Characterization of Burnout and Interpersonal Relationships : Overall and Age-stratified Analyses of Nurses Working in Palliative Care Units

The purpose of this study is to determine the relationship among the control of self-expression activities, patterns of interpersonal attitudes and burnout. A mail survey questionnaire was distributed to nurses working at 76 different palliative care units (N=782). The questionnaire consists of 5 scales: Japanese version the Maslach Burnout Inventory (MBI), self-Monitoring Scale, Other-consciousness Scale. Emotional Empathy Scale, and Internal Working Model Scale. Overall, nurse with higher scores on the MBI were likely to be more unstable interpersonal relationships, more concerned about the outward appearance of others, more susceptible to emotion. This tendency was stronger among young and less experienced nurses who lived alone.自己表出行動の操作や対人態度の傾向が、バーンアウトとどのように関係しているのかを明らかにすることを目的に、全国の緩和ケア病棟に勤務する看護師を対象に郵送による質問紙調査を行った。質問紙には日本語版バーンアウト尺度、セルフ・モニタリング尺度、他者意識尺度、情動的共感性尺度、内的作業モデル尺度の5つの尺度を使用した。 対象全体では、バーンアウト得点が高いとより不安定な対人関係を示し、他者への意識がその人の外面に向きやすく感情的な影響も受けやすいこと、年齢・看護師経験が低く同居をしていない割合が高いことが示された。20歳代・30歳代・40歳代の年代別分析では、年代が異なってもバーンアウト得点の高いほうが社交性が乏しく、内的作業モデルの表象は安定したものではなく、共感時には暖かい反応が乏しくより冷淡であるという示唆が得られた。しかしバーンアウトに陥っている群の中では、バーンア ウトの程度ではなく年代によって自己表出行動の操作や対人態度の傾向がそれぞれ異なっており、他の年代と比べて特に20歳代に違いがみられた

In Vitro Synthesis of Branchless Linear (1 → 6)-α-d-Glucan by Glucosyltransferase K: Mechanical and Swelling Properties of Its Hydrogels Crosslinked with Diglycidyl Ethers

A hydrogel was prepared from a polysaccharide, enzymatically synthesized through a one-pot reaction in aqueous solution, and its properties as a functional material were evaluated. Enzymatic synthesis using glucosyltransferase K obtained from Streptococcus salivarius ATCC 25975 was performed with sucrose as a substrate. The synthetic product was unbranched linear (1 → 6)-α-d-glucan with a high molecular weight, Mw: 1.0–3.0 × 105. The synthesized (1 → 6)-α-d-glucan was insoluble in water and crystallized in a monoclinic unit cell, which is consistent with the hydrated form of dextran. Transparent and highly swellable (1 → 6)-α-d-glucan hydrogels were obtained by crosslinking with diglycidyl ethers. The hydrogels showed no syneresis and no volume change during compression, resulting in the retention of shape under repeated compression. The elastic moduli of these hydrogels (<60 kPa) are smaller than those of other polysaccharide-based hydrogels having the same solid contents. The oven-dried gels could be restored to the hydrogel state with the original transparency and a recovery ratio greater than 98%. The mechanism of water diffusion into the hydrogel was investigated using the kinetic equation of Peppas. The properties of the hydrogel are impressive relative to those of other polysaccharide-based hydrogels, suggesting its potential as a functional biomaterial

Scattered X-rays in Obscured Active Galactic Nuclei and their Implications for Geometrical Structure and Evolution

We construct a new sample of 32 obscured active galactic nuclei (AGNs) selected from the Second XMM-Newton Serendipitous Source Catalogue to investigate their multiwavelength properties in relation to the "scattering fraction", the ratio of the soft X-ray flux to the absorption-corrected direct emission. The sample covers a broad range of the scattering fraction (0.1%-10%). A quarter of the 32 AGNs have a very low scattering fraction (smaller than 0.5%), which suggests that they are buried in a geometrically thick torus with a very small opening angle. We investigate correlations between the scattering fraction and multiwavelength properties. We find that AGNs with a small scattering fraction tend to have low [O III]lambda5007/X-ray luminosity ratios. This result agrees with the expectation that the extent of the narrow-line region is small because of the small opening angle of the torus. There is no significant correlation between scattering fraction and far-infrared luminosity. This implies that a scale height of the torus is not primarily determined by starburst activity. We also compare scattering fraction with black hole mass or Eddington ratio and find a weak anti-correlation between the Eddington ratio and scattering fraction. This implies that more rapidly growing supermassive black holes tend to have thicker tori.Comment: 13 pages, 10 figures, accepted for publication in Ap

