Collectively these data suggest that extracellular Hsp72 is released from virally infected airway epithelial cells resulting in the recruitment and activation of neutrophils.

Heat shock proteins are generally regarded as intracellular proteins acting as molecular chaperones; however, Hsp72 is also detected in the extracellular compartment. Hsp72 has been identified in the bronchoalveolar lavage fluid (BALF) of patients with acute lung injury. To address whether Hsp72 directly activated airway epithelium, human bronchial epithelial cells (16HBE14o-) were treated with recombinant Hsp72. Hsp72 induced a dose-dependent increase in IL-8 expression, which was inhibited by the NF-κB inhibitor parthenolide. Hsp72 induced activation of NF-κB, as evidenced by NF-κB trans-activation and by p65 RelA and p50 NF-κB1 binding to DNA. Endotoxin contamination of the Hsp72 preparation was not responsible for these effects. Next, BALB/c mice were challenged with a single intratracheal inhalation of Hsp72 and killed 4 h later. Hsp72 induced significant up-regulation of KC, TNF-α, neutrophil recruitment, and myeloperoxidase in the BALF. A similar challenge with Hsp72 in TLR4 mutant mice did not stimulate the inflammatory response, stressing the importance of TLR4 in Hsp72-mediated lung inflammation. Last, cultured mouse tracheal epithelial cells (MTEC) from BALB/c and TLR4 mutant and wild-type mice were treated ex vivo with Hsp72. Hsp72 induced a significant increase in KC expression from BALB/c and wild-type MTEC in an NF-κB-dependent manner; however, TLR4 mutant MTEC had minimal cytokine release. Taken together, these data suggest that Hsp72 is released and biologically active in the BALF and can regulate airway epithelial cell cytokine expression in a TLR4 and NF-κB-dependent mechanism.

Drug death victims, both for accidents and for suicides, have a broad range of ages. About two-thirds of decedents are between 30 and 50, with a mean age of 40. Sixty-eight percent of accidental overdoses and 49% of suicides are male. Selected demographic comparisons between overdose victims and the general (Maine 2000 Census) population include the following notable statistics. Compared to the general population, among victims, there are 14% more males, 9% fewer Maine natives, and 34% fewer who are married. About 6% fewer victims have earned at least a high school diploma. (Table 3): Table 3. Highlighted demographic characteristics for all drug related deaths, 1997-2002, compared to the Maine 2000 Census population Drug Overdose Victims Maine 2000 Census Males 62% 48% Born in Maine 58% 67% Married 24% 58% 71% 36% 79% Single/Divorced Education high school or greater 85%

Residency is a high-risk period for physician burnout. We aimed to determine the short-term stability of factors associated with burnout, application of these data to previous conceptual models, and the relationship of these factors over 3 months. Physician wellness questionnaire results were analyzed at 2 time points 3 months apart. Associations among variables within and across time points were analyzed. Logistic regression was used to predict burnout and compassionate care. A total of 74% of residents completed surveys. Over 3 months, burnout (P = .005) and empathy (P = .04) worsened. The most significant cross-sectional relationship was between stress and emotional exhaustion (time 1 r = 0.61, time 2 r = 0.68). Resilience was predictive of increased compassionate care and decreased burnout (P < .05). Mindfulness was predictive of decreased burnout (P < .05). Mitigating stress and fostering mindfulness and resilience longitudinally may be key areas of focus for improved wellness in pediatric residents. Larger studies are needed to better develop targeted wellness interventions.

Introduction: Traditional normative Likert-type evaluations of faculty teaching have several drawbacks, including lack of granular feedback, potential for inflation, and the halo effect. To provide more meaningful data to faculty on their teaching skills and encourage educator self-reflection and skill development, we designed and implemented a milestone-based faculty clinical teaching evaluation tool. Methods: The evaluation tool contains 10 questions that assess clinical teaching skills with descriptive milestone behavior anchors. Nine of these items are based on the Stanford Faculty Development Clinical Teaching Model and annual Accreditation Council for Graduate Medical Education (ACGME) resident survey questions; the tenth was developed to address professionalism at our institution. The tool was developed with input from residency program leaders, residents, and the faculty development committee and piloted with graduate medical education learners before implementation. Results: More than 7,200 faculty evaluations by learners and 550 faculty self-evaluations have been collected. Learners found the form easy to use and preferred it to previous Likert-based evaluations. Over the 2 years that faculty selfevaluations have been collected, their scores have been similar to the learner evaluation scores. The feedback provided faculty with more meaningful data on teaching skills and opportunities for reflection and skill improvement and was used in constructing faculty teaching skills programs at the institutional level. Discussion: This innovation provides an opportunity to give faculty members more meaningful teaching evaluations and feedback. It should be easy for other institutions and programs to implement. It leverages a familiar milestone construct and incorporates important ACGME annual resident survey information.

Objectives: Assess the overall level of burnout in pediatric critical care medicine fellows and examine factors that may contribute to or protect against its development. Design: Cross-sectional observational study. Setting: Accreditation Council for Graduate Medical Education-accredited pediatric critical care medicine fellowship programs across the United States. Subjects: Pediatric critical care medicine fellows and program directors. Interventions: Web-based survey that assessed burnout via the Maslach Burnout Inventory, as well as other measures that elicited demographics, sleepiness, social support, perceptions about prior training, relationships with colleagues, and environmental burnout. Measurements and Main Results: One-hundred eighty-seven fellows and 47 program directors participated. Fellows from 30% of programs were excluded due to lack of program director participation. Average values on each burnout domain for fellows were higher than published values for other medical professionals. Personal accomplishment was greater (lower burnout) among fellows more satisfied with their career choice (β 9.319; p ≤ 0.0001), spiritual fellows (β 1.651; p = 0.0286), those with a stress outlet (β 3.981; p = 0.0226), those comfortable discussing educational topics with faculty (β 3.078; p = 0.0197), and those comfortable seeking support from their co-fellows (β 3.762; p = 0.0006). Depersonalization was higher for second year fellows (β 2.034; p = 0.0482), those with less educational debt (β –2.920; p = 0.0115), those neutral/dissatisfied with their career choice (β –6.995; p = 0.0031), those with nursing conflict (β –3.527; p = 0.0067), those who perceived burnout among co-fellows (β 1.803; p = 0.0352), and those from ICUs with an increased number of patient beds (β 5.729; p ≤ 0.0001). Emotional exhaustion was higher among women (β 2.933; p = 0.0237), those neutral/dissatisfied with their career choice (β –7.986; p = 0.0353), and those who perceived burnout among co-fellows (β 5.698; p ≤ 0.0001). Greater sleepiness correlated with higher burnout by means of lower personal accomplishment (r = –1.64; p = 0.0255) and higher emotional exhaustion (r = 0.246; p = 0.0007). Except for tangible support, all other forms of social support showed a small to moderate correlation with lower burnout. Conclusions: Pediatric critical care medicine fellows in the United States are experiencing high levels of burnout, which appears to be influenced by demographics, fellow perceptions of their work environment, and satisfaction with career choice. The exclusion of fellows at 30% of the programs may have over or underestimated the actual level of burnout in these trainees.

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