Risk factors for burnout and depression in healthcare workers: The national AMADEUS study protocol.

CONTEXT: Burnout is an international phenomenon defined as a state of professional exhaustion. It can lead to depression and have major economic and organizational impacts. Previous studies of healthcare professionals in France have focused on physicians, but none to date have explored other healthcare professions. OBJECTIVES: The main objective of our study is to determine the prevalence of burnout among healthcare workers. The secondary objectives are to explore the associations of burnout with professional and psycho-social factors and the risk of depression, professional harassment, sexual harassment, sexual-orientation based discrimination, consumption of antidepressants, anxiolytics and also the lifestyle of the individual: smoking, alcohol consumption, coffee consumption, physical activity and sleep quality. MATERIALS AND METHODS: The survey will take the form of a voluntary and anonymous online questionnaire carried out on the FramaForm1® platform and will be disseminated via social networks, professional networks and mailings. STUDY POPULATION: Senior doctors, interns, directors of care, nurses, head nurses and senior head nurses, physiotherapists and occupational therapists, dieticians, radiology technicians, laboratory technicians, psychologists, nurses' aides, auxiliary nurses and midwives will be included. COLLECTED DATA: Burnout will be measured with the Maslach Inventory burnout (MBI) questionnaire, work environment with the Karasek questionnaire and anxiety, depression risk with the Center for Epidemiologic Studies- Depression (CES-D), physical activity with the Global Physical Activity Questionnaire (GPAQ) and sleep quality with the Pittsburgh Sleep Quality Index (PSQI). ETHICS: This protocol has been accepted by the ethical committee (IRB n°C08/21.01.06.93911, CNIL). EXPECTED RESULTS: Based on international studies, we expect a high rate of burnout with disparities according to profession, socio-demographic data, seniority and type of service. We also expect a significant rate of untreated depression. This study will provide evidence for policy makers to implement collective strategies to reduce burnout and depression in the different populations studied.

Aerodynamic impact of total inferior turbinectomy versus inferior turbinoplasty - a computational fluid dynamics study.

BACKGROUND: The aim of this study was to investigate using computational fluid dynamics (CFD) the effects on nasal aerodynamics of two different techniques for reducing the inferior turbinate. This may assist in surgical planning to select the optimal procedure. METHODS: Virtual surgery using two techniques of turbinate reduction was performed in eight nasal airway obstruction patients. Three bilateral nasal airway models for each patient were compared: 1) Pre-operative 2) Bilateral inferior turbinoplasty 3) Bilateral total inferior turbinate resection (ITR). Two representative healthy models were included. CFD modeling of airflow was performed under steady-state, laminar, inspiratory conditions. RESULTS: Nasal airway resistance was slightly more reduced following ITR compared to turbinoplasty due to loss of the pressure gradient at the head of the IT. Turbinoplasty resulted in ventilation, pressure and wall shear stress profiles closer to those of healthy models. A more prominent jet-like course of the main flow stream was observed inferiorly in the ITR group. CONCLUSIONS: Nasal air conditioning was significantly altered following IT surgery. Overall differences between the groups were small and are unlikely to bear influence on nasal function in normal environments. Further studies using a larger number of patients and healthy subjects are required, attempting to establish a clinical correlation with long-term outcomes such as the perception of nasal patency, mucosal crusting and drying, and air conditioning in different environments. Since a large proportion of IT mucosa remains following turbinoplasty, future dependence on topical therapy should also be considered.

Quantification of airflow in the sinuses following functional endoscopic sinus surgery.

