The burnout syndrome among nurses in an urban acute care hospital

Three hundred fifty-four registered nurses from an urban acute care hospital were examined through self-report questionnaires. Nurses from trauma care, critical care and non-critical care nursing specialties participated in the study. The study focuses were (1) whether sociodemographic characteristics were significantly related to burnout; (2) what was the prevalence estimate of burnout among the population; (3) whether burnout levels differed depending upon nursing specialties and; (4) whether burnout as related to nursing stress, work environment, and work relations was mediated by sociodemographic characteristics.^ Race, age, marital status, education, seniority, rank, nursing education, and birthplace were significantly related to one or more aspects of burnout in the total population. With emotional exhaustion alone the prevalence of burnout was 62%. Using emotional exhaustion and depersonalization combined with reduced sense of personal accomplishment as a measure of burnout, thirty-four percent of the nurses were either in the pre-burnout phase or burned out. The relative importance of sociodemographic characteristics indicated that experience and race were highly significant risk factors.^ Burnout levels differed significantly depending upon nursing specialty. Specifically, levels of emotional exhaustion and depersonalization differed significantly between trauma care and critical care, and trauma care and non-critical care. Personal accomplishment did not differ depending upon nursing specialty. Critical care nurses did not differ significantly from non-critical care nurses on aspect of burnout.^ Race, marital status, education, seniority and rank were significant mediators of emotional exhaustion and depersonalization. The study offers possible explanations for the mediating effect of sociodemographic characteristics on nursing stress, work environment, work relations, emotional exhaustion and depersonalization. ^

Thermal Convection in Ice Sheets: We Look But Do Not See

Thermal convection in the Antarctic and Greenland ice sheets has been dismissed on the grounds that radio-echo stratigraphy is undisturbed for long distances. However, the undisturbed stratigraphy lies, for the most part, above the density inversion in polar ice sheets and therefore does not disprove convection. An echo-free zone is widespread below the density inversion, yet nobody has cited this as a strong indication that convection is indeed present at d�pth. A generalized Rayleigh criterion for thermal convection in e1astic-viscoplastic polycrystalline solids heated from below is developed and applied to ice-sheet convection. An infinite Rayleigh number at the onset of primary creep decreases with time and becomes constant when secondary creep dominates, suggesting that any thermal buoyancy stress can initiate convection but convection cannot be sustained below a buoyancy stress of about 3 kPa. An analysis of the temperature profile down the Byrd Station core hole suggests that about 1000 m of ice below the density inversion will sustain convection. Creep along the Byrd Station strain network, radar sounding in East Antarctica, and seismic sounding in West Antarctica are examined for evidence of convective creep superimposed on advective creep. It is concluded that the evidence for convection is there, if we look for it with the intention offinding it.

Effects of acupuncture on sensory perception: a systematic review and meta-analysis.

BACKGROUND The effect of acupuncture on sensory perception has never been systematically reviewed; although, studies on acupuncture mechanisms are frequently based on the idea that changes in sensory thresholds reflect its effect on the nervous system. METHODS Pubmed, EMBASE and Scopus were screened for studies investigating the effect of acupuncture on thermal or mechanical detection or pain thresholds in humans published in English or German. A meta-analysis of high quality studies was performed. RESULTS Out of 3007 identified articles 85 were included. Sixty five studies showed that acupuncture affects at least one sensory threshold. Most studies assessed the pressure pain threshold of which 80% reported an increase after acupuncture. Significant short- and long-term effects on the pressure pain threshold in pain patients were revealed by two meta-analyses including four and two high quality studies, respectively. In over 60% of studies, acupuncture reduced sensitivity to noxious thermal stimuli, but measuring methods might influence results. Few but consistent data indicate that acupuncture reduces pin-prick like pain but not mechanical detection. Results on thermal detection are heterogeneous. Sensory threshold changes were equally frequent reported after manual acupuncture as after electroacupuncture. Among 48 sham-controlled studies, 25 showed stronger effects on sensory thresholds through verum than through sham acupuncture, but in 9 studies significant threshold changes were also observed after sham acupuncture. Overall, there is a lack of high quality acupuncture studies applying comprehensive assessments of sensory perception. CONCLUSIONS Our findings indicate that acupuncture affects sensory perception. Results are most compelling for the pressure pain threshold, especially in pain conditions associated with tenderness. Sham acupuncture can also cause such effects. Future studies should incorporate comprehensive, standardized assessments of sensory profiles in order to fully characterize its effect on sensory perception and to explore the predictive value of sensory profiles for the effectiveness of acupuncture.

