Burnout syndrome and wellbeing in anesthesiologists: the importance of emotion regulation strategies

Anesthesiologists face stressful working conditions that can culminate in burnout syndrome. Despite various studies and protective measures which have attempted to prevent this situation, burnout continues to be a problem within the profession, impacting negatively on physicians' lives and their performance. In this review article mechanisms and consequences of burnout are described in addition to individual strategies for stress management and burnout reduction with potential impact on health care quality and wellbeing in anesthesiologists. Organizational strategies appear to have an important role in burnout reduction but need to be used in conjunction with individual programs. The latter are essential to both reducing stress and burnout in anesthesiologists and improving happiness and wellbeing. New measures of emotion regulation strategies such as mindfulness, self-compassion, resilience and empathy promotion have been shown to be approaches with substantial supporting evidence for reducing burnout and improving stress management. The evaluation and implementation of these self-regulatory competencies is a challenge. Further research is necessary to identify which programs will best suit the needs of anesthesiologists and to measure their effects on patient care and health care system quality.info:eu-repo/semantics/publishedVersio

Stressors in anaesthesiology: development and validation of a new questionnaire: A cross-sectional study of Portuguese anaesthesiologists

BACKGROUND: Stress in anaesthesiologists is a common and multifactorial problem related to patients, colleagues and organisations. The consequences of stress include depression, work-home conflicts and burnout. Reduction in stress can be achieved by reducing the number and magnitude of stressors or by increasing resilience strategies. OBJECTIVES: We have created the self-reporting 'Stress Questionnaire in Anaesthesiologists' (SQA), to qualify the sources of stress in anaesthesiologists' professional lives, and measure the level of associated stress. Our study aimed to develop and validate the SQA using exploratory and confirmatory factor analyses. Construct validity was assessed through correlations between SQA and negative psychological outcomes as well as by comparing perception of stress among different known groups. DESIGN: A questionnaire-based cross-sectional, correlational, observational study. SETTINGS: The study was conducted between January 2014 and December 2014, throughout different anaesthesia departments in Portuguese hospitals. Data collection was from a representative subset at one specific time point. PARTICIPANTS: A sample of 710 anaesthesia specialists and residents from Portugal. MAIN OUTCOME MEASURES: The primary outcome measure was to identify specific stressors in anaesthesiologists. Secondary outcome was the association between stressors and burnout, depression symptoms, anxiety, stress, rumination, satisfaction with life and functional impairment. RESULTS: The exploratory analysis showed the SQA is a tri-dimensional instrument and confirmatory analysis showed the tri-dimensional structure presented good model fit. The three dimensions of SQA correlated positively with other stress measures and burnout, but negatively with satisfaction with life. CONCLUSION: SQA is a well adjusted measure for assessing stressors in anaesthesia physicians and includes clinical, organisational and team stress factors. Results showed that the SQA is a robust and reliable instrument.info:eu-repo/semantics/publishedVersio

Do sound waves transport the AGN energy in the Perseus cluster?

The level of random motions in the intracluster gas lying between 20 and 60 kpc radius in the core of the Perseus cluster has been measured by the Hitomi Soft X-ray Spectrometer (SXS) at 164 ± 10 km s$^{−1}$ . The maximum energy density in turbulent motions on that scale is therefore low. If dissipated as heat, the turbulent energy will be radiated away in less than 80 Myr and cannot spread across the core. A higher velocity is needed to prevent a cooling collapse. Gravity waves are shown to travel too slowly in a radial direction. Here we investigate propagation of energy by sound waves. The energy travels at ~1000 km s$^{−1}$ and can cross the core in a cooling time. We show that the displacement velocity amplitude of the gas required to carry the power is consistent with the Hitomi result and that the inferred density and temperature variations are consistent with $\textit{Chandra}$ observations.ACF, CP, CSR and HRR thank the Hitomi collaboration for the opportunity to participate in the analysis of the SXS data. ACF, CP, HRR and SAW acknowledge support from ERC Advanced Grant FEEDBACK, 340442

Cisatracurium – A “Safe” Neuromuscular Blocking Agent?

