Immune imprinting: The persisting influence of the first antigenic encounter with rapidly evolving viruses.

Immune imprinting is a phenomenon that stems from the fundamentals of immunological memory. Upon recurrent exposures to an evolving pathogen, the immune system must weigh the benefits of rapidly recalling established antibody repertoires with greater affinity to the initial variant or invest additional time and energy in producing de novo responses specific to the emerging variant. In this review, we delve into the mechanistic complexities of immune imprinting and its role in shaping subsequent immune responses, both de novo and recall, against rapidly evolving respiratory viruses such as influenza and coronaviruses. By exploring the duality of immune imprinting, we examine its potential to both enhance or hinder immune protection against disease, while emphasizing the role of host and viral factors. Finally, we explore how different vaccine platforms may affect immune imprinting and comment on vaccine strategies that can favor de novo variant-specific antibody responses.

Seniority of Surgeon in Chronic Subdural Hematoma Recurrence: A Systematic Review and Meta-analysis.

Chronic subdural hematoma (CSDH) is increasingly common, particularly in the older and multimorbid population. Surgical proficiency in management is required in the early years of U.K. neurosurgical training with most cases performed by nonconsultant-grade surgeons. The aim of this systematic review was to examine the effect of surgeon seniority on recurrence for patients with CSDH. Full-text articles comparing surgical treatment for CSDH with a "senior" (consultant/attending level) or "junior" (resident/registrar or similar) lead surgeon were identified. MEDLine and EMBASE databases were searched. The primary outcome of this study was recurrence. Secondary outcomes included postoperative complications and mortality rate. A random effects meta-analysis was performed. The risk of bias was assessed using the National Institute of Health risk of bias toolkit. Five studies were included in the final analysis (n = 941 total patients). Individually, no study identified a significant difference in recurrence rate and postoperative complications between senior and junior neurosurgeons. On meta-analysis, junior-led evacuations had lower recurrence rates on pooled univariable analysis (12.0% vs. 17.9% [odds ratio 0.48, 95% confidence interval 0.29-0.78, I2 = 0%]) (3 studies). Seniority of surgeon was not associated with increased rates of recurrence patients undergoing CSDH surgery. Complexity of operation may be a confounding factor in observed lower recurrence rates with more junior operators.

Medicaid Acceptance Varies by Physician Seniority and Specialty in California.

Given varied insurance acceptances and differing pay between insurances, our objective was to examine the number of California physicians enrolled in Medicare and Medicaid (Medi-Cal), stratified by specialty and graduation year. Medi-Cal and Medicare providers were extracted from publicly available databases (Centers for Medicare & Medicaid Services and California Health and Human Services) and were subsequently merged into one dataset using National Provider Identifier. From there, we stratified physicians by specialty and graduation year. We found that emergency medicine, radiology, pathology, anesthesiology, general surgery, and internal medicine had the highest percent of Medi-Cal-accepting physicians, whereas dermatology, psychiatry, physical medicine & rehabilitation, and plastic & reconstructive surgery physicians had the lowest. There also appears to be an inverse relationship between acceptance of Medi-Cal and earlier year of graduation (P < 0.05). This study demonstrated striking variability in Medi-Cal acceptance based upon physician years in practice and specialty. Older, experienced physicians, as well as physicians of certain specialties, are less likely to accept Medi-Cal.

The moderating role of age and seniority on nurses' emotional dissonance and perceived health.

This study aims to investigate the weight of surface acting (a condition in which subjects must display an emotional state that does not correspond to their real feelings) in the relationship between the emotional load of nursing work and the perception of health, and to evaluate the moderating effect of age and length of service. A moderated mediation analysis was conducted on a sample of 359 Italian nurses. The results confirmed the mediation role of surface acting and showed that both age and seniority have moderating effects so that in conditions of high emotional load, older and more experienced nurses show higher levels of surface acting, and in conditions of high surface acting, younger and less experienced nurses show lower levels of perceived health. In conclusion, surface acting seems a stressor for younger nurses, not yet used to the weight of faking emotions, while the perceived emotional load seems a stressor for older and more experienced nurses. Each result highlights the importance of providing emotional regulation skills training and support to reduce the psychological impact of emotional demands on nurses.

