Use of virtual meeting and survey technology to assess Covid-19-related mental well-being of healthcare workers.

Background and aims: Healthcare workers (HCWs) throughout the world have been exposed to economic and existential stress during the Covid-19 pandemic. The American Medical Association (AMA) has documented that increased healthcare burden correlates with increased stress, burnout, and psychological burden in HCWs. However, limits on personnel, time, and in person interactions make it challenging to assess mental health outcomes during a pandemic. This pilot study used virtual technology to efficiently assess these outcomes. Setting: Data were collected based on voluntary participation in the Coping with Covid-19 for Caregivers Survey created by AMA. The survey was sent out to approximately 300 participants who included local physicians, medical residents, medical students, and allied health professionals and students who attended a virtual Mental Health Summit. Methods: The AMA developed survey included questions about demographics, overall stress, fear of infection and transmission of the virus, perceived anxiety or depression due to Covid-19, work overload, childcare issues, and sense of meaning and purpose. The AMA allows for up to five additional questions to be added to their survey, therefore five questions regarding support service utilization, perseverance, and resilience during the Covid-19 pandemic, and two items to further understand students' areas of medical interest. The survey was administered using an online platform through the AMA. The data were analyzed using descriptive statistics. Results: There were 81 survey respondents. Based on the results of the survey, "high stress" was found in 52 (64%) participants. 66 (81%) were afraid (moderately or to a great extent) of exposure or transmission, 61 (75%) described high levels of anxiety or depression, and 67 (84%) noted work overload. Despite this increase in stress, most respondents (77%) said they were not likely to reduce their devoted hours to clinical care or research in the next 12 months, and 81% answered that they would not leave their practice or research within two years. Conclusion: Covid-19 has negatively affected the well-being of HCWs. This is a similar trend seen during other times of healthcare strain. Mental health support, work modulation, and various provisions should be explored as means to reduce Covid-19-related negative impacts. The use of an online summit and online data collection methods were appropriate for collecting data on the impact of the Covid-19 pandemic on mental health. This pilot study supports the larger scale implementation of this technology for health informatics research.

Platform for establishing interlaboratory reproducibility of selected reaction monitoring-based mass spectrometry peptide assays.

Mass spectrometry (MS) is an attractive alternative to quantification of proteins by immunoassays, particularly for protein biomarkers of clinical relevance. Reliable quantification requires that the MS-based assays are robust, selective, and reproducible. Thus, the development of standardized protocols is essential to introduce MS into clinical research laboratories. The aim of this study was to establish a complete workflow for assessing the transferability and reproducibility of selected reaction monitoring (SRM) assays between clinical research laboratories. Four independent laboratories in North America, using identical triple-quadrupole mass spectrometers (Quantum Ultra, Thermo), were provided with standard protocols and instrumentation settings to analyze unknown samples and internal standards in a digested plasma matrix to quantify 51 peptides from 39 human proteins using a multiplexed SRM assay. The interlaboratory coefficient of variation (CV) was less than 10% for 25 of 39 peptides quantified (12 peptides were not quantified based upon hydrophobicity) and exhibited CVs less than 20% for the remaining peptides. In this report, we demonstrate that previously developed research platforms for SRM assays can be improved and optimized for deployment in clinical research environments.

Novel splice variants of sFlt1 are upregulated in preeclampsia.

Soluble fms-like tyrosine kinase-1 (sFlt1) is a truncated splice variant of Flt1, which is upregulated in preeclampsia. In this study we sought to characterize the unique C-terminus of sFlt. Through bioinformatic analyses, we identified two novel sFlt1 splice variants and two previously described sFlt1 splice variants. The novel variants are identical to the previously described sFlt1_v1 through exon 13, but then diverge to unique 3' termini consisting of a novel exon 15 (sFlt1_v2 and sFlt1_v3) or an extension of exon 14 (sFlt1_v4). Quantitative PCR showed that three out of four sFlt variants were upregulated in placenta of women with preeclampsia. Mass spectrometry analysis of sFlt1 purified from placental serum confirmed the presence of sFlt1_v1 protein, and an additional variant which includes sequence derived from exon 14. siRNA experiments targeting each variant confirmed that three of the four variants contribute significantly to total sFlt1 expression by cytotrophoblasts in vitro. These findings provide evidence that human placenta expresses a family of sFlt1 splice variants, at least three of which are expressed as proteins, and which appear to be globally upregulated in preeclampsia.

