Burnout in female counsellor/therapists of the NCS

A series of three studies was conducted to investigate burnout in counsellor/therapists working with the National Counselling Service (NSC) in Ireland. The NCS was established specifically to meet the needs of adult survivors of institutional abuse. and providing a service for such clients may be very challenging. In Study I, which included 26 NCS counsellor/therapists over a period of a year, mean levels of depersonalisation, but not emotional exhaustion or personal accomplishment, increased significantly. Only 12% were in the high or clinical range for depersonalisation on the Maslach Burnout Inventory at Time 1, but 34.6% were in the high range a year later at Time II. There was a significant increase over a one year period in the number of therapists reporting that work was having a negative effect on their personal lives. The most stressful aspects of therapeutic work were the content of therapy sessions; feeling isolated and lacking support; and working with highly traumatized clients. The main negative effects of therapeutic work on therapists' lives were emotional exhaustion, sadness, and mood spillover. The main positive effects were admiring the resilience of clients and developing increased humility. In Study II, which involved 35 NCS counsellor/therapists, the impact of therapist, client, organisational, and extra-organisational factors on burnout was examined. The use of image distorting defenses was found to be associated with emotional exhaustion and depersonalisation. The percentage of cases improved was also negatively correlated with depersonalisation. On the positive side, therapist empathy for clients was associated with increased experience of personal accomplishment. Study III was a qualitative focus group investigation involving 8 NCS therapist/counsellors. A thematic content analysis identified three factors associated with spillover. These were the stigma associated to working with survivors of child abuse/neglect; the power of a client's narrative; and challenges to the boundaries of the therapeutic relationship. Three themes were identified concerning methods for managing spillover. These were separating from a client; developing and using personal energy renewal routines; and channelling of work intrusions when at home. Implications for the results of the series of three studies for an ecological model of therapist burnout, and for NCS therapist/counsellor support and supervision were discussed

The role of myocardial membrane proteins and myocardial oedema in postoperative myocardial dysfunction

The vast majority of children undergoing surgical repair of cardiac lesions do spectacularly well. However a significant proportion, ~ 25%, struggle to progress in the early postoperative period and require additional pharmacological and occasionally mechanical circulatory support. All children typically have some degree of postoperative myocardial dysfunction, with the severe spectrum termed the low cardiac output state (LCOS). LCOS is clinically defined as the requirement for new or escalated inotrope therapy, a widened arteriovenous oxygen difference, cardiac arrest or the need for reinstitution of mechanical circulatory support. LCOS is largely responsible for the morbidity and mortality involved in paediatric cardiac surgery. Despite the predictability of LCOS in the initial postoperative hours, the underlying pathophysiology remains unclear. The period of decline in cardiac function that typifies LCOS is temporally associated with the development of oedema in the tissues of the body, including the heart. This relationship between oedema and dysfunction has increasingly become blurred, with a tendency to elevate the temporal association to a causal link. We sought to explore the causes and contributions to myocardial dysfunction in this setting, including the roles of oedema and ischaemia within the heart. In focusing on oedema and ischaemia we also examined the effects of these insults on relevant myocardial membrane proteins, including those that permit rapid water transport – aquaporins (AQPs), and those involved in membrane mechanics – dystrophin, and membrane repair – dysferlin. Experimental settings which enabled the in vitro dissection of these insults and proteins of interest were combined with a clinically accurate in vivo model. This thesis describes a series of thematically linked experiments that examined LCOS, myocardial oedema and the role of various membrane proteins. We performed isolated cardiomyocyte studies, isolated heart studies as well as a clinically relevant large animal (lamb) cardiopulmonary bypass (CPB) model. Across these models we also explored the role of therapeutically protecting myocardial membranes with Poloxamer 188 (P188) and assessed any influence on myocardial function, oedema and membrane proteins. vi The results from these three models suggest that the clinically accepted dogma of a causative link between myocardial oedema and dysfunction overstates the contribution of myocardial oedema to LCOS. We found that ischaemia/reperfusion was of primary importance in causing myocardial dysfunction. Myocardial oedema without ischaemia had a mild and reversible contribution to myocardial dysfunction, but this was minor in comparison to the gross dysfunction attributable to ischaemia. Isolated cardiomyocytes, with induced oedema, functioned well. Whilst ischaemic cardiomyocytes, with less swelling still had severe contractile dysfunction. Isolated hearts, perfused with an oedema inducing crystalloid perfusate developed myocardial oedema and had minimal reversible systolic and diastolic dysfunction. Isolated hearts which experienced global ischaemia had comparable degrees of myocardial oedema, and significantly greater degrees of myocardial dysfunction that increased in severity with increasing duration of ischaemia. In the lamb CPB model, only those lambs which underwent aortic cross clamping and had a period of ischaemia had poor myocardial function. These lambs also had swollen hearts, raised myocardial AQP1 mRNA and reduced membrane dysferlin protein expression. Membrane dystrophin protein expression was not altered, somewhat unexpectedly with CPB with or without ischaemia. Lambs placed on CPB without ischaemia had good myocardial function, minimal oedema and unchanged membrane protein expression during the survival period. In a blinded lamb CPB trial of P188 there were improved haemodynamics and indicies of myocardial function associated with its use. This was also associated with preservation of dysferlin expression and reduced membrane injury. In parallel isolated heart trials of this therapy, there was a reduction in myocardial oedema associated with its use in non-ischaemic experiments. There was also a suggestion of improved diastolic function in ischaemic experiments, but no change in myocardial water content. In conclusion, we have highlighted the primacy of ischaemia/reperfusion over oedema in contributing to LCOS. We have refuted the accepted dogma that myocardial oedema causes significant dysfunction in itself, with important oedema likely to result from ischaemia. We have shown that AQP1 may be involved in the pathogenesis of the capillary leak syndrome. Finally we have hinted at a role for prophylactic P188 in the vii setting of LCOS, possibly highlighting the role of membrane repair in recovery after surgery. Isolated heart trials of P188 further support a non-rheological mechanism of action and also lend support to the causal separation of myocardial oedema and dysfunction. The integral membrane protein dysferlin, rather than dystrophin, is relevant in the setting of LCOS in the current era

