Effect of a Novel Mindfulness Curriculum on Burnout During Pediatric Internship: A Cluster Randomized Clinical Trial.

IMPORTANCE: Mindfulness curricula can improve physician burnout, but implementation during residency presents challenges. OBJECTIVE: To examine whether a novel mindfulness curriculum implemented in the first 6 months of internship reduces burnout. DESIGN, SETTING, AND PARTICIPANTS: This pragmatic, multicenter, stratified cluster randomized clinical trial of a mindfulness curriculum randomized 340 pediatric interns to the intervention or control arm within program pairs generated based on program size and region. Fifteen US pediatric training programs participated from June 14, 2017, to February 28, 2019. INTERVENTIONS: The intervention included 7 hour-long sessions of a monthly mindfulness curriculum (Mindfulness Intervention for New Interns) and a monthly mindfulness refresher implemented during internship. The active control arm included monthly 1-hour social lunches. MAIN OUTCOMES AND MEASURES: The primary outcome was emotional exhaustion (EE) as measured by the Maslach Burnout Inventory 9-question EE subscale (range, 7-63; higher scores correspond to greater perceived burnout). Secondary outcomes were depersonalization, personal accomplishment, and burnout. The study assessed mindfulness with the Five Facet Mindfulness Questionnaire and empathy with the Interpersonal Reactivity Index subscales of perspective taking and empathetic concern. Surveys were implemented at baseline, month 6, and month 15. RESULTS: Of the 365 interns invited to participate, 340 (93.2%; 255 [75.0%] female; 51 [15.0%] 30 years or older) completed surveys at baseline; 273 (74.8%) also participated at month 6 and 195 (53.4%) at month 15. Participants included 194 (57.1%) in the Mindfulness Intervention for New Interns and 146 (42.9%) in the control arm. Analyses were adjusted for baseline outcome measures. Both arms' EE scores were higher at 6 and 15 months than at baseline, but EE did not significantly differ by arm in multivariable analyses (6 months: 35.4 vs 32.4; adjusted difference, 3.03; 95% CI, -0.14 to 6.21; 15 months: 33.8 vs 32.9; adjusted difference, 1.42; 95% CI, -2.42 to 5.27). None of the 6 secondary outcomes significantly differed by arm at month 6 or month 15. CONCLUSIONS AND RELEVANCE: A novel mindfulness curriculum did not significantly affect EE, burnout, empathy, or mindfulness immediately or 9 months after curriculum implementation. These findings diverge from prior nonrandomized studies of mindfulness interventions, emphasizing the importance of rigorous study design and suggesting that additional study is needed to develop evidence-based methods to reduce trainee burnout. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03148626.

Defining Near-Term to Long-Term Research Opportunities to Advance Metrics, Models, and Methods for Smart and Sustainable Manufacturing.

Over the past century, research has focused on continuously improving the performance of manufacturing processes and systems-often measured in terms of cost, quality, productivity, and material and energy efficiency. With the advent of smart manufacturing technologies-better production equipment, sensing technologies, computational methods, and data analytics applied from the process to enterprise levels-the potential for sustainability performance improvement is tremendous. Sustainable manufacturing seeks the best balance of a variety of performance measures to satisfy and optimize the goals of all stakeholders. Accurate measures of performance are the foundation on which sustainability objectives can be pursued. Historically, operational and information technologies have undergone disparate development, with little convergence across the domains. To focus future research efforts in advanced manufacturing, the authors organized a one-day workshop, sponsored by the U.S. National Science Foundation, at the joint manufacturing research conferences of the American Society of Mechanical Engineers and Society of Manufacturing Engineers. Research needs were identified to help harmonize disparate manufacturing metrics, models, and methods from across conventional manufacturing, nanomanufacturing, and additive/hybrid manufacturing processes and systems. Experts from academia and government labs presented invited lightning talks to discuss their perspectives on current advanced manufacturing research challenges. Workshop participants also provided their perspectives in facilitated brainstorming breakouts and a reflection activity. The aim was to define advanced manufacturing research and educational needs for improving manufacturing process performance through improved sustainability metrics, modeling approaches, and decision support methods. In addition to these workshop outcomes, a review of the recent literature is presented, which identifies research opportunities across several advanced manufacturing domains. Recommendations for future research describe the short-, mid-, and long-term needs of the advanced manufacturing community for enabling smart and sustainable manufacturing.