BACKGROUND: Despite functional endoscopic sinus surgery (FESS) being the standard of care in medically recalcitrant chronic rhinosinusitis (CRS), its effect on sinus ventilation has not been fully characterized. Airflow simulations can help improve our understanding of how surgical strategies affect post-surgical sinus ventilation. METHODS: Eight postoperative sinonasal cavity models were reconstructed from a wide spectrum of CRS patients who had undergone FESS. Computational fluid dynamics modeling of steady-state, laminar, inspiratory airflow was performed. Ventilation was quantified and observed for all the sinuses in each model. RESULTS: Sinus aeration was enhanced following FESS, particularly in the maxillary and ethmoid sinuses. The degree of improvement was related to the extent of surgery performed. This finding was accentuated at a higher inhalational flow rate of 15L/min. The relationship between ostium size and corresponding sinus inflow was stronger for the maxillary and sphenoid sinuses. Maxillary inflow reached 50% in a mega-antrostomy patient, while negligible flow occurred in the frontal sinuses for except one whom had undergone a modified Lothrop procedure. CONCLUSIONS: This study has quantified sinus airflow in the largest set of post-FESS patients to date, to show that with increasing extensive surgery, the sinus and nasal cavity become more interconnected and functionally interdependent. Accordingly, sinus ventilation is improved. This may have important consequences for pre- and post-surgical assessment and planning, and on predicting how drug delivery treatments and devices can be designed to target the postoperative sinuses.

Comment on the European position paper on diagnostic tools in rhinology â€" computational fluid dynamics.

We read with interest the excellent paper authored by Rimmer et al. (1) entitled The European Position Paper on Diagnostic Tools in Rhinology. The authors are to be commended for their comprehensive, up-to-date and thorough summary of available tests in the assessment of rhinologic function. The paper describes traditional tools used in nasal airway obstruction (NAO); including subjective patient reported outcome measure questionnaires (PROMs) such as the NOSE scale; tests that are subjective to the clinician, such as clinical examination, nasendoscopy and imaging; and objective tests such peak nasal inspiratory flow (PNIF), rhinomanometry (RM) and acoustic rhinometry (AR). Unfortunately, each of these readily available, traditional tools fail to meet several accepted criteria of an ideal diagnostic test (Table 1), as outlined (2,3). In our opinion, these limitations restrict the capacity of Rhinology to develop as a discipline founded on sound evidence-based science.

Nonlinear eddy viscosity modeling and experimental study of jet spreading rates.

Indoor airflow pattern is strongly influenced by turbulent shear and turbulent normal stresses that are responsible for entrainment effects and turbulence-driven secondary motion. Therefore, an accurate prediction of room airflows requires reliable modeling of these turbulent quantities. The most widely used turbulence models include RANS-based models that provide quick solutions but are known to fail in turbulent free shear and wall-affected flows. In order to cope with this deficiency, this study presents a nonlinear k-ε turbulence model and evaluates it along with linear k-ε models for an indoor isothermal linear diffuser jet flow measured in two model rooms using PIV. The results show that the flow contains a free jet near the inlet region and a wall-affected region downstream where the jet is pushed toward the ceiling by entrainment through the well-known Coanda effect. The CFD results show that an accurate prediction of the entrainment process is very important and that the nonlinear eddy viscosity model is able to predict the turbulence-driven secondary motions. Furthermore, turbulence models that are calibrated for high Reynolds free shear layer flows were not able to reproduce the measured velocity distributions, and it is suggested that the model constants of turbulence models should be adjusted before they are used for room airflow simulations.

Combining experimental and computational techniques to understand and improve dry powder inhalers.

INTRODUCTION: Dry Powder Inhalers (DPIs) continue to be developed to deliver an expanding range of drugs to treat an ever-increasing range of medical conditions; with each drug and device combination needing a specifically designed inhaler. Fast regulatory approval is essential to be first to market, ensuring commercial profitability. AREAS COVERED: In vitro deposition, particle image velocimetry, and computational modeling using the physiological geometry and representative anatomy can be combined to give complementary information to determine the suitability of a proposed inhaler design and to optimize its formulation performance. In combination, they allow the entire range of questions to be addressed cost-effectively and rapidly. EXPERT OPINION: Experimental techniques and computational methods are improving rapidly, but each needs a skilled user to maximize results obtained from these techniques. Multidisciplinary teams are therefore key to making optimal use of these methods and such qualified teams can provide enormous benefits to pharmaceutical companies to improve device efficacy and thus time to market. There is already a move to integrate the benefits of Industry 4.0 into inhaler design and usage, a trend that will accelerate.

Computational modelling of nasal respiratory flow.

