L’enseignement de techniques de gestion du stress basées sur la pleine conscience aux étudiants en médecine par le biais de simulations

Implication Statement Acutely traumatic clinical events can exacerbate stress and burnout amongst healthcare providers.  The Simulated Training for Resilience in Various Environments (STRIVE) course may provide a useful framework for medical educators to teach stress management skills to promote resilience amongst physician trainees. The course introduces the Big Four+ techniques (goal setting, visualization, self-talk, progressive muscular relaxation, attention control and tactical breathing) created by the Canadian Armed Forces using clinical scenarios. This framework can be easily adapted across other training contexts to equip future clinicians with a foundational skill set to optimize their response and recovery following critically stressful incidents.Énoncé des implications de la recherche Un événement clinique très traumatisant peut exacerber le stress et l'épuisement professionnel vécus par les soignants. Le cours « Simulated Training for Resilience in Various Environments » ou STRIVE (formation par simulation pour développer la résilience dans divers environnements) offre un cadre utile aux enseignants en médecine pour initier les apprenants aux stratégies de gestion du stress afin de renforcer leur résilience. Le cours présente, à l'aide de scénarios cliniques, les principales techniques (les « Big Four+ ») créées par les Forces armées canadiennes, à savoir la fixation d'objectifs, la visualisation, le dialogue intérieur, la relaxation musculaire progressive, le contrôle de l'attention et la respiration tactique. Ce cadre peut être facilement adapté à d'autres contextes de formation afin de doter les futurs cliniciens d'un ensemble de compétences fondamentales pour optimiser leur capacité de réaction et de rétablissement face à un incident particulièrement stressant

Circulating Inflammatory and Oxidative Stress Responses to Steady-State Moderate-Intensity and High-Intensity Interval Exercise in Mid-Spectrum Chronic Kidney Disease

Inflammation and oxidative stress can be potent modulators of vascular function. These factors may transiently respond to moderate-intensity steady state exercise (SSE) in a manner that improves post-exercise vascular function in healthy adults. Whether exercise imparts similar effects in adults with Stage 3 or 4 chronic kidney disease (CKD) remains understudied. Moreover, a comparison of SSE and high-intensity interval exercise (HIIE) may add to clinically-relevant findings for improving vascular function in mid-spectrum CKD. PURPOSE: To determine the influence of SSE and a comparable amount of HIIE on post-exercise inflammation and oxidative stress in patients diagnosed with secondary Stage 3 or 4 CKD. METHODS: Twenty participants (n = 6 men; n = 14 women; age 62.0 + 9.9 yr; weight 80.9 + 16.2 kg; body fat 37.3 + 8.5% of weight; VO2max 19.4 + 4.7 ml/kg/min) completed 30 min of SSE at 65% VO2reserve or HIIE by treadmill walking (90% and 20% of VO2reserve in 3:2 min ratio) in a randomized crossover design. Both exercise conditions averaged ~ 65% VO2reserve. Blood samples were obtained by the same technician under standardized conditions just before, 1hr and 24hrs after exercise. Total antioxidant capacity (TAC), paraoxonase1 (PON1), asymmetric dimethylarginine (ADMA), 3nitrotyrosine (3NT) and interleukin-6 (IL6) responses were analyzed using 2 (condition) by 3 (sample point) repeated measures ANOVAs. RESULTS: Relative to pre-exercise measures: TAC increased by 4.3% 24hr after exercise (p = 0.012). PON1 was maintained 1hr and elevated by 6.1% 24hr after SSE, but not HIIE (p = 0.035). When corrected for plasma volume shifts, ADMA increased 30 ng/ml at 1hr but was 58 ng/ml lower 24hrs after exercise (p = 0.0006). 3NT and IL6 remained stable in the hours after exercise (p \u3e 0.05). CONCLUSION: Modest inflammatory and oxidative stress marker responses to either SSE and HIIE may contribute to improved vascular function in mid-spectrum CKD

Empirical Analysis of Factors Affecting Confirmation Bias Levels of Software Engineers

Confirmation bias is defined as the tendency of people to seek evidence that verifies a hypothesis rather than seeking evidence to falsify it. Due to the confirmation bias, defects may be introduced in a software product during requirements analysis, design, implementation and/or testing phases. For instance, testers may exhibit confirmatory behavior in the form of a tendency to make the code run rather than employing a strategic approach to make it fail. As a result, most of the defects that have been introduced in the earlier phases of software development may be overlooked leading to an increase in software defect density. In this paper, we quantify confirmation bias levels in terms of a single derived metric. However, the main focus of this paper is the analysis of factors affecting confirmation bias levels of software engineers. Identification of these factors can guide project managers to circumvent negative effects of confirmation bias, as well as providing guidance for the recruitment and effective allocation of software engineers. In this empirical study, we observed low confirmation bias levels among participants with logical reasoning and hypothesis testing skills

Acute Responses in Agonists of uEGF to Moderate-Intensity and High-Intensity Interval Exercise in Mid-Spectrum CKD

