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Few studies have examined burnout in psychosocial oncology clinicians. The aim of this systematic review was to summarize what is known about the prevalence and severity of burnout in psychosocial clinicians who work in oncology settings and the factors that are believed to contribute or protect against it.
Articles on burnout (including compassion fatigue and secondary trauma) in psychosocial oncology clinicians were identified by searching PubMed/MEDLINE, EMBASE, PsycINFO, the Cumulative Index to Nursing and Allied Health Literature, and the Web of Science Core Collection.
Thirty-eight articles were reviewed at the full-text level, and of those, nine met study inclusion criteria. All were published between 2004 and 2018 and included data from 678 psychosocial clinicians. Quality assessment revealed relatively low risk of bias and high methodological quality. Study composition and sample size varied greatly, and the majority of clinicians were aged between 40 and 59 years. Across studies, 10 different measures were used to assess burnout, secondary traumatic stress, and compassion fatigue, in addition to factors that might impact burnout, including work engagement, meaning, and moral distress. When compared with other medical professionals, psychosocial oncology clinicians endorsed lower levels of burnout.
Significance of results
This systematic review suggests that psychosocial clinicians are not at increased risk of burnout compared with other health care professionals working in oncology or in mental health. Although the data are quite limited, several factors appear to be associated with less burnout in psychosocial clinicians, including exposure to patient recovery, discussing traumas, less moral distress, and finding meaning in their work. More research using standardized measures of burnout with larger samples of clinicians is needed to examine both prevalence rates and how the experience of burnout changes over time. By virtue of their training, psychosocial clinicians are well placed to support each other and their nursing and medical colleagues.
Panic disorder and post-traumatic stress disorder (PTSD), which is currently classified as an anxiety disorder in DSM-IV, share some clinical characteristics. Emerging evidence suggests that CO2-induced fear reactivity is associated with anxiety disorders, especially panic disorder. However, there are only very few data available about the sensitivity of patients with PTSD to carbon dioxide.
To examine the psychometric effects of CO2 on panic anxiety and PTSD symptoms in subjects with PTSD.
In 10 patients with PTSD, 10 sex- and age-matched healthy subjects and additional 8 patients with panic disorder we assessed anxiety, panic, dissociative and PTSD symptoms before and after a single vital capacity inhalation of 35% CO2.
Inhalation of a single deep breath of 35% of carbon dioxide resulted in significant panicogenic and anxiogenic effects in PTSD patients versus healthy controls, which were similar to the well known responses of patients with panic disorder. Furthermore, significant pro-dissociative effects and significant provocation of post-traumatic flashbacks and PTSD symptoms were observed in PTSD patients.
These data provide novel evidence that panic disorder and PTSD share a common hypersensitivity to CO2 and thus might belong to the same spectrum of vulnerability.
Arrhythmia is a potentially fatal side effect of antipsychotics. A biologic predictive tool to prevent it is missing.
Identification of a genetic profile at risk for antipsychotic induced arrhythmia.
Identifying a molecular pathway enriched for antipsychotic induced QT-modifications.
Seven hundred and sixty-five SKZ individuals, M = 556, age = 40.93 ± 11.03 were included. QT-variation was a phase-specific created variable. A nested mixed regression served in R for clinical and molecular pathway analyses. Plink served for genetic analyses. Quality checking was standard, inflation factor was controlled by lambda values.
Quetiapine and Perphenazine were associated with QT variation (P = 0.002; Estimate = 5.79 and P = 5.67e-06; Estimate = 8.96 respectively). No other significant association was detected. No inflation was detected. Axon guidance and Collagen biosynthesis (Table 1) were associated with QT variation at a conservative (adjusted) P value < 0.01.
Two molecular pathways were identified as possibly involved in QT modifications during antispsychotic treatment in SKZ patients. Previous evidence supports a role of the same pathways in cardiac disorders [1,2]. Interaction of specific SNPs with the drugs will be focus of further research.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
The western societies have a rapidly aging population and an increasing number of elderly with alcohol use disorders.
The purpose of the elderly study is to develop and test an outpatient behavior therapy program for people with an alcohol use disorders.
Aim of this abstract
To investigate the association between ages, gender, drinking pattern and psychology distress.
The study is a randomized study expected to enroll and treat 1000 participants aged 60+ years before April 2017; 200 in USA; 400 in Germany and 400 in Denmark. To be included in the study the participants have to fulfil the DSM-5 criteria for alcohol use disorder. All participants are examined at baseline, and at four follow up interviews. After the baseline interview all participants are randomized to Motivational Enhancement Therapy (MET); or MET followed by 8 weeks of counseling based on the Community Reinforcement Approach (CRA) with a module added to address problems relevants to elderly people.
