Burnout After Patient Death: Challenges for Direct Care Workers.

Direct care workers in long-term care can develop close relationships with their patients and subsequently experience significant grief after patient death. Consequences of this experience for employment outcomes have received little attention. To investigate staff, institutional, patient, and grief factors as predictors of burnout dimensions among direct care workers who had experienced recent patient death; determine which specific aspects of these factors are of particular importance; and establish grief as an independent predictor of burnout dimensions. Participants were 140 certified nursing assistants and 80 homecare workers who recently experienced patient death. Data collection involved comprehensive semistructured in-person interviews. Standardized assessments and structured questions addressed staff, patient, and institutional characteristics, grief symptoms and grief avoidance, as well as burnout dimensions (depersonalization, emotional exhaustion, and personal accomplishment). Hierarchical regressions revealed that grief factors accounted for unique variance in depersonalization, over and above staff, patient, and institutional factors. Supervisor support and caregiving benefits were consistently associated with higher levels on burnout dimensions. In contrast, coworker support was associated with a higher likelihood of depersonalization and emotional exhaustion. Findings suggest that grief over patient death plays an overlooked role in direct care worker burnout. High supervisor support and caregiving benefits may have protective effects with respect to burnout, whereas high coworker support may constitute a reflection of burnout

From dementia mindsets to emotions and behaviors:Predicting person-centered care in care professionals

Background and Objective: High-quality care standards for dementia care are increasingly based on person-centered care principles. To better understand facilitating factors of person-centered care this research focuses on individual characteristics of care professionals. Applying mindset theory to dementia care, we examined dementia mindsets (viewing dementia symptoms as either malleable or fixed) in care professionals. We tested whether there is a positive relationship between a malleable dementia mindset and person-centered care as well as a negative relationship between a fixed dementia mindset and person-centered care. Moreover, we examined whether care professionals’ emotional responses in care situations help explain associations between dementia mindsets and person-centered care. Research Design and Method: In two cross-sectional studies, care professionals of long-term care facilities (total N = 370) completed a measure of dementia mindsets and reported their emotional and behavioral responses to five care scenarios. Regression and mediation analyses were performed. Findings: The tested hypotheses were partially supported. A fixed dementia mindset predicted reported person-centered care negatively, while a malleable dementia mindset did not. Mediation analyses suggest that reduced negative emotions may underlie the association between a malleable mindset and reported person-centered care, while reduced positive emotions in care situations may underlie the association of a fixed mindset and reported person-centered care. Study 2 partially replicated these findings. A fixed mindset and positive emotional responses were the most robust predictors of reported person-centered care. Discussion and Implications: This study extends knowledge on facilitators (positive emotional responses to care situations) and barriers (fixed dementia mindset) to person-centered care in care professionals working with persons with dementia. We discuss how dementia mindsets and emotional responses to care situations may be a fruitful target for trainings for care professionals

Dementia as fixed or malleable:Development and validation of the dementia mindset scale

Background and Objectives Care professionals differ in how they experience and respond to dementia caregiving. To explain such differences, we developed a new measure: the Dementia Mindset Scale. This scale captures the extent to which care professionals view dementia as stable and fixed (akin to the biomedical perspective) or as flexible and malleable (akin to the person-centered approach). Research Design and Methods We conducted four studies to develop the scale. We tested items for comprehensibility, assessed the scale’s factorial structure and psychometric properties, and investigated its predictive validity for care professionals’ well-being. Results A new scale with a two-factor structure—distinguishing a malleable dementia mindset from a fixed dementia mindset—was developed. Results showed good convergent and divergent validity. Moreover, the dementia mindsets predicted aspects of job-related well-being in care professionals. Discussion and Implications The scale allows for the assessment of individual differences in how care professionals see dementia. This insight can be used to improve interventions aimed at enhancing care professionals’ well-being and quality of care