Urine epidermal growth factor (uEGF) is a novel biomarker utilized in assessing renal health in various renal diseases, specifically chronic kidney disease (CKD). uEGF promotes multiple intracellular pathways, stimulating renal cell growth, survival, and replication. uEGF production is activated by multiple agonists that bind to the uEGF receptor. Aerobic exercise initiates the upregulation of several of these agonists to increase the production of uEGF. Depending on the mode and intensity of aerobic exercise, uEGF agonists may activate differently in CKD populations. PURPOSE: To determine the influence of an acute bout of steady-state exercise (SSE) and high-intensity interval exercise (HIIE) on concentrations of uEGF agonists (serum insulin-like growth factor 1 (IGF-1), angiotensin II receptor type 1 (AGTR-1), and transforming growth factor beta 1 (TGF-β1)) in mid-spectrum CKD. METHODS: Twenty participants (n = 6 men; n = 14 women; age 62.0 + 9.9 yr; weight 80.9 + 16.2 kg; body fat 37.3 + 8.5% of weight; VO2max 19.4 + 4.7 ml/kg/min) completed 30 min of SSE at 65% VO2reserve or HIIE by treadmill walking (90% and 20% of VO2reserve in 3:2 min ratio) in a randomized crossover design. Both exercise conditions averaged ~ 65% VO2reserve. Blood and urine samples were obtained under standardized conditions just before, 1hr, and 24hrs after exercise. uEGF (ng/mL), serum IGF-1 (ng/mL), AGTR-1 (ng/mL), and TGF-β1 (pg/mL) responses were analyzed using 2 (condition) by 3 (sample point) repeated measures ANOVAs and Pearson Correlations. RESULTS: Serum IGF-1 and AGTR-1 increased 1hr and 24hr post-exercise in both exercise conditions; however, statistical significance was not achieved (p = 0.28 and p = 0.09). Similarly, serum TGF-β1 decreased at 24hrs in both exercise conditions but statistically remained unaltered (p = 0.42). IGF-1 was significantly correlated to uEGF in both conditions at all three-time points (p = 0.03), while AGTR-1 was significantly correlated to uEGF at 1hr in HIIE. uEGF findings were previously reported in ACSM abstract (DOI: 10.1249/01.mss.0000560710.72569.11). CONCLUSION: Agonists of uEGF remained unaltered following an acute bout of SSE and HIIE in mid-spectrum CKD. Further research is needed to understand better uEGF response activation to aerobic exercise in mid-spectrum CKD

Comparative Genomics of Recent Shiga Toxin-Producing Escherichia coli O104:H4: Short-Term Evolution of an Emerging Pathogen

The large outbreak of diarrhea and hemolytic uremic syndrome (HUS) caused by Shiga toxin-producing Escherichia coli O104:H4 in Europe from May to July 2011 highlighted the potential of a rarely identified E. coli serogroup to cause severe disease. Prior to the outbreak, there were very few reports of disease caused by this pathogen and thus little known of its diversity and evolution. The identification of cases of HUS caused by E. coli O104:H4 in France and Turkey after the outbreak and with no clear epidemiological links raises questions about whether these sporadic cases are derived from the outbreak. Here, we report genome sequences of five independent isolates from these cases and results of a comparative analysis with historical and 2011 outbreak isolates. These analyses revealed that the five isolates are not derived from the outbreak strain; however, they are more closely related to the outbreak strain and each other than to isolates identified prior to the 2011 outbreak. Over the short time scale represented by these closely related organisms, the majority of genome variation is found within their mobile genetic elements: none of the nine O104:H4 isolates compared here contain the same set of plasmids, and their prophages and genomic islands also differ. Moreover, the presence of closely related HUS-associated E. coli O104:H4 isolates supports the contention that fully virulent O104:H4 isolates are widespread and emphasizes the possibility of future food-borne E. coli O104:H4 outbreaks

Comparative Genomics of Vancomycin-Resistant Staphylococcus aureus Strains and Their Positions within the Clade Most Commonly Associated with Methicillin-Resistant S. aureus Hospital-Acquired Infection in the United States

Methicillin-resistant Staphylococcus aureus (MRSA) strains are leading causes of hospital-acquired infections in the United States, and clonal cluster 5 (CC5) is the predominant lineage responsible for these infections. Since 2002, there have been 12 cases of vancomycin-resistant S. aureus (VRSA) infection in the United States—all CC5 strains. To understand this genetic background and what distinguishes it from other lineages, we generated and analyzed high-quality draft genome sequences for all available VRSA strains. Sequence comparisons show unambiguously that each strain independently acquired Tn1546 and that all VRSA strains last shared a common ancestor over 50 years ago, well before the occurrence of vancomycin resistance in this species. In contrast to existing hypotheses on what predisposes this lineage to acquire Tn1546, the barrier posed by restriction systems appears to be intact in most VRSA strains. However, VRSA (and other CC5) strains were found to possess a constellation of traits that appears to be optimized for proliferation in precisely the types of polymicrobic infection where transfer could occur. They lack a bacteriocin operon that would be predicted to limit the occurrence of non-CC5 strains in mixed infection and harbor a cluster of unique superantigens and lipoproteins to confound host immunity. A frameshift in dprA, which in other microbes influences uptake of foreign DNA, may also make this lineage conducive to foreign DNA acquisition

Emergence of Epidemic Multidrug-Resistant Enterococcus faecium from Animal and Commensal Strains

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