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325 results

Page 1 of 17

  • Relationship between Residency Burnout and Suicidal Risk in the Resident Physician Population

  • S. Jacob, R. Tabraiz, H. Raai
  • Journal:
    European Psychiatry / Volume 66 / Issue S1 / March 2023
    Published online by Cambridge University Press:
    19 July 2023, pp. S322-S323
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  • Introduction

    Resident physicians compared to the general public are exposed to a more rigorous schedule. Burnout as described by the World Health Organization is a phenomenon occurring in an occupational setting. It consists of three domains: feelings of exhaustion, reduced professional efficacy, increased mental distance from one’s own job. Research shows that increased working hours are associated with higher levels of burnout in resident physicians.

    Objectives

    Through literature review we will explore whether this burnout contributes to an increased suicidal risk in the resident physician population.

    Methods

    Various studies assessing training of residents globally were analyzed and compared. A study in Japan distributed a survey to 4306 resident physicians. Suicidal ideation was noted in 5.6% of these physicians but when working more than 100 hours in the hospital the rate increased to 7.8%. In Australia it was found that once doctors in training worked more than 55 hours per week there was was an increase of 50% in suicidal ideation. It was also found that 12.3% of the people surveyed in the Australian study had reported suicidal ideation within the past 12 months of the survey. A study observing 5126 Dutch residents found 12% of residents having suicidal ideation but double in the group with burnout vs the group without burnout.

    Results

    The studies listed show that increased work hours and burnout was associated with increased suicidal ideation in medical residents. A study observing 1354 physicians in the US found that higher measurements of burnout were associated with suicidal ideation similar to previous studies. However once adjusted for depression, it was noted that there was an association with depression and suicidal ideation but not with burnout. Depression may be a confounding variable that may have not been adjusted for when determining the association of burnout with suicidal ideation. In addition further research looking at the leading cause of death among a total of 381,614 US medical residents between the years 2000 to 2014 found suicide as the second most common cause of death. It was however found when looking at resident physicians between the age of 25-34.9 there was 4.07 suicides per 100,000 person years while in the general public there was 13.07 suicides per 100,000 years.

    Conclusions

    The rate of suicide was found to be lower in resident physicians compared to the general public. Suicidal ideation may be more closely associated with depression versus burnout itself and should be accounted for when assessing suicidal ideation in the resident physician population. Suicide rates being lower in resident physicians compared to the general public bring up the possibility that burnout in resident physicians does not have to be directly correlated with increased risk of suicide.

    Disclosure of Interest

    None Declared

  • Introduction

  • Edited by Jacob E. Gersen, Harvard Law School, Massachusetts, Joel H. Steckel, New York University
  • Book:
    The Cambridge Handbook of Marketing and the Law
    Published online:
    29 June 2023
    Print publication:
    13 July 2023, pp 1-6

  • Summary

    This volume emerged from the notion that marketers and lawyers often talk about the same things. They may use different names, but essentially the things they talk about are the same. For example, while marketers talk about brands, lawyers talk about trademarks. However, relatively late in the process of editing this volume, we, as editors, had a somewhat unsettling realization. Throughout the planning and editing process for this book, we had been laboring under, not unrelated, but certainly not identical, views about the domain of marketing and the reach of law. We had no real common understanding of what marketing is, what marketing theory entails, and how the law shapes and governs marketing activities. Such a state of affairs is part of the inevitable risk of bringing together a group of scholars from two distinct disciplines. Fortunately, the realization helped us recognize that both marketing and law are sometimes vessels into which users can pour whatever content they wish. At the start, therefore, we thought it wise to dispense with some misconceptions and offer at least some working definitions of the terms and ideas we encounter in this volume.

The Cambridge Handbook of Marketing and the Law
  • Edited by Jacob E. Gersen, Joel H. Steckel
  • Published online:
    29 June 2023
    Print publication:
    13 July 2023
  • This handbook examines a wide range of current legal and policy issues at the intersection of marketing and the law. Focusing on legal outcomes that depend on measurements and interpretations of consumer and firm behavior, the chapters explore how consumers form preferences, perceptions, and beliefs, and how marketers influence them. Specific questions include the following: How should trademark litigation be valued and patent damages assessed? What are the challenges in doing so? What divides certain marketing claims between fact and fiction? Can a litigant establish secondary meaning without a survey? How can one extract evidence on consumer behavior with the explosion of social media? This unique volume at the intersection of marketing and the law brings together an international roster of scholars to answer these questions and more.