Factory optima: a web-based system for composition and analysis of manufacturing service networks based on a reusable model repository.

This paper reports on the development of Factory Optima, a web-based system that allows manufacturing process engineers to compose, optimise and perform trade-off analysis of manufacturing and contract service networks based on a reusable repository of performance models. Performance models formally describe process feasibility constraints and metrics of interest, such as cost, throughput and CO 2 emissions, as a function of fixed and control parameters, such as equipment and contract properties and settings. The repository contains performance models representing (1) unit manufacturing processes, (2) base contract services and (3) a composite steady-state service network. The proposed framework allows process engineers to hierarchically compose model instances of service networks, which can represent production cells, lines, factory facilities and supply chains, and perform deterministic optimisation based on mathematical programming and Pareto-optimal trade-off analysis. Factory Optima is demonstrated using a case study of a service network for a heat sink product which involves contract vendors and manufacturing activities, including cutting, shearing, Computer Numerical Control (CNC) machining with milling and drilling operations, quality inspection, finishing, and assembly.

Contextualising manufacturing data for lifecycle decision-making.

Recent advances enable data from manufacturing systems to be captured and contextualised relative to other phases of the product lifecycle, a necessary step toward understanding system behaviour and satisfying traceability requirements. Significant challenges remain for integrating information across the lifecycle and enabling efficient decision-making. In this paper, we explore opportunities for mapping standard data representations, such as the Standard for the Exchange of Product Data (STEP), MTConnect, and the Quality Information Framework (QIF) to integrate information silos existing across the lifecycle. To demonstrate this vision, we describe a reference implementation with a contract manufacturer in the National Institute of Standards and Technology (NIST) Smart Manufacturing Systems Test Bed. Using this implementation, we explore how knowledge generated from manufacturing can support lifecycle decision-making. As a case study, we then present an interactive prototype correlating the test bed's data based on the context that must be provided for a specific decision-making viewpoint.

Analyzing environmental sustainability methods for use earlier in the product lifecycle.

Environmental sustainability information in the manufacturing industry is not easily shared between stages in the product lifecycle. In particular, reliable manufacturing-related information for assessing the sustainability of a product is often unavailable at the design stage. Instead, designers rely on aggregated, often outdated information or make decisions by analogy (e.g., a similar manufacturing process for a similar product yielded X and Y results). However, smart manufacturing and the Internet of Things have potential to bridge the gap between design and manufacturing through data and knowledge sharing. This paper analyzes environmental sustainability assessment methods to enable more accurate decisions earlier in design. The techniques and methods are categorized based on the stage they apply to in the product lifecycle, as described by the Systems Integration of Manufacturing Applications (SIMA) reference architecture. Furthermore, opportunities for aligning standard data representation to promote sustainability assessment during design are identified.

GENERATING CONTEXTUAL DESIGN FOR ENVIRONMENT PRINCIPLES IN SUSTAINABLE MANUFACTURING USING VISUAL ANALYTICS.

Design for Environment (DfE) principles are helpful for integrating manufacturing-specific environmental sustainability considerations into product and process design. However, such principles are often overly general, static, and disconnected from production contexts. This paper proposes a visual analytics-based framework for generating DfE principles that are contextualized to specific production setups. These principles are generated through interactive visual exploration of design and process parameters as well as manufacturing process performance metrics corresponding to the production setup. We also develop a formal schema for aiding storage, updating, and reuse of the generated DfE principles. In this schema, each DfE principle is associated with corresponding product lifecycle data and the evidence that led to the generation of that principle. We demonstrate the proposed visual analytics framework using data from an industry-led experiment that compared dry ice based and oil based milling for a specific production setup.

Visual Analytics Tools for Sustainable Lifecycle Design: Current Status, Challenges, and Future Opportunities.

