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BACKGROUND Background: The U.S. faces a nursing shortage driven by a burnout epidemic among nurses and nursing students. Nursing students are an integral population to fuel the nursing workforce at high risk of burnout and increased rates of perceived stress. OBJECTIVE Objective: The objective of this manuscript is to describe WellNurse, a holistic, interdisciplinary, multidimensional longitudinal research study that examines evidence-based interventions intended to reduce burnout and increase resilience among graduate and undergraduate nursing students. METHODS Methods: Graduate and undergraduate nursing students matriculated at a large public university in the northeastern United States are eligible to enroll in this ongoing, longitudinal cohort study beginning in March 2021. Participants complete a battery of health measurements twice each semester during the fourth week and the week before final exams. The measures include the Perceived Stress Scale, the Satisfaction with Life Scale, the Oldenburg Burnout Inventory, the Brief Resilience Scale, and the Pittsburgh Sleep Quality Index. Participants are eligible to enroll in a variety of interventions, including Mindfulness-Based Stress Reduction, Mindful Eating, Fitness Training, and Massage Therapy. Those who enroll in specific, targeted interventions complete additional measures designed to target the aim of the intervention. All participants receive a free Fitbit device. Additional environmental changes are being implemented to further promote a culture that supports academic well-being, including recruiting a diverse student population through evidence-based holistic admissions, inclusive teaching design, targeted resilience and stress reduction workshops, and cultural shifts within classrooms and curricula. The study design protocol is registered at Open Science Framework DOI 10.17605/OSF.IO/NCBPE. RESULTS Analysis and results: Analyses for each intervention use a matched control design and are disseminated as new knowledge is identified. WellNurse evaluation follows the Rapid Cycle Quality Improvement (RCQI) Framework to continuously monitor ongoing project processes, activity outcomes, and progress toward reducing burnout and increasing resilience. RCQI promotes the ability to alter WellNurse interventions, examine multiple interventions, and test their effectiveness among the nursing education population to identify the most effective intervention(s). CONCLUSIONS Discussion: Academic nursing organizations must address student burnout risk and increase resilience to produce a future workforce that provides high-quality patient care to a diverse population. Findings from WellNurse will support evidence-based implementations for public baccalaureate and master's nursing programs in the U.S. CLINICALTRIAL Open Science Framework DOI 10.17605/OSF.IO/NCBPE.

WellNurse is a holistic, interdisciplinary, multidimensional longitudinal research study that examines evidence-based interventions intended to reduce burnout and increase resilience among graduate and undergraduate nursing students at a public university in the northeastern United States.

Forensic handwriting examination involves the comparison of writing samples by forensic document examiners (FDEs) to determine whether or not they were written by the same person. Here we report the results of a large-scale study conducted to assess the accuracy and reliability of handwriting comparison conclusions. Eighty-six practicing FDEs each conducted up to 100 handwriting comparisons, resulting in 7,196 conclusions on 180 distinct comparison sets, using a five-level conclusion scale. Erroneous “written by” conclusions (false positives) were reached in 3.1% of the nonmated comparisons, while 1.1% of the mated comparisons yielded erroneous “not written by” conclusions (false negatives). False positive rates were markedly higher for nonmated samples written by twins (8.7%) compared to nontwins (2.5%). Notable associations between training and performance were observed: FDEs with less than 2 y of formal training generally had higher error rates, but they also had higher true positive and true negative rates because they tended to provide more definitive conclusions; FDEs with at least 2 y of formal training were less likely to make definitive conclusions, but those definitive conclusions they made were more likely to be correct (higher positive predictive and negative predictive values). We did not observe any association between writing style (cursive vs. printing) and rates of errors or incorrect conclusions. This report also provides details on the repeatability and reproducibility of conclusions, and reports how conclusions are affected by the quantity of writing and the similarity of content.

Introduction The Centers for Disease Control and Prevention recommend considering screening asymptomatic women for trichomonas in high-prevalence settings. Whether urban abortion clinics constitute such a setting is unknown. Material and Methods We offered trichomonas screening to patients presenting for abortion from October 2018 to February 2019 as a practice improvement and conducted a chart review. Results Ninety-two percent (593/644) of patients underwent testing. Trichomonas prevalence was 10.0% (95% CI 7.7−12.6). Ninety five percent of patients diagnosed were treated. Testing only symptomatic patients would have missed 98% of infections. Conclusions Trichomonas was highly prevalent, and universal testing and treatment was feasible in an urban abortion clinic.