The presentation will include baseline characteristics of the Danish participants including demographics, expectations to treatment, history of drinking in the last 90 days before baseline and their psychological distress. We have now enrolled 259 participants in the Danish database. We expect to present results from 320 patients.
The data will present information about the profile of 60+ years’ individuals seeking treatment for alcohol use disorder, and thereby provide knowledge about which characteristics that may be important when planning treatment for this age group.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Apples are a rich source of polyphenols and fiber. Proanthocyanidins (PAs), the largest polyphenolic class in apples, can reach the colon almost intact where they interact with the gut microbiota producing simple phenolic acids. These metabolites have the potential to modulate gut microbiota composition and activity and impact on host physiology. A randomized, controlled, crossover, dietary intervention study was performed to determine the broad effects of whole apple intake on fecal gut microbiota composition and activity. Forty heathy mildly hypercholesterolemic volunteers (23 women, 17 men), with a mean BMI (± SD) 25.3 ± 3.7 kg/m2 and age 51 ± 11 years, consumed 2 apples/day (Renetta Canada, rich in PAs), or a sugar matched control apple beverage, for 8 weeks separated by a 4-week washout period in a random order. Fecal and 24-h urine samples were collected before and after each treatment. The broad effects of apple intake on fecal gut microbiota composition were explored by the high throughput sequencing (HTS) of 16S rRNA gene lllumina MiSeq sequencing (V3-V4 region). Sequencing data analysis was performed using the Quantitative Insight Into Microbial Ecology (QIIME) open-source pipeline version 1.9.1. Specific bacterial groups were also enumerated using the quantitative Fluorescence In Situ Hybridization (FISH). Furthermore, the potential formation of microbial polyphenol metabolites, after apple intake, was explored in urine using Liquid Chromatography (LC) High-Resolution Mass Spectrometry (HRMS) metabolomics. Preliminary analysis showed no changes in gut microbiota abundances measured by Illumina MiSeq, after correction for multiple testing. Apple intake significantly decreased Enterobacteriaceae population (P = 0.04) compared to the control beverage, as determined with FISH. Twenty-four polyphenol microbial metabolites were identified in higher concentrations in the apple group (P < 0.05) compared to the control, including valerolactones, valeric and phenolic acids. In conclusion, preliminary data suggest that the daily intake of 2 Renetta Canada apples significantly decreased Enterobacteriaceae population, a family known for its pathogenic members, in healthy mildly hypercholesterolemic subjects. Moreover, several polyphenol microbial metabolites were identified, suggesting that microbial activity is crucial and a prerequisite for the absorption of apple polyphenols, producing active metabolites with potential health benefits.
Plant secondary compounds (PSC) are prevalent in many woody, temperate-climate plant species and play a crucial role in dietary attempts to mitigate methane emissions in ruminants. However, their application requires sufficient palatability and feeding value. In the present study, leaves from silver birch (Betula pendula), hazel (Corylus avellana), blackcurrant (Ribes nigrum), green grape vine (Vitis vinifera) and the herbs rosebay willow (Epilobium angustifolium) and wood avens (Geum urbanum) were tested in various doses with the Hohenheim gas test method in vitro and their short-term palatability in dairy cows. For the palatability experiment, the plants were pelleted with lucerne in different proportions to obtain the same phenol content, but realised contents differed from expected contents. The pellets were provided separately from a mixed basal ration (0.4 : 0.6) to each cow, in a randomised order, for 3 days per plant. All plants mitigated in vitro methane and ammonia formation, often in a linear dose response. These levels of effects differed among plants. Significant effects were observed at 100 (hazel, rosebay willow) to 400 g/kg of plant material. The test plants had a lower feeding value than the high-quality basal diet. This was indicated by in vitro organic matter digestibility, short-chain fatty acid formation and calculated contents of net energy of lactation. Simultaneously, the linear depression of ammonia formation indicated a dose-dependent increase of utilisable CP. Only blackcurrant and birch were less preferred to lucerne. However, this aversion subsided on day 3 of offer. The rosebay willow pellets had the highest phenol content but were not the least palatable. Accordingly, PSC may not be the main determinants of palatability for the plants tested. Plants did not differ significantly in their short-term effects on milk yield and composition, and all of the plants substantially reduced milk urea content. Overall, the results suggest that hazel and vine leaves, and rosebay willow and wood avens herbs should be tested for their potential to mitigate methane and N emissions in vivo.
