (MM) of FND photoluminescence (PL) to sense spins to a distance of ca. 10-30 nm. We show that ODMR and MM sensing was not sensitive to the temperature-induced SCO of FeII in 1 as formation of paramagnetic FeIII through surface oxidation (detected by X-ray photoelectron spectroscopy) on heating obscured the signal of bulk SCO switching. We found that proximal FNDs could effectively sense the chemical transformations induced by the 200 keV electron beam in 1, namely, AgI → Ag0 and FeII → FeIII. However, transformations induced by the electron beam are irreversible as they substantially disrupt the structure of MOF particles. Finally, we demonstrate NV- sensing of reversible photomagnetic switching, FeIII + (18-crown-6) ⇆ FeII + (18-crown-6)+ •, triggered in 2a and 2b by 405 nm light. The photoredox process of 2a and 2b proved to be the best candidate for room-temperature single-particle magnetic switching utilizing FNDs as a sensor, which could have applications into next-generation quantum technologies.

Atomic-Scale Time-Resolved Imaging of Krypton Dimers, Chains and Transition to a One-Dimensional Gas.

Single-atom dynamics of noble-gas elements have been investigated using time-resolved transmission electron microscopy (TEM), with direct observation providing for a deeper understanding of chemical bonding, reactivity, and states of matter at the nanoscale. We report on a nanoscale system consisting of endohedral fullerenes encapsulated within single-walled carbon nanotubes ((Kr@C60)@SWCNT), capable of the delivery and release of krypton atoms on-demand, via coalescence of host fullerene cages under the action of the electron beam (in situ) or heat (ex situ). The state and dynamics of Kr atoms were investigated by energy dispersive X-ray spectroscopy (EDS), electron energy loss spectroscopy (EELS), and X-ray photoelectron spectroscopy (XPS). Kr atom positions were measured precisely using aberration-corrected high-resolution TEM (AC-HRTEM), aberration-corrected scanning TEM (AC-STEM), and single-atom spectroscopic imaging (STEM-EELS). The electron beam drove the formation of 2Kr@C120 capsules, in which van der Waals Kr2 and transient covalent [Kr2]+ bonding states were identified. Thermal coalescence led to the formation of longer coalesced nested nanotubes containing more loosely bound Krn chains (n = 3-6). In some instances, delocalization of Kr atomic positions was confirmed by STEM analysis as the transition to a one-dimensional (1D) gas, as Kr atoms were constrained to only one degree of translational freedom within long, well-annealed, nested nanotubes. Such nested nanotube structures were investigated by Raman spectroscopy. This material represents a highly compressed and dimensionally constrained 1D gas stable under ambient conditions. Direct atomic-scale imaging has revealed elusive bonding states and a previously unseen 1D gaseous state of matter of this noble gas element, demonstrating TEM to be a powerful tool in the discovery of chemistry at the single-atom level.

Subnanometer-Wide Indium Selenide Nanoribbons.

Indium selenides (InxSey) have been shown to retain several desirable properties, such as ferroelectricity, tunable photoluminescence through temperature-controlled phase changes, and high electron mobility when confined to two dimensions (2D). In this work we synthesize single-layer, ultrathin, subnanometer-wide InxSey by templated growth inside single-walled carbon nanotubes (SWCNTs). Despite the complex polymorphism of InxSey we show that the phase of the encapsulated material can be identified through comparison of experimental aberration-corrected transmission electron microscopy (AC-TEM) images and AC-TEM simulations of known structures of InxSey. We show that, by altering synthesis conditions, one of two different stoichiometries of sub-nm InxSey, namely InSe or ß-In2Se3, can be prepared. Additionally, in situ AC-TEM heating experiments reveal that encapsulated ß-In2Se3 undergoes a phase change to γ-In2Se3 above 400 °C. Further analysis of the encapsulated species is performed using X-ray photoelectron spectroscopy (XPS), thermogravimetric analysis (TGA), energy dispersive X-ray analysis (EDX), and Raman spectroscopy, corroborating the identities of the encapsulated species. These materials could provide a platform for ultrathin, subnanometer-wide phase-change nanoribbons with applications as nanoelectronic components.

Changes in Work Characteristics and Pediatrician Satisfaction: 2012-2020.

