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Purpose of Review: In a time of record levels of physician burnout coupled with a global pandemic, protecting physician wellness is critical. The experience of cognitive flow has been found to enhance both wellness and performance. Although flow has been vastly explored in other fields including elite sport, it has not been deeply investigated or applied in cardiac surgery. Here we discuss flow and flow-promoting techniques employed in other fields that may be beneficial within cardiac surgery., Recent Findings: Flow is a prevalent experience among surgeons, amplified during operations. Possible strategies to cultivate flow may be separated into individual skills training, such as mindfulness practice and stress management, institutional changes, such as ensuring adequate resources and protected spaces, and strategies targeting the intersectionality of individuals and systems, such as how workplace culture shapes an individual's experience. These techniques may be applicable within cardiac surgery, especially in training., Summary: Flow has been identified as a key component of a happy and meaningful life, and a potential protector against burnout. Harnessing the benefits of flow may help promote flourishing, particularly in demanding fields, such as cardiac surgery., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Physician stress impacts patient care and provider wellness. Researchers have largely used reductionist approaches to study stress (e.g. focusing on physiology). This study sought to understand surgeons' subjective experiences of stress in the workplace, using a holistic perspective., Methods: Using a constructivist grounded theory methodology, semi-structured interviews were conducted with 24 staff surgeons at the University of Toronto, purposively sampled for specialties and experience levels., Results: The stress experience was reconceptualized as a variable and multidimensional state of fracture, comprised of physiologic, cognitive, emotional, sociocultural, and environmental facets., Conclusions: Reconceptualizing surgeon stress as a multidimensional state of fracture may help surgeons recognize the contributing facets and identify appropriate strategies for promoting wellness and optimizing performance., Competing Interests: Declaration of competing interest We have no conflicts of interest to declare., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: Anxiety and depression are common, debilitating and costly. These disorders are influenced by multiple risk factors, from genes to psychological vulnerabilities and environmental stressors, but research is hampered by a lack of sufficiently large comprehensive studies. We are recruiting 40,000 individuals with lifetime depression or anxiety and broad assessment of risks to facilitate future research., Methods: The Genetic Links to Anxiety and Depression (GLAD) Study (www.gladstudy.org.uk) recruits individuals with depression or anxiety into the NIHR Mental Health BioResource. Participants invited to join the study (via media campaigns) provide demographic, environmental and genetic data, and consent for medical record linkage and recontact., Results: Online recruitment was effective; 42,531 participants consented and 27,776 completed the questionnaire by end of July 2019. Participants' questionnaire data identified very high rates of recurrent depression, severe anxiety, and comorbidity. Participants reported high rates of treatment receipt. The age profile of the sample is biased toward young adults, with higher recruitment of females and the more educated, especially at younger ages., Discussion: This paper describes the study methodology and descriptive data for GLAD, which represents a large, recontactable resource that will enable future research into risks, outcomes, and treatment for anxiety and depression., (Copyright © 2019 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Fuel chromatography is inherently limited by the high complexity of petroleum fuel compositions. In practice, almost no fuel components are fully resolved in gas chromatography. This is due to both insufficient peak capacity for the large number of individual components within time and chromatographic efficiency constraints, and insufficient resolving power of the stationary phase in the gas chromatography column relative to the many structurally similar isomers or homologs present in petrochemical fuels. Multidimensional approaches, longer columns and slower heating rates can offer some benefits but will not necessarily fully resolve co-eluting fuel compounds, especially within reasonable analysis times. The following work details how deconvolved mass spectral loadings, combined with library matching, provide a quality metric against which to automatically evaluate results obtained from an experimental evolving window factor analysis-multivariate curve resolution deconvolution algorithm applied to gas chromatography-mass spectrometry data. This algorithm was evaluated in the context of trace component detection in synthetic fuel data sets, dodecane and tetradecane detection in petrochemical fuels, and the detection of natural products unlikely to be present in petrochemical fuels. In the case of the trace component detection challenge, the experimental algorithm outperformed a control algorithm that utilized a singular value-based quality metric. Meanwhile, when detecting dodecane, tetradecane, and natural products in petrochemical fuels, the experimental algorithm allowed for higher-quality compound identification results than could be obtained without peak deconvolution, thus reliably improving fuel component resolution in an automated fashion., (Published by Elsevier B.V.)

Objective: Progressing from trainee to attending surgeon is arguably one of the most significant transitions in a surgeon's career. Despite this, little is known about this critical period. The purpose of this study was to develop a framework for understanding the phenomenon of the transition from trainee to attending surgeon., Design: A constructivist grounded theory methodology was used to explore the experience of new attending surgeons as they transition into practice. A purposeful sampling strategy was used to conduct 13 semistructured interviews with surgeons from various specialties. Data collection and analysis were performed simultaneously as part of the iterative process. Themes were identified and informed the development of the conceptual framework., Setting: The setting included 4 separate Canadian urban, academic health centers., Participants: A total of 13 surgeons in their first 5 years of practice from 6 separate departments were included., Results: Participants described 4 phases that marked their transition from trainee to attending surgeon. In the initial phase (getting undressed), participants shared vivid moments where they realized they no longer fit their trainee identity, but did not yet belong to the attending group. An intense phase of vulnerability and self-doubt (exposed and vulnerable), which was associated with building a new reputation and identity, followed. In the next phase (suiting up), surgeons began to project the image associated with their new role to others. With the passage of time and accumulation of successful cases, participants began to internalize their new identity in the final phase (tailoring the fit)., Conclusions: The transition from trainee to attending surgeon is a critical time during which new surgeons experience an identity shift. The conceptual framework presented contributes to a deeper understanding of the experience of this transition in order to help new surgeons transition successfully into independent practice., (Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

