Once present, burnout tends to persist through residency. Men and residents who screened positive for depression as interns are at the highest risk for persistent burnout. Interventions to prevent burnout during internship may significantly decrease burnout throughout residency.

NK and T lymphocytes express both activating and inhibiting receptors for various members of the major histocompatibility complex class I superfamily (MHCISF). To evade immunologic cytotoxicity, many viruses interfere with the function of these receptors, generally by altering the displayed profile of MHCISF proteins on host cells. Using a structurally constrained hidden Markov model, we discovered an orthopoxvirus protein, itself distantly class I–like, that acts as a competitive antagonist of the NKG2D activating receptor. This orthopoxvirus MHC class I–like protein (OMCP) is conserved among cowpox and monkeypox viruses, secreted by infected cells, and bound with high affinity by NKG2D of rodents and humans (KD ∼ 30 and 0.2 nM, respectively). OMCP blocks recognition of host-encoded ligands and inhibits NKG2D-dependent killing by NK cells. This finding represents a novel mechanism for viral interference with NKG2D and sheds light on intercellular recognition events underlying innate immunity against emerging orthopoxviruses.

Objective: To examine allied health client, provider and community referrer perceptions of telehealth for the delivery of rural paediatric allied health services to facilitate adoption. Design: A qualitative design employed semistructured interviews with the three key stakeholder groups. Setting: Stakeholders were associated with BUSHkids (The Royal Queensland Bush Children's Health Scheme), a not-for-profit organisation serving children and families in Queensland, Australia. Participants: Thirty-nine stakeholders (12 clients, 16 providers and 11 community referrers). Main outcome measures:Participants were asked about familiarity with telehealth, willingness to use telehealth and perceived barriers and facilitators to telehealth acceptability. Result: Fifty-nine percent of participants had experienced telehealth and 77 percent were willing to use it. Participants perceived that technology problems were a barrier to telehealth, that children would not be able to concentrate on or enjoy telehealth sessions, that relationships and communication would be inferior to in-person sessions, and that telehealth was inappropriate for disciplines employing physical touch. Participants identified access to health services as a key benefit of telehealth, said that technology problems could be worked around, and said that telehealth services could be supported with internal partners (eg, assistants) and external partners (eg, local medical centres).They also identified a variety of telehealth benefits to families (eg, convenience, privacy). Conclusion: Overall, telehealth was acceptable to stakeholders. Providers need training to facilitate child participation online and identify alternatives to physical touch. Co-learning opportunities should be used to address low provider and referrer self-efficacy. K E Y W O R D Sallied health, children, perceptions, stakeholders, telehealth 420 |