Rationale: Lung cancer surgical morbidity has been decreasing, increasing attention to quality-of-life measures. A chronic sequela of lung cancer surgery is use of postoperative oxygen at home afte...

The study objective was to determine the relationship between lung resection and the development of postoperative hiatal hernia.Preoperative and postoperative computed tomography imaging from 373 patients from the International Early Lung Cancer Action Program and the Initiative for Early Lung Cancer Research on Treatment were compared at a median of 31.1 months of follow-up after resection of clinical early-stage non-small cell lung cancer. Incidence of new hiatal hernia or changes to preexisting hernias were recorded and evaluated by patient demographics, surgical approach, extent of resection, and resection site.New hiatal hernias were seen in 9.6% of patients after lung resection (5.6% after wedge or segmentectomy and 12.4% after lobectomy;Both open and minimally invasive lung resection for clinical early-stage lung cancer are associated with new or enlarging postoperative hiatal hernia, especially after resections involving the left lower lobe.

Children's caregivers are their first play partners, and toys influence the quality of these caregiver-child interactions-with research suggesting that electronic toys are not as supportive of these interactions as traditional toys. In this study, we investigate (1) toy use amongst caregivers and infants, with an eye towards investigating the prevalence of traditional vs. electronic toys, (2) caregivers' preferences when selecting electronic or traditional toys for their children and (3) whether caregivers' choices are impacted by the claims made by toy manufacturers. Sixty-three primary caregivers participated in a survey asking about their toy selection decisions. Results demonstrate the prevalence of electronic toys (even for the youngest infants) as well as caregivers' preferences and the potential of toy descriptions to impact caregivers' toy purchasing decisions. Despite scientific evidence that there may be a developmental cost to electronic toys relative to traditional toys, after highlighting the toys' developmental benefits, caregivers became more likely to select electronic toys for their infant.

Introduction To maximize the benefits of computed tomographic screening for lung cancer, optimal treatment for small, early lung cancers is needed. Limiting the extent of surgery spares lung tissue, preserves pulmonary function, and decreases operative time, complications, and morbidities. It also increases the likelihood of resecting future new primary lung cancers. The goal is to assess alternative treatments in a timely manner. Methods The focus sessions with patients and physicians separately highlighted the need to consider their perceptions. Literature reviews and analyses of treatment results using large databases were performed to formulate critical questions about long-term treatment outcomes, recurrence, and quality of life of alternative treatments. Based on these analyses, the investigators developed a prospective multi-institutional cohort study, the Initiative for Early Lung Cancer Research for Treatment, to compare treatments for stage I NSCLC. HIPAA compliant institutional review board approval was obtained and we performed a feasibility study of the first 206 surgical patients. Results Lobectomy was performed in 89 (43.2%) patients, and sublobar resection was performed in 117 (56.7%) patients. Mediastinal lymph node resection was performed in 173 (84.0%) patients, 8 had N1 and 3 N2 lymph node metastases. Patients stated that both the surgeon's opinion (93%) and the patient's own opinion (93%) were extremely important, followed by the patients' view that the chosen procedure would provide the best quality of life (90%). Conclusions It was feasible to obtain pre- and postsurgical information from patients and surgeons. We anticipate statistically meaningful results about treatment alternatives in 3 to 5 years.

Background In 2017, the multiplex respiratory viral panel (RVP) test was the only test available for patients (pts) with respiratory symptoms in our emergency department (ED). In 2018, the more rapid influenza/respiratory syncytial virus (Flu/RSV) test was incorporated in a stratified testing algorithm (STA) – depending on clinical features and physician discretion, pts underwent either Flu/RSV or RVP. We analyzed the STA impact by comparing data between winters of 2017 and 2018. Methods In a retrospective, single-center cohort study in suburban NY, admitted pts ≥18 years diagnosed with viral infections (by either test) were included. We excluded pts diagnosed at another hospital, admitted to intensive care or observation (< 24 hours) units and pts with missing data. Data was collected through electronic medical chart review. Primary outcomes were clinical evaluation time [time between triage and test order]; laboratory-turnaround (lta) time (between order and result); ED length of stay [EDLOS] (between admit order and bed assignment). Secondary outcomes included isolation time (between result to start of isolation precautions), treatment time (between result to influenza treatment). Outcome differences were assessed using Chi-Square and Mann-Whitney rank sum tests for categorical and continuous variables, respectively. Results 734 pts were included in the study [368 in 2017; 366 in 2018]. Median age was 75 years and 55.9% were female. After implementing the STA, EDLOS was significantly lower [Table 1], with no significant differences in other parameters. Lta times were slightly higher after implementation [25 minutes (2017) v/s 29 minutes (2018)]. Table 1. Differences in clinical and laboratory turnaround times among patients admitted with viral infections in winters of 2017 and 2018 Conclusion A stratified diagnostic algorithm may have reduced EDLOS, but without significant differences in other outcomes. A higher lta time might have been due to testing constraints, heterogeneous pt populations or other confounders. Prospective studies will help assess the real-world impact of such algorithms. Disclosures Prashant Malhotra, MBBS, MD,FACP, FIDSA, Gilead Sciences (Scientific Research Study Investigator, Other Financial or Material Support, Site PI for a industry funded multi center research study)

