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As emergency medicine (EM) residents prepare for the transition into unsupervised practice, their focus shifts from demonstrating competencies within familiar training environments to anticipating their new roles and responsibilities as attending physicians, often in unfamiliar settings. Using the self-regulated learning framework, we explored how senior EM residents proactively identify goals and enact learning strategies leading up to the transition from residency into unsupervised practice. In this study we used a constructivist grounded theory approach, interviewing EM residents in their final year of training at two residency programs. Using the self-regulated learning framework as a sensitizing concept for analysis, we conducted inductive, line-by-line coding of interview transcripts and grouped codes into categories. Theoretical sufficiency was reached after 12 interviews, with four subsequent interviews producing no divergent or disconfirming examples. We interviewed16 senior residents about their self-regulated learning approaches to preparing for unsupervised practice. Participants identified two types of gaps that they sought to address prior to entering practice: knowledge/skill gaps, and autonomy gaps. We employed specific workplace learning strategies to address each type of gap, which we have termed cherry-picking, case-based hypotheticals, parachuting, and making the call, and reflection on both internal and external sources of feedback to assess the effectiveness of these learning strategies. This study presents participants' identification of gaps in their residency training, their learning strategies, and reflections as cyclical processes of self-regulated learning. In their final months of training EM residents strategically leverage learning strategies to bridge gaps between their self-assessed capabilities and those they anticipate needing to succeed in unsupervised practice. These findings show that trainees have agency in how they use goal setting, strategic actions, and ongoing reflection to prepare themselves for unsupervised practice. Our findings also suggest tailored approaches whereby programs can support learning experiences that foster senior residents' agency when preparing for the challenges of future practice.

Introduction: As emergency medicine (EM) residents prepare for the transition into unsupervised practice, their focus shifts from demonstrating competencies within familiar training environments to anticipating their new roles and responsibilities as attending physicians, often in unfamiliar settings. Using the self-regulated learning framework, we explored how senior EM residents proactively identify goals and enact learning strategies leading up to the transition from residency into unsupervised practice. Methods: In this study we used a constructivist grounded theory approach, interviewing EM residents in their final year of training at two residency programs. Using the self-regulated learning framework as a sensitizing concept for analysis, we conducted inductive, line-by-line coding of interview transcripts and grouped codes into categories. Theoretical sufficiency was reached after 12 interviews, with four subsequent interviews producing no divergent or disconfirming examples. Results: We interviewed16 senior residents about their self-regulated learning approaches to preparing for unsupervised practice. Participants identified two types of gaps that they sought to address prior to entering practice: knowledge/skill gaps, and autonomy gaps. We employed specific workplace learning strategies to address each type of gap, which we have termed cherry-picking, case-based hypotheticals, parachuting, and making the call, and reflection on both internal and external sources of feedback to assess the effectiveness of these learning strategies. This study presents participants’ identification of gaps in their residency training, their learning strategies, and reflections as cyclical processes of self-regulated learning. Conclusion: In their final months of training EM residents strategically leverage learning strategies to bridge gaps between their self-assessed capabilities and those they anticipate needing to succeed in unsupervised practice. These findings show that trainees have agency in how they use goal setting, strategic actions, and ongoing reflection to prepare themselves for unsupervised practice. Our findings also suggest tailored approaches whereby programs can support learning experiences that foster senior residents’ agency when preparing for the challenges of future practice.

This study addressed the issue of burnout among middle school teachers in the West Houston area. It explored how their shared experiences contributed to teacher shortages and increased attrition rates. This qualitative phenomenological study aimed to examine the lived experiences of teachers in Grades 6–8 in public schools who had experienced burnout or had left their positions due to the stress associated with classroom environments. The sample comprised eight certified middle school teachers, including former classroom educators, from a suburban school district in West Houston. Participants were selected through purposeful sampling to ensure alignment with the research objectives. Data collected through interviews were analyzed using inductive coding in NVivo, which identified recurring themes and patterns in participant responses. The findings revealed that teacher burnout was a pervasive issue that significantly affected middle school educators, often leading to their premature departure from the teaching profession. Participants emphasized the need for increased funding to support higher teacher salaries, improved incentives to make teaching competitive with opportunities outside the K–12 sector, and pathways for career advancement that did not require substantial financial investment in additional degrees or certifications for administrative roles. These insights highlighted the urgent need for systemic changes. School administrators, district leaders, policymakers, and state officials were urged to consider teachers' perspectives when addressing budgets, benefits, and retention strategies. A key recommendation involved implementing compensation structures aligned with the earning potential of other professions requiring at least a bachelor’s degree. Such measures were found to have the potential to enhance teacher retention, reduce burnout, and improve the stability and effectiveness of the educational workforce.