Hydrilla is an invasive aquatic plant that has rapidly spread through many inland water bodies across the globe by outcompeting native aquatic plants. The negative impacts of hydrilla invasion have become a concern for water resource management authorities, power companies, and environmental scientists. The early detection of hydrilla infestation is very important to reduce the costs associated with control and removal efforts of this invasive species. Therefore, in this study, we aimed to develop a tool for rapid, frequent, and large-scale monitoring and predicting spatial extent of hydrilla habitat. This was achieved by integrating in situ and Landsat 8 Operational Land Imager satellite data for Lake J. Strom Thurmond, the largest US Army Corps of Engineers lake east of the Mississippi River, located on the border of Georgia and South Carolina border. The predictive model for presence of hydrilla incorporated radiometric and physical measurements, including remote-sensing reflectance, Secchi disk depth (SDD), light-attenuation coefficient (Kd), maximum depth of colonization (Zc), and percentage of light available through the water column (PLW). The model-predicted ideal habitat for hydrilla featured high SDD, Zc, and PLW values, low values of Kd. Monthly analyses based on satellite images showed that hydrilla starts growing in April, reaches peak coverage around October, begins retreating in the following months, and disappears in February. Analysis of physical and meteorological factors (i.e., water temperature, surface runoff, net inflow, precipitation) revealed that these parameters are closely associated with hydrilla extent. Management agencies can use these results not only to plan removal efforts but also to evaluate and adapt their current mitigation efforts.
Healthcare organizations are required to provide workers with respiratory protection (RP) to mitigate hazardous airborne inhalation exposures. This study sought to better identify gaps that exist between RP guidance and clinical practice to understand issues that would benefit from additional research or clarification.
Highly resolved, well-dated paleoclimate records from the southern South African coast are needed to contextualize the evolution of the highly diverse extratropical plant communities of the Greater Cape Floristic Region (GCFR) and to assess the environmental impacts on early human hunter-gatherers. We present new speleothem stable oxygen and carbon isotope ratios (δ18Oc and δ13C) from two caves at Pinnacle Point, South Africa, covering the time between 330 and 43 ka. Composite δ18Oc and δ13C records were constructed for Staircase Cave and PP29 by combining all stable isotope analyses into a single time series and smoothing by a 3-point running mean. δ18Oc and δ13C values record changes in rainfall seasonality and the proportions of C3 and C4 plants in the vegetation, respectively. We show that in general increased summer rainfall brought about a wider spread of C4 grasses and retreat of the C3 plant–dominated GCFR communities. The occurrence of summer rainfall on the southern coast of South Africa was linked to total rainfall amounts in the interior region through tropical temperate troughs. These rainfall systems shifted the southern coastal climate toward more summer (winter) rainfall when precession was high (low) and/or the westerlies were in a northern (southern) position.
Feeding phenol-containing plants to ruminants has the potential to mitigate both methane and ammonia formation. In the present study, mostly woody plants, such as the leaves of trees and shrubs, were tested for their influence on in vitro fermentation. The plants selected grow naturally under temperate climatic conditions, are usually available in bulk and do not directly compete with human food production. The detailed screening included whole plants or parts of different plant species reporting their effects on methane and/or ammonia formation. The plant materials were added at 167 mg/g of total dry matter (DM) to a common total mixed ration and incubated for 24 h with the Hohenheim gas test method. The results from in vitro fermentation were also used to determine the net energy of lactation and utilizable crude protein in the complete diets. Thirteen out of 18 test materials did not impair the organic matter (OM) digestibility of the diet. Ammonia concentrations decreased up to 35% when adding any of the test materials. Methane formation per unit of feed DM and per unit of digestible OM was lowered by 13 of the 18 test materials from 12 to 28% and 5 to 20%, respectively. In conclusion, a number of plant materials tested have the potential to mitigate ruminal ammonia and methane formation without adversely affecting digestibility. The leaves of Betula pendula, Corylus avellana, Ribes nigrum, Vitis vinifera and the aerial part of Geum urbanum were particularly promising in this respect.
Background: Therapeutic hypothermia (TH) improves the outcome in HIE but cvEEG is vital to detect any seizures that occur. Unfortunately, the costs associated with cvEEG can make it impractical. We studied outcomes in TH with the objective of optimizing the length of cvEEG required. Methods: Term infants with HIE were treated with 72 h of TH followed by 6 h of rewarming. cvEEG reports were quantified (background, sharp transients, seizures) and compared with pre and post-cooling variables to determine whether risk stratification was possible. Results: 25/78 infants had seizures during the TH, however, most seizures occurred early, with 7 infants seizing prior to cooling and 15 having their first seizure within 24h. Only 3 infants had their first seizure between 24-48h and none were recorded after. Novel seizures after 24h were brief and did not require treatment. EEG variables such as frequent sharp transients and first seizures within 24h were correlated with MRI abnormalities. Conclusions: For the majority of infants undergoing TH, 24h of cvEEG may be sufficient with few infants requiring longer than 48h. A combination of clinical variables (abnormal neurological exam) and EEG traits (frequency of discharges, seizures) can help to decide on the likelihood of seizures and length of EEG recording needed.