The rapid rise in technologies for data collection has created an unmatched opportunity to advance the use of data-rich tools for lifecycle decision-making. However, the usefulness of these technologies is limited by the ability to translate lifecycle data into actionable insights for human decision-makers. This is especially true in the case of sustainable lifecycle design (SLD), as the assessment of environmental impacts, and the feasibility of making corresponding design changes, often relies on human expertise and intuition. Supporting human sense-making in SLD requires the use of both data-driven and user-driven methods while exploring lifecycle data. A promising approach for combining the two is through the use of visual analytics (VA) tools. Such tools can leverage the ability of computer-based tools to gather, process, and summarize data along with the ability of human-experts to guide analyses through domain knowledge or data-driven insight. In this paper, we review previous research that has created VA tools in SLD. We also highlight existing challenges and future opportunities for such tools in different lifecycle stages-design, manufacturing, distribution & supply chain, use-phase, end-of-life, as well as life cycle assessment. Our review shows that while the number of VA tools in SLD is relatively small, researchers are increasingly focusing on the subject matter. Our review also suggests that VA tools can address existing challenges in SLD and that significant future opportunities exist.

Towards Knowledge Management for Smart Manufacturing.

The need for capturing knowledge in the digital form in design, process planning, production, and inspection has increasingly become an issue in manufacturing industries as the variety and complexity of product lifecycle applications increase. Both knowledge and data need to be well managed for quality assurance, lifecycle-impact assessment, and design improvement. Some technical barriers exist today that inhibit industry from fully utilizing design, planning, processing, and inspection knowledge. The primary barrier is a lack of a well-accepted mechanism that enables users to integrate data and knowledge. This paper prescribes knowledge management to address a lack of mechanisms for integrating, sharing, and updating domain-specific knowledge in smart manufacturing. Aspects of the knowledge constructs include conceptual design, detailed design, process planning, material property, production, and inspection. The main contribution of this paper is to provide a methodology on what knowledge manufacturing organizations access, update, and archive in the context of smart manufacturing. The case study in this paper provides some example knowledge objects to enable smart manufacturing.

The novel mouse Polo-like kinase 5 responds to DNA damage and localizes in the nucleolus.

Polo-like kinases (Plk1-4) are emerging as an important class of proteins involved in many aspects of cell cycle regulation and response to DNA damage. Here, we report the cloning of a fifth member of the polo-like kinase family named Plk5. DNA and protein sequence analyses show that Plk5 shares more similarities with Plk2 and Plk3 than with Plk1 and Plk4. Consistent with this observation, we show that mouse Plk5 is a DNA damage inducible gene. Mouse Plk5 protein localizes predominantly to the nucleolus, and deletion of a putative nucleolus localization signal (NoLS) within its N-terminal moiety disrupts its nucleolar localization. Ectopic expression of Plk5 leads to cell cycle arrest in G1, decreased DNA synthesis, and to apoptosis, a characteristic it shares with Plk3. Interestingly, in contrast to mouse Plk5 gene, the sequence of human Plk5 contains a stop codon that produces a truncated protein lacking part of the kinase domain.

The accuracy of transcutaneous bilirubin measurements in neonates: a correlation study.

A prospective observational study was conducted on 212 neonates born between 24 and 42 weeks of gestation who required blood sampling to determine total serum bilirubin (TSB) in the first week of life, prior to phototherapy. The transcutaneous bilirubin (TcB) measurements were performed on the infant's forehead using BiliCheck within +/-30 min of a blood sample being drawn. There was significant (r = 0.78) correlation between bilirubin levels obtained transcutaneously and those measured in the infant's blood. The correlation was not affected by birth weight and was dependent on the bilirubin levels. The negative nonsignificant correlation appears when TSB levels are greater than 11 mg/dl. Thus, TcB measurements can accurately predict TSB values lower than 11 mg/dl in a multiracial preterm and term neonatal population.

Improving America's health care system by investing in information technology.

Large-scale investment in health care information technology (IT) infrastructure will not take place without leadership by the federal government. But how the federal government supports the financing of health care IT is critical. Health care IT development has multiple aspects, but it is fundamentally a problem of community infrastructure development. A policy approach that has had consistent success in financing our country's essential physical infrastructure in transportation and environmental protection will be well suited to fostering health care IT infrastructure as well. We propose the creation of a health care IT revolving loan fund program to invest public dollars in health care IT infrastructure projects through community-level nonprofit lending agencies.