Wrist-Worn Electrodermal Activity as a Novel Neurophysiological Biomarker of Autonomic Symptoms in Spatial Disorientation

Background: Spatial disorientation is one of the most frequent causes of aircraft accidents, and is thus a major problem affecting air safety. Although a number of studies have examined spatial disorientation, the precise physiological changes occurring as a direct result of spatial disorientation and motion sickness remain unclear. The present study sought to investigate electrodermal activity (EDA) and subjective autonomic symptoms during spatial disorientation training, and to develop an indicator of physiological changes for pilot candidates.Methods: In the current study, we investigated changes in EDA measured using a wrist-worn device, and subjective autonomic nervous system symptoms during spatial disorientation training for pilot candidates. We then used the Graybiel diagnostic criteria to develop a novel physiological biomarker.Results: We found that maximum EDA change and peak amplitude were significantly increased in participants with a Graybiel score of ≥3 points compared with those who scored &lt; 2 points. Furthermore, for symptoms of cold sweating and saliva secretion (from the seven Graybiel diagnostic criteria), the maximum EDA change in participants with scores ≥1 point was significantly higher than that of participants scoring 0 points.Conclusion: Our results indicate that EDA data measured with a wrist-worn device could provide a useful method for objective evaluation of the severity of spatial disorientation and motion sickness

How do we manage the gastrectomy for gastric cancer after coronary artery bypass grafting using the right gastroepiploic artery? Report of two cases and a review of the literature

<p>Abstract</p> <p>Background</p> <p>Recently, the right gastroepiploic artery (RGEA) has been used in coronary artery bypass grafting (CABG) as an alternative arterial graft. Unfortunately, an increased incidence of gastric cancers has been reported after CABG using the RGEA. Handling of the RGEA during gastrectomy in these patients may cause lethal complications, which sometimes reduces the feasibility of curative dissection of lymph nodes at the base of the graft.</p> <p>Case presentations</p> <p>We describe two cases of gastric cancer undergoing gastrectomy after CABG with the use of RGEA. To avoid the potentially fatal coronary event during gastrectomy, safe handling of the conduit including preparations for injuries and prevention of vessel spasm was performed in both cases, accompanied by an adequate monitoring of the systemic circulation. Intraoperative frozen section examination showed no lymph node metastasis around the graft in any of the cases; therefore, complete lymph node dissection at the base of the graft was not undertaken. No complications occurred during the operation. In addition to these two cases, twenty-four cases reported in the literatures were reviewed (a total of 26 cases). Ten early and 16 advanced gastric cancers were included. Among the 16 advanced gastric cancer cases, an alternative graft was employed in 8 due to the resection of an original graft to complete lymph node dissection. Mere handling of a graft often caused lethal complications suggesting that the operation should be completed by isolation of the graft. A pedicled graft harvesting via the ante-gastric route was popular. However, a skeletonized harvesting with resection of the pyloric branches of the RGEA would be better because this would interrupt the original lymph flow, which could eliminate the need for lymph node dissection and graft isolation. Among the 10 cases having early gastric cancers, 6 were found within 1.5 years after CABG. Early detection in these 6 cases was possible due to the use of gastric fiberscopic examination before and after CABG, which gave them opportunities to receive a less extensive operation such as endoscopic mucosal resection.</p> <p>Conclusion</p> <p>Adequate intraoperative care as well as an optimal lymph node dissection considering the graft harvesting method at the first CABG leads to successful gastrectomy after CABG using the RGEA graft. Therefore, this operation should be carried out with careful management by both gastrointestinal and cardiovascular surgeons.</p

Protogenin, a new member of the immunoglobulin superfamily, is implicated in the development of the mouse lower first molar

