An empirical investigation into a manager's learning with respect to stress and burnout among mental health practitioners

There is growing evidence that nursing is a stressful occupation, particularly mental health nursing. (Nolan 1995). The objective of this dissertation was to assess the degree and nature of occupational stress and burnout in psychiatric nurses. Two questionnaires, The Professional Life Scale, (Fontana 1989), and Are you burning out ? (Freudenberger 1980), were administered to a group of psychiatric nurses, (n=15). The data was supplemented by series of individual qualitative interviews (n=9). Additional statistical data regarding occupational sickness and leaver profiles was also evaluated and integrated into the main research outcomes. Setting - A National Health Service hospital trust, specialising in psychiatry. There were 15 subjects in the quantitative study, representative of nursing staff from acute residential psychiatric admission wards, community psychiatric nurses, and staff from a therapy day hospital. There were five staff from each clinical area involved with the study, which represented approximately 10% of the staff from the clinical areas. Three female and two male staff were randomly selected for each study group. There were nine subjects involved in the qualitative study, two female, and one male from each clinical area. Freudenberger's questionnaire revealed few burnout factors in ward staff, and a low to moderate burnout factor in day hospital and CPN questionnaire respondents. Fontana's questionnaire did not indicate professional stress of any significance in any of the respondent groups but the CPN group scored a relatively higher professional stress factor. A series of qualitative interviews (n=9) confirmed that the outcomes of the quantitative questionnaires were considered by subjects to be a reasonable indicator of stress and burnout. Respondents felt that stress that they encountered was reactionary, not sustained, and normal. Non-occupational stress issues were considered by the staff groups as major influences in potentially creating occupational stress. Other indicators, including low sickness and leaver rates led to a conclusion that the staff groups did not display occupational stress or burnout of any significance. Supervision and training were consistently cited as positive variables in reducing stress and burnout factors, and were professionally valued

RESEARCH AND DEVELOPMENT ACTIVITIES AT SAVANNAH RIVER SITE'S H CANYON FACILITY

The Savannah River Site's (SRS) H Canyon Facility is the only large scale, heavily shielded, nuclear chemical separations plant still in operation in the U.S. The facility's operations historically recovered uranium-235 (U-235) and neptunium-237 (Np-237) from aluminum-clad, enriched-uranium fuel tubes from Site nuclear reactors and other domestic and foreign research reactors. Today the facility, in conjunction with HB Line, is working to provide the initial feed material to the Mixed Oxide Facility also located on SRS. Many additional campaigns are also in the planning process. Furthermore, the facility has started to integrate collaborative research and development (R&D) projects into its schedule. H Canyon can serve as the appropriate testing location for many technologies focused on monitoring the back end of the fuel cycle, due to the nature of the facility and continued operation. H Canyon, in collaboration with the Savannah River National Laboratory (SRNL), has been working with several groups in the DOE complex to conduct testing demonstrations of novel technologies at the facility. The purpose of conducting these demonstrations at H Canyon will be to demonstrate the capabilities of the emerging technologies in an operational environment. This paper will summarize R&D testing activities currently taking place in H Canyon and discuss the possibilities for future collaborations

Assessment of biological responses of EpiAirway 3-D cell constructs versus A549 cells for determining toxicity of ambient air pollution

EpiAirway™ 3-D constructs are human-derived cell cultures of differentiated airway epithelial cells that may represent a more biologically relevant model of the human lung. However, limited information is available of its utility for exposures to air pollutants at the air-liquid interface (ALI)

Fluorescent Affibody Peptide Penetration in Glioma Margin Is Superior to Full Antibody

