Timothy R. Johnson

Predictors of physician career satisfaction, work-life balance, and burnout

OBJECTIVE: To explore factors associated with physician career satisfaction, work–life balance, and burnout focusing on differences across age, gender, and specialty. METHODS: A cross-sectional, mailed, self-administered survey was sent to a national sample of 2,000 randomly-selected physicians, stratified by specialty, age, and gender (response rate 48%). Main outcome measures included career satisfaction, burnout, and work–life balance. Scales ranged from 1 to 100. RESULTS: Both women and men report being highly satisfied with their careers (79% compared with 76%, P<.01), having moderate levels of satisfaction with work–life balance (48% compared with 49%, P=.24), and having moderate levels of emotional resilience (51% compared with 53%, P=.09). Measures of burnout strongly predicted career satisfaction (standardized β 0.36–0.60, P<.001). The strongest predictor of work–life balance and burnout was having some control over schedule and hours worked (standardized β 0.28, P<.001, and 0.20–0.32, P<.001, respectively). Physician gender, age, and specialty were not strong independent predictors of career satisfaction, work–life balance, or burnout. CONCLUSION: This national physician survey suggests that physicians can struggle with work–life balance yet remain highly satisfied with their career. Burnout is an important predictor of career satisfaction, and control over schedule and work hours are the most important predictors of work–life balance and burnout. LEVEL OF EVIDENCE: II

Maternal bisphenol-A levels at delivery: a looming problem?

Objective:The objective was to determine whether bisphenol-A (BPA) is found in maternal circulation of pregnant women in the US population and is related to gestational length and birth weight.Method:Circulating levels of BPA were quantified by high performance liquid chromatography-tandem mass spectrometry at delivery in 40 southeastern Michigan mothers and correlated with gestational length and birth weight of offspring.Result:Maternal levels of unconjugated BPA ranged between 0.5 and 22.3 ng ml−1 in southeastern Michigan mothers. There was no correlation between BPA concentrations and gestational length or birth weight of offspring.Conclusion:This is the first study to document measurable levels of BPA in maternal blood of the US population. Long-term follow-up studies of offspring are needed to validate or refute concerns over human fetal exposure to synthetic exogenous steroids.

Elevated serum human chorionic gonadotropin as evidence of secretory response in severe preeclampsia

OBJECTIVE Because preeclampsia is a trophoblastic disorder and human chorionic gonadotropin is secreted from trophoblast, we sought to determine whether measurement of serum human chorionic gonadotropin might reflect a different trophoblastic secretory response of preeclampsia. STUDY DESIGN Twenty patients with mild preeclampsia and 12 with severe preeclampsia were matched with 32 healthy, normotensive women in the third trimester with singleton pregnancies. Serum total human chorionic gonadotropin and total human chorionic gonadotropin-beta were measured by a two-site immunoenzymometric assay, and total hCG-alpha was determined by a double-antibody radioimmunoassay. Wilcoxon signed-rank and Mann-Whitney rank-sum tests were used for statistical analysis. RESULTS Serum total human chorionic gonadotropin, total human chorionic gonadotropin-alpha, and total human chorionic gonadotropin-beta levels were significantly higher in severely preeclamptic women (p < 0.05), but not in those with mild preeclampsia, compared with those in their matched controls. CONCLUSION Elevated serum human chorionic gonadotropin levels in severely preeclamptic women might reflect a significantly pathologic change and secretory reaction of the placenta.

Presidential capital and the supreme court confirmation process

The Supreme Court nomination and confirmation process has become one of the most contentious aspects of American politics in recent years, representing a seismic struggle between the president and the U.S. Senate over the ideological makeup of the nations highest court. Existing research focuses on how the ideological compatibility of the president and the Senate affects the ideology of the presidents nominees. However, little work addresses whether presidents can overcome an ideologically hostile Senate by spending political capital to support a nominee. As such, we examine the presidents public expenditure of capital to obtain confirmation for Supreme Court nominees facing a Senate that is reticent to confirm. By content analyzing public statements made by presidents during confirmation battles we find strong support for the hypothesis that presidents strategically “go public.” Further, this strategy has a marked influence on presidents’ ability to win confirmation for their most important nominees. “Tell your senators to resist the politicization of our court system. Tell them you support the appointment of Judge Bork.” —President Ronald Reagan, 1987

Elevated circulating thrombomodulin in severe preeclampsia

A relationship between serum thrombomodulin and preeclampsia was investigated. In women with severely preeclamptic pregnancies, serum thrombomodulin levels were found to be significantly elevated as compared with those of matched control subjects (p < 0.005). Serum thrombomodulin levels correlated positively with serum creatinine (r = 0.854, p < 0.0001) and uric acid levels (r = 0.784, p < 0.001).