Influence of residency discipline and seniority on traumatic musculoskeletal radiographs interpretation accuracy: a multicenter study.

OBJECTIVES: Imaging studies are a significant and integral part of the initial assessment of patients admitted to the emergency department. Developing imaging diagnostic abilities early in residency is of paramount importance. The purpose of this study was to evaluate and compare diagnosis accuracy of common musculoskeletal X-rays (XR) between residency disciplines and seniority. METHODS: A multicenter study which evaluated orthopedic surgery, emergency medicine (EM), and radiology residents, through a test set of common MSK XR. Residents were classified as "beginner" or "advanced" according to postgraduate year per residency. Residents were asked to answer whether the radiograph shows normal or pathological findings (success rate) and what is the diagnosis ("diagnosis accuracy"). Residents' answers were analyzed and assessed compared to experts' consensus. RESULTS: A total of 100 residents (62% beginners) participated in this study. Fifty-four were orthopedic surgeons, 29 were EM residents and 17 were radiologists. The entire cohort's overall success rate was 88.5%. The overall mean success rates for orthopedic, EM, and radiology residents were 93.2%, 82.8%, and 83.3%, respectively, and were significantly different (p < 0.0001). Orthopedic residents had significantly higher diagnostic accuracy rates compared with both radiology and EM residents (p < 0.001). Advanced orthopedic and EM residents demonstrated higher diagnostic accuracy rates compared to beginner residents (p = 0.001 and p = 0.03, respectively). CONCLUSION: Orthopedic residents presented higher diagnosis accuracy of MSK imaging compared to EM and radiology residents. Seniority had a positive effect on diagnosis accuracy. The development of an educational program on MSK XR is necessary to enhance the competency of physicians in their daily practice.

Are we happy with our work in globalization? Globalization experience, achievement motivation, and job seniority as predictors of work satisfaction in a group of office workers.

BACKGROUND: The main aim of this study was to determine whether globalization experience is a predictor of work satisfaction. In addition, we inspected a regression model consisting of globalization experience, job seniority, and goal achievement to determine how much variance in work satisfaction is accounted for by globalization experience. Most the theoretical texts about globalization suggest its negative impact on everyday life. The negative effects are - work-life balance problem, weakening of mechanisms to protect against the fear of death, and uncertainty. METHOD: 250 office workers participated in the study (Mage = 38.37; 145 females and 105 males). They responded to paper-and-pencil anonymous questionnaires measuring globalization experience, achievement goals, and work satisfaction. Respondents were also asked about their job seniority. We used Spearman's rho correlations and multiple linear regression to check the basic linear relation between variables, and hierarchical multiple regression to determine which of them is the strongest predictor of work satisfaction. RESULTS: The results indicated that globalization experience (R2 change = 0.089; p < .05) is a statistically significant negative predictor of work satisfaction and job seniority (R2 change = 0.056; p < .05) while achievement goals (R2 change = 0.188; p < .001) are positive predictors of work satisfaction. CONCLUSION: We concluded that further research on globalization experience is necessary because it is the precursory individualistic approach to globalization research and we obtained a statistically significant yet small relation with work satisfaction in correlation and regression analyses. The presented results are also the rationale for promoting mastery approach goals in the workplace to improve work satisfaction as they are statistically significant positive predictors of it.

Curriculum framework to facilitate critical thinking skills of undergraduate nursing students: A cooperative inquiry approach.

AIM: Critical thinking (CT) is vital in assisting nurses to function efficiently in the ever-changing health care environment. A CT-based curriculum framework provides the impetus necessary to drive the acquisition of CT skills of students. Yet, there is no known CT-based framework contextualized to developing countries where seniority tradition is a norm. Therefore, the aim of this study was to develop a CT-based curriculum framework to facilitate the development of CT skills of nursing students in developing countries. DESIGN: Cooperative inquiry. METHODS: Using purposive sampling, 11 participants comprising students, educators and preceptors developed a CT-based curriculum framework. RESULTS: Findings were organized into a framework illustrating interconnected concepts required to foster CT skills of nursing students. These concepts include authentic student-facilitator partnership, a facilitator that makes a difference; a learner that is free to question and encouraged to reflect; a conducive and participatory learning environment; curriculum renewal processes and contextual realities.