Retrieving the paleoclimatic signal from the deeper part of the EPICA Dome C ice core

An important share of paleoclimatic information is buried within the lowermost layers of deep ice cores. Because improving our records further back in time is one of the main challenges in the near future, it is essential to judge how deep these records remain unaltered, since the proximity of the bedrock is likely to interfere both with the recorded temporal sequence and the ice properties. In this paper, we present a multiparametric study (δD-δ18Oice, δ18Oatm, total air content, CO2, CH4, N2O, dust, high-resolution chemistry, ice texture) of the bottom 60 m of the EPICA (European Project for Ice Coring in Antarctica) Dome C ice core from central Antarctica. These bottom layers were subdivided into two distinct facies: the lower 12 m showing visible solid inclusions (basal dispersed ice facies) and the upper 48 m, which we will refer to as the "basal clean ice facies". Some of the data are consistent with a pristine paleoclimatic signal, others show clear anomalies. It is demonstrated that neither large-scale bottom refreezing of subglacial water, nor mixing (be it internal or with a local basal end term from a previous/initial ice sheet configuration) can explain the observed bottom-ice properties. We focus on the high-resolution chemical profiles and on the available remote sensing data on the subglacial topography of the site to propose a mechanism by which relative stretching of the bottom-ice sheet layers is made possible, due to the progressively confining effect of subglacial valley sides. This stress field change, combined with bottom-ice temperature close to the pressure melting point, induces accelerated migration recrystallization, which results in spatial chemical sorting of the impurities, depending on their state (dissolved vs. solid) and if they are involved or not in salt formation. This chemical sorting effect is responsible for the progressive build-up of the visible solid aggregates that therefore mainly originate "from within", and not from incorporation processes of debris from the ice sheet's substrate. We further discuss how the proposed mechanism is compatible with the other ice properties described. We conclude that the paleoclimatic signal is only marginally affected in terms of global ice properties at the bottom of EPICA Dome C, but that the timescale was considerably distorted by mechanical stretching of MIS20 due to the increasing influence of the subglacial topography, a process that might have started well above the bottom ice. A clear paleoclimatic signal can therefore not be inferred from the deeper part of the EPICA Dome C ice core. Our work suggests that the existence of a flat monotonic ice–bedrock interface, extending for several times the ice thickness, would be a crucial factor in choosing a future "oldest ice" drilling location in Antarctica.

Hemodynamics analyses in treated and untreated carotid arteries of the same patient: A preliminary study based on three patient cases

Carotid atherosclerotic disease is highly related to cerebrovascular events. Carotid endarterectomy is the common operation method to treat this disease. In this study, hemodynamics analyses are performed on the carotid arteries in three patients, whose right carotid artery had been treated by carotid endarterectomy and the left carotid artery remained untreated. Flow and loading conditions are compared between these treated and untreated carotid arteries and evaluation of the operative results is discussed. Patient-specific models are reconstructed from MDCT data. Intraoperative ultrasound flow measurements are performed on the treated carotid arteries and the obtained data are used as the boundary conditions of the models and the validations of the computational results. Finite volume method is employed to solve the transport equations and the flow and loading conditions of the models are reported. The results indicate that: (i) in two of the three patients, the internal-to-external flow rate ratio in the untreated carotid artery is larger than that in the treated one, and the average overall flow split ratio by summing up the data of both the left and right carotid arteries is about 2.15; (ii) in the carotid bulb, high wall shear stress occurs at the bifurcation near the external carotid artery in all of the cases without hard plaques; (iii) the operated arteries present low time-averaged wall shear stress at the carotid bulb, especially for the treated arteries with patch technique, indicating the possibility of the recurrence of stenosis; (iv) high temporal gradient of wall shear stress (>35 Pa/s) is shown in the narrowing regions along the vessels; and (v) in the carotid arteries without serious stenosis, the maximum velocity magnitude during mid-diastole is 32~37% of that at systolic peak, however, in the carotid artery with 50% stenosis by hard plaques, this value is nearly doubled (64%). The computational work quantifies flow and loading distributions in the treated and untreated carotid arteries of the same patient, contributing to evaluation of the operative results and indicating the recurrent sites of potential atheromatous plaques.

