Preventing the Burnout Syndrome by Creating a Healthy & Healing Environment

Occupational burnout is a significant global problem that has impacted clinical outcomes, patient safety, and patient-centered care across healthcare settings (World Health Organization) [WHO], 2019. The classic definition of burnout, as defined by Dr. Christina Maslach, is “a psychologic syndrome involving emotional exhaustion, depersonalization, and a diminished sense of personal accomplishment (Maslach & Jackson, 1982). Burnout affects cognitive, behavioral and emotional aspects of human behavior. It also interferes with how individuals process and interact with others at an individual and organizational level. Others have noted that burn-out individuals tend to focus on negative things rather than positive emotions (Bianchi & Laurent, 2015). Nurse and physician burnout was recognized before the COVID-19 pandemic as a growing problem. Evidence now suggests that more than 50% of nurses, physician assistants and physicians report syndromes of burnout. The problem has become even more pronounced when the work environment contributes stressors associated with technological advancements, EMRs, increased patient acuity, and financial cost cutting measures. It is now recognized that individuals and organizations burnout. As a public health issue, burnout and well-being are multifactorial and recognize that individuals and organizations contribute significant factors to the burnout syndrome. It appears that burnout rates are rising across specialties and settings resulting in increase of costs to individuals and organizations (National Academy of Medicine [NAM]), 2018. What is needed is a clear map to make decisions on clinical burnout. Healthcare workers (HCW) need confidential access to wellness activities, support systems and mental health consultation. A new model is needed to further refine the work-life balance and create a caring corporate culture. Healthcare leaders need to rethink how to support employees across disciplines when it comes to burnout and well-being.

The National Lung Cancer Audit: The Impact of COVID-19

Since 2014, the National Lung Cancer Audit (NLCA) has been evaluating the performance of the UK NHS lung cancer services against established standards of care. Prior to the onset of the COVID-19 pandemic, the NLCA's annual reports revealed a steady stream of improvements in early diagnosis, access to surgery, treatment with anti-cancer therapies, input from specialist nursing and survival for patients with lung cancer in the NHS. In January 2022, the NLCA reported on the negative impact COVID-19 has had on all aspects of the lung cancer diagnosis and treatment pathway within the NHS. This article details the fundamental changes made to the NLCA data collection and analysis process during the COVID-19 pandemic and details the negative impact COVID-19 had on NHS lung cancer patient outcomes during 2020.

Collapse of Healthcare Providers-medical and Paramedical-healthcare Staff after last Three Years of Pandemics and War Conflicts

This Editorial dispatch focuses on absolute shortage of healthcare workers and their psychical and physical exhaustion with devastation consequences on healthcare providers and management of pandemics and health destruction within ongoing armed conflicts in Europe and Middle East,focusing on non prioritizing HCW versus healthcare infrastructure, vaccines medications, but putting both to the same level of priority.

Devastation Consequences of Pandemia and War Conflicts in Health and Social Security

This current issue of Clinical Social Work and Health Intervention(1) reflects to some extent on two previous issues of this interdisciplinary Journal dealing within the last 2 years with two groups of catastrophic effects on civil society, social security, healthcare and finally to economics worldwide l. Pandemic, declared by WHO and most states authorities worldwide, due to the potentially deadly virus COVID-19, may be followed by another endemic disease e.g. zoonotic influenza, monkey pox and hepatitis X. 2. At least four War conflicts: Azerbaijan versus Armenia; Yemen versus Saudi Forces; Afghanistan versus NATO; and recently the Russian Federation & Belarus versus Ukraine.

354 Thoracic Complex Case Review Meeting (CCRM): A Multidisciplinary Approach to Improving Patient Care and Service Efficiency

Objectives

The profile of thoracic patients and the indications for surgery are becoming increasingly complex. A multidisciplinary perioperative approach can optimise patients, improve outcomes and prevent high-risk patients being inappropriately declined surgery. We aim to retrospectively review the first 100 patients discussed at the CCRM in 2016-17 with a primary outcome of number of on-the-day cancellations. Secondary outcomes include unplanned critical care (HDU) admissions, 30 and 90-day morbidity and mortality.

Method

Data was collected retrospectively for demographics, co-morbidities, lung-function and dynamic testing, diagnosis and proposed surgical approach. CCRM outcomes included need for HDU, requiring further optimisation, change in surgical strategy or patient deemed too high risk.