This autoethnographic research project examines the transformational learning of a transracial adoptive adult mother and daughter through the lens of postcolonialism. As collaborative researchers, adult adoptee and adoptive mother, examine this lifelong learning experience through critical self-reflection, qualitative meta-analysis, and autoethnographic research methods within the overarching historical and sociopolitical context of Haiti. The findings address the lived complexities of increasingly hybrid families, particularly around the contentious boundaries of race, nationality, and colonial history, as they impact transformational learning. Color blindness and racial identity development for both mother and daughter within their relationship are explored. Implications for adult educators around the use of autoethnography to engage the social imagination and employ disclosure toward transformative learning are discussed.

Background The prevalence of non-Tuberculous mycobacteria (NTM) lung disease has increased from 8.7 to 13.9/100,000 from 2008-2013 making NTM lung disease a rising public health problem. Patterns of infection include fibrocavitary, bronchiectatic or nodular. Diagnosis of NTM may be incidental after surgical resection performed during malignancy work up. We aimed to identify the proportion of NTM in resected lung lesions (both nodules and masses) with granulomas (GL) both necrotizing (NGL) and non-necrotizing (n-NGL) on pathology and to compare differences in characteristics of patients with NTM versus those without NTM. Methods This was a retrospective chart review of patients who underwent resection of lung nodules and/or a lung mass during malignancy work up from January 2013 through March 2019 including only those with granulomatous inflammation on pathology. 497 patients met these criteria and their electronic medical records were reviewed. Findings of culture-confirmed NTM on tissue, bronchoalveolar lavage or sputum (at time of resection) were classified as “NTM” group; and those with no NTM diagnoses were classified as “Non-NTM” group. Patients with NTM and another diagnoses were classified within the NTM group. Study variables were compared by the dichotomous NTM group using Chi-square test for categorical variables and T-test for continuous variables. Results Among all patients, the most common diagnosis was lung cancer (21.93%). There were 81 (16.3%) patients with NTM (Table 1). Within the NTM group, percentage of Asians, presence of NGL, placement on airborne precautions and prior history of tuberculosis were significantly higher. The NTM group also had a higher proportion of both COPD and lung cancer as their underlying condition (Table 2). 161 patients had non-diagnostic biopsies. Table 1 Table 2 Table 2 Conclusion Mycobacterial infections made up a significant percentage of resected lung nodules and/or lung masses for malignancy evaluation. NTM were isolated with greater frequency than M. Tuberculosis even with NGL on lung pathology. This reflects the changing epidemiology of NTM. The significant proportion of Asians with NTM compared with GL found during a malignancy work up without NTM is interesting and deserves further investigation. Disclosures All Authors: No reported disclosures

