Exploring the Relationship Between COVID-19 Unit Designation and Nurse Burnout Syndrome

Background: The COVID-19 pandemic impacted healthcare due to surges in infected patient and respiratory failure. Nursing burnout syndrome (NBS) results from occupational factors leading to mental health problems. Nurses working in intensive care units (ICUs) dedicated to caring for COVID-19infected individuals may be even more susceptible to NBS due to increased burdens of futile care delivery and high mortality rates within overstretched healthcare systems. Identifying socio-demographic, work-related, and psychological predictors of NBS may help organizations mitigate, or at least minimize, the negative psychological impact on ICU nurses working during future pandemics. Purpose/Aims: The aim of this study was to compare burnout levels in ICU nurses providing direct care to COVID infected patients with nurses caring for non-COVID infected patients. Methods: An observational descriptive study was conducted using 1) a case-controlled prospective quantitative comparative design to compare neonatal and pediatric ICU to cardiac and medical ICU survey scores measuring nurse burnout, work-related, and psychological predictors of NBS and 2) across-sectional longitudinal quantitative causal and comparative study design comparing NBS scores for nurses working in a cardiac and medical ICU captured in 2019 prior to the COVID-19 pandemic to scores captured in the same units after conversion to dedicated COVID-19 ICUs in 2020. This study will explore the relationship between three subscales(Emotional Exhaustion, Depersonalization, and Personal Accomplishment) of the Maslach Burnout Inventory (MBI) as outcome variables and exposure to COVID-19 infected patients during 12-hour shifts worked as explanatory variables in a subset regression model. The study will also measure four subscales (Vocation, Finances, Health, and Social Relationships) associated with post-traumatic stress disorder using the Well Being Instrument(WBI) as control variables. A convenience sample of direct care registered nurses working in four ICUs in a large tertiary care hospital will be recruited to participate in the study. Female nurses working day shifts were surveyed in February and March 2019in two ICUs. In November 2020, four ICUs were used for sampling of both male and female nurses working either day or night 12-hour shifts based on designation as COVID-19 ICUs. Results: Researchers hypothesize burnout scores among nurses working in neonatal and pediatric ICUs will be less than burnout scores for nurses working in designated COVID ICUs. Additionally, investigators hypothesize nurse burnout measured in cardiac and medical ICUs in 2019 will be less than measurements obtained in 2020 after the same ICUs converted into COVID ICUs. This study will also analyze participant socio-demographic and work-related data for psychological predictors of NBS. Conclusion: NBS has been identified as a global problem facing ICU clinicians. Pinpointing associations betweenCOVID-19 infection and nurse burnout may lead to innovative strategies to mitigate burnout in those caring for the most critically ill individuals during future pandemics. Implications for practice: Further research is required to establish relationships between socio-demographic and work-related psychological predictors of NBS. Understanding relationships between these variables may guide development of strategies to build nurse resilience and decrease NBS in ICU settings impacted during pandemics.https://digitalcommons.psjhealth.org/prov_rn_conf_all/1009/thumbnail.jp

Emissions and Energy Impacts of the Inflation Reduction Act

If goals set under the Paris Agreement are met, the world may hold warming well below 2 C; however, parties are not on track to deliver these commitments, increasing focus on policy implementation to close the gap between ambition and action. Recently, the US government passed its most prominent piece of climate legislation to date, the Inflation Reduction Act of 2022 (IRA), designed to invest in a wide range of programs that, among other provisions, incentivize clean energy and carbon management, encourage electrification and efficiency measures, reduce methane emissions, promote domestic supply chains, and address environmental justice concerns. IRA's scope and complexity make modeling important to understand impacts on emissions and energy systems. We leverage results from nine independent, state-of-the-art models to examine potential implications of key IRA provisions, showing economy wide emissions reductions between 43-48% below 2005 by 2035

Should adding pain, oxygen saturation and physical assessment to vital signs become the new standard of care for detecting blood transfusion reactions?

BACKGROUND AND OBJECTIVES: Clinicians sought to ascertain what frequency of vital signs best detects blood transfusion reactions. This review discusses early and delayed blood product transfusion reaction detection through the lens of scientific literature. METHODS: A comprehensive appraisal of published literature was conducted using Integrative Research Review methodology through June 2022 not limited to English or research in Cumulative Index to Nursing and Allied Health Literature, Cochrane Library of Systematic Reviews, Medline and PubMed. RESULTS: Full-text articles in the final sample included four articles discussing vital signs detecting blood transfusion reactions and four articles reporting the importance of adding physical assessments for early reaction detection. None of the studies provided evidence regarding how often vital signs should be monitored to detect transfusion reactions. No studies included identical screening components for detecting blood product transfusion reactions. Main themes emerged including variations in what was included in vital signs, importance of respiratory assessment, inclusion of physical assessment, nurse documentation and reporting compliance, and patient and family inclusion in transfusion reaction recognition. CONCLUSION: Vital sign components varied across reviewed studies. Respiratory rate and pain were not always included in \u27vital signs\u27 to identify transfusion reactions. Only low-level data and no clinical trials loosely informing frequency of vital sign monitoring to transfusion reaction detection were found. Respiratory (to include oxygen saturation, lung sounds and respiratory rate) and pain assessment emerged as crucial to acute and delayed transfusion reaction recognition. The disconnect between \u27vital signs\u27 and the varied vital sign components reported to detect transfusion reactions in scientific literature requires further exploration

Plexin-B2 and Plexin-D1 in Dendritic Cells: Expression and IL-12/IL-23p40 Production