Results

Average age was 69 years (IQR 12.5) (65 M: 35 F). American Society of Anaesthesiologists’ classification of 3 with predicted of mortality of 2 % (IQR 0.8). Maximal oxygen uptake (VO2 max) was 18.6ml/kg/min (SD ± 4.2). 24 patients were recommended for optimisation and 34 to proceed with HDU. 14 were deemed too high-risk and 30 had a change in surgical strategy. Only 1 patient was cancelled on-the-day due to a recent deterioration in health. 30 and 90-day mortality rates were 1% and 2% respectively, and 2 patients required unplanned HDU.

Conclusions

CCRM is a simple approach to optimise high-risk patients and minimise unplanned HDU. No patients were cancelled on-the-day due to inadequate optimisation or unexpected need for HDU. Mortality was acceptable and lower than predicted. Our study established CCRM as a safe and effective way of selecting high-risk patients for further optimisation and appropriate perioperative care.

Emerging Wake-up Call before next Pandemics as Apart of Medicine and Technology: We terribly need Social and Healthcare Workers

Thousands of healthcare and social workers (HCSW) died or lost their ability to work in their field after Covid pandemics in all three waves, and thousands left their profession due to burnout syndrome. Despite development of vaccines took 6- 18 months and refreshment of old molecules for treatment weeks, many countries paid a very high price for this pandemics not due to lack of medications or ventilator assistance devices but due to the increasing lack of trained HCSW.

iPSC modeling of young-onset Parkinson's disease reveals a molecular signature of disease and novel therapeutic candidates

Young-onset Parkinson's disease (YOPD), defined by onset at <50 years, accounts for approximately 10% of all Parkinson's disease cases and, while some cases are associated with known genetic mutations, most are not. Here induced pluripotent stem cells were generated from control individuals and from patients with YOPD with no known mutations. Following differentiation into cultures containing dopamine neurons, induced pluripotent stem cells from patients with YOPD showed increased accumulation of soluble α-synuclein protein and phosphorylated protein kinase Cα, as well as reduced abundance of lysosomal membrane proteins such as LAMP1. Testing activators of lysosomal function showed that specific phorbol esters, such as PEP005, reduced α-synuclein and phosphorylated protein kinase Cα levels while increasing LAMP1 abundance. Interestingly, the reduction in α-synuclein occurred through proteasomal degradation. PEP005 delivery to mouse striatum also decreased α-synuclein production in vivo. Induced pluripotent stem cell-derived dopaminergic cultures reveal a signature in patients with YOPD who have no known Parkinson's disease-related mutations, suggesting that there might be other genetic contributions to this disorder. This signature was normalized by specific phorbol esters, making them promising therapeutic candidates.

Visual Immunoprecipitate Assay (VIP) for Listeria monocytogenes and Related Listeria Species Detection in Selected Foods: Collaborative Study

Six foods representing a variety of food products were analyzed by the Assurance Listeria polyclonal enzyme immunoassay (EIA) and by either the Bacteriological Analytical Manual or the U.S. Department of Agriculture culture method for detecting Listeria monocytogenes and related Listeria species. Samples of each food type, at each inoculation level, were analyzed simultaneously by both methods. A total of 19 laboratories representing federal government agencies and private industry in the United States and Canada participated. Food types were inoculated with Listeria species including L. monocytogenes, with the exception of 3 lots of green beans, which were naturally contaminated. During this study, 1764 samples and controls were analyzed and confirmed, of which 492 were positive and 947 were negative by both methods. There were 159 samples that were positive by culture method but negative by the EIA and 188 that were negative by culture method but positive by EIA. Twenty-two samples were negative by EIA and by culture method but confirmed positive when Assurance selective enrichment broths were subcultured to selective agar. The Assurance polyclonal EIA for detecting L. monocytogenes and related Listeria species in foods has been adopted first action by AOAC INTERNATIONAL.

Assurance Enzyme Immunoassay for Detection of Enterohemorrhagic Escherichia coli 0157:H7 in Selected Foods: Collaborative Study

Five foods types were analyzed by the Assurance EHEC (Escherichia coli 0157:H7) enzyme immunoassay (EIA) and by the Bacteriological Analytical Manual (BAM) culture method. Each sample of each food type at each inoculation level was simultaneously analyzed by both methods. A total of 21 laboratories representing state and federal government agencies and private industry in the United States and Canada participated. Samples were inoculated with E. coli 0157:H7, except for one lot of poultry that was naturally contaminated. A total of 1304 samples and controls were analyzed and confirmed, of which 473 were positive and 818 were negative by both methods. Thirteen samples were positive by BAM but negative by EIA. Because of the study design, it was not possible for the BAM method to produce false-negative or falsepositive results. The Assurance method for detection of E. coli OI57:H7 in selected foods has been adopted first action by AOAC INTERNATIONAL.