  • Expert Consensus Statement: Anatomy, Imaging, and Nomenclature of Congenital Aortic Root Malformations

  • Justin T. Tretter, Diane E. Spicer, Rodney C. G. Franklin, Marie J. Béland, Vera D. Aiello, Andrew C. Cook, Adrian Crucean, Rohit S. Loomba, Shi-Joon Yoo, James A. Quintessenza, Christo I. Tchervenkov, Jeffrey P. Jacobs, Hani K. Najm, Robert H. Anderson
  • Journal:
    Cardiology in the Young / Volume 33 / Issue 7 / July 2023
    Published online by Cambridge University Press:
    08 June 2023, pp. 1060-1068
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  • Over the past 2 decades, several categorizations have been proposed for the abnormalities of the aortic root. These schemes have mostly been devoid of input from specialists of congenital cardiac disease. The aim of this review is to provide a classification, from the perspective of these specialists, based on an understanding of normal and abnormal morphogenesis and anatomy, with emphasis placed on the features of clinical and surgical relevance. We contend that the description of the congenitally malformed aortic root is simplified when approached in a fashion that recognizes the normal root to be made up of 3 leaflets, supported by their own sinuses, with the sinuses themselves separated by the interleaflet triangles. The malformed root, usually found in the setting of 3 sinuses, can also be found with 2 sinuses, and very rarely with 4 sinuses. This permits description of trisinuate, bisinuate, and quadrisinuate variants, respectively. This feature then provides the basis for classification of the anatomical and functional number of leaflets present. By offering standardized terms and definitions, we submit that our classification will be suitable for those working in all cardiac specialties, whether pediatric or adult. It is of equal value in the settings of acquired or congenital cardiac disease. Our recommendations will serve to amend and/or add to the existing International Paediatric and Congenital Cardiac Code, along with the Eleventh iteration of the International Classification of Diseases provided by the World Health Organization.

  • Zebra Finch Behaviour and Effect of Modest Enrichment of Standard Cages

  • H Jacobs, N Smith, P Smith, L Smyth, P Yew, P Saibaba, J Hau
  • Journal:
    Animal Welfare / Volume 4 / Issue 1 / February 1995
    Published online by Cambridge University Press:
    11 January 2023, pp. 3-9

  • Zebra finches are often housed in monogamous pairs in small barren cages. In the present study it was investigated whether modest enrichment resulted in behavioural changes. Four plywood box cages of two different lengths were compared. A small and a large cage were used for the barren environment. Another small and large cage were used for the enriched environment, and included additional perches, twigs as well as sand and water baths. An ethogram consisting of 19 different behavioural patterns was used. The behaviour of the birds was studied using a combination of alternating (20s) one-zero and instantaneous sampling, one hour per day during a continuous four-week period.

    Locomotor activity, vocalization and singing was significantly increased in the enriched cages and flying was more frequent in the large enriched cage than in any of the other cages. The study demonstrated the usefulness of behavioural analyses to determine to what extent simple enrichment allows the birds to exhibit a wider range of their natural behaviour.

  • Flow of a concentrated emulsion with surfactant through a periodic porous medium

  • Alexander Z. Zinchenko, Jacob R. Gissinger, Robert H. Davis
  • Journal:
    Journal of Fluid Mechanics / Volume 953 / 25 December 2022
    Published online by Cambridge University Press:
    07 December 2022, A21

  • High-resolution, long-time three-dimensional simulations are presented for slow, pressure-driven flow of a periodic emulsion of deformable drops through a dense, simple cubic array of solid spheres (one drop and one particle per periodic cell). The drops, covered with insoluble, non-diffusive surfactant, are large compared with pores, and they squeeze with high resistance, very closely coating the solids to overcome surface tension and lubrication effects. The solid volume fraction is 50 %, the emulsion concentration $c_{em}$ in the pore space is 36 % or 50 %, the drop-to-medium viscosity ratio $\lambda$ is 0.25 to 4. The contamination measure $\beta \leq 0.1$ keeps the linear surfactant model (assumed in most of the work) physically relevant. The boundary-integral solution requires extreme resolutions (tens of thousands of boundary elements per surface) achieved by multipole acceleration with special desingularizations, combined with flow-biased surfactant transport algorithms for numerical stability. The time-periodic regime is typically attained after a few squeezing cycles; the motion period is used in the extrapolation scheme to evaluate critical capillary numbers $Ca_{crit}$ demarcating squeezing from trapping. Due to Marangoni stresses, even light ($\beta =0.05$) to moderate ($\beta =0.1$) contaminations significantly reduce the average drop-phase migration velocity (up to 2.8 times, compared with clean drops), especially at small $\lambda =0.25$. In contrast, $Ca_{crit}$ is weakly sensitive to contamination and levels off completely at $\beta =0.05$. At $\lambda =0.25$ and $c_{em}=0.36$, the average drop-phase velocities are much different for lightly and moderately contaminated emulsions, except for near-critical squeezing when they become the same. Nonlinear surfactant models (Langmuir, Frumkin) are used to validate the linear model.