OBJECTIVES: To examine the association of changes in pediatricians' work characteristics with their satisfaction using longitudinal data. METHODS: Data from a cohort study, the American Academy of Pediatrics Pediatrician Life and Career Experience Study (PLACES), were used to examine self-reported work satisfaction from 2012 to 2020 among 2002-2004 and 2009-2011 residency graduates (N = 1794). Drawing from the Physician Worklife Study, work satisfaction was measured as a 4-item scale score and averaged [range, 1 (low)-5 (high)]. Mixed effects linear regression for longitudinal analysis examined work satisfaction with year as the lone explanatory variable and then with 11 variables that might change over time (time variant) to assess how changes in work might be linked to increased or decreased satisfaction. RESULTS: In total, 85.9% of pediatricians in 2020 (September-December) thought their work was personally rewarding. Overall mean work satisfaction scale score displayed a small but significant (P < .001) decrease over time (3.80 in 2012 to 3.69 in 2020). Mixed effects modeling identified several changes associated with increasing work satisfaction over time: increased flexibility in work hours (B = 0.23; 95% confidence interval, 0.20 to 0.25) and personal support from physician colleagues (B = 0.18; 95% confidence interval, 0.15 to 0.21) had the largest associations. Pediatricians reporting increased stress balancing work and personal responsibilities and increased work hours had decreased satisfaction scores. CONCLUSIONS: Early- to midcareer pediatricians expressed high levels of work satisfaction, though, satisfaction scale scores decreased slightly over time for the sample overall, including during 2020 (year 1 of the coronavirus disease 2019 pandemic). Pediatricians reporting increases in flexibility with work hours and colleague support showed the strongest increase in work satisfaction.

High-Deductible Health Plans for US Children: Trends, Health Service Use, and Financial Barriers to Care.

OBJECTIVE: Few studies have examined children's enrollment in high-deductible health plans (HDHPs) and associations with health service use. We examine trends, health service use, and financial barriers to care for US children with high-deductible private insurance. METHODS: Trend data on HDHP enrollment were available for 58,910 children ages 0 to 17 with private insurance from the 2007 to 2018 National Health Interview Survey. Health service indicators were examined in a cross-sectional sample of 23,959 children in the 2014-2018 datasets. High deductible was defined as a minimum of $2,700 for a family in 2018. Chi-square tests examined associations of HDHPs with health service indicators. Logistic regression models adjusted for sociodemographics and child health. RESULTS: The percent of privately insured children with HDHPs increased from 18.4% to 48.6% from 2007 to 2018. In adjusted regression, those with HDHPs fared worse than those with traditional plans on 7 of 10 measures and those with HDHPs and no health savings account (HSA) fared worse on eight. While small differences were found for various child-focused measures, the most consistent differences were found for family-focused measures. Parents with HDHPs were more likely than parents with traditional private insurance to report they had delayed or forgone their medical care (10.2% vs 5.7%), had problems paying medical bills (15.7% vs 10.3%), and had family medical debt (34.1% vs 25.8%). CONCLUSIONS: Privately insured families have seen substantial growth in high-deductible plans in the last decade. Families with HDHPs, especially those without HSAs, have more financial barriers to care.

Screening and Referral for Low-Income Families' Social Determinants of Health by US Pediatricians.

OBJECTIVE: To measure the frequency US pediatricians report screening and referring for social needs and identify pediatrician and practice-level predictors for screening and referral. METHODS: Data were from the American Academy of Pediatrics Periodic Survey for October 2014 to March 2015 with a response rate of 46.6% (732/1570). Respondents reported on: 1) routine screening of low-income families for social needs, 2) attitudes toward screening, and 3) referral of low-income families for community resources. Results were analyzed by pediatrician and practice characteristics. RESULTS: Although most pediatricians (61.6%) thought that screening is important, fewer (39.9%) reported that screening is feasible or felt prepared addressing families' social needs (20.2%). The topics that pediatricians reported routinely asking low-income families about at visits (defined as ≥50% visits) were need for childcare (41.5%) and transportation barriers (28.4%). Pediatricians were less likely to report asking about housing (18.7%), food (18.6%), and utilities/heating (14.0%) insecurity. In multivariable analyses, pediatricians were more likely to report both that they screen and refer when they reported having more patients in financial hardship and having someone in the practice with the responsibility to connect low-income families to community services. Pediatricians who endorsed the importance of screening and who reported being prepared were also more likely to screen/refer. CONCLUSIONS: A minority of pediatricians report routinely screening for social needs. Pediatricians were more likely to report that they screen and refer if they had positive attitudes toward the importance of screening, felt prepared, and had support staff to assist families in need.