Modified cilia in sensory organs of juvenile stages of a parasitic nematode.

Electron microscopical studies revealed the presence of dendritic nerve processes in sensory organs of the third- and fourth-stage juveniles of Haemonchus contortus, which contained structures resembling modified cilia. With few exceptions, the outer circle of fibers consisted of ten doublets, and in place of typical cilia-like central fibers were small microtubules or vesicles varying in number from zero to five.

Cyclocarbon coalescence: mechanisms for tailor-made fullerene formation.

The availability of macroscopic quantities of fullerenes has resulted in a vast number of physical and chemical studies of these new materials. However, the mechanisms that lead to the formation of these spherical carbon allotropes are not well understood. Mass spectral evidence has been obtained for the size-selective growth of fullerenes through the coalescence of cyclo[n] carbons, molecular carbon allotropes consisting of monocyclic rings with n carbon atoms. Whereas coalescence of cyclo[30]carbon (cyclo-C(30)) produces predominantly buckminsterfullerene (C(60)), the smaller rings cyclo-C(l8) and cyclo-C(24) preferentially produce fullerene C(70) through distinct intermediates. The present studies not only provide new insights into fullerene formation mechanisms but also raise the possibility of tailoring the size distributions of fullerenes by variation of the appropriate properties of the precursors.

Large odd-numbered carbon clusters from fullerene-ozone reactions.

The odd-numbered carbon clusters C(119), C(129), and C(139) have been observed in the mass spectra of toluene extracts of fullerene soots and of the products of ozone-fullerene reactions. Specifically, ozone-C(60) reactions yield C(119), ozone-C(70) reactions yield C(139), and ozone-(C(60)/C(70)) reactions produce C(119), C(129), and C(139). These unexpected species correspond to dimers of C(60), C(60)/C(70), and C(70), respectively, less one carbon atom, and are stable gas-phase ions with behavior similar to that of fullerenes. The results suggest a new route to functionalization and derivatization of fullerenes through controlled ozone-catalyzed cage-opening reactions.

The peptide recognized by HLA-A68.2-restricted, squamous cell carcinoma of the lung-specific cytotoxic T lymphocytes is derived from a mutated elongation factor 2 gene.

The identification of naturally processed tumor peptides that can stimulate a tumor-specific, CTL response is crucial to the development of a vaccine-based, immunotherapeutic approach to cancer treatment. One type of cancer in which a tumor-specific, CTL response has been observed is squamous cell carcinoma of the lung. In the system investigated here, the tumor-specific CTLs are HLA-A68.2 restricted. Immunoaffinity chromatography was used to isolate the HLA-A68.2 molecules from the tumor cell line, and peptide was eluted with acid from the HLA-A68.2 molecules and subjected to three rounds of separation by reversed phase-high performance liquid chromatography (RP-HPLC). To determine which fractions contained the peptide recognized by the tumor-specific CTLs, an aliquot of each RP-HPLC fraction was added to the autologous, B-lymphoblastoid cell line, and the cells were then tested as targets for tumor-specific CTLs. After the third round of RP-HPLC, mass spectrometry was used to sequence individual peptide candidates, and a peptide with a m/z of 497 was identified as the active peptide. Collision-activated dissociation of m/z 497 allowed identification of the peptide sequence as ETVSEQSNV. With the exception of a single amino acid difference (glutamic acid versus glutamine as the sixth position in the peptide), this peptide is identical to residues 581 to 589 of elongation factor 2. The PCR was used to amplify the elongation factor 2 gene in both the tumor cells and the autologous B cell line, and DNA sequencing of the products revealed the presence of a heterozygous mutation in the tumor cells that accounts for the difference between the two peptide sequences. Although a similar analysis did not reveal the presence of the mutation in three additional lung cell carcinomas, this does not rule out the possibility that a survey of a larger population of tumor cells would reveal the presence of the mutation at a low frequency. These results demonstrate the utility of this approach for identifying tumor-specific antigens that are the targets of a CTL response.

Mass spectrometry and fullerenes.