Emergent variant modeling of the serological repertoire to norovirus in young children.

Human norovirus is the leading cause of acute gastroenteritis. Young children and the elderly bear the greatest burden of disease, representing more than 200,000 deaths annually. Infection prevalence peaks at younger than 2 years and is driven by novel GII.4 variants that emerge and spread globally. Using a surrogate neutralization assay, we characterize the evolution of the serological neutralizing antibody (nAb) landscape in young children as they transition between sequential GII.4 pandemic variants. Following upsurge of the replacement variant, antigenic cartography illustrates remodeling of the nAb landscape to the new variant accompanied by improved nAb titer. However, nAb relative avidity remains focused on the preceding variant. These data support immune imprinting as a mechanism of immune evasion and GII.4 virus persistence across a population. Understanding the complexities of immunity to rapidly evolving and co-circulating viral variants, like those of norovirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV2), and dengue viruses, will fundamentally inform vaccine design for emerging pathogens.

The Impact of Surgical Experience in VATS Lobectomy on Conversion and Patient Quality of Life: Results from a Comprehensive National Video-Assisted Thoracic Surgical Database.

OBJECTIVES: Although unexpected conversion during Video-Assisted Thoracic Surgery (VATS) lobectomy is up to 23%, the effects on postoperative outcomes remain debatable. This retrospective study aimed: (i) to identify potential preoperative risk factors of VATS conversion to standard thoracotomy; (ii) to assess the impact of surgical experience in VATS lobectomy on conversion rate and patient health-related quality of life. METHODS: We extracted detailed information on VATS lobectomy procedures performed consecutively (2014-2019). Predictors of conversion were assessed with univariable and multivariable logistic regressions. To assess the impact of VATS lobectomy experience, observations were divided according to surgeons' experiences with VATS lobectomy. The impact of VATS lobectomy experience on conversion and occurrence of postoperative complications was evaluated using logistic regressions. The impact of VATS lobectomy experience on EuroQoL-5D (EQ-5D) scores at discharge was assessed using Tobit regressions. RESULTS: A total of 11,772 patients underwent planned VATS for non-small-cell lung cancer (NSCLC), with 1074 (9.1%) requiring conversion to thoracotomy. The independent predictors at multivariable analysis were: FEV1% (OR = 0.99; 95% CI: 0.98-0.99, p = 0.007), clinical nodal involvement (OR = 1.43; 95% CI: 1.08-1.90, p = 0.014). Experienced surgeons performed 4079 (34.7%) interventions. Experience in VATS lobectomy did not show a relevant impact on the risk of open surgery conversion (p = 0.13) and postoperative complications (p = 0.10), whereas it showed a significant positive impact (p = 0.012) on EQ-5D scores at discharge. CONCLUSIONS: Clinical nodal involvement was confirmed as the most critical predictor of conversion. Greater experience in VATS lobectomy did not decrease conversion rate and postoperative complications but was positively associated with postoperative patient quality of life.

Positive affect and job performance in psychiatric nurses: A moderated mediation analysis.

AIMS: The aims of this research were (a) to determine if job satisfaction plays an intermediary role between positive affect and job performance; (b) to explore whether the mediating process of positive affect affecting job performance through job satisfaction is moderated by the work seniority of psychiatric nurses. DESIGN: A questionnaire-based cross-sectional study. METHODS: From January 2021 to May 2022, a total of 328 psychiatric nurses were recruited through online advertisements. Data regarding positive affect, job satisfaction, work seniority and job performance were obtained through survey questionnaires. The moderated mediation model was examined in this study utilizing the SPSS (Version 26.0) macro process 3.3, with job satisfaction as the mediation variable and work seniority as the moderation variable. RESULTS: Job performance and job satisfaction were both positively connected with positive affect, while job satisfaction was favourably correlated with job performance. Job satisfaction played a part mediating role between positive affect and job performance, with an effect value of 0.10, accounting for 22.22% of the total effect. And work seniority moderated the second half of the mediating process. CONCLUSION: Positive affect positively affected job performance through two paths, directly or indirectly. Part of the intermediate role of job satisfaction between positive affect and job performance is regulated by seniority; that is, work seniority buffered the positive effect of positive affect on job performance. IMPACT: This study revealed how positive affect works and elaborated the conditions to play a role, which greatly enriched the content of positive psychology and had important significance for deepening and expanding the relationship between positive affect and job performance. It also provided a reference for nursing managers to implement humanized management, build a high-performance psychiatric nurse team and promote the long-term development of psychiatric hospitals. PATIENT OR PUBLIC CONTRIBUTION: Three hundred and twenty-eight psychiatric nurses participated in the questionnaire. Trained staff were involved in data collection.