Mitochondrial dysfunction leads to NOX activation: A novel mechanism to maintain high glycolysis in cancer cells

Increased glycolysis and oxidative stress are common features of cancer cells. These metabolic alterations are associated with mitochondrial dysfunction and can be caused by mitochondrial DNA (mtDNA) mutations, oncogenic signals, loss of tumor suppressor, and tumor tissue hypoxia. It is well established that mitochondria play central roles in energy metabolism, maintenance of redox balance, and regulation of apoptosis. However, the biochemical and molecular mechanisms that maintain high glycolysis in cancer cells (the Warburg effect) with mitochondrial dysfunction and oxidative stress remain to be determined. The major goals of this study were to establish a unique experimental system in which the mitochondrial respiratory function can be regulated as desired, and to use this system to investigate the mechanistic link between mitochondrial dysfunction and the Warburg effect along with oxidative stress in cancer cells. To achieve these goals, I have established a tetracycline-inducible system in which a dominant negative form of mitochondrial DNA polymerase y (POLGdn) expression could be regulated by tetracycline; thus controlling mitochondrial respiratory function. Using this cell system, I demonstrated that POLGdn expression resulted in mitochondrial dysfunction through decreasing mtDNA content, depletion of mtDNA encoded mRNA and protein expression. This process was mediated by TFAM proteasome degradation. Mitochondrial dysfunction mediated by POLGdn expression led to a significant increase in cellular glycolysis and oxidative stress. Surprisingly, mitochondrial dysfunction also resulted in increased NAD(P)H oxidase (NOX) enzyme activity, which was shown to be essential for maintaining high glycolysis. Chemical Inhibition of NOX activity by diphenyliodonium (DPI) preferentially impacted the survival of mitochondrial defective cells. The colon cancer HCT116-/- cells that have lost transcriptional regulation of the mitochondrial assembling enzyme SCO2, leading to compromised mitochondrial respiratory function, were found to have increased NOX activity and were highly sensitive to DPI treatment. Ovarian epithelial cells with Ras transformation also exhibited an increase in NOX gene expression and NOX enzyme activity, rendering the cells sensitive to DPI inhibition especially under hypoxic condition. These data together suggest that NOX plays a novel role in maintaining high glycolysis in cancer cells with mitochondrial defects, and that NOX may be a potential target for cancer therapy. ^

A methodologic study of pain assessment in Anglo and Hispanic children with cancer

There is growing clinical evidence that even young children experience pain and accompanying anxiety. Few instruments have been validated to assess pain characteristics in children. The study of related demographic, illness, psychologic and parental factors in children has also been limited. This study examines the reliability and validity of pain assessment tools in an outpatient pediatric cancer population. A total of 78 children from three to fifteen years of age were observed and interviewed about the pain of invasive procedures. The effect of cultural factors and the stress of acculturation were examined by comparing data from two cultural groups, Anglo and Hispanic.^ Spielberger State-Trait Anxiety Scales were administered to children and parents prior to an invasive procedure. The Procedure Behavioral Checklist (PBCL) was used for observation of the child's response during the procedure. The Children's Procedural Interview (CPI) which contains items on the PBCL and visual analogues (scales of faces indicating varying degrees of pain and anxiety) was administered following the procedure.^ Reliability coefficients for Anglos were.78 on the PBCL,.79 on the CPI and.85 on the visual analogue scales. For Hispanics, the reliability for the PBCL was.54, while the CPI had a reliability of.72 and the visual analogue scales,.87. Construct validity was demonstrated by high correlations between the PBCL and CPI scores for both ethnic groups (.66 for Anglos and.64 for Hispanics) and by the significant correlation of State anxiety scores with both PBCL and CPI scores. Age was inversely correlated with PBCL and CPI scores for both ethnic groups. Hispanic parents' anxiety scores were higher than Anglo parents, but were not highly correlated with their child's PBCL, CPI or State-Trait anxiety scores. Caregivers' ratings were correlated with the PBCL scores for Anglos but not for Hispanics.^ The findings of this study indicate that pain responses may be reliably assessed using both observational and self-report methods in children, though differences in Anglo and Hispanic cultures exist. Differences in pain symptomatology and assessment in the two cultural groups warrant further study. ^

