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Allurin, a 21-kDa protein secreted by the oviduct of female Xenopus frogs, is incorporated into the jelly layers of eggs as they pass single fi le on their way to the uterus and subsequent spawning. Hydration of the egg jelly layers at spawning releases allurin as a chemoattractant that binds to the midpiece of Xenopus sperm in a dose-dependent manner. Gradients of allurin elicit directed swimming across a porous membrane in two-chamber assays and preferential, up-gradient swimming of sperm in video-microscopic assays. Allurin, purifi ed from X. laevis or produced in recombinant form, also elicits chemotaxis by mouse sperm in twochamber and video microscopic assays. Allurin binds to mouse sperm at the midpiece and head, a pattern also seen in frog sperm. Western blots suggest the presence of an allurin-like protein in the follicular fl uid of mice and humans and peptides that mimic subdomains within allurin elicit chemoattractive behavior in both mouse and human sperm. By sequence homology, allurin is a truncated member of the CysteineRIch Secretory Protein (CRISP) family whose members include Crisps 1, 2, and 4, which have been demonstrated to modulate mammalian sperm functions including Dedication This chapter is dedicated to Allan L. Bieber, a long-time collaborator of ours who recently passed on. Allan was an expert biochemist who guided our purifi cation of allurin and characterization of its disulfi de bonding pattern using mass spectrometry. His long-term interest in venom proteins from snakes was culminated by his delight in fi nding that allurin is closely related to Crisp snake toxin proteins.

Background: To relieve hospital capacity strain, hospitals often encourage clinicians to prioritize early morning discharges which may have unintended consequences. Objective: We aimed to test the effects of hospitalist physicians prioritizing discharging patients first compared to usual rounding style. Design, Setting and Participants: Prospective, multi-center randomized controlled trial. Three large academic hospitals. Participants were Hospital Medicine attendinglevel physicians and patients the physicians cared for during the study who were at least 18 years of age, admitted to a Medicine service, and assigned by standard practice to a hospitalist team. Intervention: Physicians were randomized to: (1) prioritizing discharging patients first as care allowed or (2) usual practice.Main Outcome and Measures: Main outcome measure was discharge order time. Secondary outcomes were actual discharge time, length of stay (LOS), and order times for procedures, consults, and imaging.Results: From February 9, 2021, to July 31, 2021, 4437 patients were discharged by 59 physicians randomized to prioritize discharging patients first or round per usual practice. In primary adjusted analyses (intention-to-treat), findings showed no significant difference for discharge order time (13:03 ± 2 h:31 min vs. 13:11 ± 2 h:33 min, p = .11) or discharge time (15:22 ± 2 h:50 min vs. 15:21 ± 2 h:50 min, p = .45), for physicians randomized to prioritize discharging patients first compared to physicians using usual rounding style, respectively, and there was no significant change in LOS or on order times of other physician orders.Conclusions: Prioritizing discharging patients first did not result in significantly earlier discharges or reduced LOS.

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Background Morale and burnout were concerns for hospitalists prior to the COVID-19 pandemic; these concerns were amplified as COVID-19 spread and hospitals experienced unprecedented stress. In contrast to prior literature, our study assesses both satisfaction and the importance of various factors. This study examines morale of hospitalists early in the COVID-19 pandemic in two settings: conventional hospitals and a COVID-19 Alternate Care site (ACS) in the same geographic region in Maryland. Multiple studies published early in the pandemic show low morale in COVID-19 hospitals. Methods In a cross-sectional survey study, we analyze data from the Hospitalist Morale Index (HMI) administered between September 2020 and March 2021 to determine the pandemic’s impact on hospitalist morale. Results Surprisingly, our study found morale in the ACS was better than morale at the conventional hospitals. ACS hospitalists and conventional hospitalists were demographically similar. Our results show that a significantly higher proportion of conventional hospitalists reported burnout compared to the ACS hospitalists. General quality of life was rated significantly higher in the ACS group than the conventional group. Significantly more ACS hospitalists were invested in making their group outstanding. Five main HMI domains were examined with questions on a 5-point rating scale: Clinical Factors, Workload, Material Rewards, Leadership, and Appreciation/Acknowledgement. ACS hospitalists rated most measures higher than conventional hospitalists; largest differences were observed in Clinical Factors and Appreciation/Acknowledgement domains. Narrative comments from ACS hospitalists revealed strong identification with the mission of the ACS and pride in contributing during a crisis. One key difference between the two groups explains these findings: provider autonomy. The ACS staff chose the position and the assignment, while conventional hospitalists caring for COVID-19 patients could not readily opt out of this work. Conclusion Our data suggest that autonomy in assignments with risk has implications for morale and burnout.

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