Os agentes anestésicos representam uma causa importante de anafilaxia a fármacos, sendo os relaxantes neuromusculares (RNM) dos principais responsáveis pelos casos de anafilaxia perioperatória. O cisatracúrio é o RNM mais recente, sendo um estereoisómero do atracúrio que se acreditava não ter potencial de libertação de histamina e, consequentemente, causar menos reações alérgicas do que os outros RNM. No entanto, têm sido relatados vários casos de reação anafilática grave após administração de cisatracúrio, não existindo, do nosso conhecimento, registo na literatura de nenhum em Portugal. As autoras apresentam dois casos de anafilaxia perioperatória grave (grau 4 na escala de Ring & Messmer) com paragem cardiorrespiratória. Na investigação alergológica foram realizados testes cutâneos, cujos intradérmicos se revelaram positivos para o cisatracúrio (1:100) em ambos os doentes. É importante alertar que este RNM não será tão desprovido de potencial alergénico como previamente pensado e esse facto deve ser considerado na investigação de uma reação alérgica que ocorra durante a indução anestésica.info:eu-repo/semantics/publishedVersio

AGN feedback in the Phoenix cluster

Active galactic nuclei (AGN) release a huge amount of energy into the intracluster medium (ICM) with the consequence of offsetting cooling and star formation (AGN feedback) in the centers of cool core clusters. The Phoenix cluster is among the most massive clusters of galaxies known in the Universe. It hosts a powerful starburst of several hundreds of Solar masses per year and a large amount of molecular gas in the center. In this work we use the high-resolution Reflection Grating Spectrometer (RGS) on board XMM-Newton to study the X-ray emitting cool gas in the Phoenix cluster and heating-cooling balance. We detect for the first time evidence of O VIII and Fe XXI-XXII emission lines, the latter demonstrating the presence of gas below 2 keV. We find a cooling rate of 350 (-200,+250) Msun/year below 2 keV (at the 90% confidence level), which is consistent with the star formation rate in this object. This cooling rate is high enough to produce the molecular gas found in the filaments via instabilities during the buoyant rising time. The line broadening indicates that the turbulence (~ 300 km/s or less) is below the level required to produce and propagate the heat throughout the cool core. This provides a natural explanation to the coexistence of large amounts of cool gas, star formation and a powerful AGN in the core. The AGN activity may be either at a young stage or in a different feedback mode, due to a high accretion rate

Advanced load-shift system: an experimental validation of the ac-dc converter as shunt active power filter

This paper presents a load-shift system with advanced functionalities to interface the power grid (PG). When compared with the conventional approach, an advanced load-shift system (aLSS) permits the compensation of power quality (PQ) problems for the grid-side, namely problems related to current harmonics, current imbalance, and power factor. The proposed aLSS is composed by a bidirectional ac-dc converter to interface the PG and by a bidirectional dc-dc converter to interface an energy storage system (ESS). Since the main innovation is related with the PG interface, the focus of this work is on the analysis of the ac-dc converter, which is based on a three-phase four-leg converter. A theoretical study and the details concerning the control algorithm are presented and discussed along the paper. A laboratory prototype of the proposed aLSS was developed and the details of implementation are described in the paper. Experimental results obtained with the developed prototype prove that the aLSS contributes for the technology progress in this area, validating a new concept of operation concerning the PQ on the PG side.This work has been supported by FCT – Fundação para a Ciência e Tecnologia with-in the Project Scope: UID/CEC/00319/2019. This work has been supported by the FCT Project QUALITY4POWER PTDC/EEI-EEE/28813/2017, and by the FCT Project newERA4GRIDs PTDC/EEI-EEE/30283/2017

Improved measurements of turbulence in the hot gaseous atmospheres of nearby giant elliptical galaxies

We present significantly improved measurements of turbulent velocities in the hot gaseous haloes of nearby giant elliptical galaxies. Using deep XMM-Newton Reflection Grating Spectrometer (RGS) observations and a combination of resonance scattering and direct line broadening methods, we obtain well bounded constraints for 13 galaxies. Assuming that the turbulence is isotropic, we obtain a best-fitting mean 1D turbulent velocity of similar to 110 km s(-1). This implies a typical 3D Mach number similar to 0.45 and a typical non-thermal pressure contribution of similar to 6 per cent in the cores of nearby massive galaxies. The intrinsic scatter around these values is modest-consistent with zero, albeit with large statistical uncertainty-hinting at a common and quasi-continuous mechanism sourcing the velocity structure in these objects. Using conservative estimates of the spatial scales associated with the observed turbulent motions, we find that turbulent heating can be sufficient to offset radiative cooling in the inner regions of these galaxies (< 10 kpc, typically 2-3 kpc). The full potential of our analysis methods will be enabled by future X-ray micro-calorimeter observations

HST imaging of the dusty filaments and nucleus swirl in NGC4696 at the centre of the Centaurus Cluster