Distribution of Recent benthic foraminifera in Arctic galciomarine sediments

Foraminifera were examined in recent (<100 years) fine-grained glaciomarine muds from surface sediments and cores from Nordensheld Bay, Novaja Zemlja, and Hornsund and Bellsund, Spitsbergen. This study presents the first data on modern foraminifera distribution for fjord environments in Novaja Zemlja, Russia. The data are interpreted with reference to the distribution of foraminiferal near Svalbard and the Barents Sea. In Nordensheld Bay, live and dead Nonionellina labradorica and Islandiella norcrossi are most abundant in the outer fjord. Cassidulina reniforme and Allogromiina spp. dominate in the middle and inner fjord. The dominant species are dissimilar to species occurring in other areas of the Barents Sea region, with the exception of Svalbard fjords. The number of live foraminifera (24 to 122 tests/10 cm1) in outer and middle Nordensheld Bay corresponds with values known from the open Barents Sea. However, the biomass (0.03 mg/10 cm**3) is two orders of magnitude less due to smaller foraminiferal test size, which in glaciomarine sediments reflects the absence of larger species, paucity of large specimens, and high occurrence of juvenile foraminifera. The smaller size indicates an opportunistic response to environmental stress due to glacier proximity. The presence of Quinqueloculina stalkeri is diagnostic of glaciomarine environments in fjords of Novaja Zemlja and Svalbard.

Heat flow in the Central Basin of the Indian Ocean and the northern part of the Afanasy Nikitin Rise

Heat flux data obtained during Cruise 20 of R/V Akademik Mstislav Keldysh in the Central Basin of the Indian Ocean and northern part of the Afanasy Nikitin Rise are presented. Thermal conditions on the rise are not associated with an anomalous zone of the large tectonic deformation block north of it. Geothermal data indicate that the Afanasy Nikitin Rise has formed near an ancient spreading axis. Distribution of measured heat flux values indicates an additional source of heat in the Central Basin resulting from dissipative heating of the crust in the two-stage plate tectonics model.

(Table 1) Results of geothermal measurements in the Black Sea 2000 and 2001 expeditions

According to the World Ocean Program in the northeastern part of the continental slope of the Black Sea geothermal, seismologic and seismic studies were carried out. An analysis of heat flow distribution allowed to distinguish a negative geothermal anomaly near the Dzhubga area, where the Russia-Turkey pipeline was being constructed. During seismological observations (August-September 1999, September 2001) more than 1200 seismic events were recorded. They proved high tectonic activity of the region under study, which stimulates gravitational sediment transport on the continental slope. The seismo-acoustic survey carried out in the area of the geothermal anomaly revealed no reflecting horizons within the sedimentary cover. This may be related to turbidite-landsliding processes. Results of modeling of the heat flow anomaly showed that it had originated approximately 1000 years ago due to a powerful landslide. This also suggests a possibility of an avalanche displacement of sedimentary masses in the area of the pipeline at present.

Geothermal measurements in the Tyrrhenian Sea

Geothermal data obtained during Cruise 12 of the R/V Vityaz-II and published data on heat flux of the Tyrrhenian Sea are analyzed. The thermal field is related to principal tectonic structures of the basin. Distribution of heat flux indicates that the initial stage of rifting occurs in the central basin of the Tyrrhenian Sea.