Longitudinal Analyses of Pediatrician Burnout.

OBJECTIVE: Utilize the unique capabilities of a longitudinal design to 1) examine whether burnout is increasing over time among 2 cohorts of pediatricians, and 2) identify factors associated with decreased burnout. METHODS: Data from a national longitudinal study, the American Academy of Pediatrics Pediatrician Life and Career Experience Study, were used to examine self-reported burnout over a 5-year period (2012 to 2016) among 2002 to 2004 and 2009 to 2011 residency graduates (N = 1804). Study participation rates ranged from 94% in 2012 to 85% in 2016. Mixed-effects logistic regression for longitudinal analysis was used to examine burnout over time. RESULTS: In any given year, between 20% and 35% of study pediatricians reported that they were currently experiencing burnout. Significant increases in burnout over time were found for all participants combined and for each subgroup examined. Several factors were associated with reduced burnout. The largest associations with reduced burnout were found for increased flexibility in work schedule (adjusted odds ratio [aOR], 0.28; 95% confidence interval [CI], 0.22-0.35), decreased work busyness (aOR, 0.28; 95% CI, 0.22-0.36), or a job change (aOR, 0.48; 95% CI, 0.36-0.65). CONCLUSIONS: Following 5 years of participation in a longitudinal study, more than 1 in 3 early- to mid-career pediatricians reported experiencing burnout. This represents a 75% relative increase in burnout from the start of the study. Specific characteristics of pediatricians' jobs, such as flexible work schedules and busyness of work settings, were most strongly associated with reduced burnout.

United States Pediatricians' Attitudes Regarding Public Policies for Low-Income Children and Their Profession's Advocacy Priorities.

OBJECTIVE: To examine pediatricians' attitudes toward public policies for low-income children and the advocacy efforts for the American Academy of Pediatrics (AAP). METHODS: Data from the AAP Periodic Survey in October 2014 to March 2015 were used. Respondents ranked 1) attitudes toward government programs, and 2) attitudes toward AAP policies on: income support, housing, education, job training, food, and health care. Results were analyzed according to age, gender, practice location, practice region, type of practice setting, and percent of patients with economic hardship. RESULTS: Response rate was 47% (n = 650). Most respondents reported that for children, the government should guarantee health insurance (88.9%), and food and shelter (90.0%). Most also reported that the government should guarantee health insurance (68.9%) and food and shelter (63.9%) for every citizen and to take care of people who cannot take care of themselves. There was variation among the level of support on the basis of practice setting. In multivariable analyses related to supporting the role of government for children and citizens, not being from the Northeast was associated with lower odds of support of children as well as citizens; primary care practices in rural areas were less supportive of government involvement related to all citizens but similar for children; and those younger than 40 and 50 to 59 years of age were more supportive of government guaranteeing enough to eat and a place to sleep for children. More than 55% supported the AAP advocating for income support, housing, education, and access to health care. CONCLUSIONS: Pediatricians strongly support government policies that affect child poverty and the provision of basic needs to families. This support should be used to inform professional organizations, advocates, and policy-makers focused on children and families.

Graduating Pediatric Resident Reports on Procedural Training and Preparation.

OBJECTIVE: To determine pediatric resident training and preparation for 14 Accreditation Council for Graduate Medical Education (ACGME)-required procedures. METHODS: We included a national, random sample of 1000 graduating pediatric residents in 2015. For each of the ACGME-required procedures, residents were asked if they received training, successfully completed the procedure at least once, were comfortable performing the procedure unsupervised, and desired more training. To examine relationships among these 4 measures of training, we conducted logistic regression models and receiver operating characteristics curves. We used chi-square to examine whether desiring more training varied according to program size or career goal. RESULTS: Response rate was 55% (550 of 1000). More than half of the residents received training in each procedure (56.4%-99.3% across procedures) and had successfully completed them at least once (59.8%-99.6%). However, 91.3% desired more training in at least 1 procedure, and 30.0% would like more training in more than half of the procedures (≥8). Relationships were found between the 4 training measures, with some relationships stronger than others. Residents with primary care goals were more likely than those with subspecialty or hospital practice goals to desire more training in abscess incision and drainage and temporary splinting of fractures (P < .05). Residents in large programs were more likely than those in smaller programs to desire more training in bladder catheterization, peripheral intravenous catheter placement, and venipuncture (P < .05). CONCLUSIONS: Although pediatric residents are overall well prepared to perform ACGME-required procedures, exceptions exist. Considering the role of program size and resident career goal might help when optimizing and individualizing resident procedural training and preparation.