Vanadium dioxide thin films are considered as smart functional coatings for thermal shielding, and are attractive as a passive thermal shield for spacecrafts. In space they would, however, be subjected to bombardment by interstellar dust particles and electromagnetic radiation. Materials subjected to irradiation will suffer damages induced by the displacement cascades initiated by nuclear reaction. Such cosmic radiation can severely impact the structure and function of materials. To study this effect in the laboratory, we have deposited VO2 films on silicon wafers and exposed them to γ-radiation of doses up to 100 kGy by using a 60Co nuklid source with 1.17 and 1.33 MeV photon energy. We anticipate that the γ-radiation causes local structural perturbations which can amount to defects with a corresponding change in electronic structure and thermal shielding property. We report on the photo emission spectroscopy of gamma irradiated VO2 thin films.
To assess resource allocation and costs associated with US hospitals preparing for the possible spread of the 2014–2015 Ebola virus disease (EVD) epidemic in the United States.
A survey was sent to a stratified national probability sample (n=750) of US general medical/surgical hospitals selected from the American Hospital Association (AHA) list of hospitals. The survey was also sent to all children’s general hospitals listed by the AHA (n=60). The survey assessed EVD preparation supply costs and overtime staff hours. The average national wage was multiplied by labor hours to calculate overtime labor costs. Additional information collected included challenges, benefits, and perceived value of EVD preparedness activities.
The average amount spent by hospitals on combined supply and overtime labor costs was $80,461 (n=133; 95% confidence interval [CI], $56,502–$104,419). Multivariate analysis indicated that small hospitals (mean, $76,167) spent more on staff overtime costs per 100 beds than large hospitals (mean, $15,737; P<.0001). The overall cost for acute-care hospitals in the United States to prepare for possible EVD cases was estimated to be $361,108,968. The leading challenge was difficulty obtaining supplies from vendors due to shortages (83%; 95% CI, 78%–88%) and the greatest benefit was improved knowledge about personal protective equipment (89%; 95% CI, 85%–93%).
The financial impact of EVD preparedness activities was substantial. Overtime cost in smaller hospitals was >3 times that in larger hospitals. Planning for emerging infectious disease identification, triage, and management should be conducted at regional and national levels in the United States to facilitate efficient and appropriate allocation of resources in acute-care facilities.
Quasi-experimental studies evaluate the association between an intervention and an outcome using experiments in which the intervention is not randomly assigned. Quasi-experimental studies are often used to evaluate rapid responses to outbreaks or other patient safety problems requiring prompt, nonrandomized interventions. Quasi-experimental studies can be categorized into 3 major types: interrupted time-series designs, designs with control groups, and designs without control groups. This methods paper highlights key considerations for quasi-experimental studies in healthcare epidemiology and antimicrobial stewardship, including study design and analytic approaches to avoid selection bias and other common pitfalls of quasi-experimental studies.
Experiments on the National Ignition Facility show that multi-dimensional effects currently dominate the implosion performance. Low mode implosion symmetry and hydrodynamic instabilities seeded by capsule mounting features appear to be two key limiting factors for implosion performance. One reason these factors have a large impact on the performance of inertial confinement fusion implosions is the high convergence required to achieve high fusion gains. To tackle these problems, a predictable implosion platform is needed meaning experiments must trade-off high gain for performance. LANL has adopted three main approaches to develop a one-dimensional (1D) implosion platform where 1D means measured yield over the 1D clean calculation. A high adiabat, low convergence platform is being developed using beryllium capsules enabling larger case-to-capsule ratios to improve symmetry. The second approach is liquid fuel layers using wetted foam targets. With liquid fuel layers, the implosion convergence can be controlled via the initial vapor pressure set by the target fielding temperature. The last method is double shell targets. For double shells, the smaller inner shell houses the DT fuel and the convergence of this cavity is relatively small compared to hot spot ignition. However, double shell targets have a different set of trade-off versus advantages. Details for each of these approaches are described.
