Increasing Resident Physician Well-Being through a Motivational Fitness Curriculum: A Pilot Study.

INTRODUCTION: Healthcare professionals who participate in regular exercise better manage job related stressors, utilize fewer sick days, and discuss fitness with patients at increased rates. Although resident physicians are aware of the health benefits of exercise their rates of exercise are much lower than among medical trainees and practicing physicians. Resident physicians have reported lack of time for traditional structured workouts as one of the greatest barriers to fitness. This study sought to increase resident physician well-being by providing brief workouts through a motivational fitness curriculum. METHODS: This pilot study utilized a nonexperimental design; a pre-/post-intervention consisted of a 10-month motivational fitness curriculum. Thirteen family medicine residents at a training program in the midwestern United States participated in this study. The Depression Anxiety Stress Scale-21 (DASS-21) and the Abbreviated Maslach Burnout Inventory (MBI-9) were used to measure the participants' well-being, pre- and post-curriculum. Standard descriptive statistics and paired samples t-test were used to analyze the data. RESULTS: Twenty-eight percent (13/36) of eligible first-year and second-year family medicine resident physicians participated in the study. On the DASS-21, study participants displayed an improvement in depression, anxiety, and stress scores post-curriculum. On the MBI-9, the participants reported decreased score in emotional exhaustion, but there were no changes in depersonalization and personal accomplishment scores over time. CONCLUSION: A motivational fitness curriculum may be a convenient way to support well-being among resident physicians. These findings were salient, as graduate medical education programs can implement similar initiatives to support resident physicians' psychological and physical well-being.

Characterization of acoustic noise in a neonatal intensive care unit MRI system.

BACKGROUND: To eliminate the medical risks and logistical challenges of transporting infants from the neonatal intensive care unit (NICU) to the radiology department for magnetic resonance imaging, a small-footprint 1.5-T MRI scanner has been developed for neonatal imaging within the NICU. MRI is known to be noisy, and exposure to excessive acoustic noise has the potential to elicit physiological distress and impact development in the term and preterm infant. OBJECTIVE: To measure and compare the acoustic noise properties of the NICU MRI system against those of a conventional 1.5-T MRI system. MATERIALS AND METHODS: We performed sound pressure level measurements in the NICU MRI scanner and in a conventional adult-size whole-body 1.5-T MRI system. Sound pressure level measurements were made for six standard clinical MR imaging protocols. RESULTS: The average sound pressure level value, reported in unweighted (dB) and A-weighted (dBA) decibels for all six imaging pulse sequences, was 73.8 dB and 88 dBA for the NICU scanner, and 87 dB and 98.4 dBA for the conventional MRI scanner. The sound pressure level values measured on the NICU scanner for each of the six MR imaging pulse sequences were consistently and significantly (P = 0.03) lower, with an average difference of 14.2 dB (range 10-21 dB) and 11 dBA (range 5-18 dBA). The sound pressure level frequency response of the two MR systems showed a similar harmonic structure above 200 Hz for all imaging sequences. The amplitude, however, was appreciably lower for the NICU scanner, by as much as 30 dB, for frequencies below 200 Hz. CONCLUSION: The NICU MRI system is quieter than conventional MRI scanners, improving safety for the neonate and facilitating siting of the unit within the NICU.

MRI in the neonatal ICU: initial experience using a small-footprint 1.5-T system.

OBJECTIVE: The objective of our study was to develop a small 1.5-T MRI system for neonatal imaging that can be installed in the neonatal ICU (NICU) and to evaluate its performance in 15 neonates. SUBJECTS AND METHODS: A 1.5-T MR system designed for orthopedic use was adapted for neonatal imaging. Modifications included raising and leveling the magnet, construction of a patient table, and integration of imaging electronics from a high-performance adult-sized scanner. The system was used to perform MR examinations of the brain, abdomen, and chest in 15 medically stable neonates using standard clinical protocols. The scanning time was limited to 60 minutes. The MR examinations were performed without administering sedation to the patients. ECG, heart rate, oxygen saturation, and temperature were monitored continuously throughout the examination. The images were evaluated by two pediatric radiologists for overall study quality, motion artifact, spatial resolution, signal-to-noise ratio, and contrast. RESULTS: All 15 neonates were successfully imaged without sedation. No adverse MRI-related events were noted. In total, 19 brain and seven abdominal examinations were performed. Six chest and two cardiac examinations were also obtained. Gross (versus physiologic) subject motion proved to be the most influential factor in determining overall study and image quality. High-quality diagnostic images were obtained at each anatomic location. CONCLUSION: The customized neonatal MRI system provides state-of-the-art MRI capabilities in the NICU.

An MRI system for imaging neonates in the NICU: initial feasibility study.

BACKGROUND: Transporting premature infants from a neonatal intensive care unit (NICU) to a radiology department for MRI has medical risks and logistical challenges. OBJECTIVE: To develop a small 1.5-T MRI system for neonatal imaging that can be easily installed in the NICU and to evaluate its performance using a sheep model of human prematurity. MATERIALS AND METHODS: A 1.5-T MRI system designed for orthopedic use was adapted for neonatal imaging. The system was used for MRI examinations of the brain, chest and abdomen in 12 premature lambs during the first hours of life. Spin-echo, fast spin-echo and gradient-echo MR images were evaluated by two pediatric radiologists. RESULTS: All animals remained physiologically stable throughout the imaging sessions. Animals were imaged at two or three time points. Seven brain MRI examinations were performed in seven different animals, 23 chest examinations in 12 animals and 19 abdominal examinations in 11 animals. At each anatomical location, high-quality images demonstrating good spatial resolution, signal-to-noise ratio and tissue contrast were routinely obtained within 30 min using standard clinical protocols. CONCLUSION: Our preliminary experience demonstrates the feasibility and potential of the neonatal MRI system to provide state-of-the-art MRI capabilities within the NICU. Advantages include overall reduced cost and site demands, lower acoustic noise, improved ease of access and reduced medical risk to the neonate.

