An exploratory study of the role of emotion regulation and emotional intelligence in compassion satisfaction and fatigue among doctors and nurses

Aim: To explore relationships between emotion management strategies (ER), emotional intelligence (EI), and compassion satisfaction (CS) and fatigue (CF) in doctors and nurses at a large National Health Service (NHS) Hospital in the United Kingdom (UK).Objective: To identify predicting variable(s) for compassion satisfaction and fatigue in doctors and nurses.Method: Four hundred and eighty-seven participants completed questionnaires assessing six possible explanatory variables for compassion satisfaction and fatigue: (i) intrapersonal EI (ii) interpersonal EI, (iii) cognitive reappraisal, (iv) cognitive fusion, (v) expressive suppression, and (vi) emotional contagion. Two open-ended questionnaire items assessed the best and worst aspects of doctors and nurses’ roles that might be associated with emotional stress and potentially influence CS and CF. Data Analysis: Descriptive statistics, correlations, regression, and mediation analysis were undertaken. The two open-ended items were analysed using content analysis. Results: Only cognitive reappraisal and intra-personal EI predicted CS positively and CF negatively. Intra-personal EI was the stronger predictor. It predicted CS (β = .29, p < .001) and CF (β = - .35, p < .001) versus cognitive reappraisal CS (β = .27, p < .001) and CF (β = - .15, p < .001). Intrapersonal EI also partially mediated relationships between cognitive reappraisal and CS (b = .59, BCI .298, .927) and between cognitive reappraisal and CF (b = -.72, BCI -1.099, -.378). Content analysis of the two open-ended questionnaire items demonstrated that 54% of the enjoyable aspects of participants’ roles related to direct patient care/contact, while 60% of the least enjoyable aspects related to workplace stress, bureaucracy, lack of support and resources, and workplace politics. This provides contextual support for the main quantitative findings above, and reiterates the importance of supporting development of intrapersonal emotional intelligence skills which does help enhance reappraisal strategies required to manage undesirable effects of workplace stressors like negative emotions e.g. anger or anxiety, that can influence CS and CF. Conclusion: Intrapersonal EI represents an important target variable for possible psychological interventions aimed at enhancing CS and reducing CF in doctors and nurses in clinical settings

The patient's own bone marrow-derived stromal cells:disease modifiers in (neuro)degenerative disorders

The aim of this thesis was to identify a standardized stem cell product that can be used to treat secondary inflammation in neurodegenerative diseases to improve the clinical outcome. In a comprehensive literature search, the concept of the patient’s own fresh naïve stem cells was developed, tested in animal models in order to prepare for the first clinical trials in patients suffering a neurodegenerative disorder. A standardized human stem cell product (Neuro-Cells®) was developed and patented, which is produced on the Brightlands campus in the good manufacturing product (GMP) facility. In animal experiments, using human GMP processed stem cells (Neuro-Cells), the researchers were able to proof safety and efficacy in the indications spinal cord injury, amyotrophic Lateral sclerosis and Frontotemporal lobar degeneration. The stem cells act as an anti-inflammatory drug and proved to be superior to methylprednison, Celecoxib and Riluzole. They concluded that in preclinical trials, a transplantation with human stem cells might be seen as a disease modifier, acting on the secondary inflammatory mechanisms and thereby decreasing disability. With the results of the spinal cord injury experiments, they were able to start a phase I study with chronic spinal cord injured patients together with the Hospital Nacional de Parapléjicos de Toledo in Spain. All 10 patients are treated with their stem cells and so far no side effects were reported. A multi-centre Phase II/III is planned to start in June 2021

In vitro expanded human CD4+CD25+ regulatory T cells suppress effector T cell proliferation.

Regulatory T cells (Tregs) have been shown to be critical in the balance between autoimmunity and tolerance and have been implicated in several human autoimmune diseases. However, the small number of Tregs in peripheral blood limits their therapeutic potential. Therefore, we developed a protocol that would allow for the expansion of Tregs while retaining their suppressive activity. We isolated CD4+CD25 hi cells from human peripheral blood and expanded them in vitro in the presence of anti-CD3 and anti-CD28 magnetic Xcyte Dynabeads and high concentrations of exogenous Interleukin (IL)-2. Tregs were effectively expanded up to 200-fold while maintaining surface expression of CD25 and other markers of Tregs: CD62L, HLA-DR, CCR6, and FOXP3. The expanded Tregs suppressed proliferation and cytokine secretion of responder PBMCs in co-cultures stimulated with anti-CD3 or alloantigen. Treg expansion is a critical first step before consideration of Tregs as a therapeutic intervention in patients with autoimmune or graft-versus-host disease