Object: Fluorescence imaging has the potential to significantly improve neurosurgical resection of oncologic lesions through improved differentiation between normal and cancerous tissue at the tumor margins. In order to successfully mark glioma tissue a fluorescent tracer must have the ability to penetrate through the blood brain barrier (BBB) and provide delineation in the tumor periphery where heterogeneously intact BBB may exist. In this study it was hypothesized that, due to its smaller size, fluorescently labeled anti-EGFR Affibody protein (~7 kDa) would provide a more clear delineation of the tumor margin than would fluorescently labeled cetuximab, a full antibody (~150 kDa) to the epidermal growth factor receptor (EGFR). Methods: Cetuximab and anti-EGFR targeted Affibody were conjugated to two different fluorescent dyes (both emitting in the near-infrared) and injected intravenously into 6 athymic mice which were inoculated orthotopically with green fluorescent protein (GFP) expressing human U251 glioma cells. Each mouse was sacrificed at 1-h post injection, at which time brains were removed, snap frozen, sectioned and quantitatively analyzed for fluorescence distribution. Results: Ex vivo analysis showed on average, nearly equal concentrations of cetuximab and Affibody within the tumor (on average Affibody made up 49 ± 6% of injected protein), however, the cetuximab was more confined to the center of the tumor with Affibody showing significantly higher concentrations at the tumor periphery (on average Affibody made up 72 ± 15% of injected protein in the outer 50 um of the tumor). Further ex vivo analysis of detection studies showed that the Affibody provided superior discrimination for differentiation of tumor from surrounding normal brain. Conclusions: The present study indicates that fluorescently labeled anti-EGFR Affibody can provide significantly better delineation of tumor margins than a fluorescently labeled anti-EGFR antibody and shows considerable potential for guiding margin detection during neurosurgery

Effects of 1,3-Butadiene, Isoprene, and Their Photochemical Degradation Products on Human Lung Cells

Because of potential exposure both in the workplace and from ambient air, the known carcinogen 1,3-butadiene (BD) is considered a priority hazardous air pollutant. BD and its 2-methyl analog, isoprene (ISO), are chemically similar but have very different toxicities, with ISO showing no significant carcinogenesis. Once released into the atmosphere, reactions with species induced by sunlight and nitrogen oxides convert BD and ISO into several photochemical reaction products. In this study, we determined the relative toxicity and inflammatory gene expression induced by exposure of A549 cells to BD, ISO, and their photochemical degradation products in the presence of nitric oxide. Gas chromatography and mass spectrometry analyses indicate the initial and major photochemical products produced during these experiments for BD are acrolein, acetaldehyde, and formaldehyde, and products for ISO are methacrolein, methyl vinyl ketone, and formaldehyde; both formed < 200 ppb of ozone. After exposure the cells were examined for cytotoxicity and interleukin-8 (IL-8) gene expression, as a marker for inflammation. These results indicate that although BD and ISO alone caused similar cytotoxicity and IL-8 responses compared with the air control, their photochemical products significantly enhanced cytotoxicity and IL-8 gene expression. This suggests that once ISO and BD are released into the environment, reactions occurring in the atmosphere transform these hydrocarbons into products that induce potentially greater adverse health effects than the emitted hydrocarbons by themselves. In addition, the data suggest that based on the carbon concentration or per carbon basis, biogenic ISO transforms into products with proinflammatory potential similar to that of BD products

Improved Tumor Contrast Achieved by Single Time Point Dual-Reporter Fluorescence Imaging

In this study, we demonstrate a method to quantify biomarker expression that uses an exogenous dual-reporter imaging approach to improve tumor signal detection. The uptake of two fluorophores, one nonspecific and one targeted to the epidermal growth factor receptor (EGFR), were imaged at 1 h in three types of xenograft tumors spanning a range of EGFR expression levels (n  =  6 in each group). Using this dual-reporter imaging methodology, tumor contrast-to-noise ratio was amplified by \u3e6 times at 1 h postinjection and \u3e2 times at 24 h. Furthermore, by as early as 20 min postinjection, the dual-reporter imaging signal in the tumor correlated significantly with a validated marker of receptor density (P  \u3c  0.05, r  =  0.93). Dual-reporter imaging can improve sensitivity and specificity over conventional fluorescence imaging in applications such as fluorescence-guided surgery and directly approximates the receptor status of the tumor, a measure that could be used to inform choices of biological therapies