<div><p>Plexins are a family of genes (A,B,C, and D) that are expressed in many organ systems. Plexins expressed in the immune system have been implicated in cell movement and cell-cell interaction during the course of an immune response. In this study, the expression pattern of Plexin-B2 and Plexin-D1 in dendritic cells (DCs), which are central in immune activation, was investigated. Plexin-B2 and Plexin-D1 are reciprocally expressed in myeloid and plasmacytoid DC populations. Plasmacytoid DCs have high Plexin-B2 but low Plexin-D1, while the opposite is true of myeloid DCs. Expression of Plexin-B2 and Plexin-D1 is modulated upon activation of DCs by TLR ligands, TNFα, and anti-CD40, again in a reciprocal fashion. Semaphorin3E, a ligand for Plexin-D1 and Plexin-B2, is expressed by T cells, and interestingly, is dramatically higher on Th2 cells and on DCs. The expression of Plexins and their ligands on DCs and T cells suggest functional relevance. To explore this, we utilized chimeric mice lacking <em>Plxnb2</em> or <em>Plxnd1.</em> Absence of Plexin-B2 and Plexin-D1 on DCs did not affect the ability of these cells to upregulate costimulatory molecules or the ability of these cells to activate antigen specific T cells. Additionally, Plexin-B2 and Plexin-D1 were dispensable for chemokine-directed <em>in-vitro</em> migration of DCs towards key DC chemokines, CXCL12 and CCL19. However, the absence of either Plexin-B2 or Plexin-D1 on DCs leads to constitutive expression of IL-12/IL-23p40. This is the first report to show an association between Plexin-B2 and Plexin-D1 with the negative regulation of IL-12/IL-23p40 in DCs. This work also shows the presence of Plexin-B2 and Plexin-D1 on mouse DC subpopulations, and indicates that these two proteins play a role in IL-12/IL-23p40 production that is likely to impact the immune response.</p> </div

<i>Plxnb2^−/−</i> and <i>Plxnd1^−/−</i> DCs efficiently stimulate antigen specific T cells.

<p>(A) OVA uptake for <i>Plxnb2^−/−, Plxnd1^−/−,</i> and wild type DCs. DCs were isolated from spleens of mice reconstituted with <i>Plxnb2^−/−, Plxnd1^−/−,</i> and wild type fetal liver cells and cultured in the presence of OVA-FITC for 30 minutes. OVA uptake was assessed by flow cytometry. Data are representative of 2 independent experiments. n = 6 mice per group. (B) DCs were isolated from spleens of mice reconstituted with <i>Plxnb2^−/−, Plxnd1^−/−,</i> and wild type fetal liver cells. DCs were then co-cultured with OTII-specific T cells in the presence of OVA and T cell proliferation was assessed by CFSE dilution 72 hours later using flow cytometry. Data are representative of 3 independent experiments. n = 9 mice per group.</p

Plexin-B2, Plexin-D1, and Semaphorin-3E expression.

<p>(A) Expression of <i>Plxnb2</i> in splenic DCs, BMDCs at day 6 (D6) and day 10 (D10), D10 post 16 hour activation by TNF (20 ng/ml), CD40L (1 µg/ml), TLR ligands P3C (1 µg/ml), (LPS (1 µg/ml), CpG (4 µg/ml), and plasmacytoid DCs (pDCs) as measured by real-time PCR. Data are representative of three independent experiments. (B) Expression of <i>PlxnB2</i> in BM-derived pDCs and cDCs at D3, D6, and D10. Green lines indicate IgG control antibody staining, red histograms are <i>Plxnb2</i> antibody staining. (C) Expression of <i>Plxnd1</i> in sDCs, BM-derived DCs D6, D10, post activation, and pDC as measured by real-time PCR. (D) Expression of <i>Semaphorin3E</i> in sorted naïve and activated T cell and B cell populations, and DCs. Data are representative of 3 independent experiments.</p

DCs maturation is not affected in the absence of <i>Plxnb2</i> and <i>Plxnd1</i>.

<p><i>Plxnb2^−/−</i> and <i>Plxnd1^−/−</i> DCs are able to upregulate cell surface receptors. DCs were derived in the presence of GM-CSF and IL4 from the bone marrow of mice reconstituted with <i>Plxnb2−/−, Plxnd1^−/−,</i> and wild type fetal liver cells. DCs were then cultured in the presence of LPS and cell surface receptor expression was assessed 24 hours later using flow cytometry. Data are representative of 3 independent experiments. n = 6 mice per group.</p

<i>Plxnb2^−/−</i> and <i>Plxnd1^−/−</i> DCs migrate similarly to wild type control towards chemokine gradients.

<p>(A) Purified wildtype (black bar), <i>Plxnb2^−/−</i> (grey bar), and <i>Plxnd1^−/−</i> (open bar) DCs were placed in upper wells and subjected to <i>in-vitro</i> migration assays in the presence of medium alone, CXCL12 and CCL19. Migrated cells were quantified by toxilight (Lonza, Basel, Switzerland) according to the manufacturers instructions and normalized to a standard curve n = 6–7 mice per group. (B) Five µm sections of spleens from wildtype, <i>Plxnb2^−/−</i> and <i>Plxnd1^−/−</i> mice were labeled with B220-AF350 (blue), CD11b-PE (red) and CD11c-FITC (green). FITC signal was amplified using anti-FITC-AF488. Images were acquired using a Zeiss Axiovert 200 M confocal immunofluorescent microscope. n = 3 mice per group.</p