CFD has emerged as a promising diagnostic tool for clinical trials, with tremendous potential. However, for real clinical applications to be useful, overall statistical findings from large population samples (e.g., multiple cases and models) are needed. Fully resolved solutions are not a priority, but rather rapid solutions with fast turn-around times are desired. This leads to the issue of what are the minimum modelling criteria for achieving adequate accuracy in respiratory flows for large-scale clinical applications, with a view to rapid turnaround times. This study simulated a highly-resolved solution using the large eddy simulation (LES) method as a reference case for comparison with lower resolution models that included larger time steps and no turbulence modelling. Differences in solutions were quantified by pressure loss, flow resistance, unsteadiness, turbulence intensity, and hysteresis effects from multiple cycles. The results demonstrated that sufficient accuracy could be achieved with lower resolution models if the mean flow was considered. Furthermore, to achieve an established transient result unaffected by the initial start-up quiescent effects, the results need to be taken from at least the second respiration cycle. It was also found that the exhalation phase exhibited strong turbulence. The results are expected to provide guidance for future modelling efforts for clinical and engineering applications requiring large numbers of cases using simplified modelling approaches.

Optimising nasal spray parameters for efficient drug delivery using computational fluid dynamics.

Experimental images from particle/droplet image analyser (PDIA) and particle image velocimetry (PIV) imaging techniques of particle formation from a nasal spray device were taken to determine critical parameters for the study and design of effective nasal drug delivery devices. The critical parameters found were particle size, diameter of spray cone at a break-up length and a spray cone angle. A range of values for each of the parameters were ascertained through imaging analysis which were then transposed into initial particle boundary conditions for particle flow simulation within the nasal cavity by using Computational Fluid Dynamics software. An Eulerian-Lagrangian scheme was utilised to track mono-dispersed particles (10 and 20 microm) at a breathing rate of 10 L/min. The results from this qualitative study aim to assist the pharmaceutical industry to improve and help guide the design of nasal spray devices.

Deposition of inhaled wood dust in the nasal cavity.

Detailed deposition patterns of inhaled wood dust in an anatomically accurate nasal cavity were investigated using computational fluid dynamics (CFD) techniques. Three wood dusts, pine dust, heavy oak dust, and light oak dust, with a particle size distribution generated by machining (Chung et al., 2000), were simulated at an inhalation flow rate of 10 L/min. It was found that the major particle deposition sites were the nasal valve region and anterior section of the middle turbinate. Wood dust depositing in these regions is physiologically removed much more slowly than in other regions. This leads to the surrounding layer of soft tissues being damaged by the deposited particles during continuous exposure to wood dust. Additionally, it was found that pine dust had a higher deposition efficiency in the nasal cavity than the two oak dusts, due to the fact that it comprises a higher proportion of larger sized particles. Therefore, this indicates that dusts with a large amount of fine particles, such as those generated by sanding, may penetrate the nasal cavity and travel further into the lung.

Comparison of micron- and nanoparticle deposition patterns in a realistic human nasal cavity.

Knowledge regarding particle deposition processes in the nasal cavity is important in aerosol therapy and inhalation toxicology applications. This paper presents a comparative study of the deposition of micron and submicron particles under different steady laminar flow rates using a Lagrangian approach. A computational model of a nasal cavity geometry was developed from CT scans and the simulation of the fluid and particle flow within the airway was performed using the commercial software GAMBIT and FLUENT. The air flow patterns in the nasal cavities and the detailed local deposition patterns of micron and submicron particles were presented and discussed. It was found that the majority of micron particles are deposited near the nasal valve region and some micron particles are deposited on the septum wall in the turbinate region. The deposition patterns of micron particles in the left cavity are different compared with that in the right one especially in the turbinate regions. In contrast, the deposition for nanoparticles shows a moderately even distribution of particles throughout the airway. Furthermore the particles releasing position obviously influences the local deposition patterns. The influence of the particle releasing position is mainly shown near the nasal valve region for micron particle deposition, while for submicron particles deposition, both the nasal valve and turbinate region are influenced. The results of the paper are valuable in aerosol therapy and inhalation toxicology.