Synthesis and antiproliferative activity of [2-(phthaloylamino)alkyl]triphenyl phosphonium derivatives against K562 cell line.

Given the reported cytotoxicity of phthaloylaminoethyltriphenylphosphonium bromide 2a in the P-388 cell line, we have developed new [2-(phthaloylamino)alkyl]phosphonium derivatives 2b-e and evaluated their cytotoxic activity. These compounds have been synthetized from N,N-phthaloylaminoalcohols and triphenylphosphonium hydrobromide via a one-pot reaction. 2a was found inactive in the K562 cell line, but 2c-e exhibited a cytotoxic activity with IC50 values about 1 microM.

Mutations in the voltage-dependent anion channel of the mitochondrial outer membrane cause a dominant nonlethal growth impairment.

Point mutations at K234 and K236 in the yeast voltage-dependent anion channel 1 (VDAC1) of the mitochondrial outer membrane have been shown to markedly impair the membrane insertion of this protein (Smith et al., 1995; Angeles et al., 1998). Mutants of this type were expressed in vivo in a strain of yeast with a disruption in the VDAC1 gene. Expression of the various VDAC1 forms was under the control of a Gall promoter. Wild-type VDAC1 expression fully complemented the slow growth phenotype caused by the disruption. VDAC1 mutants in which K234 and K236 were replaced by arginine, glutamate, or glutamine caused a more severe negative effect on growth. This effect appeared to be dominant since the mutant VDAC1 forms suppressed growth in a yeast strain that retained its VDAC1 gene. This apparent dominant negative effect on growth did not seem to be specific for any stage of the cell cycle. However, the growth defect was not lethal as the affected cells still could accumulate the vital stain, FUN1. Expression of a mutant in which K234 had been replaced by glutamate had more serious negative growth effects than did a similar mutation at K236. Expression of delta71-116 VDAC1 complemented the VDAC1 disruption; however, expression of the same deletion mutant in which the lysines corresponding to K234 and K236 were mutated to glutamate severely impaired growth. These results have shown that a deficiency of lysine at positions 234 and 236 in VDAC I causes a nonlethal growth defect that is more severe than deletion of 45 amino acids from VDACI or disruption of the VDAC1 gene. They also indicate that there is a hierarchy in the importance of these lysines with mutations at K234 being the more serious.

The role of adolescent fathers in parenting and childrearing.

PIP: Many professionals believe teenage fathers' stereotypes such as stud, Don Juan, macho, cool, and absent father, yet data do not support them. Teenage fathers and mothers have known each other for 1-4 years and care for each other; many fathers accompany mothers to prenatal visits. Teenage fathers and mothers do tend to fail as parents, however. Parental interference limits access to their child. Dropping out of school, low income, ignorance of child rearing and child development, and stress that comes with adolescence and with early fatherhood also contribute to parenting failure. Teenage fathers are as ignorant about sex and sexuality as young mothers. For example, about 67% of all sexually active teenagers rarely, if ever, use contraception. 41% do not know that either they could impregnate someone or become pregnant. Research shows that upcoming fatherhood generates stress for teenage fathers. They are concerned about financially supporting the mother and child, completing school, the health and welfare of mother and child, and taking care of the child. Most research indicates that fathers really do want to be involved with the child. Children of teenage fathers who do take part in child rearing and whose mothers have a positive perception of the father's support exhibit better cognitive ability and behavior that in those whose fathers do not contact their children and mothers think negatively of the father's support. Children of teenagers are more likely to be premature, abused, and poor; to die before age 1; have several health problems; develop behavioral/emotional problems; and to become teenage parents. Outreach programs to teenage fathers show that they are very willing to become competent and caring parents. Methods to attract teenage fathers include going to schools and recreational facilities, public service spots on TV, and newspaper interviews with teenage fathers.^ieng

Metabolism of metapramine in vitro by chemical model systems and rat liver microsomes.

Metapramine (Timaxel) was oxidised by hepatic microsomes from rat and by biomimetic chemical systems; vanadyl acetylacetonate-iodylbenzene, phthalocyanin-iron II-iodosylbenzene, meso tetraphenyl porphyrine-iron III chloride-iodosylbenzene and Fenton's reagent. The major metabolite in all cases was the monodemethylated product formed by oxydative removal of the methyl group on the endocyclic nitrogen atom.

Study of experimental cataract produced by sugar alcohols in the organ-cultured mammalian ocular lens.

Freshly isolated rabbit lenses were cultured in isosmolar TC-199 medium or hyperosmolar medium containing 180 mM sorbitol or mannitol. These experiments were performed to investigate the probable effects of hyperosmolar media on lens clarity and the ability of lens fiber cells to synthesize membrane intrinsic protein, MP-26. The data from these experiments show that incubation in hyperosmolar medium causes depressed MP-26 synthesis, whereas the presence of sugar alcohols in the culture medium induced anterior and posterior subcapsular opacities. The cation levels of lenses incubated in iso- and hyperosmolar medium were also measured. Data from these experiments revealed that although the experimental lenses display prominent opacities, their cation levels are generally similar to those of control lenses. It is proposed that the observed lens opacities are due to the presence of sugar alcohols in the culture medium and not to hyperosmolar shock.