Encouraging physicians' continuous knowledge-sharing in online health communities: A motivational perspective.

Online health communities (OHCs) as an essential means of patient education can significantly improve patients' health literacy and treatment outcomes. However, sustaining these social benefits brought by OHCs establishes the prerequisite that physicians can continuously share their knowledge on OHCs. Although previous studies have explored physicians' knowledge-sharing in OHCs, scholarly knowledge related to the means of motivating physicians to continue sharing their knowledge remains limited. Therefore, this study developed a research model based on motivation theory to explore the influence of practical benefits, psychological rewards, and perceived connectedness with OHCs on physicians' continuous knowledge-sharing behaviors and the contingent role of physicians' online seniority status. The research model and relevant hypotheses were examined using objective data from one of the leading OHCs in China. The empirical results reveal that both practical benefits and psychological rewards positively affect physicians' continuous knowledge-sharing behaviors. However, an unexpected finding is that perceived connectedness is negatively associated with physicians' continuous knowledge-sharing behaviors. In addition, physicians' online seniority status strengthens the relationship between practical benefits and continuous knowledge-sharing behaviors but weaken the role of psychological rewards and perceived connectedness on continuous knowledge-sharing behaviors. This study contributes to the understanding of the motivational mechanisms underlying physicians' continuous knowledge-sharing behaviors in OHCs and provides significant practical implications for practitioners of OHCs.

Immune Imprinting Drives Human Norovirus Potential for Global Spread.

Understanding the complex interactions between virus and host that drive new strain evolution is key to predicting the emergence potential of variants and informing vaccine development. Under our hypothesis, future dominant human norovirus GII.4 variants with critical antigenic properties that allow them to spread are currently circulating undetected, having diverged years earlier. Through large-scale sequencing of GII.4 surveillance samples, we identified two variants with extensive divergence within domains that mediate neutralizing antibody binding. Subsequent serological characterization of these strains using temporally resolved adult and child sera suggests that neither candidate could spread globally in adults with multiple GII.4 exposures, yet young children with minimal GII.4 exposure appear susceptible. Antigenic cartography of surveillance and outbreak sera indicates that continued population exposure to GII.4 Sydney 2012 and antigenically related variants over a 6-year period resulted in a broadening of immunity to heterogeneous GII.4 variants, including those identified here. We show that the strongest antibody responses in adults exposed to GII.4 Sydney 2012 are directed to previously circulating GII.4 viruses. Our data suggest that the broadening of antibody responses compromises establishment of strong GII.4 Sydney 2012 immunity, thereby allowing the continued persistence of GII.4 Sydney 2012 and modulating the cycle of norovirus GII.4 variant replacement. Our results indicate a cycle of norovirus GII.4 variant replacement dependent upon population immunity. Young children are susceptible to divergent variants; therefore, emergence of these strains worldwide is driven proximally by changes in adult serological immunity and distally by viral evolution that confers fitness in the context of immunity. IMPORTANCE In our model, preepidemic human norovirus variants harbor genetic diversification that translates into novel antigenic features without compromising viral fitness. Through surveillance, we identified two viruses fitting this profile, forming long branches on a phylogenetic tree. Neither evades current adult immunity, yet young children are likely susceptible. By comparing serological responses, we demonstrate that population immunity varies by age/exposure, impacting predicted susceptibility to variants. Repeat exposure to antigenically similar variants broadens antibody responses, providing immunological coverage of diverse variants but compromising response to the infecting variant, allowing continued circulation. These data indicate norovirus GII.4 variant replacement is driven distally by virus evolution and proximally by immunity in adults.