Pre-deployment programmes for building resilience in military and frontline emergency service personnel

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the effectiveness of pre-deployment programmes for building resilience in military and front-line emergency service personnel

Synchronous Chip-to-Chip Communication with a Multi-Chip Resonator Clock Distribution Network

Superconducting digital circuits are a promising approach to build packaged-level integrated systems with high energy-efficiency and computational density. In such systems, performance of the data link between chips mounted on a multi-chip module (MCM) is a critical driver of performance. In this work we report a synchronous data link using Reciprocal Quantum Logic (RQL) enabled by resonant clock distribution on the chip and on the MCM carrier. The simple physical link has only four Josephson junctions and 3 fJ/bit dissipation, including a 300 W/W cooling overhead. The driver produces a signal with 35\,GHz analog bandwidth and connects to a single-ended receiver via 20 $\Omega$ Nb Passive Transmission Line (PTL). To validate this link, we have designed, fabricated and tested two 32$\times$32 mm$^2$ MCMs with eight 5$\times$5 mm$^2$ chips connected serially and powered with a meander clock, and with four 10$\times$10 mm$^2$ chips powered with a 2 GHz resonant clock. The meander clock MCM validates performance of the data link components, and achieved 5.4 dB AC bias margin with no degradation relative to individual chip test. The resonator MCM validates synchronization between chips, with a measured AC bias margin up to 4.8 dB between two chips. The resonator MCM is capable of powering circuits of 4 million Josephson junctions across the four chips with a projected 10 Gbps serial data rate.Comment: 8 pages, 8 figure

The Role of Attachment Style, Adverse Childhood Experiences and Dissociation in Migraine