A novel vapor delivery testbed, referred to as the Trace Explosives Sensor Testbed, or TESTbed, is demonstrated that is amenable to both high- and low-volatility explosives vapors including nitromethane, nitroglycerine, ethylene glycol dinitrate, triacetone triperoxide, 2,4,6-trinitrotoluene, pentaerythritol tetranitrate, and hexahydro-1,3,5-trinitro-1,3,5-triazine. The TESTbed incorporates a six-port dual-line manifold system allowing for rapid actuation between a dedicated clean air source and a trace explosives vapor source. Explosives and explosives-related vapors can be sourced through a number of means including gas cylinders, permeation tube ovens, dynamic headspace chambers, and a Pneumatically Modulated Liquid Delivery System coupled to a perfluoroalkoxy total-consumption microflow nebulizer. Key features of the TESTbed include continuous and pulseless control of trace vapor concentrations with wide dynamic range of concentration generation, six sampling ports with reproducible vapor profile outputs, limited low-volatility explosives adsorption to the manifold surface, temperature and humidity control of the vapor stream, and a graphical user interface for system operation and testing protocol implementation.

Background: The U.S. Institute of Medicine recommends that cancer patients receive survivorship care plans, but evaluations to date have found little evidence of the effectiveness of such plans. We conducted a qualitative follow-on study to a randomized controlled trial (rct) to understand the experiences of family physicians using survivorship care plans to support the follow-up of breast cancer patients., Methods: A subset of family physicians whose patients were enrolled in the parent rct in Ontario and Nova Scotia were eligible for this study. In interviews, the physicians discussed survivorship care plans (intervention) or usual discharge letters (control), and their confidence in providing follow-up cancer care., Results: Of 123 eligible family physicians, 18 (10 intervention, 8 control) were interviewed. In general, physicians receiving a survivorship care plan found only the 1-page care record to be useful. Physicians who received only a discharge letter had variable views about the letter's usefulness; several indicated that it lacked information about potential cancer- or treatment-related problems. Most physicians were comfortable providing care 3-5 years after diagnosis, but desired timely and informative communication with oncologists., Conclusions: Although family physicians did not find extensive survivorship care plans useful, discharge letters might not be sufficiently comprehensive for follow-up breast cancer care. Effective strategies for two-way communication between family physicians and oncologists are still lacking.

Background: Patient-centered care ideally considers patient preferences, values and needs. However, it is unclear if policies such as wait time strategies for hip and knee replacement surgery (TJR) are patient-centred as they focus on an isolated episode of care. This paper describes the accounts of people scheduled to undergo TJR, focusing on their experience of (OA) as a chronic disease that has considerable impact on their everyday lives., Methods: Semi-structured qualitative interviews were conducted with participants scheduled to undergo TJR who were recruited from the practices of two orthopaedic surgeons. We first used maximum variation and then theoretical sampling based on age, sex and joint replaced. 33 participants (age 38-79 years; 17 female) were included in the analysis. 20 were scheduled for hip replacement and 13 for knee replacement. A constructivist approach to grounded theory guided sampling, data collection and analysis., Results: While a specific hip or knee was the target for surgery, individuals experienced multiple-joint symptoms and comorbidities. Management of their health and daily lives was impacted by these combined experiences. Over time, they struggled to manage symptoms with varying degrees of access to and acceptance of pain medication, which was a source of constant concern. This was a multi-faceted issue with physicians reluctant to prescribe and many patients reluctant to take prescription pain medications due to their side effects., Conclusions: For patients, TJR surgery is an acute intervention in the experience of chronic disease, OA and other comorbidities. While policy has focused on wait time as patient/surgeon decision for surgery to surgery date, the patient's experience does not begin or end with surgery as they struggle to manage their pain. Our findings suggest that further work is needed to align the medical treatment of OA with the current policy emphasis on patient-centeredness. Patient-centred care may require a paradigm shift that is not always evident in current policy and strategies.

Electrochemical sensors composed of a ceramic-metallic (cermet) solid electrolyte are used for the detection of gaseous sulfur compounds SO(2), H(2)S, and CS(2) in a study involving 11 toxic industrial chemical (TIC) compounds. The study examines a sensor array containing four cermet sensors varying in electrode-electrolyte composition, designed to offer selectivity for multiple compounds. The sensors are driven by cyclic voltammetry to produce a current-voltage profile for each analyte. Raw voltammograms are processed by background subtraction of clean air, and the four sensor signals are concatenated to form one vector of points. The high-resolution signal is compressed by wavelet transformation and a probabilistic neural network is used for classification. In this study, training data from one sensor array was used to formulate models which were validated with data from a second sensor array. Of the 11 gases studied, 3 that contained sulfur produced the strongest responses and were successfully analyzed when the remaining compounds were treated as interferents. Analytes were measured from 10 to 200% of their threshold-limited value (TLV) according to the 8-h time weighted average (TWA) exposure limits defined by the National Institute of Occupational Safety and Health (NIOSH). True positive classification rates of 93.3, 96.7, and 76.7% for SO(2), H(2)S, and CS(2), respectively, were achieved for prediction of one sensor unit when a second sensor was used for modeling. True positive rates of 83.3, 90.0, and 90.0% for SO(2), H(2)S, and CS(2), respectively, were achieved for the second sensor unit when the first sensor unit was used for modeling. Most of the misclassifications were for low concentration levels (such 10-25% TLV) in which case the compound was classified as clean air. Between the two sensors, the false positive rates were 2.2% or lower for the three sulfur compounds, 0.9% or lower for the interferents (eight remaining analytes), and 5.8% or lower for clean air. The cermet sensor arrays used in this analysis are rugged, low cost, reusable, and show promise for multiple compound detection at parts-per-million (ppm) levels.