Reciprocal relationship between left ventricular filling pressure and the recruitable human coronary collateral circulation

AIMS The aim of our study in patients with coronary artery disease (CAD) and present, or absent, myocardial ischaemia during coronary occlusion was to test whether (i) left ventricular (LV) filling pressure is influenced by the collateral circulation and, on the other hand, that (ii) its resistance to flow is directly associated with LV filling pressure. METHODS AND RESULTS In 50 patients with CAD, the following parameters were obtained before and during a 60 s balloon occlusion: LV, aortic (Pao) and coronary pressure (Poccl), flow velocity (Voccl), central venous pressure (CVP), and coronary flow velocity after coronary angioplasty (V(Ø-occl)). The following variables were determined and analysed at 10 s intervals during occlusion, and at 60 s of occlusion: LV end-diastolic pressure (LVEDP), velocity-derived (CFIv) and pressure-derived collateral flow index (CFIp), coronary collateral (Rcoll), and peripheral resistance index to flow (Rperiph). Patients with ECG signs of ischaemia during coronary occlusion (insufficient collaterals, n = 33) had higher values of LVEDP over the entire course of occlusion than those without ECG signs of ischaemia during occlusion (sufficient collaterals, n = 17). Despite no ischaemia in the latter, there was an increase in LVEDP from 20 to 60 s of occlusion. In patients with insufficient collaterals, CFIv decreased and CFIp increased during occlusion. Beyond an occlusive LVEDP > 27 mmHg, Rcoll and Rperiph increased as a function of LVEDP. CONCLUSION Recruitable collaterals are reciprocally tied to LV filling pressure during occlusion. If poorly developed, they affect it via myocardial ischaemia; if well grown, LV filling pressure still increases gradually during occlusion despite the absence of ischaemia indicating transmission of collateral perfusion pressure to the LV. With low, but not high, collateral flow, resistance to collateral as well as coronary peripheral flow is related to LV filling pressure in the high range.

Trade-offs between voice and silence: a qualitative exploration of oncology staff's decisions to speak up about safety concerns

BACKGROUND Research suggests that "silence", i.e., not voicing safety concerns, is common among health care professionals (HCPs). Speaking up about patient safety is vital to avoid errors reaching the patient and thus to prevent harm and also to improve a culture of teamwork and safety. The aim of our study was to explore factors that affect oncology staff's decision to voice safety concerns or to remain silent and to describe the trade-offs they make. METHODS In a qualitative interview study with 32 doctors and nurses from 7 oncology units we investigated motivations and barriers to speaking up towards co-workers and supervisors. An inductive thematic content analysis framework was applied to the transcripts. Based on the individual experiences of participants, we conceptualize the choice to voice concerns and the trade-offs involved. RESULTS Preventing patients from serious harm constitutes a strong motivation to speaking up but competes with anticipated negative outcomes. Decisions whether and how to voice concerns involved complex considerations and trade-offs. Many respondents reflected on whether the level of risk for a patient "justifies" the costs of speaking up. Various barriers for voicing concerns were reported, e.g., damaging relationships. Contextual factors, such as the presence of patients and co-workers in the alarming situation, affect the likelihood of anticipated negative outcomes. Speaking up to well-known co-workers was described as considerably easier whereas "not knowing the actor well" increases risks and potential costs of speaking up. CONCLUSIONS While doctors and nurses felt strong obligation to prevent errors reaching individual patients, they were not engaged in voicing concerns beyond this immediacy. Our results offer in-depth insight into fears and conditions conducive of silence and voicing and can be used for educational interventions and leader reinforcement.

Rethinking science for sustainable development: Reflexive interaction for a paradigm transformation

If we postulate a need for the transformation of society towards sustainable development, we also need to transform science and overcome the fact/value split that makes it impossible for science to be accountable to society. The orientation of this paradigm transformation in science has been under debate for four decades, generating important theoretical concepts, but they have had limited impact until now. This is due to a contradictory normative science policy framing that science has difficulties dealing with, not least of all because the dominant framing creates a lock-in. We postulate that in addition to introducing transdisciplinarity, science needs to strive for integration of the normative aspect of sustainable development at the meta-level. This requires a strategically managed niche within which scholars and practitioners from many different disciplines can engage in a long-term common learning process, in order to become a “thought collective” (Fleck) capable of initiating the paradigm transformation. Arguing with Piaget that “decentration” is essential to achieve normative orientation and coherence in a learning collective, we introduce a learning approach—Cohn's “Theme-Centred Interaction”—which provides a methodology for explicitly working with the objectivity and subjectivity of statements and positions in a “real-world” context, and for consciously integrating concerns of individuals in their interdependence with the world. This should enable a thought collective to address the epistemological and ethical barriers to science for sustainable development.

Diminishing reciprocal fairness by disrupting the right prefrontal cortex.

Humans restrain self-interest with moral and social values. They are the only species known to exhibit reciprocal fairness, which implies the punishment of other individuals' unfair behaviors, even if it hurts the punisher's economic self-interest. Reciprocal fairness has been demonstrated in the Ultimatum Game, where players often reject their bargaining partner's unfair offers. Despite progress in recent years, however, little is known about how the human brain limits the impact of selfish motives and implements fair behavior. Here we show that disruption of the right, but not the left, dorsolateral prefrontal cortex (DLPFC) by low-frequency repetitive transcranial magnetic stimulation substantially reduces subjects' willingness to reject their partners' intentionally unfair offers, which suggests that subjects are less able to resist the economic temptation to accept these offers. Importantly, however, subjects still judge such offers as very unfair, which indicates that the right DLPFC plays a key role in the implementation of fairness-related behaviors.

Reciprocal Relationships between Leader–Member Exchange (LMX) and Job Satisfaction: A Cross‐Lagged Analysis

While previous research has mainly emphasised the importance of leader–member exchange (LMX) to job satisfaction, there is a lack of research on reciprocal relationships between job satisfaction and LMX. In this study, we not only suggest that good LMX increases job satisfaction, but that job satisfaction can also enhance high-quality supervisor–employee relationships. A full cross-lagged panel analysis was used to test reciprocal relationships between LMX and job satisfaction. Employees (N= 279) of a large information technology company filled out questionnaires at two times, with a time lag of 3 months. In line with our predictions, findings revealed a positive relationship between LMX and job satisfaction both at Time 1 and Time 2. Moreover, LMX at Time 1 predicted the increase of job satisfaction at Time 2, and job satisfaction at Time 1 predicted the increase of LMX at Time 2. The results demonstrate the need to consider reciprocal relationships between job satisfaction and LMX when explaining employees' workplace outcomes. Our findings are discussed in terms of positive psychology theory.