Effect of P-glycoprotein on flavopiridol sensitivity

Flavopiridol is the first potent inhibitor of cyclin-dependent kinases (CDKs) to enter clinical trials. Little is known about mechanisms of resistance to this agent. In order to determine whether P-glycoprotein (Pgp) might play a role in flavopiridol resistance, we examined flavopiridol sensitivity in a pair of Chinese hamster ovary cell lines differing with respect to level of Pgp expression. The IC 50 s of flavopiridol in parental AuxB1 (lower Pgp) and colchicine-selected CHRC5 (higher Pgp) cells were 90.2 ± 6.6 nM and 117 ± 2.3 nM, respectively (P< 0.01), suggesting that Pgp might have a modest effect on flavopiridol action. Consistent with this hypothesis, pretreatment with either quinidine or verapamil (inhibitors of Pgp-mediated transport) sensitized CHRC5 cells to the antiproliferative effects of flavopiridol. Because of concern that colony forming assays might not accurately reflect cytotoxicity, we also examined flavopiridol-treated cells by trypan blue staining and flow cytometry. These assays confirmed that flavopiridol was less toxic to cells expressing higher levels of Pgp. Further experiments revealed that flavopiridol inhibited the binding of [3H]-azidopine to Pgp in isolated membrane vesicles, but only at high concentrations. Collectively, these results identify flavopiridol as a weak substrate for Pgp. © 2001 Cancer Research Campaign www.bjcancer.co

Detection of hydrodynamic stimuli by the postcranial body of Florida manatees (Trichechus manatus latirostris) A Neuroethology, sensory, neural, and behavioral physiology

Manatees live in shallow, frequently turbid waters. The sensory means by which they navigate in these conditions are unknown. Poor visual acuity, lack of echo- location, and modest chemosensation suggest that other modalities play an important role. Rich innervation of sen- sory hairs that cover the entire body and enlarged soma- tosensory areas of the brain suggest that tactile senses are good candidates. Previous tests of detection of underwater vibratory stimuli indicated that they use passive movement of the hairs to detect particle displacements in the vicinity of a micron or less for frequencies from 10 to 150 Hz. In the current study, hydrodynamic stimuli were created by a sinusoidally oscillating sphere that generated a dipole field at frequencies from 5 to 150 Hz. Go/no-go tests of manatee postcranial mechanoreception of hydrodynamic stimuli indicated excellent sensitivity but about an order of magnitude less than the facial region. When the vibrissae were trimmed, detection thresholds were elevated, suggest- ing that the vibrissae were an important means by which detection occurred. Manatees were also highly accurate in two-choice directional discrimination: greater than 90% correct at all frequencies tested. We hypothesize that mana- tees utilize vibrissae as a three-dimensional array to detect and localize low-frequency hydrodynamic stimul

Scaling algebras and pointlike fields: A nonperturbative approach to renormalization

We present a method of short-distance analysis in quantum field theory that does not require choosing a renormalization prescription a priori. We set out from a local net of algebras with associated pointlike quantum fields. The net has a naturally defined scaling limit in the sense of Buchholz and Verch; we investigate the effect of this limit on the pointlike fields. Both for the fields and their operator product expansions, a well-defined limit procedure can be established. This can always be interpreted in the usual sense of multiplicative renormalization, where the renormalization factors are determined by our analysis. We also consider the limits of symmetry actions. In particular, for suitable limit states, the group of scaling transformations induces a dilation symmetry in the limit theory.Comment: minor changes and clarifications; as to appear in Commun. Math. Phys.; 37 page

An Interface Region Imaging Spectrograph first view on Solar Spicules

Solar spicules have eluded modelers and observers for decades. Since the discovery of the more energetic type II, spicules have become a heated topic but their contribution to the energy balance of the low solar atmosphere remains unknown. Here we give a first glimpse of what quiet Sun spicules look like when observed with NASA's recently launched Interface Region Imaging Spectrograph (IRIS). Using IRIS spectra and filtergrams that sample the chromosphere and transition region we compare the properties and evolution of spicules as observed in a coordinated campaign with Hinode and the Atmospheric Imaging Assembly. Our IRIS observations allow us to follow the thermal evolution of type II spicules and finally confirm that the fading of Ca II H spicules appears to be caused by rapid heating to higher temperatures. The IRIS spicules do not fade but continue evolving, reaching higher and falling back down after 500-800 s. Ca II H type II spicules are thus the initial stages of violent and hotter events that mostly remain invisible in Ca II H filtergrams. These events have very different properties from type I spicules, which show lower velocities and no fading from chromospheric passbands. The IRIS spectra of spicules show the same signature as their proposed disk counterparts, reinforcing earlier work. Spectroheliograms from spectral rasters also confirm that quiet Sun spicules originate in bushes from the magnetic network. Our results suggest that type II spicules are indeed the site of vigorous heating (to at least transition region temperatures) along extensive parts of the upward moving spicular plasma.Comment: 6 pages, 4 figures, accepted for publication in ApJ Letters. For associated movies, see http://folk.uio.no/tiago/iris_spic

