Compassion satisfaction, burnout and secondary traumatic stress in UK therapists

Section A: A literature review was conducted to identify the negative and positive impact that working with adult trauma clients has on therapists. Key theoretical concepts and possible causal mechanisms are summarised and the research evidence supporting these concepts is reviewed. The key limitations to the extant literature and future research are discussed. Section B: Background: Therapists who work with trauma clients are impacted by this work both positively and negatively. However, most studies have tended to focus on the negative impact of the work, the quantitative evidence has been inconsistent, and the research has primarily been conducted outside the UK. Method: An online questionnaire was developed which used a standardised measure to assess compassion satisfaction (CS), burnout, and secondary traumatic stress (STS) in 253 UK therapists working with adult trauma clients. Results: Whilst the majority of therapists scored within the average range for CS and burnout, 70% of scores indicated that they were at high risk of STS. Maturity, time spent engaging in R&D activities, and a higher perceived supportiveness of management and supervision predicted higher potential for CS. Youth and a lower perceived supportiveness of management predicted higher risk of burnout. Higher risk of STS was predicted in therapists engaging in more individual supervision and self-care activities, as well as those who had a personal trauma history. Discussion: These results are discussed in light of previous research. Of particular note is that exposure to trauma stories did not significantly predict STS scores as suggested by STS theory. Contextual and methodological limitations and ideas for future research are highlighted. Section C: A critical appraisal of the research process is summarised which answers the four set questions. A final personal reflection is also given

The relationship between parental education and children's schooling in a time of economic turmoil: The case of East Zimbabwe, 2001 to 2011.

Using data collected from 1998 to 2011 in a general population cohort study in eastern Zimbabwe, we describe education trends and the relationship between parental education and children's schooling during the Zimbabwean economic collapse of the 2000s. During this period, the previously-rising trend in education stalled, with girls suffering disproportionately; however, female enrolment increased as the economy began to recover. Throughout the period, children with more educated parents continued to have better outcomes such that, at the population level, an underlying increase in the proportion of children with more educated parents may have helped to maintain the upwards education trend

Resilience, security, and the railway station: a unique case study of the current and future resilience to security threats

Major railway stations in England and Wales are highly networked and open locations, frequently crowded, and are vulnerable to criminal and terrorist activities. Successive Government policies and agendas have sought to lessen this susceptibility, by promoting the understanding of and the application of resilience and security measures. Thus, the complex stakeholders are responsibilised (Garland, 1996) and urged to integrate and merge resilience, crime prevention and counter-terrorism measures into their governance, and operational policies and agendas. The aim of this research is to determine and examine the interdependencies and boundaries of the multiple stakeholders within St Pancras International Railway Station (SPIRS), and to analyse how their governance, operational and legislative requirements, and agendas influence current and future resilience of complex Category A railway stations to human malign security threats. Through a unique single case study of SPIRS, qualitative data was collected from thirty-two stakeholder participants, sampled for their expert opinion and experience. Data was also collected via documents and observations. SPIRS interconnected and complex stakeholders were represented using stakeholder analysis and mapping to create an original and innovative map highlighting those who can influence and impact the resilience of the space to human malign security threats. From the thematic analysis of the data, the overarching themes exposed the resilience within SPIRS operates in an uncertain legal space, competing with disparate institutional processes creating a gulf between reality and rhetoric of the responsibilisation of resilience and security strategies. The blurred boundaries of responsibility and understanding of the resilience and security agendas within SPIRS created tension between the national and local level stakeholders. The research adds an original and novel contribution to knowledge, as through contemporary empirical evidence it has established the political rhetoric of responsibilisation (Garland, 1996) for resilience and security policies are inconsistent and contradictory with the reality of how these transpire in an ambiguous operational and legal space such as SPIRS. Regardless of the mapped interdependencies between the multiple stakeholders and their interconnecting operational and legislative obligations, there is a definite absence of a clear and united approach to resilience, with concerns being dealt with by multiple stakeholders and policies. The research has revealed the complications and disparities the complex and multiple stakeholders face implementing policy and subsequently institutional changes in a cohesive manner. The findings of the research necessitate transformations in established organisational procedures, thus ensuring these interdependencies are dealt with now to make certain the effectual incorporation and integration of agendas and strategies are unified, and which maintain the resilience of Category A railway stations and SPIRS for future generations

Social contact structures and time use patterns in the Manicaland Province of Zimbabwe.