Changes of glaciers and snow cover in polar regions affect a wide range of physical and ecosystem processes on land and in the adjacent marine environment. In this study, we investigated the potential of 11-day repeat high-resolution satellite image time series from the TerraSAR-X mission to derive glaciological and hydrological parameters on King George Island, Antarctica, between 25 October 2010 and 19 April 2011. The spatial pattern and temporal evolution of snow cover extent on ice-free areas can be monitored using multi-temporal coherence images. Synthetic aperture radar (SAR) coherence is used to map glacier extent of land-terminating glaciers with an average accuracy of 25 m. Multi-temporal SAR colour composites identify the position of the late summer snow line at ~220 m a.s.l. Glacier surface velocities are obtained from intensity feature-tracking. Surface velocities near the calving front of Fourcade Glacier were up to 1.8±0.01 m d-1. Using an intercept theorem based on fundamental geometric principles together with differential GPS field measurements, the ice discharge of Fourcade Glacier was estimated at 20 700±5500 m3 d-1 (corresponding to ~19±5 kt d-1). The rapidly changing surface conditions on King George Island and the lack of high-resolution digital elevation models for the region remain restrictions for the applicability of SAR data and the precision of derived products. Supplemental data are available at http://dx.doi.org/10.1594/PANGAEA.853954.
Background: Following cessation interventions, self-reported smoking abstinence with biochemical verification is the “gold standard” for defining outcomes. Because obtaining biochemical verification is challenging in community studies, we compared self-reported cessation among smokers completing treatment to the smoking status reported by each participant's spouse or proxy.
Method: Participants were smokers who had reported quitting 12 months after a cessation intervention. Participants had either attended a smoking cessation clinic or they were patients seen by physicians who had recently participated in a cessation-training program. Proxies living with these participants were interviewed by telephone to ask about their partner's smoking status. We compared the participants' responses to those from their spouses.
Results: At 12 months, 346 of 1423 baseline smokers had quit; 161/346 reported non-smokers were called and 140 proxies were interviewed. The participants averaged 51 years of age, 69% were women. At baseline, the mean number of cigarettes smoked per day was 20.1 (SD = 9.9) and the average number of quit attempts was 2.4 (SD = 1.2). Cessation methods used were medical advice (21%) and/or pharmacotherapy (79%). Of the 140 spouses interviewed, only 10 (7.1%) reported that their partners were currently smoking.
Conclusions: Proxy-reported data on smoking status could be used to validate self-report.
Hospital Ebola preparation is underway in the United States and other countries; however, the best approach and resources involved are unknown.
To examine costs and challenges associated with hospital Ebola preparation by means of a survey of Society for Healthcare Epidemiology of America (SHEA) members.
Electronic survey of infection prevention experts.
A total of 257 members completed the survey (221 US, 36 international) representing institutions in 41 US states, the District of Columbia, and 18 countries. The 221 US respondents represented 158 (43.1%) of 367 major medical centers that have SHEA members and included 21 (60%) of 35 institutions recently defined by the US Centers for Disease Control and Prevention as Ebola virus disease treatment centers. From October 13 through October 19, 2014, Ebola consumed 80% of hospital epidemiology time and only 30% of routine infection prevention activities were completed. Routine care was delayed in 27% of hospitals evaluating patients for Ebola.
Convenience sample of SHEA members with a moderate response rate.
Hospital Ebola preparations required extraordinary resources, which were diverted from routine infection prevention activities. Patients being evaluated for Ebola faced delays and potential limitations in management of other diseases that are more common in travelers returning from West Africa.
This paper describes the system architecture of a newly constructed radio telescope – the Boolardy engineering test array, which is a prototype of the Australian square kilometre array pathfinder telescope. Phased array feed technology is used to form multiple simultaneous beams per antenna, providing astronomers with unprecedented survey speed. The test array described here is a six-antenna interferometer, fitted with prototype signal processing hardware capable of forming at least nine dual-polarisation beams simultaneously, allowing several square degrees to be imaged in a single pointed observation. The main purpose of the test array is to develop beamforming and wide-field calibration methods for use with the full telescope, but it will also be capable of limited early science demonstrations.
This white paper identifies knowledge gaps and new challenges in healthcare epidemiology research, assesses the progress made toward addressing research priorities, provides the Society for Healthcare Epidemiology of America (SHEA) Research Committee's recommendations for high-priority research topics, and proposes a road map for making progress toward these goals. It updates the 2010 SHEA Research Committee document, “Charting the Course for the Future of Science in Healthcare Epidemiology: Results of a Survey of the Membership of SHEA,” which called for a national approach to healthcare-associated infections (HAIs) and a prioritized research agenda. This paper highlights recent studies that have advanced our understanding of HAIs, the establishment of the SHEA Research Network as a collaborative infrastructure to address research questions, prevention initiatives at state and national levels, changes in reporting and payment requirements, and new patterns in antimicrobial resistance.