3D Surface Measurement for Medical Application—Technical Comparison of Two Established Industrial Surface Scanning Systems

In 3D mapping of flexible surfaces (e.g. human faces) measurement errors due to movement or positioning occur. Aggravated by equipment- or researcher-caused mistakes considerable deviations can result. Therefore first the appliances' precision handling and reliability in clinical environment must be established. Aim of this study was to investigate accuracy and precision of two contact-free 3D measurement systems (white light vs. laser). Standard specimens of known diameter for sphere deviation, touch deviation and plane deviation were tested. Both systems are appropriate for medical application acquiring solid data (<mm). The more complex white-light system shows better accuracy at 0.2s measuring time. The laser system is superior concerning robustness, while accuracy is poorer and input time (1.5-2.5s) longer. Due to the clinical demand the white-light system is superior in a laboratory environment, while the laser system is easier to handle under non-laboratory condition

Detection of supersonic downflows and associated heating events in the transition region above sunspots

IRIS data allow us to study the solar transition region (TR) with an unprecedented spatial resolution of 0.33 arcsec. On 2013 August 30, we observed bursts of high Doppler shifts suggesting strong supersonic downflows of up to 200 km/s and weaker, slightly slower upflows in the spectral lines Mg II h and k, C II 1336 \AA, Si IV 1394 \AA, and 1403 \AA, that are correlated with brightenings in the slitjaw images (SJIs). The bursty behavior lasts throughout the 2 hr observation, with average burst durations of about 20 s. The locations of these short-lived events appear to be the umbral and penumbral footpoints of EUV loops. Fast apparent downflows are observed along these loops in the SJIs and in AIA, suggesting that the loops are thermally unstable. We interpret the observations as cool material falling from coronal heights, and especially coronal rain produced along the thermally unstable loops, which leads to an increase of intensity at the loop footpoints, probably indicating an increase of density and temperature in the TR. The rain speeds are on the higher end of previously reported speeds for this phenomenon, and possibly higher than the free-fall velocity along the loops. On other observing days, similar bright dots are sometimes aligned into ribbons, resembling small flare ribbons. These observations provide a first insight into small-scale heating events in sunspots in the TR.Comment: accepted by ApJ

On the Distribution of Haloes, Galaxies and Mass

The stochasticity in the distribution of dark haloes in the cosmic density field is reflected in the distribution function $P_V(N_h|\delta_m)$ which gives the probability of finding $N_h$ haloes in a volume $V$ with mass density contrast $\delta_m$. We study the properties of this function using high-resolution $N$-body simulations, and find that $P_V(N_n|\delta_m)$ is significantly non-Poisson. The ratio between the variance and the mean goes from $\sim 1$ (Poisson) at $1+\delta_m\ll 1$ to $<1$ (sub-Poisson) at $1+\delta_m\sim 1$ to $>1$ (super-Poisson) at $1+\delta_m\gg 1$. The mean bias relation is found to be well described by halo bias models based on the Press-Schechter formalism. The sub-Poisson variance can be explained as a result of halo-exclusion while the super-Poisson variance at high $\delta_m$ may be explained as a result of halo clustering. A simple phenomenological model is proposed to describe the behavior of the variance as a function of $\delta_m$. Galaxy distribution in the cosmic density field predicted by semi-analytic models of galaxy formation shows similar stochastic behavior. We discuss the implications of the stochasticity in halo bias to the modelling of higher-order moments of dark haloes and of galaxies.Comment: 10 pages, 6 figures, Latex using MN2e style. Minor changes. Accepted for publication in MNRA