BACKGROUND: Patterns of person-to-person contacts relevant for infectious diseases transmission are still poorly quantified in Sub-Saharan Africa (SSA), where socio-demographic structures and behavioral attitudes are expected to be different from those of more developed countries. METHODS AND FINDINGS: We conducted a diary-based survey on daily contacts and time-use of individuals of different ages in one rural and one peri-urban site of Manicaland, Zimbabwe. A total of 2,490 diaries were collected and used to derive age-structured contact matrices, to analyze time spent by individuals in different settings, and to identify the key determinants of individuals' mixing patterns. Overall 10.8 contacts per person/day were reported, with a significant difference between the peri-urban and the rural site (11.6 versus 10.2). A strong age-assortativeness characterized contacts of school-aged children, whereas the high proportion of extended families and the young population age-structure led to a significant intergenerational mixing at older ages. Individuals spent on average 67% of daytime at home, 2% at work, and 9% at school. Active participation in school and work resulted the key drivers of the number of contacts and, similarly, household size, class size, and time spent at work influenced the number of home, school, and work contacts, respectively. We found that the heterogeneous nature of home contacts is critical for an epidemic transmission chain. In particular, our results suggest that, during the initial phase of an epidemic, about 50% of infections are expected to occur among individuals younger than 12 years and less than 20% among individuals older than 35 years. CONCLUSIONS: With the current work, we have gathered data and information on the ways through which individuals in SSA interact, and on the factors that mostly facilitate this interaction. Monitoring these processes is critical to realistically predict the effects of interventions on infectious diseases dynamics

HIV decline in Zimbabwe due to reductions in risky sex? Evidence from a comprehensive epidemiological review.

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Marketing Logistics Systems Analysis: The Development of Heuristic Guidelines to Aid Decision Making in the Pharmaceutical Manufacturing Industry

This thesis describes the development of heuristic guidelines to aid logistics management in manufacturing industry, in this case pharmaceutical manufacturers, to make decisions when faced with the appraisal of alternative methods of operation. A number of research suppositions are proposed which suggest that a more formalised approach to decision making than is current practice can be implemented in assessing the total logistics costs and customer service implications of operations. A study is made of existing research in logistics and related areas, the pharmaceutical industry in general, and in particular the logistics activities of pharmaceutical manufacturers and the service requirements of their customers. A research programme is devised whose primary purpose is to enable a comparison to be made between the implications of the research suppositions and the empirical data obtained by administering questionnaires to manufacturers and samples of customers. A model of the decision making process is presented around the framework of a cost-effectiveness analysis. A systems approach is used to analyse a manufacturer's logistics operation, highlighting as it does the interactive effects between logistics activities. The research suppositions provide heuristic guidelines which relate an activity's position on a manufacturer's material flow path to that of the proposed change, and which assign service priorities in terms of lead time to customer types. These guidelines serve to decrease the number of considered interactions and, subsequently, to reduce the complexity of the analysis. A number of implications of the findings for manufacturing industry in general, for pharmaceutical manufacturers in particular, and for logistics research, are presented. Suggestions are also made to aid any company wishing to apply its own logistics systems analysis along the lines pursued in this study.Ph

The Effects of Evening Bright Light Exposure on Subsequent Morning Exercise Performance

