Exhaustion and lack of psychological detachment from work during off-job time: moderator effects of time pressure and leisure experiences

Lack of psychological detachment from work during off-job time contributes to the increase in employee exhaustion over time. This study examines the reverse causal path from exhaustion to lack of psychological detachment, suggesting that this reverse process may operate within a relatively short time frame. Specifically, we examine if exhaustion predicts a decrease in psychological detachment from work during off-job time within several weeks. We propose that time pressure at work intensifies and that pleasurable leisure experiences reduce this association between exhaustion and the decrease in psychological detachment. We tested our hypotheses in a short-term prospective study (time lag: 4 weeks) with a sample of 109 employees. Ordinary least square regression analysis indicates that exhaustion predicted a decrease in psychological detachment from work over the course of 4 weeks. This decrease was particularly strong for employees working under time pressure and for employees who did not engage in pleasurable leisure experiences. Our findings suggest that exhausted employees find detachment from work increasingly difficult and therefore might suffer from insufficient recovery-although they need it most. The situation is particularly severe when exhausted employees face high time pressure and a lack of pleasurable leisure experiences

Dacron Graft Intussusception Technique for Treatment of Type A Aortic Dissections: Technical Notes and Preliminary Results

Abstract Introduction: Optimal surgical management for acute type A aortic dissection (AAAD) remains unclear. The in-hospital mortality rate is still high (15%), and the intraoperative bleeding is an independent risk factor for hospital mortality. Objective: The aim of our study was describe a new method for aortic anastomosis in the repair of AAAD and report the hospital mortality and bleeding complications. Methods: Between January 2008 and November 2014, 24 patients, 16 male, median age 62 years, underwent surgical treatment of AAAD. The surgical technique consisted of intussusception of a Dacron tube in the dissected aorta, which is anastomosed with a first line of 2-0 polyester everting mattress suture and a second line of 3-0 polypropylene running suture placed at the outermost side. Open distal anastomosis was performed with bilateral selective antegrade cerebral perfusion in 13 (54.1%) patients. Results: Cardiopulmonary bypass and aortic clamping time ranged from 75 to 135 min (mean=85 min) and 60 to 100 min (mean=67 min), respectively. The systemic circulatory arrest ranged from 29 to 60 min (mean=44.5 min). One (4.1%) patient required reoperation for bleeding, due to the use of preoperative clopidogrel. The postoperative bleeding was 382-1270 ml (mean=654 ml). We used an average of 4.2 units of red blood cells/patient. There were two (8.3%) hospital deaths, one due to intraoperative bleeding and another due to mesenteric ischemia. The average length of stay in the intensive care unit and hospital was 44 hours and 6.7 days, respectively. Conclusion: This new method for surgical correction of AAAD was reproducible and resulted in satisfactory clinical outcomes