A Study of Pediatricians' Debt Repayment a Decade After Completing Residency.

PURPOSE: Pediatricians' education debt has been increasing. Less is known about the pace of their debt repayment. The authors examined patterns of debt repayment for pediatricians who completed residency from 2002-2004. METHOD: The authors analyzed weighted 2013 survey data from the American Academy of Pediatrics Pediatrician Life and Career Experience Study. They categorized participants based on education debt level at residency completion ($0; $1-$49,999; $50,000-$99,999; $100,000-$149,999; ≥ $150,000) and explored debt repayment and well-being by starting debt group using multivariable logistic regression. RESULTS: Of 830 pediatricians surveyed, 266 (32%) had no starting debt and 166 (20%) had ≥ $150,000 in starting debt. A decade after residency, the percentage of participants who completely repaid their debt varied from 76% (68/89) of those with $1-$49,999 of starting debt to 15% (25/164) of those with ≥ $150,000 of starting debt. The percentage of participants concerned about their debt increased with starting debt level, with over half of those in the highest group concerned. Starting debt was associated with all examined measures of debt repayment and with recent financial difficulties among those in the two highest debt groups ($100,000-$149,999: adjusted odds ratio = 3.82, confidence interval = 1.17-12.43; ≥ $150,000: adjusted odds ratio = 4.55, confidence interval = 1.47-14.14). CONCLUSIONS: A decade after completing residency, pediatricians had made progress repaying their debt, yet many still expressed concern, especially those with the greatest amount of starting debt. As debt levels continue to increase, these issues could worsen.

Cholesterol Screening and Treatment Practices and Preferences: A Survey of United States Pediatricians.

OBJECTIVES: To determine pediatricians' practices, attitudes, and barriers regarding screening for and treatment of pediatric dyslipidemias in 9- to 11-year-olds and 17- to 21-year-olds. STUDY DESIGN: American Academy of Pediatrics (AAP) 2013-2014 Periodic Survey of a national, randomly selected sample of 1627 practicing AAP physicians. Pediatricians' responses were described and modeled. RESULTS: Of 614 (38%) respondents who met eligibility criteria, less than half (46%) were moderately/very knowledgeable about the 2008 AAP cholesterol statement; fewer were well-informed about 2011 National Heart, Lung, and Blood Institute Guidelines or 2007 US Preventive Service Task Force review (both 26%). Despite published recommendations, universal screening was not routine: 68% reported they never/rarely/sometimes screened healthy 9- to 11-year-olds. In contrast, more providers usually/most/all of the time screened based on family cardiovascular history (61%) and obesity (82%). Screening 17- to 21-year-olds was more common in all categories (P?

Trends in Access to Health Care Services for US Children: 2000-2014.

BACKGROUND AND OBJECTIVE: Recent years have witnessed substantial gains in health insurance coverage for children, but few studies have examined trends across a diverse set of access indicators. We examine US children's access to health services and whether trends vary by race/ethnicity and income. METHODS: Analysis of 178 038 children ages 0 to 17 from the 2000 to 2014 National Health Interview Survey. Trends are examined for health insurance and 5 access indicators: no well-child visit in the year, no doctor office visit, no dental visit, no usual source of care, and unmet health needs. Logistic regression models add controls for sociodemographics and child health status. Statistical interactions test whether trends vary by race/ethnicity and income. RESULTS: Among all children, uninsured rates declined from 12.1% in 2000 to 5.3% in 2014, with improvement across all 5 access indicators. Along with steep declines in the uninsured rate, Hispanic children had sizeable improvement for no doctor office (19.8% to 11.9%), no dental visit (43.2% to 21.8%), and no usual source of care (13.9% to 6.3%). Black children and those in poor and near-poor families also had large gains. Results from adjusted statistical interaction models showed more improvement for black and Hispanic children versus whites for 3 of 5 access indicators and for children in poor and near-poor families for 4 of 5 access indicators. CONCLUSIONS: Children's access to health services has improved since 2000 with greater gains in vulnerable population groups. Findings support a need for continued support of health insurance for all children.