We investigated the effects of evening bright light on the circadian timing of core temperature and morning exercise performance under conditions of high thermal stress. At 20:00 h, 8 males were exposed to a standardised light protocol and thereafter to either polychromatic bright light (2 500 lux at 50 cm, BL) or no light (0 lux, NL) for 30 min. The following morning, intermittent cycling exercise was undertaken followed by a 10 km time-trial in an environmental chamber set to 35°C and 60% relative humidity. Core body temperature was measured throughout. Data were analysed using a within-subjects model and presented as mean±SD. Time of the sleep-trough in core temperature occurred ~1.75 h later following BL (P=0.07). Prior to time-trial, core temperature was 0.27±0.42°C lower in BL (95%CI: −0.02 to 0.57, P=0.07). The time-trial was completed 1.43±0.63 min (0.98–1.87) faster in BL (P=0.001). Post time-trial, intestinal temperature was 38.21±0.56°C (37.84–38.57) in BL compared to 38.64±0.42°C (38.34–38.93) in NL (P=0.10). These data provide the first evidence that a 30-min exposure to bright light prior to sleep can influence exercise performance under hot conditions during the subsequent early morning

Effect of base sequence on the DNA cross-linking properties of pyrrolobenzodiazepine (PBD) dimers

Pyrrolo[2,1-c][1,4]benzodiazepine (PBD) dimers are synthetic sequence-selective DNA minor-groove cross-linking agents that possess two electrophilic imine moieties (or their equivalent) capable of forming covalent aminal linkages with guanine C2-NH2 functionalities. The PBD dimer SJG-136, which has a C8–O–(CH2)3–O–C8′′ central linker joining the two PBD moieties, is currently undergoing phase II clinical trials and current research is focused on developing analogues of SJG-136 with different linker lengths and substitution patterns. Using a reversed-phase ion pair HPLC/MS method to evaluate interaction with oligonucleotides of varying length and sequence, we recently reported (JACS, 2009, 131, 13 756) that SJG-136 can form three different types of adducts: inter- and intrastrand cross-linked adducts, and mono-alkylated adducts. These studies have now been extended to include PBD dimers with a longer central linker (C8–O–(CH2)5–O–C8′), demonstrating that the type and distribution of adducts appear to depend on (i) the length of the C8/C8′-linker connecting the two PBD units, (ii) the positioning of the two reactive guanine bases on the same or opposite strands, and (iii) their separation (i.e. the number of base pairs, usually ATs, between them). Based on these data, a set of rules are emerging that can be used to predict the DNA–interaction behaviour of a PBD dimer of particular C8–C8′ linker length towards a given DNA sequence. These observations suggest that it may be possible to design PBD dimers to target specific DNA sequences

Randomised crossover trial of rate feedback and force during chest compressions for paediatric cardiopulmonary resuscitation

Objective: To determine the effect of visual feedback on rate of chest compressions, secondarily relating the forces used. / Design: Randomised crossover trial. / Setting: Tertiary teaching hospital. / Subjects: Fifty trained hospital staff. / Interventions: A thin sensor-mat placed over the manikin's chest measured rate and force. Rescuers applied compressions to the same paediatric manikin for two sessions. During one session they received visual feedback comparing their real-time rate with published guidelines. / Outcome measures: Primary: compression rate. Secondary: compression and residual forces. / Results: Rate of chest compressions (compressions per minute (compressions per minute; cpm)) varied widely (mean (SD) 111 (13), range 89–168), with a fourfold difference in variation during session 1 between those receiving and not receiving feedback (108 (5) vs 120 (20)). The interaction of session by feedback order was highly significant, indicating that this difference in mean rate between sessions was 14 cpm less (95% CI −22 to −5, p=0.002) in those given feedback first compared with those given it second. Compression force (N) varied widely (mean (SD) 306 (94); range 142–769). Those receiving feedback second (as opposed to first) used significantly lower force (adjusted mean difference −80 (95% CI −128 to −32), p=0.002). Mean residual force (18 N, SD 12, range 0–49) was unaffected by the intervention. / Conclusions: While visual feedback restricted excessive compression rates to within the prescribed range, applied force remained widely variable. The forces required may differ with growth, but such variation treating one manikin is alarming. Feedback technologies additionally measuring force (effort) could help to standardise and define effective treatments throughout childhood