The Public's Conditional Response to Supreme Court Decisions

To investigate the effect of the Supreme Court on public opinion, we offer the conditional response hypothesis based on a theory of Supreme Court legitimacy and a microlevel social-psychological theory of attitude formation. Together these theories predict that the Court may affect public opinion when it initially rules on a salient issue, but that subsequent decisions on the same issue will have little influence on opinion. To test our predictions, we analyze public opinion data before and after the Supreme Court ruled in a highly visible abortion case ( Webster v. Reproductive Health Services [1989]) and before and after three key capital punishment rulings ( Furman v. Georgia [1972], Gregg v. Georgia [1976], and McCleskey v. Kemp [1987]). The results suggest that our theory is not issue bound but is generally applicable to how the Supreme Court affects public opinion when it rules in highly salient cases.

Umbilical cord blood pH and Apgar scores as an index of neonatal health

In an effort to determine the clinical usefulness of Apgar scoring and cord pH in neonatal management, specimens of umbilical cord blood were obtained after 257 of 329 consecutive deliveries at a community-based hospital. A notable number of babies who were born in a vigorous state were in fact acidotic (umbilical arterial pH >1 SD below mean). Seventy-two percent of acidotic babies had an Apgar score >7 at 1 minute, and 92% had an Apgar score >7 at 5 minutes. Correlation coefficients of Apgar scores at 1 and 5 minutes and arterial pH with the health status of newborn infants were poor. A X 2 analysis of arterial pH and Apgar scores at 1 and 5 minutes indicated that a larger number of sick babies had an Apgar score >7 and acidosis than expected by pure chance. However, the sensitivity values of the Apgar score at 1 minute (0.48) and 5 minutes (0.24) and the arterial pH (0.40) for predicting sick children limit the clinical usefulness of these tests. While technically feasible in a community hospital, routine cord pH measurements add little to neonatal evaluation and management.

The Supreme Court, the Solicitor General, and the Separation of Powers

Supreme Court justices attempt to rule as closely as possible to their policy preferences, but their decisions are not unconstrained. Rather, justices pay attention to the preferences of other actors—including those external to the Court. Whereas most scholars focus on the relationship between the Court and Congress, this article focuses on the relationship between the Court and the executive. Specifically, it argues that justices seek information about how the administration wants them to act because, like Congress, it can sanction the Court for making decisions that diverge from administration policies. Certainly this information can be gathered in a number of ways, but this article argues that when not readily available, justices can obtain it by inviting the solicitor general to appear before the Court as amicus curiae. The findings provide the first systematic evidence that justices actively seek information about the preferences of other actors during their decision-making process.

Information, Oral Arguments, and Supreme Court Decision Making

Conventional wisdom in judicial politics is that oral arguments play little if any role in how the Supreme Court makes decisions. A primary reason for this view is that insufficient evidence exists to test this hypothesis. Thus, I ask, do Supreme Court justices use information from oral arguments that may help them make decisions as close as possible to their preferred goals? My answer is straightforward: An investigation of the oral arguments and the Courts majority opinions in a sample of cases from the Burger Court era shows that the Court gathers information during oral arguments and then uses this information when making substantive policy choices. This finding has clear implications for the way in which scholars view the Supreme Courts decision-making process, as it suggests that the accepted view of where oral arguments fit into this process is far from accurate.

Lanthanide-dependent cross-feeding of methane-derived carbon is linked by microbial community interactions

Significance A great challenge in microbial ecology lies in determining the underlying mechanisms that drive interactions in complex natural communities. In this study we used bacterial isolates from Lake Washington sediment that are important for the utilization of the greenhouse gas methane. We show how simple cocultures can be used to identify mechanisms involved in cross-feeding in microbial communities; these mechanisms cannot be deduced from pure cultures alone. We demonstrate that the presence of one species alters gene expression and metabolism in another species such that the second species excretes a carbon and energy source to sustain the cross-fed species. This mode of cross-feeding based on partner-induced altered gene expression may have important implications for microbial interactions in the environment. The utilization of methane, a potent greenhouse gas, is an important component of local and global carbon cycles that is characterized by tight linkages between methane-utilizing (methanotrophic) and nonmethanotrophic bacteria. It has been suggested that the methanotroph sustains these nonmethanotrophs by cross-feeding, because subsequent products of the methane oxidation pathway, such as methanol, represent alternative carbon sources. We established cocultures in a microcosm model system to determine the mechanism and substrate that underlay the observed cross-feeding in the environment. Lanthanum, a rare earth element, was applied because of its increasing importance in methylotrophy. We used co-occurring strains isolated from Lake Washington sediment that are involved in methane utilization: a methanotroph and two nonmethanotrophic methylotrophs. Gene-expression profiles and mutant analyses suggest that methanol is the dominant carbon and energy source the methanotroph provides to support growth of the nonmethanotrophs. However, in the presence of the nonmethanotroph, gene expression of the dominant methanol dehydrogenase (MDH) shifts from the lanthanide-dependent MDH (XoxF)-type, to the calcium-dependent MDH (MxaF)-type. Correspondingly, methanol is released into the medium only when the methanotroph expresses the MxaF-type MDH. These results suggest a cross-feeding mechanism in which the nonmethanotrophic partner induces a change in expression of methanotroph MDHs, resulting in release of methanol for its growth. This partner-induced change in gene expression that benefits the partner is a paradigm for microbial interactions that cannot be observed in studies of pure cultures, underscoring the importance of synthetic microbial community approaches to understand environmental microbiomes.