Relationships Between Program Size, Training Experience, and Career Intentions: Pediatrics Resident Reports From 2010 to 2014.

OBJECTIVE: To determine the relationship between pediatric residency program size and resident demographic characteristics, career intentions, and training experiences. METHODS: Annual national random samples of 1000 graduating pediatrics residents were surveyed between 2010 and 2014. Response years were pooled for analysis, and trends in resident demographic characteristics, career intentions and job search, and training experiences were compared across program class size: small (<10 residents per class), medium (10-19 residents per class), and large (≥20 residents per class). RESULTS: Overall response rate was 61% (3038 of 5000). Primary care goals at the end of residency varied according to program size: 45.9% for small programs, 43.4% for medium programs, and 35.1% for large programs. Reports of excellent or very good preparation for subspecialty fellowship and hospitalist positions increased across program size, whereas primary care preparation reports decreased. Only half of the residents in large programs who enter primary care believe they are prepared and less than half in small programs who accept subspecialty fellowship positions believe they are prepared for these new positions. Residents in medium and large programs report being most prepared for hospitalist work. CONCLUSIONS: Notable numbers of residents in small programs pursue subspecialties and notable numbers in large programs enter primary care. However, residents believe they are less prepared for primary care as program size increases and less prepared for subspecialty training as program size decreases. These findings suggest that the training experiences of some residents do not optimally align with their future practice.

Pediatricians Working Part-Time Has Plateaued.

OBJECTIVE: To examine trends in pediatricians working part-time and residents seeking part-time work and to examine associated characteristics. STUDY DESIGN: The American Academy of Pediatrics (AAP) Periodic Survey of Fellows and the AAP Annual Survey of Graduating Residents were used to examine part-time employment. Fourteen periodic surveys were combined with an overall response rate of 57%. Part-time percentages were compared for surveys conducted from 2006-2009 and 2010-2013. The AAP Annual Surveys of Graduating Residents (combined response rate = 60%) from 2006-2009 were compared with 2010-2013 surveys for residents seeking and obtaining part-time positions following training. Multivariable logistic regression models identified characteristics associated with part-time work. RESULTS: Comparable percentages of pediatricians worked part-time in 2006-2009 (23%) and 2010-2013 (23%). There was similarly no statistically significant difference in residents seeking part-time work (30%-28%), and there was a slight decline in residents accepting part-time work (16%-13%, aOR .75, 95% CI .56-.96). Increases in working part-time were not found for any subgroups examined. Women consistently were more likely than men to work part-time (35% vs 9%), but they showed different patterns of part-time work across age. Women in their 40s (40%) were more likely than other women (33%) and men in their 60s (20%) were more likely than other men (5%) to work part-time. CONCLUSIONS: There has been a levelling off in the number of pediatricians working part-time and residents seeking part-time work. Overall, women remain more likely to work part-time, although 1 in 5 men over 60 work part-time.

Underserved Areas and Pediatric Resident Characteristics: Is There Reason for Optimism?

OBJECTIVE: To examine whether resident characteristics and experiences are related to practice in underserved areas. METHODS: Cross-sectional survey of a national random sample of pediatric residents (n = 1000) and additional sample of minority residents (n = 223) who were graduating in 2009 was conducted. Using weighted logistic regression, we examined relationships between resident characteristics (background, values, residency experiences, and practice goals) and reported 1) expectation to practice in underserved area and 2) postresidency position in underserved area. RESULTS: Response rate was 57%. Forty-one percent of the residents reported that they had an expectation of practicing in an underserved area. Of those who had already accepted postresidency positions, 38% reported positions in underserved areas. Service obligation in exchange for loans/scholarships and primary care/academic pediatrics practice goals were the strongest predictors of expectation of practicing in underserved areas (respectively, adjusted odds ratio 4.74, 95% confidence interval 1.87-12.01; adjusted odds ratio 3.48, 95% confidence interval 1.99-6.10). Other significant predictors include hospitalist practice goals, primary care practice goals, importance of racial/ethnic diversity of patient population in residency selection, early plan (before medical school) to care for underserved families, mother with a graduate or medical degree, and higher score on the Universalism value scale. Service obligation and primary care/academic pediatrics practice goal were also the strongest predictors for taking a postresidency job in underserved area. CONCLUSIONS: Trainee characteristics such as service obligations, values of humanism, and desire to serve underserved populations offer the hope that policies and public funding can be directed to support physicians with these characteristics to redress the maldistribution of physicians caring for children.