This article presents, from amass spectrometry perspective, an historical account of research on gas-phase carbon clusters, which has led to the discovery of another form of carbon, fullerenes. In addition, more recent mass spectrometric studies on analysis of fullerene derivatives and synthesis of doped fullerenes are described. The early, strong evidence for certain "magic number" carbon clusters, most notably C60 (buckminsterfullerene), was obtained largely from mass spectrometric experiments. These studies led to the controversial postulation of the soccerball structure for C60, which provoked increased experimental and theoretical efforts. This research eventually resulted in the discovery of a simple method by which large quantities of fullerenes can be produced. The availability of these new, all-carbon molecules has motivated a broad range of synthetic and characterization studies that are expanding at a frenetic pace. Mass spectrometry not only played a critical role in the discovery of fullerenes but also now is crucial for determination of the unusual chemical and physical properties of fullerenes and fullerene-based materials.

Mass spectrometric analysis of anatoxin-a.

Secondary ion mass spectrometry (SIMS), gas chromatography/mass spectrometry (GC/MS), desorption chemical ionization/mass spectrometry (DCI/MS), and thermospray/mass spectrometry (TSP/MS) were evaluated for the detection of a low-molecular weight biological toxin, anatoxin-a. The lowest detection limit was obtained using isobutane or ammonia DCI/MS. Tandem mass spectrometry (MS/MS) was used to enhance the selectivity and sensitivity of the analysis. The detection limit for the pure material is 10 pg, and 100 pg of the toxin can be analyzed directly from urine using DCI/MS/MS.

Beyond the family: informal support in later life.

This paper adopts the position that although the Canadian family is, and will continue to be an important source of support for its older members, there are limitations in its ability to do so. These limitations have to do with demographic and social changes occurring in contemporary society and highlight the importance of looking to alternative sources of support emerging in the literature as significant to people in their later years. These alternative sources of support which have potential importance for health and wellbeing in later life, have to a large extent been neglected by health care providers. It is suggested that health care practitioners expand the notion of family as the unit of care, which is central to their practice, to include sources of support beyond the immediate family.

Providing palliative care to older adults: context and challenges.

This paper presents the findings of a study aimed at understanding more fully the work of nurses who provide care to older adults who are dying at home. The method employed was qualitative in nature and involved the use of focus groups for data collection. Data were gathered from a total of 40 community-based nurses during four sessions lasting approximately two hours each. Analysis revealed that the provision of care occurred within a context of aging and dying characterized by clients' awareness of impending death, the presence of multiple pathologies, diminishing social support, and a lack of control. Challenges to providing care stemmed from an ethic of high expectation and a health care system experienced as fragmented, bureaucratic, and driven by cost efficiency. Challenges included working in isolation, achieving closure, securing personal support, working collaboratively with others, and keeping up to date. Findings from this study have implications for both education and practice.

Family caregiving in long-term care facilities.

Family caregiving within institutional settings is a neglected area of research In an era of cost containment, more and more is being asked of families of institutionalized persons. This article presents the results of a study designed to investigate family caregiving following the admission of an elderly relative to a long-term care facility. Beginning with a brief summary of findings from previous research, the article reports on visiting and task performance by families within the long-term care facility. Continuing with descriptions of families' satisfaction with institutional care and their care-related learning needs, the article concludes with recommendations for policy and practice.

The use of the diary as a data collection technique.

The initiation of a research project requires many decisions, not the least of which is the selection of a method for data collection. This decision is, in large measure, guided by the nature of the research question which generally prescribes the selection of a strategy for data collection from among an array of possible alternatives. This article addresses the use of a diary for data collection. Although diaries have traditionally been used in social science and health research, their use in nursing research is more recent. The article begins with a brief discussion of the rationale for using the diary to gather data in a study of personal and professional caregiving. A brief review of the use of diaries in previous studies follows, along with a description of the use of a diary in the caregiving study and a discussion of the possible threats to high quality data as well as measures used to ensure the collection of high quality data. The article concludes with a discussion of the strengths and weaknesses of the diary and makes recommendations regarding its use in nursing research.

Nurses' work: balancing personal and professional caregiving careers.