<p>Abstract</p> <p>Background</p> <p><it>Protogenin (Prtg) </it>has been identified as a gene which is highly expressed in the mouse mandible at embryonic day 10.5 (E10.5) by a cDNA subtraction method between mandibles at E10.5 and E12.0. Prtg is a new member of the deleted in colorectal carcinoma (DCC) family, which is composed of DCC, Neogenin, Punc and Nope. Although these members play an important role in the development of the embryonic central nervous system, recent research has also shed on the non-neuronal organization. However, very little is known regarding the fetal requirement of the non-neuronal organization for Prtg and how this may be associated with the tooth germ development. This study examined the functional implications of Prtg in the developing tooth germ of the mouse lower first molar.</p> <p>Results</p> <p>Ptrg is preferentially expressed in the early stage of organogenesis. Prtg mRNA and protein were widely expressed in the mesenchymal cells in the mandible at E10.5. The oral epithelial cells were also positive for Prtg. The expression intensity of Prtg after E12.0 was markedly reduced in the mesenchymal cells of the mandible, and was restricted to the area where the tooth bud was likely to be formed. Signals were also observed in the epithelial cells of the tooth germ. Weak signals were observed in the inner enamel epithelial cells at E16.0 and E18.0. An inhibition assay using a hemagglutinating virus of Japan-liposome containing <it>Prtg </it>antisense-phosphorothioated-oligodeoxynucleotide (AS-S-ODN) in cultured mandibles at E10.5 showed a significant growth inhibition in the tooth germ. The relationship between Prtg and the odontogenesis-related genes was examined in mouse E10.5 mandible, and we verified that the Bmp-4 expression had significantly been decreased in the mouse E10.5 mandible 24 hr after treatment with Prtg AS-S-ODN.</p> <p>Conclusion</p> <p>These results indicated that the <it>Prtg </it>might be related to the initial morphogenesis of the tooth germ leading to the differentiation of the inner enamel epithelial cells in the mouse lower first molar. A better understanding of the Prtg function might thus play a critical role in revealing a precious mechanism in tooth germ development.</p

Classification of Imbalanced Data Represented as Binary Features

Typically, classification is conducted on a dataset that consists of numerical features and target classes. For instance, a grayscale image, which is usually represented as a matrix of integers varying from 0 to 255, enables one to apply various classification algorithms to image classification tasks. However, datasets represented as binary features cannot use many standard machine learning algorithms optimally, yet their amount is not negligible. On the other hand, oversampling algorithms such as synthetic minority oversampling technique (SMOTE) and its variants are often used if the dataset for classification is imbalanced. However, since SMOTE and its variants synthesize new minority samples based on the original samples, the diversity of the samples synthesized from binary features is highly limited due to the poor representation of original features. To solve this problem, a preprocessing approach is studied. By converting binary features into numerical ones using feature extraction methods, succeeding oversampling methods can fully display their potential in improving the classifiers’ performances. Through comprehensive experiments using benchmark datasets and real medical datasets, it was observed that a converted dataset consisting of numerical features is better for oversampling methods (maximum improvements of accuracy and F1-score were 35.11% and 42.17%, respectively). In addition, it is confirmed that feature extraction and oversampling synergistically contribute to the improvement of classification performance

The Educational Effect of Jigsaw Method for Pediatric Nursing Skill

application/pdfWe incorporate the jigsaw method which is one of the cooperative learnings after partial study into instructive means of pediatric nursing skill. And we investigate the effect of education to confirm the condition of the acquirement and the attainment of the purpose of cooperative learning referring to the self estimation of 73students （2nd grade nursing course of A university）. The rate of the answer that they could not learn the skills by jigsaw method is low, 14% taking medicine ,6% enema, 3% suction, 10% hypodermic injection. 90% of the students answered that they could learn the techniques by partial study, and 71% of them could learn from other members. So, we think the jigsaw method is adequate as the way to acquire the techniques. Jigsaw method is one of teaching-learning ways to learn the process composing safety and comfortable techniques by the cooperation between students and teachers using useful informations, and students answered that they could exchange their opinions between students（95%), between teachers and students（75%), however it needs more time than the former that is taken initiative by teachers、and the efficiency is not so good.小児看護技術の教育方法に、分担学習後に教え合う協同学習の１つであるジグソー学習法を組み入れた。その結果をA大学看護学科2年次生73人（92％）の自己評価から、技術の習得状況と協同学習の目的達成度を明らかにし、教育効果を検討した。ジグソー学習法で「習得できなかった技術」と回答した割合は、内服14%、注腸6 %、吸引3 %、皮下注射10％と少ない。分担学習で担当した技術は90％の学生が「習得できたと思う・ややそう思う」と回答し、同様にメンバーの担当した3 項目も71％と多いことから、技術の習得方法として適している。ジグソー学習法は従来の教員主導型より授業時間数を要し、効率は悪いが、「意見交換できたと思う・ややそう思う」が学生間で95％、教員と学生間で75％と多く、有用な情報を相互に利用し、学生間と教員の協力により安全で安楽な技術を構築するプロセスを学ぶ教授－学習方法の1つである。departmental bulletin pape