Animal studies of effort-based choice behavior are being used to model effort-related motivational dysfunctions in humans. With these procedures, animals are offered a choice between high-effort instrumental actions leading to highly valued reinforcers vs. low effort/ low reward options. Several previous studies have shown that dopamine (DA) uptake inhibitors, including GBR12909, lisdexamfetamine, methylphenidate, and PRX-14040, can reverse the effort-related effects of the vesicular monoamine transport blocker tetrabenazine, which inhibits DA storage. Because many drugs that block DA transport act as major stimulants that also release DA, and produce a number of undesirable side effects, there is a need to develop and characterize novel atypical DA transport inhibitors. (S)-CE-123 ((S)-5-((benzhydrylsulfnyl) methyl)thiazole) is a recently developed analog of modafnil with the biochemical characteristics of an atypical DA transport blocker. The present paper describes the enantioselective synthesis and initial chemical characterization of (S)-CE-123, as well as behavioral experiments involving effort-based choice and microdialysis studies of extracellular DA. Rats were assessed using the fxed ratio 5/chow feeding choice test. Tetrabenazine (1.0 mg/kg) shifted choice behavior, decreasing lever pressing and increasing chow intake. (S)-CE-123 was coadministered at doses ranging from 6.0 to 24.0 mg/kg, and the highest dose partially but signifcantly reversed the effects of tetrabenazine, although this dose had no effect on fxed ratio responding when administered alone. Additional experiments showed that (S)-CE-123 signifcantly increased lever pressing on a progressive ratio/chow feeding choice task and that the effective dose (24.0 mg/kg) increased extracellular DA in nucleus accumbens core. In summary, (S)-CE-123 has the behavioral and neurochemical profle of a compound that can block DA transport, reverse the effort-related effects of tetrabenazine, and increase selection of high-effort progressive ratio responding. This suggests that (S)-CE- 123 or a similar compound could be useful as a treatment for effort-related motivational dysfunction in humans.

Animal studies of effort-based choice behavior are being used to model effort-related motivational dysfunctions in humans. With these procedures, animals are offered a choice between high-effort instrumental actions leading to highly valued reinforcers vs. low effort/low reward options. Several previous studies have shown that dopamine (DA) uptake inhibitors, including GBR12909, lisdexamfetamine, methylphenidate, and PRX-14040, can reverse the effort-related effects of the vesicular monoamine transport blocker tetrabenazine, which inhibits DA storage. Because many drugs that block DA transport act as major stimulants that also release DA, and produce a number of undesirable side effects, there is a need to develop and characterize novel atypical DA transport inhibitors. (S)-CE-123 ((S)-5-((benzhydrylsulfinyl) methyl)thiazole) is a recently developed analog of modafinil with the biochemical characteristics of an atypical DA transport blocker. The present paper describes the enantioselective synthesis and initial chemical characterization of (S)-CE-123, as well as behavioral experiments involving effort-based choice and microdialysis studies of extracellular DA. Rats were assessed using the fixed ratio 5/chow feeding choice test. Tetrabenazine (1.0 mg/kg) shifted choice behavior, decreasing lever pressing and increasing chow intake. (S)-CE-123 was coadministered at doses ranging from 6.0 to 24.0 mg/kg, and the highest dose partially but significantly reversed the effects of tetrabenazine, although this dose had no effect on fixed ratio responding when administered alone. Additional experiments showed that (S)-CE-123 significantly increased lever pressing on a progressive ratio/chow feeding choice task and that the effective dose (24.0 mg/kg) increased extracellular DA in nucleus accumbens core. In summary, (S)-CE-123 has the behavioral and neurochemical profile of a compound that can block DA transport, reverse the effort-related effects of tetrabenazine, and increase selection of high-effort progressive ratio responding. This suggests that (S)-CE-123 or a similar compound could be useful as a treatment for effort-related motivational dysfunction in humans.

This article describes a tool that can be used by blind and visually impaired students in phonetics and phonology classrooms: a tactile International Phonetic Alphabet (IPA) magnet-board system. This tool consists of IPA magnets and phonological rule symbols that are printed and embossed, so as to be readable by both sighted and visually impaired individuals. A user of the tool can lay out phonetic and phonological data on the magnet board for communicative, organizational, or problem-solving purposes. Since the magnet board can be read both visually and tactually, it can serve as a collaborative space that can be used by both sighted and visually impaired members of the classroom. Potential uses include group work in class and as an augmentation to chalkboard problem-solving demonstrations. The tool can complement already extant options for blind and visually impaired students and facilitate collaboration between sighted and visually impaired students. Here, we describe the tool, exemplify some potential uses, and offer suggestions for further improvement.