Wearable technology has advanced significantly, and the proposed health benefits have been widely touted. Most of the discussion has been surrounding the identification and diagnosis of asymptomatic atrial fibrillation. However, the heart monitoring functions of the wearable technology can also identify other abnormalities as well. We present the first case of wearable technology identified bradycardia diagnosed as the primary presentation of complete heart block. Wearable technology has advanced significantly, but still poses questions regarding its use in screening for rare conditions. One remaining challenge is balancing the desire to screen for rare asymptomatic conditions without overburdening emergency departments with patients responding to alarms on their devices.

BACKGROUND AND OBJECTIVES: Research suggests there may be a relationship between maternal cholesterol levels during pregnancy and both fetal growth and preterm birth. This research studied how changes in maternal cholesterol during pregnancy differ based on various maternal demographics. In addition, the relationships between changes in maternal cholesterol and fetal growth and changes in maternal cholesterol and gestational age at delivery were analyzed. METHODS: The Archive for Research on Child Health (ARCH) database was utilized for this dissertation. Maternal cholesterol at two time points during pregnancy was obtained and changes in maternal cholesterol levels were calculated for 195 women. RESULTS: First, second, and third trimester maternal cholesterol levels were higher in women with a pre-pregnancy body mass index less than 25 kg/m2. No significant associations were found between changes in maternal cholesterol levels and fetal growth. Exploratory analyses found that maternal cholesterol levels at single time points during gestation were lower in pregnancies resulting in small for gestational age infants. Lastly, in women with a history of a previous preterm birth, changes in maternal cholesterol levels were found to be significantly associated with the corrected gestational age at delivery. Exploratory analyses found maternal cholesterol levels were higher in pregnancies resulting in preterm birth for all three trimesters. CONCLUSION: Changes in maternal cholesterol levels may provide a more complete picture of cholesterol during pregnancy compared to maternal cholesterol levels at a single time point during pregnancy. This research found associations between both low and high maternal cholesterol levels and adverse birth outcomes indicating that cholesterol levels that are either too high or too low may increase risk of adverse birth outcomes.

Roles: JB - 12 to 14 years of age, a sweet young boy FUZZY - 12 to 14 years of age, a pretty and sweet young girl PANDY - 12 to 14 years of age, FUZZYS young friend, a bit of a tomboy GRIZZLY - 12 to 14 years of age, a tough young boy with an attitude All young people must sing and move well MOM - mid-30s, JBs mom, pretty, intelligent and kind-hearted, with a good folk-rock voice DAD - mid-30s, JBs dad, a nice, caring father with a good folk-rock voice TEDDY - mid-30s 40s the principal on the school, a funny character HONEY - mid-30s 40s TEDDYS WIFE, a funny character It would be very helpful if those auditioning play an instrument, and while that is not crucial, familiarity with basic guitar a plus.

Roles: JB - 12 to 14 years of age, a sweet young boy FUZZY - 12 to 14 years of age, a pretty and sweet young girl PANDY - 12 to 14 years of age, FUZZYS young friend, a bit of a tomboy GRIZZLY - 12 to 14 years of age, a tough young boy with an attitude All young people must sing and move well MOM - mid-30s, JBs mom, pretty, intelligent and kind-hearted, with a good folk-rock voice DAD - mid-30s, JBs dad, a nice, caring father with a good folk-rock voice TEDDY - mid-30s 40s the principal on the school, a funny character HONEY - mid-30s 40s TEDDYS WIFE, a funny character It would be very helpful if those auditioning play an instrument, and while that is not crucial, familiarity with basic guitar a plus.

At the Tony Awards in 1956, Damn Yankees won Best Musical, Best Choreography, Best Conductor and Musical Director, Best Leading Actor, Best Leading Actress, and Best Featured Actor in a Musical.

At the Tony Awards in 1956, Damn Yankees won Best Musical, Best Choreography, Best Conductor and Musical Director, Best Leading Actor, Best Leading Actress, and Best Featured Actor in a Musical.