Development and validation of the Japanese version of the secondary traumatic stress for nursing staff

This study’s aim was to develop a scale to measure secondary traumatic stress for nursing staff,and to examine its reliability and validity. A mailed questionnaire survey was carried out twice. Survey 1 was distributed to five hundred fifty six nurses from three polyclinic hospitals in the “A” prefecture, with a valid response rate of 60.8%. Survey 2 included 996 nursing staff from 21 general hospitals nationwide, with a valid response rate of 72.2%. 　Following analysis of the survey data, a 20-item scale was developed, with three factors, “anxiety and reduced intentionality,” “post-traumatic stress reactions,” and “negative emotional reactions.” The internal consistency and reliability of the scale was analyzed using exploratory factor, reliability, cross-correlation, and item score-total score correlation. Concurrent validity of the scale was examined by correlation analysis with the General Health Questionnaire (GHQ-28) and Japanese version of the Burnout Scale; construct validity was also verified by examining differences in the scale scores by the group, which was selected based on the level of sympathy for patients and duration of care provided. Final confirmatory factor analysis indicated fit indices of CFI = .914 and RMSEA = .092, which met a degree of criteria as the scale. Thus, the Secondary Traumatic Stress Scale for nursing staff exhibited a degree of reliability and validity.看護職者の二次的外傷性ストレスの測定尺度を作成し、その信頼性・妥当性の検討することを目的に、託送調査法による２度の質問紙調査を実施した。調査１は尺度の作成のために、Ａ県内３ヶ所の総合病院に勤務する看護職者556名を対象とし、内的整合性および信頼性、並存的妥当性の検討を経て、「不安・志向性の低下」「外傷後のストレス反応」「否定的な感情反応」の３因子・20項目から成る尺度が作成された。調査２は、作成尺度がより広い地域・対象で使用に耐え得るか検討するために、全国21ヶ所の一般病院に勤務する看護職者996名を対象とした。因子間での質問項目の移動は１項目あったが、因子の変化や削除すべき項目はなく、内的整合性および信頼性、並存的妥当性、構成概念妥当性が確認された。確証的因子分析による適合度指標は、CFI＝.914，RMSEA＝.092であった。以上により、一定の信頼性・妥当性を確保した二次的外傷性ストレス尺度が作成された

Issues related to postmortem measures at medical facilities : Based on a survey on death care industry workers

The objective of the present study was to elucidate issues related to postmortem measures at medical facilities based on the condition of corpses after they leave the hospital and the participation of family members in postmortem measures. A questionnaire survey on problems related to corpses, infection prevention conditions, and other factors was conducted on 680 death care industry workers, and a total of 232 valid responses were analyzed. The results indicated problems such as openings in the body and leakage of body fluids, and suggested the need for medical facilities to perform postmortem measures according to the condition of corpses. Because death care industry workers who believed that family participation led to grief care tended to verbally encourage families to participate in postmortem measures, and because problems such as bleeding and leakage of body fluids led to difficulties in handling among families, a review of postmortem measures, such as storage at lower temperatures of corpses at their medical facility and suturing of the sites where intravenous tubes had been removed, was considered necessary. Families were also given opportunities to participate in postmortem measures after corpses had been released from the hospital. Given that explanations that consider the possibility of infection for families, as with death care industry workers, are required, and that despite a great need, medical personnel provided little information on corpses such as the possibilities of infection and problems, investigation of approaches for cooperation between nurses and death care industry workers was considered necessary.本研究の目的は、退院後の遺体の状況や家族の処置への参加状況から、医療施設での死後の処置の課題を明らかにすることである。葬祭業従事者680名に遺体に関するトラブルや感染予防状況などの質問紙調査を実施し、232名の有効回答を分析した。結果、開口や体液漏れなどのトラブルがみられ、遺体の状況に応じた処置を医療施設から行う必要性が示唆された。葬祭業者の中で家族参加がグリーフケアにつながると考えているほうが参加の声かけを行い、出血や体液漏れなどのトラブルの際には家族の対応が困難になることから、医療施設からの冷却、太い点滴チューブ抜去後の縫合など処置の見直しが求められる。家族は退院後も処置に参加する機会があり、葬祭業者と同様に家族の感染の可能性も考慮した説明が必要である。医療者から感染やトラブルの可能性など遺体に関する情報提供が少なく、そのニーズも高いことから、看護師と葬祭業者間の連携のあり方を検討することが課題である