Modified Immunodiffusion Method for Detection of Salmonella in Raw Flesh and Highly Contaminated Foods: Collaborative Study

A total of 19 government and private industry laboratories in Canada and the United States participated in the collaborative study. Naturally contaminated ground poultry and animal meals, as well as inoculated raw shrimp, were examined for presence of Salmonella by both the modified immunodiffusion method and the Bacteriological Analytical Manual culture method, resulting in an agreement rate of 93.1%. The 2 methods are statistically equivalent for all food types at each inoculation level and for all lots of naturally contaminated foods evaluated in this study. The modification of the AOAC Official Method 989.13, immunodiffusion (1–2 TEST) method for detection of motile Salmonella in all foods, has been adopted revised first action by AOAC INTERNATIONAL.

Visual Immunoprecipitate Assay (VIP) for Detection of Enterohemorrhagic Escherichia coli (EHEC) 0157:H7 in Selected Foods: Collaborative Study

Five foods representative of a variety of food products were analyzed by the Visual Immunoprecipitate Assay (VIP) and the Bacteriological Analytical Manual (BAM) culture method for the presence of Escherichia coli 0157: H7. A total of 21 laboratories representing state and federal government agencies, as well as private industry, in the United States and Canada participated. Food types were inoculated with strains of E. coli 0157:H7, with the exception of one lot of poultry, which was naturally contaminated. During this study, a total of 1377 samples and controls were analyzed and confirmed, of which 508 were positive and 867 were negative by both methods. Two samples were positive by BAM and negative by VIP. Because of the study design, it was not possible for the BAM method to produce false-negative or false-positive results. The VIP assay for detection of EHEC in selected foods has been adopted first action by AOAC INTERNATIONAL.

Assurance Polyclonal Enzyme Immunoassay for Detection of Listeria monocytogenes and Related Listeria Species in Selected Foods: Collaborative Study

Six foods representing a variety of food products were analyzed by the Assurance Listeria polyclonal enzyme immunoassay (EIA) and by either the Bacteriological Analytical Manual or the U.S. Department of Agriculture culture method for detecting Listeria monocytogenes and related Listeria species. Samples of each food type, at each inoculation level, were analyzed simultaneously by both methods. A total of 19 laboratories representing federal government agencies and private industry in the United States and Canada participated. Food types were inoculated with Listeria species including L. monocytogenes, with the exception of 3 lots of green beans, which were naturally contaminated. During this study, 1764 samples and controls were analyzed and confirmed, of which 492 were positive and 947 were negative by both methods. There were 159 samples that were positive by culture method but negative by the EIA and 188 that were negative by culture method but positive by EIA. Twenty-two samples were negative by EIA and by culture method but confirmed positive when Assurance selective enrichment broths were subcultured to selective agar. The Assurance polyclonal EIA for detecting L. monocytogenes and related Listeria species in foods has been adopted first action by AOAC INTERNATIONAL.

Equivalence of Assurance® Gold Enzyme Immunoassay for Visual or Instrumental Detection of Motile and Nonmotile Salmonella in All Foods to AOAC Culture Method: Collaborative Study

Six foods representative of a wide variety of processed, dried powder processed, and raw food types were analyzed by the Assurance® Gold Salmonella Enzyme Immunoassay (EIA) and AOAC INTERNATIONAL culture method. Paired samples of each food type were simultaneously analyzed; one sample by the Assurance method and one by the AOAC culture method. The results for Assurance method were read visually and instrumentally with a microplate reader. A total of 24 laboratories representing federal government agencies and private industry, in the United States and Canada, participated in this collaborative study. Food types were inoculated with species of Salmonella with the exception of raw ground chicken, which was naturally contaminated. No statistical differences (p &lt; 0.05) were observed between Assurance Gold Salmonella EIA with either visual or instrumental interpretation and the AOAC culture method for any inoculation level of any food type or naturally contaminated food. The Assurance visual and instrumental options of reading sample reactions produced the same results for 1277 of the 1296 sample and controls analyzed.