The impact of healthcare executive seniority on implementation of innovative methods of diagnosis and prevention.

Innovative methods of diagnosis and prevention play a key role in the survival of healthcare systems as well as the wellbeing of patients. Effective healthcare management is a critical factor in implementing hospital innovation. Healthcare executive (HE) personal and job characteristics such as age and seniority have been found to affect innovative decision-making. However, no study has yet investigated age and seniority effects on the propensity to implement innovation in health prevention strategies. This study fills the literature gap by providing evidence for the effect of HE age and seniority on the implementation of innovative methods for diagnosis and prevention. Predicated on 57 in-depth interviews with HEs, we employ mixed methods research, combining qualitative and quantitative analysis. Structural Equation Modeling was used to test the model's goodness-of-fit. Results show that while HE age and number of years in the organization positively affect job tenure, job tenure, in turn, negatively affects willingness to implement innovative methods of diagnosis and prevention in hospitals. This study extends the Upper-Echelon Theory to health workforce management. Practical implications are discussed.

Latent Occupational Burnout Profiles of Working Women.

According to scientific research, emergency call-takers and dispatchers (ECD) are particularly vulnerable to burnout syndrome. It can be observed that this occupation is predominantly performed by women. Moreover, the studies on occupational burnout indicate its different causes depending on employees' gender. The aim of this research was to apply a Person-Oriented approach in order to examine the relationships between particular risk factors, the level of burnout, and its health consequences in a group of women. A cross-sectional survey study was conducted on 296 women (call-takers and dispatchers) from public-safety answering points in Poland. The Link Burnout Questionnaire and a sociodemographic questionnaire were used to gather information. The method of latent profile analysis (LPA) was employed in the study. The study revealed burnout patterns without full symptoms as well as four different burnout profiles. The findings partially confirmed initial assumptions about correlations between the length of service as ECD, marital status, motherhood, burnout symptoms, and body mass index (BMI). Sociodemographic variables differentiated the examined women in terms of their emotional exhaustion and BMI. Three groups of women at risk of burnout and overweight were identified: those with the shortest job experience, those with the longest job experience, and an intermediate group. In each of these groups, symptoms indicating a possible risk of burnout-related health issues could be observed. The application of a Person-Oriented approach allowed for assessing possible correlations between burnout risk factors, its symptoms, and health consequences.

Antigenic Site Immunodominance Redirection Following Repeat Variant Exposure.

Human norovirus is a leading cause of acute gastroenteritis, driven by antigenic variants within the GII.4 genotype. Antibody responses to GII.4 vaccination in adults are shaped by immune memory. How children without extensive immune memory will respond to GII.4 vaccination has not been reported. Here, we characterized the GII.4 neutralizing antibody (nAb) landscape following natural infection using a surrogate assay and antigenic site chimera virus-like particles. We demonstrate that the nAb landscape changes with age and virus exposure. Among sites A, C, and G, nAbs from first infections are focused on sites A and C. As immunity develops with age/exposure, site A is supplemented with antibodies that bridge site A to sites C and G. Cross-site nAbs continue to develop into adulthood, accompanied by an increase in nAb to site G. Continued exposure to GII.4 2012 Sydney correlated with a shift to co-dominance of sites A and G. Furthermore, site G nAbs correlated with the broadening of nAb titer across antigenically divergent variants. These data describe fundamental steps in the development of immunity to GII.4 over a lifetime, and illustrate how the antigenicity of one pandemic variant could influence the pandemic potential of another variant through the redirection of immunodominant epitopes.

Humility and Competence: Which Attribute Affects Social Relationships at Work?

Between likability and competence, people value likable colleagues (regardless of their competence level) more than competent colleagues. If humility replaces competence, the preference might be different since humility is not always associated with positive outcomes. Humility and competence form four archetypes: humble star, humble fool, competent jerk, and incompetent jerk. This study examined the personal and professional preferences for these archetypes in the workplace and how the preference is moderated by colleagues' seniority. There were 475 working adults aged between 21 and 77 (M = 40.34, SD = 11.32) recruited to complete an online survey. While humble fools were more likable than competent jerks in personal interactions, competent jerks received more cooperation than humble fools in professional interactions. Seniority did not affect these findings. Our findings shed light on whether, and when, humility should be highly valued in organizational settings. Promoting humility in the workplace setting might require more caution.