A Toxicogenomic Comparison of Primary and Photochemically Altered Air Pollutant Mixtures

Background: Air pollution contributes significantly to global increases in mortality, particularly within urban environments. Limited knowledge exists on the mechanisms underlying health effects resulting from exposure to pollutant mixtures similar to those occurring in ambient air. In order to clarify the mechanisms underlying exposure effects, toxicogenomic analyses are used to evaluate genomewide transcript responses and map these responses to molecular networks

Aerosol and physical atmosphere model parameters are both important sources of uncertainty in aerosol ERF

Changes in aerosols cause a change in net top-of-the-atmosphere (ToA) short-wave and long-wave radiative fluxes, rapid adjustments in clouds, water vapour and temperature, and cause an effective radiative forcing (ERF) of the planetary energy budget. The diverse sources of model uncertainty and the computational cost of running climate models make it difficult to isolate the main causes of aerosol ERF uncertainty and to understand how observations can be used to constrain it. We explore the aerosol ERF uncertainty by using fast model emulators to generate a very large set of aerosol-climate model variants that span the model uncertainty due to twenty-seven parameters related to atmospheric and aerosol processes. Sensitivity analyses shows that the uncertainty in the ToA flux is dominated (around 80 %) by uncertainties in the physical atmosphere model, particularly parameters that affect cloud reflectivity. However, uncertainty in the change in ToA flux caused by aerosol emissions over the industrial period (the aerosol ERF) is controlled by a combination of uncertainties in aerosol (around 60 %) and physical atmosphere (around 40 %) parameters. Four of the atmospheric and aerosol parameters that cause uncertainty in short-wave ToA flux (mostly parameters that directly scale cloud reflectivity, cloud water content or cloud droplet concentrations) also account for around 60% of the aerosol ERF uncertainty. The common causes of uncertainty mean that constraining the modelled planetary brightness to tightly match satellite observations changes the lower 95 % credible aerosol ERF value from −2.65 Wm−2 to −2.37 Wm−2. This suggests the strongest forcings (below around −2.4 Wm−2) are inconsistent with observations. These results show that, regardless of the fact that the ToA flux is an order of magnitude larger than the aerosol ERF, the observed flux can constrain the uncertainty in ERF because their values are connected by constrainable process parameters. The key to reducing the aerosol ERF uncertainty further will be to identify observations that can additionally constrain individual parameter ranges and/or combined parameter effects, which can be achieved through sensitivity analysis of perturbed parameter ensembles

Clinical and Financial Outcomes Due to Methicillin Resistant Staphylococcus aureus Surgical Site Infection: A Multi-Center Matched Outcomes Study

The clinical and financial outcomes of SSIs directly attributable to MRSA and methicillin-resistance are largely uncharacterized. Previously published data have provided conflicting conclusions.We conducted a multi-center matched outcomes study of 659 surgical patients. Patients with SSI due to MRSA were compared with two groups: matched uninfected control patients and patients with SSI due to MSSA. Four outcomes were analyzed for the 90-day period following diagnosis of the SSI: mortality, readmission, duration of hospitalization, and hospital charges. Attributable outcomes were determined by logistic and linear regression.In total, 150 patients with SSI due to MRSA were compared to 231 uninfected controls and 128 patients with SSI due to MSSA. SSI due to MRSA was independently predictive of readmission within 90 days (OR = 35.0, 95% CI 17.3-70.7), death within 90 days (OR = 7.27, 95% CI 2.83-18.7), and led to 23 days (95% CI 19.7-26.3) of additional hospitalization and $61,681 (95$24,113 (95% 4,521-43,704) of additional charges.The attributable impact of S. aureus and methicillin-resistance on outcomes of surgical patients is substantial. Preventing a single case of SSI due to MRSA can save hospitals as much as $60,000