35 pagesMigraine and chronic migraine are caused by a combination of modifiable and non-modifiable genetic, social, behavioral and environmental risk factors. Further research of possible modifiable risk factors for this headache disorder is merited, given its role as one of the leading causes of years lived with disability per year. The first aim of this online cross-sectional study was to investigate the psychosocial risk factors that predicted chronic migraine and severe migraine-related disability in 507 Irish and UK participants, focusing specifically on childhood maltreatment, attachment and tendency to dissociate, or experience depressed mood and/or anxiety. Additionally, this study aimed to examine variables that mediated the relationships between these psychosocial risk factors and migraine chronicity or severe migraine-related disability. Adjusted binary logistic regression revealed that shutdown dissociation (Odds Ratio [OR] 4.57, 95% Confidence Interval [CI] 2.66–7.85) and severe physical abuse (OR 4.30, 95% CI 1.44–12.83 had significant odds of predicting migraine chronicity, while depression (OR 3.28, 95% CI 1.86–5.77) significantly predicted severe migraine-related disability. Mediation analyses indicated that shutdown dissociation mediated the relationship between seven predictor variables and both chronicity and severe disability including possible predisposing factors emotional abuse, physical neglect, avoidant attachment and anxious attachment. These findings suggest that early life stressors (such as childhood trauma and avoidant attachment style), shutdown dissociation and depression may impact on migraine trajectory. To investigate whether these psychosocial factors are risk factors for migraine chronicity or disability, prospective research should be conducted in this area to account for fluctuations in migraine chronicity over time

Two Massive, Low-Luminosity Cores Toward Infrared Dark Clouds

This article presents high-resolution interferometric mosaics in the 850 micron waveband of two massive, quiescent infrared dark clouds. The two clouds were chosen based on their likelihood to represent environments preceding the formation of massive stars. The brightest compact sources detected in each cloud have masses of approximately 110 and 60 solar masses with radii < 0.1 pc, implying mean volume densities of approximately 1 million particles per cubic centimeter and mean column densities of about 1 gram per square centimeter. Supplementary data show these cores to be cold and inactive. Low upper limits to their bolometric luminosities and temperatures place them at a very early stage of evolution while current models of massive star formation suggest they have the potential to form massive stars.Comment: 6 pages, 5 figures. Accepted for publication by the Astrophysical Journa

Quantifying Ca 2+ Current and Permeability in ATP-gated P2X7 Receptors

International audienceATP-gated P2X7 receptors are prominently expressed in inflammatory cells and play a key role in the immune response. A major consequence of receptor activation is the regulated influx of Ca(2+) through the self-contained cation non-selective channel. Although the physiological importance of the resulting rise in intracellular Ca(2+) is universally acknowledged, the biophysics of the Ca(2+) flux responsible for the effects are poorly understood, largely because traditional methods of measuring Ca(2+) permeability are difficult to apply to P2X7 receptors. Here we use an alternative approach, called dye-overload patch-clamp photometry, to quantify the agonist-gated Ca(2+) flux of recombinant P2X7 receptors of dog, guinea pig, human, monkey, mouse, rat, and zebrafish. We find that the magnitude of the Ca(2+) component of the ATP-gated current depends on the species of origin, the splice variant, and the concentration of the purinergic agonist. We also measured a significant contribution of Ca(2+) to the agonist-gated current of the native P2X7Rs of mouse and human immune cells. Our results provide cross-species quantitative measures of the Ca(2+) current of the P2X7 receptor for the first time, and suggest that the cytoplasmic N terminus plays a meaningful role in regulating the flow of Ca(2+) through the channel

Mapping Large-Scale CO Depletion in a Filamentary Infrared Dark Cloud

Infrared Dark Clouds (IRDCs) are cold, high mass surface density and high density structures, likely to be representative of the initial conditions for massive star and star cluster formation. CO emission from IRDCs has the potential to be useful for tracing their dynamics, but may be affected by depleted gas phase abundances due to freeze-out onto dust grains. Here we analyze C18O J=1-0 and J=2-1 emission line data, taken with the IRAM 30m telescope, of the highly filamentary IRDC G035.39.-0033. We derive the excitation temperature as a function of position and velocity, with typical values of ~7K, and thus derive total mass surface densities, Sigma_C18O, assuming standard gas phase abundances and accounting for optical depth in the line, which can reach values of ~1. The mass surface densities reach values of ~0.07 g/cm^2. We compare these results to the mass surface densities derived from mid-infrared (MIR) extinction mapping, Sigma_SMF, by Butler & Tan, which are expected to be insensitive to the dust temperatures in the cloud. With a significance of >10sigma, we find Sigma_C18O/Sigma_SMF decreases by about a factor of 5 as Sigma increases from ~0.02 to ~0.2 g/cm^2, which we interpret as evidence for CO depletion. Several hundred solar masses are being affected, making this one of the most massive clouds in which CO depletion has been observed directly. We present a map of the depletion factor in the filament and discuss implications for the formation of the IRDC.Comment: 9 pages, accepted to ApJ, Mac users: Figure 1 is best viewed with Adobe acroread rather than previe