Senior first, junior second.

The seniority system exists in most companies, including in healthcare industries. Seniority often plays an essential role in the organizational success and career advance of employees. However, there are pros and cons in the application of the seniority system in all organizations, especially in the healthcare industry. This article prompts a discussion about seniority in nursing and provides some particular concerns and recommendations for consideration, and this begs the question, should senior be first and junior second?

Social and Economic Exchange Between Social Workers and their Employers in the Context of their Sectorial Affiliation and Seniority.

Partial privatization creates organizational hybrids that can generate conflict between professional and institutional logic among social workers. Research is scant but necessary to identify better organizational approaches. Using the social and economic exchange (SEE) model, we examined Israeli social workers' perception of their relationships with their workplaces. To examine organizational affiliation and seniority impact on SEE, we conducted a two-way ANOVA on data from 824 social workers: 55.1% from government sector (GSO) 30.8% from 'third sector' (TSO), and 14.1% from for-profit sector (FPO) organizations. Our findings showed the SEE model identified ways organizations and their social workers manage sector hybridity. Social exchange among TSO social workers was higher than GSOs, but similar to FPOs. Economic exchange was higher in FPOs, compared to GSOs. Seniority related only to economic exchange, possibly signaling change among newer social workers. TSOs must strengthen their social exchange to maintain their advantage among social workers.

Psychological distress and perceived job stressors among hospital nurses and physicians during the COVID-19 outbreak.

AIMS: The study examined self-reported job-related stressors induced by the COVID-19 pandemic and psychological distress among hospital nurses and physicians. In addition, we explored the role of negative affect (NA) and background variables in relation to COVID-19-related job stressors and psychological distress. BACKGROUND: During COVID-19 pandemic, hospital nurses and physicians were exposed to highly enduring occupational stress, that stem from subjective appraisal of inadequate job resources (i.e., personal protection equipment, information on how to manage safely in the ongoing work and organizational attention to the needs arising from the ongoing work). DESIGN: Cross-sectional design. METHODS: Between May and July 2020, 172 nurses and physicians working at a medical centre in Israel filled in self-report questionnaires about sociodemographic data, COVID-19-related job stressors, psychological distress and NA. RESULTS: Our results confirmed the positive direct link between perceived COVID-19-related job stressors and psychological distress among hospital nurses and physicians. NA was found to serve as a mediator in this association (indirect link). Furthermore, nurses and physicians' seniority was related positively to psychological distress and also played a moderator role in the indirect link. CONCLUSION: We recommend to monitor the mental health of hospital nurses and physicians and to provide a platform to address their job stressor concerns related to COVID-19, and share helpful coping strategies. IMPACT STATEMENT: During the abrupt COVID-19 outbreak, hospital nurses and physicians face challenges that might raise NA and psychological distress. Our study revealed that among hospital nurses and physicians, COVID-19-related perceived job stressors and psychological distress were positively linked, and NA plays a mediating role in this association. Among nurses and physicians with moderate or high years of seniority (>11 years), higher COVID-19-related perceived job stressors associated with higher NA, which in turn was associated with greater psychological distress. Policymakers would be wise to provide a platform to address hospital nurses and physicians' mental health.

The Effort-Reward Model and Its Effect on Burnout Among Nurses in Ecuador.

Burnout has harmful consequences for individuals and organizations. The study of its antecedents can help us to manage and prevent it. This research aims to explore the role of the effort-reward imbalance (ERI) model as well as the mediation of the working experience in the burnout processes. For this purpose, we have conducted a study in 629 employees from two hospitals in the city of Guayaquil (Ecuador). For this study, the Spanish version of the Maslach Burnout Inventory was applied, as well as the ERI Questionnaire, along with other socio-demographical and occupational variables. A statistical analysis was performed with the obtained data, using structural equation models (SEMs). Results showed that employee effort has a stronger and statistically significant direct effect on emotional burnout, whereas the perception of the obtained reward also had this effect but indirectly in a negative sense, with job experience as a mediating variable.