Forty full-time nurses who were also responsible for providing care to individuals in their private lives volunteered for a qualitative study of combined caregiving careers. Each respondent kept a diary of caregiving activities during two representative 24-hour periods, and was interviewed prior to, and after diary-recording. Most nurses experienced high levels of stress associated with caregiving in both their professional and private lives. In general, they were relatively satisfied with their lives in both spheres, and felt a slightly greater sense of control in their work lives than in their home lives. Regarding the tensions/conflicts they alluded to, the following themes emerged: an ethic of high expectation, feeling torn between two worlds, a sense of working in isolation, and working in overdrive. The rewards/benefits included remuneration, recognition and self-esteem, opportunities for personal growth, and opportunities for family growth.

Patterns of caregiving following the institutionalization of elderly husbands.

The purpose of this study was to examine the caregiving career of older women following the institutionalization of their husbands. Informed by the interpretive perspective in sociology and Hughes's (1971) concept of career, the study employed a longitudinal, prospective, and descriptive design and combined the quantitative and qualitative approaches. The data used in the analysis were drawn from a larger study designed to explore the transition to quasi-widowhood and wives' responses to their husbands' institutionalization. The caregiving career of wives was seen as a pattern of frequent visiting and increasing involvement in the provision of care. Over the nine-month period of the study, two caregiving patterns emerged that were distinguished by a variety of circumstances and interactions. Wives who relinquished aspects of caregiving were more likely to be caring for husbands who were, in large measure, cognitively impaired. These wives reported good morale, few symptoms of depression, change in marital closeness, and satisfaction with aspects of institutional care. Wives who continued to be heavily involved in caregiving were more likely to have husbands who were physically impaired. They had depression scores indicative of moderate to severe depression, reported no change in marital closeness, and were dissatisfied with aspects of institutional care.

Nursing curricula and violence issues.

This article presents the findings of a survey of Canadian schools of nursing (N = 155) that determined the extent to which violence-related content is addressed in nursing curricula. The study yielded a response rate of 88%. Theoretical content regarding violence against children and women of all ages, and suicide as a response to abuse formed part of the curriculum of all schools of nursing, if only in readings. Child abuse and suicide received the greatest number of hours of instruction, followed by woman abuse, sexual assault, and elder abuse. University schools of nursing provided the greatest number of hours of instruction when compared with other types of schools. Schools in Western and Atlantic Canada provided the greatest number of hours of instruction on woman abuse when compared with other regions of the country. The majority of university schools provided experiential instruction in the area of violence, with the other types of schools providing very little such instruction. Findings revealed a sensitivity to the importance of including content on violence in nursing curricula; however, the approach to this content is largely incidental and heavily dependent on individual faculty interests. Implications of this study point to the need for the systematic inclusion of violence-related content and the sharing of resources among schools of nursing.

Continuing education for staff in long-term care facilities: corporate philosophies and approaches.

The purpose of this study was to determine corporate philosophies of continuing education and approaches to meeting the learning needs of staff who strive to provide for the increasingly challenging care requirements of seniors who reside in long-term care facilities. In-depth interviews lasting approximately 1 hour were conducted with key informants at the administrative level from nine long-term care facilities. Content analysis revealed a commitment to continuing education for staff. While recognizing the importance of organizational responsibility for continuing education, administrators placed emphasis on the individual responsibility of staff. Learning needs were identified as affective, managerial, and physical in nature. Challenges to providing continuing education programs were derived from a general lack of fiscal and human resources. A variety of measures was suggested as important to supporting the continuing learning of staff. Implications of this study point to the need for long-term care facilities to incorporate into their strategic plans measures of ensuring continuing education as a basis for the ongoing competence and development of staff. In addition, there is a need for collaboration between long-term care facilities and other institutions of a long-term care, acute care, and educational nature in the development of strategies to operationalize a philosophy of continuing learning as a basis for the provision of optimal care to residents.

Palliative care. An integral part of life's end.

While the needs of dying individuals and their families have come under increasing scrutiny in the past decade, issues related to the needs of older adults (75 years or more) who are dying have not been systematically addressed. Death and dying are increasingly associated with old age, yet the conceptualization of palliative care in later life is not well developed. All too often, the philosophy and principles of palliative care are not invoked in the care of people who are both old and dying. It is an omission that must cease.