Objectives Respiratory viral illnesses (RVI) are reliably diagnosed by respiratory viral panel using polymerase chain reaction (RVP-PCR); however, owing to the scant data, clinical presentation alone is unreliable in establishing viral etiology. The primary objective of this study was to characterize signs and symptoms of RVI among inpatients in a major tertiary care hospital. Methods Between 2013 and 2015, adult inpatients with RVI undergoing RVP-PCR were prospectively enrolled in our study. Clinical data were collected by interviews and electronic medical record reviews. Data analysis was performed using χ(2) testing, analysis of variance for continuous variables, and logistic regression modeling. Results Of 421 patients analyzed, 175 (41.7%) had a positive RVP-PCR. Patients were evenly matched at baseline except for renal disease. Multivariate logistic regression modeling demonstrated the following positive correlations: positive RVP-PCR with renal disease (odds ratio [OR] 2.08), cough (OR 2.28), and wheezing (OR 1.8); influenza with cough (OR 5.04), and renal disease (OR 2.17); metapneumovirus with age older than 65 (OR 3.24); respiratory syncytial viruses with wheezing (OR 3.42) and immunosuppression (OR 3.11); and parainfluenza with smoking (OR 3.16). Negative correlations included influenza with anosmia (OR 0.41); rhinovirus/enterovirus with feeling confined to bed (OR 0.3); metapneumovirus with smoking (OR 0.29); and parainfluenza with male sex (OR 0.22). Conclusions In this descriptive study, we noted specific viral associations with clinical signs and symptoms among 421 inpatients with RVIs. With increasing RVP-PCR use, studies similar to ours may be able to better define the clinical presentation of RVIs and lead to evidence-based, clinical presentation-guided diagnostic and management algorithms.

This study explored the current psychological characteristics and criminal behavior history of individuals who retrospectively reported being bullies, bully-victims, victims, or controls (i.e. neither victims nor bullies) during their last 2 years of high school. College students (n = 960) completed measures of criminal thinking, aggression, psychopathy, and criminal behavior online. We predicted bullies and bully-victims would demonstrate the highest scores for criminal thinking, proactive aggression, psychopathy, and have the most criminal infractions. Bullies and bully-victims had significantly higher scores on criminal thinking, aggression, psychopathy, and criminal behaviors than victims or controls. Additionally, men were significantly higher in criminal thinking, aggression, psychopathy, and had more criminal acts than women. There were no gender by bully group interactions. Logistic regression analyses differentiated bully-victims from bullies. Bully-victims tended to be male, higher in criminal thinking, and higher in reactive aggression. In addition, bully-victims were distinct from victims, showing higher criminal thinking and higher proactive aggression. Aggr. Behav. 35:1-16, 2010. © 2010 Wiley-Liss, Inc. Language: en

Current latent print and trace evidence collecting technologies are usually invasive and can be destructive to the original deposits. We describe a non-invasive vibrational spectroscopic approach that yields latent fingerprints that are overlaid on top of one another or that may contain trace evidence that needs to be distinguished from the print. Because of the variation in the chemical composition distribution within the fingerprint, we demonstrate that linear unmixing applied to the spectral content of the data can be used to provide images that reveal superimposed fingerprints. In addition, we demonstrate that the chemical composition of the trace evidence located in the region of the print can potentially be identified by its infrared spectrum. Thus, trace evidence found at a crime scene that previously could not be directly related to an individual, now has the potential to be directly related by its presence in the individual-identifying fingerprints.

Terrorism using conventional weapons and explosive devices is a likely scenario and occurs almost daily somewhere in the world. Caring for those injured from explosive devices is a major concern for acute injury care providers. Learning from nations that have experienced conventional weapon attacks on their civilian population is critical to improving preparedness worldwide. In September 2005, a multidisciplinary meeting of blast-related injury experts was convened including representatives from eight countries with experience responding to terrorist bombings (Australia, Colombia, Iraq, Israel, United Kingdom, Spain, Saudi Arabia, and Turkey). This article describes these experiences and provides a summary of common findings that can be used by others in preparing for and responding to civilian casualties resulting from the detonation of explosive devices.

The capability of Fourier transform infrared (FTIR) spectroscopic imaging to provide detailed images of unprocessed latent fingerprints while also preserving important trace evidence is demonstrated. Unprocessed fingerprints were developed on various porous and nonporous substrates. Data-processing methods used to extract the latent fingerprint ridge pattern from the background material included basic infrared spectroscopic band intensities, addition and subtraction of band intensity measurements, principal components analysis (PCA) and calculation of second derivative band intensities, as well as combinations of these various techniques. Additionally, trace evidence within the fingerprints was recovered and identified.