Narrow-band HST imaging has resolved the detailed internal structure of the 10 kpc diameter H alpha+[NII] emission line nebulosity in NGC4696, the central galaxy in the nearby Centaurus cluster, showing that the dusty, molecular, filaments have a width of about 60pc. Optical morphology and velocity measurements indicate that the filaments are dragged out by the bubbling action of the radio source as part of the AGN feedback cycle. Using the drag force we find that the magnetic field in the filaments is in approximate pressure equipartition with the hot gas. The filamentary nature of the cold gas continues inward, swirling around and within the Bondi accretion radius of the central black hole, revealing the magnetic nature of the gas flows in massive elliptical galaxies. HST imaging resolves the magnetic, dusty, molecular filaments at the centre of the Centaurus cluster to a swirl around and within the Bondi radius.This is the accepted manuscript. It is currently embargoed pending publication

EXAME DE PAPANICOLAOU: FATORES QUE INFLUENCIAM AS MULHERES A NÃO RECEBEREM O RESULTADO

The increase in providing services, prevention and treatment of cancer in the uterine neck will be limited in their application, if women do not return to receive the result of the Papanicoulau exam. Not receiving the citopathological reports means discontinued treatment, which impedes efficient therapy for detected lesions. The objective of this study is to identify the reasons that cause women not to receive the results of the preventative exams. The study was carried out with women that had their prevented exam from the year 2005 through June 2006, and did not return to receive the result. A total of 29 women collaborated in the investigation. Factors that made it difficult to receive the results of the Papanicolau exam, according to the interviewed women range from questions related to the organization of the institution to questions related to the individual woman. However, the questions related to the institution represent a percentage much higher (27.3%) in comparison with other questions. From factors that affect women not receiving the results, professionals can intervene in the hospital visit and emphasize the importance of obtaining the result and having regular follow-ups.El aumento en la prestaci&oacute;n de servicios, prevenci&oacute;n y tratamiento de casos de c&aacute;ncer de cuello de &uacute;tero tendr&aacute; limitado su &aacute;mbito de aplicaci&oacute;n, si las mujeres no vuelven para recibir el resultado del examen de Papanicolaou. La no recepci&oacute;n de los informes citopatol&oacute;gicos acarrea discontinuidad del tratamiento, lo que impide terapias eficaces para las lesiones detectadas. Este estudio tiene como objetivo identificar las razones que llevan a las mujeres a no recibir los resultados de los ex&aacute;menes de prevenci&oacute;n. La encuesta se realiz&oacute; con mujeres que han realizado su examen de prevenci&oacute;n en el a&ntilde;o 2005 hasta junio de 2006 y no volvieron para recibir el resultado. Un total de 29 mujeres colaboraron en la investigaci&oacute;n. Los factores dificultadores para recibir el resultado del examen de Papanicoloau, seg&uacute;n las mujeres entrevistadas, van desde cuestiones relacionadas con la organizaci&oacute;n de la instituci&oacute;n a cuestiones relacionadas con la propia mujer. Sin embargo, las cuestiones relacionadas con la instituci&oacute;n representan un porcentaje mucho mayor (27,3%) en comparaci&oacute;n con las dem&aacute;s. A partir de los factores que influyen en las mujeres a no recibir los informes, los profesionales podr&aacute;n intervenir en la consulta haciendo hincapi&eacute; en la importancia de recibir el resultado y tener un seguimiento regular.O incremento na oferta de servi&ccedil;os, na preven&ccedil;&atilde;o e tratamento dos casos de c&acirc;ncer de colo uterino ter&aacute; seu alcance limitado, se as mulheres n&atilde;o retornarem para receber o resultado do exame de Papanicolaou. O n&atilde;o recebimento dos laudos citopatol&oacute;gicos acarreta descontinuidade do tratamento, impedindo a&ccedil;&otilde;es terap&ecirc;uticas eficazes para as les&otilde;es detectadas. Este estudo teve como objetivo identificar os motivos que levam as mulheres a n&atilde;o receberem os resultados dos exames de preven&ccedil;&atilde;o. A pesquisa foi realizada com mulheres que fizeram seu exame de preven&ccedil;&atilde;o no ano de 2005 at&eacute; junho de 2006 e n&atilde;o retornaram para receber o resultado. Um total de 29 mulheres colaboraram com a pesquisa. Os fatores dificultadores para o recebimento do resultado do exame de Papanicoloau, segundo as mulheres entrevistadas, perpassam desde quest&otilde;es ligadas &agrave; organiza&ccedil;&atilde;o da institui&ccedil;&atilde;o at&eacute; quest&otilde;es ligadas &agrave; pr&oacute;pria mulher. Todavia, as quest&otilde;es ligadas &agrave; institui&ccedil;&atilde;o representaram uma parcela bem maior (27,3%) quando comparada &agrave;s demais. A partir dos fatores que influenciam as mulheres a n&atilde;o receberem os laudos, os profissionais poder&atilde;o intervir durante a consulta enfatizando a import&acirc;ncia de receber o resultado e ter um seguimento regula