Heat flow ratios of stations from the Iberian abyssal plain (Table 1)

New heat flow observations have been made in the Iberia abyssal plain off the Galicia margin along the transeat of Ocean Drilling Program Leg 149 drill sites. in order to investigate the nature of this unusually wide and deep continet-ocean transition region. Our results indicate the presence of three separate zones. Average values of 47.5 +/- 3 mW/m in the westernmost zone III agree with predictions of standard oceanic lithospheric models for its estimated age of 126 Ma. In contrast, the heat flow within zone II is 5-15 mW/m higher than predicted. assuming that the mantle heat flow remains constant across the basin. This region of high values is coincident with the location of a major intra-crustal "S"-type reflector east of ODP Site 900. and the anomaly is consistent with the presence of 2-3 km of primarily upper continental crust above the reflector, with concentrations of radiogenic components similar to those from granodiorite samplles dredged off Galicia Bank. It is not, however, consistent with the low values of heat production measured on gabbroic sanhples from its western end at ODP Site 900. In zone I, detailed measurements across the tilted fault block south of ODP Site 901 show consistent variations which closely match predictions due to the effects of basement structure and sediment deposition. There is no evidence for variations due to vertical convective transport along the dipping basement fault block. Once corrected for these variations. measurements in zone I yield average values that agree quite well with previous measurements across Calicia Bank. indicating no systematic landward increase in heat flow with decreasing amounts of continental, extension.

Growth of AlN oriented films on insulating substrates.

This work describes the structural and piezoelectric assessment of aluminum nitride (AlN) thin films deposited by pulsed-DC reactive sputtering on insulating substrates. We investigate the effect of different insulating seed layers on AlN properties (crystallinity, residual stress and piezoelectric activity). The seed layers investigated, silicon nitride (Si3N4), silicon dioxide (SiO2), amorphous tantalum oxide (Ta2O5), and amorphous or nano-crystalline titanium oxide (TiO2) are deposited on glass plates to a thickness lower than 100 nm. Before AlN films deposition, their surface is pre-treated with a soft ionic cleaning, either with argon or nitrogen ions. Only AlN films grown of TiO2 seed layers exhibit a significant piezoelectric activity to be used in acoustic device applications. Pure c-axis oriented films, with FWHM of rocking curve of 6º, stress below 500 MPa, and electromechanical coupling factors measured in SAW devices of 1.25% are obtained. The best AlN films are achieved on amorphous TiO2 seed layers deposited at high target power and low sputtering pressure. On the other hand, AlN films deposited on Si3N4, SiO2 and TaOx exhibit a mixed orientation, high stress and very low piezoelectric activity, which invalidate their use in acoustic devices.

Overall and local mechanical behaviour of dissimilar laser welded joints

The present investigation addresses the overall and local mechanical performance of dissimilar joints of low carbon steel (CS) and stainless steel (SS) thin sheets achieved by laser welding in case of heat source displacement from the weld gap centreline towards CS. Microstructure characterization and residua! strain scanning, carried out by neutron diffraction, were used to assess the joints features. It was found that the heat source position influences the base metals dilution and the residua! stress field associated to the welding process; the transverse residual stress is smaller than for the longitudinal component, of magnitudes close to the parent CS yield strength. Furthermore, compressive transverse residual stresses were encountered at the SS-weld interface. The tensile behavior of the joint different zones assessed by using a video-image based system (VIC-2D) reveals that the residual stress field, together with the positive difference in yield between the weld metal and the base materials protects the joint from being piastically deformed. The tensile loadings of flat transverse specimens generate the strain localization and failure in CS, far away from the weld.En este trabajo se exponen los resultados de una investigacion sobre el comportamiento mecanico de soldaduras disimiles acero inoxidable-acero al carbono, realizadas para unir chapas delgadas, desplazando la fuente de calor del eje longitudinal de la union soldada por laser sobre el acero al carbono. Se han determinado las caracteristicas microestructurales de la union soldada, las tensiones residuales generadas (mediante difraccion de neutrones) y las curvas tension-deformacion locales y globales, mediante medidas locales de deformacion empleando el sistema VIC-2D "video image correlation". El desplazamiento de la fuente de calor infiuye en la dilution de los metales base y el campo de tensiones residuales asociado al proceso de soldeo; las tensiones residuales medidas en direction longitudinal se aproximan al limite elastico del acero al carbono, mientras que las tensiones residuales transversales son menores, e incluso de compresion. El ensayo a traccion de la union soldada revela que las tensiones residuales y la diferencia de limite elastico entre los metales base y la soldadura propician que la rotura se produzca por inestabilidad plastica del acero al carbono, lejos de la soldadura, sin que la union plastifique.