  • Content of lunchboxes of Dutch primary school children and their perceptions of alternative healthy school lunch concepts

  • Frédérique C Rongen, Ellen van Kleef, Monique H Vingerhoeds, Jacob C Seidell, Sanne Coosje Dijkstra
  • Journal:
    Public Health Nutrition / Volume 26 / Issue 3 / March 2023
    Published online by Cambridge University Press:
    21 October 2022, pp. 554-562
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  • Objective:

    To investigate the content of lunchboxes of primary school children and to examine children’s support and preferences for alternative healthy school lunch concepts.

    Design:

    A cross-sectional study among Dutch children from seven primary schools. The content of the lunchboxes was assessed by photographs. Support and preferences for alternative lunch concepts were examined via a self-reported questionnaire. Linear regression analyses were used to investigate the associations between children’s support and preferences and sex, educational group and migration background.

    Setting:

    The Netherlands.

    Participants:

    Primary school children.

    Results:

    A total of 660 children were included (average 9·9 years old). Most lunchboxes contained sandwiches and a drink. Few lunchboxes contained fruit or vegetables. The alternative school lunch concepts elicited mixed support among children. The lunch concepts ‘Sandwiches prepared by the children themselves’ and a ‘hot lunch buffet’ had the highest mean support, while the concept ‘a healthy lunch brought from home’ was the most preferred concept. Small significant differences were observed depending on sex, educational group and migration background.

    Conclusion:

    Lunchboxes of Dutch children contained sandwiches and a drink but rarely fruit and vegetables. Among different alternatives, children reported the highest support for the preparation of their own sandwiches in class or a hot lunch buffet. Future studies should investigate if these alternative lunch concepts improve the dietary intake of children.

  • Pre-pregnancy exposure to arsenic in diet and non-cardiac birth defects

  • Jonathan Suhl, Kristin M Conway, Anthony Rhoads, Peter H Langlois, Marcia L Feldkamp, Adrian M Michalski, Jacob J Oleson, Alpa Sidhu, Vijaya Kancherla, John Obrycki, Maitreyi Mazumdar, Paul A Romitti, the National Birth Defects Prevention Study
  • Journal:
    Public Health Nutrition / Volume 26 / Issue 3 / March 2023
    Published online by Cambridge University Press:
    27 May 2022, pp. 620-632
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  • Objectives:

    To explore associations between maternal pre-pregnancy exposure to arsenic in diet and non-cardiac birth defects.

    Design:

    This is a population-based, case–control study using maternal responses to a dietary assessment and published arsenic concentration estimates in food items to calculate average daily total and inorganic arsenic exposure during the year before pregnancy. Assigning tertiles of total and inorganic arsenic exposure, logistic regression analysis was used to estimate OR for middle and high tertiles, compared to the low tertile.

    Setting:

    US National Birth Defects Prevention Study, 1997–2011.

    Participants:

    Mothers of 10 446 children without birth defects and 14 408 children diagnosed with a non-cardiac birth defect.

    Results:

    Maternal exposure to total dietary arsenic in the middle and high tertiles was associated with a threefold increase in cloacal exstrophy, with weak positive associations (1·2–1·5) observed either in both tertiles (intercalary limb deficiency) or the high tertile only (encephalocele, glaucoma/anterior chamber defects and bladder exstrophy). Maternal exposure to inorganic arsenic showed mostly weak, positive associations in both tertiles (colonic atresia/stenosis, oesophageal atresia, bilateral renal agenesis/hypoplasia, hypospadias, cloacal exstrophy and gastroschisis), or the high (glaucoma/anterior chamber defects, choanal atresia and intestinal atresia stenosis) or middle (encephalocele, intercalary limb deficiency and transverse limb deficiency) tertiles only. The remaining associations estimated were near the null or inverse.

    Conclusions:

    This exploration of arsenic in diet and non-cardiac birth defects produced several positive, but mostly weak associations. Limitations in exposure assessment may have resulted in exposure misclassification. Continued research with improved exposure assessment is recommended to identify if these associations are true signals or chance findings.

Page 1 of 17