Older men display elevated levels of senescence-associated exercise-responsive CD28null angiogenic T cells compared with younger men

Aging is associated with elevated cardiovascular disease risk. As a result of aging, endothelial dysfunction develops, partly due to a reduction in vascular regenerative ability. CD31+ T cells (angiogenic T cells; TANG ) possess highly angiogenic capabilities; however, these cells are significantly reduced in older populations. In addition, older populations possess significantly higher senescent and highly differentiated T-cell levels in circulation, and these are reported to be highly exercise responsive. We investigated whether older adults display greater levels of circulating senescent (CD28null ) TANG cells and whether these cells were more exercise responsive than CD28+ TANG cells. Young (18-25 years; n = 9) and older (60-75 years; n = 10) healthy men undertook a 30-min cycling bout at 70% V˙O2 peak, with circulating TANG cells (CD3+  CD31+  CD28+/null ; including CD4+ and CD8+ subsets) measured preexercise, postexercise, and 1 h post exercise by flow cytometry. Older adults displayed reduced basal levels of TANG cells (mean ± SEM: 410 ± 81 vs. 784 ± 118 cells·μL, P = 0.017), despite a greater proportion of these cells being CD28null (26.26 ± 5.08 vs. 13.36 ± 2.62%, P = 0.044). Exercise significantly increased the circulating number of TANG cells in both young and older men. However, in older men alone, exercise preferentially mobilized CD28null CD8+ TANG cells compared with CD28+ TANG cells (time × phenotype interaction: P = 0.022; Δ74 ± 29 vs. Δ27 ± 15 cells·μL, P = 0.059), with no such difference observed between these phenotypes in the young population. In conclusion, this is the first study to demonstrate that despite observing lower circulating numbers of TANG cells, older adults display greater levels of senescent TANG cells in comparison with younger individuals, and these cells are more exercise responsive than CD28+ TANG cells. Lower number of circulating TANG and greater levels of senescent-associated CD28null TANG may contribute to greater CVD risk with advancing age.

Long-time atomistic dynamics through a new self-adaptive accelerated molecular dynamics method

A self-adaptive accelerated molecular dynamics method is developed to model infrequent atomic-scale events, especially those events that occur on a rugged free-energy surface. Key in the new development is the use of the total displacement of the system at a given temperature to construct a boost-potential, which is slowly increased to accelerate the dynamics. The temperature is slowly increased to accelerate the dynamics. By allowing the system to evolve from one steady-state configuration to another by overcoming the transition state, this self-evolving approach makes it possible to explore the coupled motion of species that migrate on vastly different time scales. The migrations of single vacancy (V) and small He-V clusters, and the growth of nano-sized He-V clusters in Fe for times in the order of seconds are studied by this new method. An interstitial-assisted mechanism is first explored for the migration of a helium-rich He-V cluster, while a new two-component Ostwald ripening mechanism is suggested for He-V cluster growth.

Inhibition of the integrin/FAK signaling axis and c-Myc synergistically disrupts ovarian cancer malignancy

Integrins, a family of heterodimeric receptors for extracellular matrix, are promising therapeutic targets for ovarian cancer, particularly high-grade serous-type (HGSOC), as they drive tumor cell attachment, migration, proliferation and survival by activating focal adhesion kinase (FAK)-dependent signaling. Owing to the potential off-target effects of FAK inhibitors, disruption of the integrin signaling axis remains to be a challenge. Here, we tackled this barrier by screening for inhibitors being functionally cooperative with small-molecule VS-6063, a phase II FAK inhibitor. From this screening, JQ1, a potent inhibitor of Myc oncogenic network, emerged as the most robust collaborator. Treatment with a combination of VS-6063 and JQ1 synergistically caused an arrest of tumor cells at the G2/M phase and a decrease in the XIAP-linked cell survival. Our subsequent mechanistic analyses indicate that this functional cooperation was strongly associated with the concomitant disruption of activation or expression of FAK and c-Myc as well as their downstream signaling through the PI3K/Akt pathway. In line with these observations, we detected a strong co-amplification or upregulation at genomic or protein level for FAK and c-Myc in a large portion of primary tumors in the TCGA or a local HGSOC patient cohort. Taken together, our results suggest that the integrin–FAK signaling axis and c-Myc synergistically drive cell proliferation, survival and oncogenic potential in HGSOC. As such, our study provides key genetic, functional and signaling bases for the small-molecule-based co-targeting of these two distinct oncogenic drivers as a new line of targeted therapy against human ovarian cancer.