Compassion Fatigue and Satisfaction among Turkish Emergency Medicine Residents Using the Professional Quality of Life Scale.

Introduction: Emergency medicine (EM) residents are at high risk for burnout syndrome. The professional quality of life scale (ProQOL) is a validated survey that measures compassion satisfaction (CS) and compassion fatigue, which is comprised of burnout and secondary traumatic stress (STS) scales. This study sought to evaluate CS and fatigue among Turkish EM residents using the ProQOL survey. Methods: This was a cross-sectional study of Turkish EM residents who are part of the EM Residency Association of Turkey. The ProQOL survey version 5 was E-mailed in Turkish to all 150 EM residents. Participants were currently employed as EM residents. Demographics and satisfaction with quality of life were also collected. Results: Eighty residents completed the survey. Almost half of the respondents were either very dissatisfied or dissatisfied with their overall quality of life. Turkish EM residents not only had moderate levels of CS (scoring 33.9 ± 7.9), but also suffered moderate burnout (27.0 ± 5.9) and STS (24.7 ± 5.3). Conclusions: Turkish EM residents have moderate levels of CS and moderate levels of burnout and secondary traumatic stress.

On-chip Carba NP test for accurate and high throughput detection of carbapenemase-producing Enterobacteriaceae.

Given the great threat posed by clinical Carbapenemase-producing Enterobacteriaceae (CPE), its rapid and accurate detection is highly required to guide infection treatment and to prevent serious outbreaks. While the Carba NP test (CNPt) is a popular and methodologically simple colorimetric assay for detecting carbapenemase activity, its clinical application is limited by low throughput, poor sensitivity and obscure color interpretation due to the lack of quantitative information on time- and dose-dependent color changes. To address these limitations, we developed a multiplexed microfluidic device (1280 chambers) that is able to automatically generate 16 bacterial concentration gradients and uses green channel intensity to extract quantitative color changes as a function of time. Here we examined the dynamic color changing profiles of 3 reference and 8 clinical bacteria isolates. The results demonstrated linear correlations between color developments and time (within 0-120 min) or bacterial doses (within OD600 of 0.8-8.0), enabling accurate and reproducible detection of CPE with over 105 fold improved sensitivity for an NDM-producer (LOD of 2.4 × 103 cells) and over 104 fold improved sensitivity for an OXA-48-producer (LOD of 7.2 × 104 cells) as compared to the conventional CNPt method (LOD above 1.3 × 109 cells). As the first digital microfluidic platform for CPE, this on-chip CNPt compared favourably with the conventional bench-based method by significantly improved sensitivity, high throughput, low consumption and automatization, favouring its potential clinical applications for rapid screening of CPE with a low cost. Furthermore, the results also revealed dynamic signature associated with bacteria, which may hold promise for a new approach to study divergent bacterial responses to antibiotic treatments.

Label-Free Visualization of Carbapenemase Activity in Living Bacteria.

Evaluating enzyme activity intracellularly on natural substrates is a significant experimental challenge in biomedical research. We report a label-free method for real-time monitoring of the catalytic behavior of class A, B, and D carbapenemases in live bacteria based on measurement of heat changes. By this means, novel biphasic kinetics for class D OXA-48 with imipenem as substrate is revealed, providing a new approach to detect OXA-48-like producers. This in-cell calorimetry approach offers major advantages in the rapid screening (10 min) of carbapenemase-producing Enterobacteriaceae from 142 clinical bacterial isolates, with superior sensitivity (97 %) and excellent specificity (100 %) compared to conventional methods. As a general, label-free method for the study of living cells, this protocol has potential for application to a wider range and variety of cellular components and physiological processes.

Program Director Perceptions of the General Surgery Milestones Project.

OBJECTIVE: As a result of the Milestones Project, all Accreditation Council for Graduate Medical Education accredited training programs now use an evaluation framework based on outcomes in 6 core competencies. Despite their widespread use, the Milestones have not been broadly evaluated. This study sought to examine program director (PD) perceptions of the Milestones Project. DESIGN, SETTING, AND PARTICIPANTS: A national survey of general surgery PDs distributed between January and March of 2016. RESULTS: A total of 132 surgical PDs responded to the survey (60% response rate). Positive perceptions included value for education (55%) and evaluation of resident performance (58%), as well as ability of Milestones to provide unbiased feedback (55%) and to identify areas of resident deficiency (58%). Meanwhile, time input and the ability of Milestones to discriminate underperforming programs were less likely to be rated positively (25% and 21%, respectively). Half of PDs felt that the Milestones were an improvement over their previous evaluation system (55%). CONCLUSIONS: Using the Milestones as competency-based, developmental outcomes measures, surgical PDs reported perceived benefits for education and objectivity in the evaluation of resident performance. The overall response to the Milestones was generally favorable, and most PDs would not return to their previous evaluation systems. To improve future iterations of the Milestones, many PDs expressed a desire for customization of the Milestones' content and structure to allow for programmatic differences.

Charge composition features of model single-span membrane proteins that determine selection of YidC and SecYEG translocase pathways in Escherichia coli.

We have investigated the features of single-span model membrane proteins based upon leader peptidase that determines whether the proteins insert by a YidC/Sec-independent, YidC-only, or YidC/Sec mechanism. We find that a protein with a highly hydrophobic transmembrane segment that inserts into the membrane by a YidC/Sec-independent mechanism becomes YidC-dependent if negatively charged residues are inserted into the translocated periplasmic domain or if the hydrophobicity of the transmembrane segment is reduced by substituting polar residues for nonpolar ones. This suggests that charged residues in the translocated domain and the hydrophobicity within the transmembrane segment are important determinants of the insertion pathway. Strikingly, the addition of a positively charged residue to either the translocated region or the transmembrane region can switch the insertion requirements such that insertion requires both YidC and SecYEG. To test conclusions from the model protein studies, we confirmed that a positively charged residue is a SecYEG determinant for the endogenous proteins ATP synthase subunits a and b and the TatC subunit of the Tat translocase. These findings provide deeper insights into how pathways are selected for the insertion of proteins into the Escherichia coli inner membrane.