Early Career Experiences of Pediatricians Pursuing or Not Pursuing Fellowship Training.

BACKGROUND AND OBJECTIVES: Choosing career paths can be difficult decisions for residents contemplating fellowship training. This study compares the experiences of early career pediatricians who did and did not pursue fellowships. METHODS: We analyzed national, weighted data from pediatricians 8 to 10 years after residency (n = 842). Work environment, work-life balance, and satisfaction were compared for pediatricians who had pursued fellowship training (fellowship trained) and those who did not pursue fellowship training (generalist trained). Logistic and linear regression examined the independent effects of fellowship training while controlling for demographic differences. RESULTS: A total of 39% of the pediatricians (328/842) pursued fellowship training. The fellowship-trained group was less likely than the generalist-trained group to spend time in direct patient care and more likely to report learning opportunities in their work environment. This group was also more likely to report an income of ≥$150,000, although no difference was found when only full-time pediatricians were examined. Generalist-trained pediatricians were more likely to work <50 hours per week, have flexibility with their schedules, and be satisfied with time spent with their own children. Pediatricians in both the fellowship-trained and generalist-trained groups generally found their work to be rewarding and were satisfied with their lives. CONCLUSIONS: Although residents need to consider important life and career differences when contemplating fellowship training and general care, pediatricians in both groups can achieve overall life and career satisfaction.

A Longitudinal Study of Pediatricians Early in Their Careers: PLACES.

The American Academy of Pediatrics (AAP) launched the Pediatrician Life and Career Experience Study (PLACES), a longitudinal study that tracks the personal and professional experiences of early career pediatricians, in 2012. We used a multipronged approach to develop the study methodology and survey domains and items, including review of existing literature and qualitative research with the target population. We chose to include 2 cohorts of US pediatricians on the basis of residency graduation dates, including 1 group who were several years out of residency (2002-2004 Residency Graduates Cohort) and a second group who recently graduated from residency at study launch (2009-2011 Residency Graduates Cohort). Recruitment into PLACES was a 2-stage process: (1) random sample recruitment from the target population and completion of an initial intake survey and (2) completion of the first Annual Survey by pediatricians who responded positively to stage 1. Overall, 41.2% of pediatricians randomly selected to participate in PLACES indicated positive interest in the study by completing intake surveys; of this group, 1804 (93.7%) completed the first Annual Survey and were considered enrolled in PLACES. Participants were more likely to be female, AAP members, and graduates of US medical schools compared with the target sample; weights were calculated to adjust for these differences. We will survey PLACES pediatricians 2 times per year. PLACES data will allow the AAP to examine career and life choices and transitions experienced by early-career pediatricians.

Graduating Pediatrics Residents' Reports on the Impact of Fatigue Over the Past Decade of Duty Hour Changes.

OBJECTIVE: Concern about resident and patient safety has led to changes in Accreditation Council on Graduate Medical Education requirements over the past decade, with duty hour limitations in 2003 and 2011. This study examines pediatric residents' experiences on the impact of fatigue before, during, and after this time. METHODS: An annual survey of graduating pediatrics residents was administered to a national, random sample in 2002, 2004, and 2013. Respondents were asked about the impact of fatigue. Multivariable logistic regression was conducted to compare differences between survey years. RESULTS: The combined response rate for all 3 years was 62.6% (1,251 of 2,000). In multivariable analyses, residents were less likely in both 2004 and 2013 than in 2002 to fall asleep during an educational conference (adjusted odds ratio [aOR] 0.61, 95% confidence interval [CI] 0.41-0.91 and aOR 0.32, 95% CI 0.22-0.45, respectively) and to fall asleep while driving from work (aOR 0.55, 95% CI 0.37-0.81 and 0.43, 95% CI 0.31-0.60, respectively). Residents were less likely in 2004 than in 2002 to report making an error in patient care due to fatigue (aOR 0.46, 95% CI 0.27-0.76); however, in 2013 resident report of making an error in patient care due to fatigue returned to levels similar those reported in 2002. CONCLUSIONS: Surveys of graduating pediatrics residents over the past decade (2002-2013) indicate overall reduced fatigue effects. During this same time frame, however, reports about making patient care errors improved but then returned to a level not significantly different from 2002, a finding warranting further exploration.