An empirical investigation: How small to mid-sized enterprises use innovation on the path toward ecological sustainability

Dependence upon the natural environment is redefining the business relationship between ecological, economic, and social systems. In addition, the major market forces of diminishing natural resources, extreme transparency, and increasing social expectations are reshaping a new sustainability path for companies. This empirical investigation explored the phenomenon of sustainability in small to mid-sized enterprises, focusing on the link between innovation and ecological sustainability. In addressing the research questions, an Eco-Sustainability Conceptual Framework was developed and applied to a sample of small to mid-sized enterprises. In addition, the development and use of an Eco-Scorecard helped to identify key performance indicators for measuring the extent to which companies are sustainable enterprises. Testing the compatibility of the Eco-Sustainability Conceptual Framework and Eco-Scorecard occurred through semi-structured interviews conducted at five small to mid-sized enterprises, which allowed participants to identify strengths and weaknesses in terms of the company\u27s progress toward ecological sustainability. Overall, key conclusions revealed sustainability is best approached in a multidisciplinary manner and is a long-term process, as observed in the companies. The Eco-Sustainability Conceptual Framework and Eco-Scorecard blended the natural and social (management) sciences together as a diagnostic tool in showing the significance of small to mid-sized enterprises in implementing sustainable manufacturing processes, products, and services. Based on the case studies, it was possible to track how companies use innovation along the path to ecological sustainability. Small to mid-sized enterprises are an integral part of the ecology of a local community and how they use innovation for sustainability is important to their local community and to other stakeholders. In addition, privately owned firms have an advantage on their path to ecological sustainability because they are better able to balance short-term demands with longer term planning horizons. Although bottom-line profitability is emphasized, environmental and social systems need to be in balance. In addition, based on a small to mid-sized enterprise\u27s sustainability success, global companies are targeting them as acquisitions. Lastly, all the researched firms are identifying and implementing new sustainable processes and products as solutions for their larger company customers in helping them problem-solve sustainability challenges

Identifying new genes in mitochondrial disease

PhD ThesisMendelian mitochondrial disease presents vast clinical and genetic heterogeneity, which provides challenges in attaining genetic diagnoses for affected patients. With approximately 1,200 proteins encoded by the nuclear genome that tightly coordinate mitochondrial function, targeted screening of a subset of genes provides a low diagnostic yield. Clinicians and researchers have increasingly turned to whole exome sequencing (WES), a targeted next-generation sequencing technology for the identification of all variants in the exons (coding regions) of all known genes for variant discovery and prioritisation, constituting approximately 1% of the human genome. WES was utilised to provide genetic diagnoses in two patients cohorts with clinically well-defined, genetically undetermined mitochondrial disease: (i) adult-onset progressive external ophthalmoplegia (PEO) (n=19), a mitochondrial DNA (mtDNA) maintenance disorder characterised by extraocular paresis and skeletal muscle restricted multiple mtDNA deletions, with broad phenotypes ranging from indolent PEO and fatal multisystem PEO-plus; (ii) early-onset mitochondrial respiratory chain complex (RC) deficiency (n=20), typically affecting patients in the first decade of life and are associated with heterogeneous phenotypes. Pathogenic mtDNA mutations were previously excluded in all patients. Adult-onset PEO with multiple mtDNA deletions patients were recruited following negative genetic testing of commonly associated nuclear genes, while early-onset RC deficiency patients were negative genetic testing in a small selection of nuclear genes. Using custom variant filtering strategies for each cohort, confirmed diagnoses were attained in 10% of adult-onset PEO with multiple mtDNA deletions patients and 35% of early-onset RC deficiency patients. This was comprised of known mitochondrial disease associated genes in both cohorts (AARS2, EARS2, MRPS22, PDHA1, SCO1, TK2, TRMU, TWNK), while novel candidate genes involved in mitochondrial translation, mtDNA replication, nucleotide metabolism and mitochondrial dynamics were also proposed. The pathological mechanism of a novel heterozygous GMPR1 variant was characterised as a potential new candidate gene associated with late-onset PEO due to impaired nucleotide balance for mtDNA maintenance. GTPBP3 was identified as a novel locus causing defective tRNA modification with multiple RC deficiency and the clinical, molecular and genetic features of AARS2, EARS2 and YARS2 mutations were expanded. Finally, this research highlights the potential significance of de novo and somatic mosaic variants in WES variant discovery and prioritisation.Medical Research Counci