Human immunodeficiency virus (HIV)-infected individuals frequently have consumed garlic, a popular complementary supplement. Researchers rarely have studied garlic's association with antiretroviral therapies, however, even though that association is very relevant clinically.To examine associations of supplemental use of garlic with highly active antiretroviral treatment (HAART) adherence level and HAART effectiveness (HIV viral load and CD4+ cell counts) in HIV-infected women.The research team carried out a self-controlled, longitudinal study nested within the Women's Interagency HIV Study (WIHS). The team used a paired study design that allowed participants to serve as their own controls. The team first identified all of the studies visits in which the participant self-reported the use of a garlic supplement since her last visit (index visit). Then for each index visit, the team identified a matching visit (a control visit) using the following criteria: (a) the visit must be one for the same participant in which that participant reported no garlic supplementation; (b) the visit must immediately precede the index visit (less than 1 year apart); and (c) at the time of the control visit, the participant must have been using antiretroviral therapy identical to that used at the time of the index visit.Participants were persons using garlic supplementation who already were participants in the WIHS.The research team used a logistic regression model to examine the association between garlic supplementation and HAART adherence level. The team used a mixed linear model to examine the association of garlic supplementation with HIV viral load and CD4+ cell counts.From October 1994 to April 2009, 390 HIV-infected women in the WIHS made 1112 visits at which they reported using garlic supplements. Seventy-seven HIV-infected women using HAART met the research teams selection criteria and contributed 99 pairs of visits for the study. Among the women who used garlic supplements, 22% were 50 years and older; 58% were black and non-Hispanic; and 23% had less than a high-school education. Neither use of garlic supplementation nor reasons for using garlic supplements were significantly associated with the HAART adherence level, HIV viral load, or CD4+ cell counts; however, use garlic as needed, a potential marker of a disease state, was significantly associated with higher viral load (P=.0003).Short-term garlic supplementation did not impact HAART adherence level, HIV viral load, and CD4+ cell counts.

This study had three purposes: to explore psychological characteristics of animal abusers (criminal thinking styles, empathy, and personality traits), to replicate previously reported results (past illegal actions, bullying behavior), and to examine potential gender differences. The self-reported animal abuser group was 29 college students who reported two or more incidents of animal abuse; controls were 29 college students matched on age and gender. Participants completed self-report measures of criminal thinking, illegal behaviors, bullying, empathy, and the five-factor personality traits. Results indicated animal abusers had more previous criminal behaviors, were more likely to bully, and had the highest scores on the power orientation criminal thinking scale. Abuser by gender interactions were detected; female animal abusers scored significantly higher on several measures of criminal thinking, were found to be more likely to bully, and exhibited lower scores on measures of perspective taking and empathy compared to female controls.

The files of sex offenders who had been offered treatment at a medium-security state prison were divided into three groups: treatment refusal ( n = 59), treatment noncompliance ( n = 61), and treatment compliance ( n = 36). Demographic, offense-related, clinical, and psychological assessment data were collected. Significant differences were found between groups on years to parole eligibility; plea; relation to victim; childhood sexual victimization; and Minnesota Multiphasic Personality Inventory–2 Variable Response Inconsistency (VRIN), Lie (L), and Masculinity–Femininity (Mf) scale scores. Logistic regression analyses revealed that significant predictors of treatment refusal include increased time until parole eligibility and lower VRIN and Mf scores (vs. noncompliant) as well as no history of childhood sexual victimization and higher L scores (vs. compliant). Having entered a not-guilty plea was the only significant predictor of noncompliance among those who initially accepted treatment. These findings are discussed in relation to previous studies of sex offender treatment compliance and directions for future research.

Patriots' Day is a legal holiday in Massachusetts and Maine, celebrating the battle of Concord and Lexington on April 19, 1775. The event of April 19, 1950, was very unusual, because of the origin of a fire at Children's Hospital Boston. At that time, the hospital consisted of 2-story stucco pavilion buildings that housed patients of diverse ages. In addition, on the southwest side of the area, there was a routine laboratory facility adjacent to the clinical neurology unit. The surgical suite was also on the southwest side. In the midst of these buildings was Dr James Gamble's study research laboratory, with his magnificent cherry wood library that contained his personal collection of research journals. This conference room was used for chart reviews for patient and brief seminars. The personnel in the Gamble Division consisted of Dr Gamble, the director and professor; Dr William M. Wallace, his protege; and 4 postgraduate fellows, including the author who personally observed these events. Before 1945, clinical chemistry consisted of quantitative chemical analysis1,2; thus, sodium was determined after ashing at … Address correspondence to Robert Schwartz, 33 North Ave, Providence, RI 02906