Chemistry in Infrared Dark Cloud Clumps: a Molecular Line Survey at 3 mm

We have observed 37 Infrared Dark Clouds (IRDCs), containing a total of 159 clumps, in high-density molecular tracers at 3 mm using the 22-meter ATNF Mopra Telescope located in Australia. After determining kinematic distances, we eliminated clumps that are not located in IRDCs and clumps with a separation between them of less than one Mopra beam. Our final sample consists of 92 IRDC clumps. The most commonly detected molecular lines are (detection rates higher than 8%): N2H+, HNC, HN13C, HCO+, H13CO+, HCN, C2H, HC3N, HNCO, and SiO. We investigate the behavior of the different molecular tracers and look for chemical variations as a function of an evolutionary sequence based on Spitzer IRAC and MIPS emission. We find that the molecular tracers behave differently through the evolutionary sequence and some of them can be used to yield useful relative age information. The presence of HNC and N2H+ lines do not depend on the star formation activity. On the other hand, HC3N, HNCO, and SiO are predominantly detected in later stages of evolution. Optical depth calculations show that in IRDC clumps the N2H+ line is optically thin, the C2H line is moderately optically thick, and HNC and HCO+ are optically thick. The HCN hyperfine transitions are blended, and, in addition, show self-absorbed line profiles and extended wing emission. These factors combined prevent the use of HCN hyperfine transitions for the calculation of physical parameters. Total column densities of the different molecules, except C2H, increase with the evolutionary stage of the clumps. Molecular abundances increase with the evolutionary stage for N2H+ and HCO+. The N2H+/HCO+ and N2H+/HNC abudance ratios act as chemical clocks, increasing with the evolution of the clumps.Comment: Accepted to ApJ. 29 page

The Bolocam Galactic Plane Survey: Survey Description and Data Reduction

We present the Bolocam Galactic Plane Survey (BGPS), a 1.1 mm continuum survey at 33" effective resolution of 170 square degrees of the Galactic Plane visible from the northern hemisphere. The survey is contiguous over the range -10.5 < l < 90.5, |b| < 0.5 and encompasses 133 square degrees, including some extended regions |b| < 1.5. In addition to the contiguous region, four targeted regions in the outer Galaxy were observed: IC1396, a region towards the Perseus Arm, W3/4/5, and Gem OB1. The BGPS has detected approximately 8400 clumps over the entire area to a limiting non-uniform 1-sigma noise level in the range 11 to 53 mJy/beam in the inner Galaxy. The BGPS source catalog is presented in a companion paper (Rosolowsky et al. 2010). This paper details the survey observations and data reduction methods for the images. We discuss in detail the determination of astrometric and flux density calibration uncertainties and compare our results to the literature. Data processing algorithms that separate astronomical signals from time-variable atmospheric fluctuations in the data time-stream are presented. These algorithms reproduce the structure of the astronomical sky over a limited range of angular scales and produce artifacts in the vicinity of bright sources. Based on simulations, we find that extended emission on scales larger than about 5.9' is nearly completely attenuated (> 90%) and the linear scale at which the attenuation reaches 50% is 3.8'. Comparison with other millimeter-wave data sets implies a possible systematic offset in flux calibration, for which no cause has been discovered. This presentation serves as a companion and guide to the public data release through NASA's Infrared Processing and Analysis Center (IPAC) Infrared Science Archive (IRSA). New data releases will be provided through IPAC IRSA with any future improvements in the reduction.Comment: Accepted for publication in Astrophysical Journal Supplemen