Cognitive Emotion Regulation Strategies Predict Burnout in Geriatric Nursing Staff.

OBJECTIVES: Burnout contributes to high turnover rates, medical errors, and poor patient satisfaction in geriatric nursing staff. Nurses' cognitive emotion regulation (ER) strategies are emerging as an important personal resource related to burnout that are modifiable with intervention. This study examined the association between cognitive ER strategies and burnout among geriatric nursing staff. METHODS: Participants were 54 nurses (RNs, LPNs, CNA/UWs) with a mean age of 43.1 years (SD = 12.2), majority female (96.3%), and racially diverse: Black (20.4%), White (63.0%), and Other (13.0%). RESULTS: After controlling for CVs, cognitive ER strategies accounted for unique variance in depersonalization, but did not account for unique variance in emotional exhaustion or personal accomplishment. Rumination was associated with greater depersonalization, and greater refocus on planning was associated with lower depersonalization. CONCLUSIONS: Findings suggest that depersonalization may be most impacted by ER; however, other ER strategies may be important that were not included in the current study (e.g., experiential avoidance, mindfulness). Future research is needed with additional ER strategies and larger samples. CLINICAL IMPLICATIONS: Findings support the use of person-centered interventions, such as cognitive-behavioral and mindfulness-based techniques, to improve stress management and decrease depersonalization.

Slip-resistant footwear reduces slips among National Health Service workers in England: a randomised controlled trial.

OBJECTIVES: Assess the effectiveness of 5* GRIP-rated slip-resistant footwear in preventing slips in the workplace compared to usual footwear (control group). METHODS: A multicentre, randomised controlled trial; 4553 National Health Service (NHS) staff were randomised 1:1 to the intervention group (provided with 5* GRIP-rated slip-resistant footwear) or the control group. The primary outcome of incidence rate of self-reported slips in the workplace over 14 weeks was analysed using a mixed-effects negative binomial model. Secondary outcome measures included incidence rate of falls from a slip, falls not from a slip, proportion of participants reporting a slip, fall or fracture and time to first slip and fall. RESULTS: 6743 slips were reported: 2633 in the intervention group (mean 1.16 per participant, range 0 to 36) and 4110 in the control group (mean 1.80 per participant, range 0 to 83). There was a statistically significant reduction in slip rate in the intervention group relative to the control group (incidence rate ratio (IRR) 0.63, 95% CI 0.57 to 0.70, p<0.001). Statistically significant differences, in favour of the intervention group, were observed in falls from a slip (IRR 0.51, 95% CI 0.28 to 0.92, p=0.03), the proportion of participants who reported a slip (OR 0.58, 95% CI 0.50 to 0.66, p<0.001) or fall (OR 0.73, 95% CI 0.54 to 0.99, p=0.04) and time to first slip (HR 0.73, 95% CI 0.67 to 0.80, p<0.001). CONCLUSIONS: The offer and provision of 5* GRIP-rated footwear reduced slips in NHS staff in the workplace. TRIAL REGISTRATION NUMBER: ISRCTN33051393.

The Individualized Addictions Consultation Team Residential Program: A Creative Solution for Integrating Care for Veterans With Substance Use Disorders Too Complex for Other Residential Treatment Programs.

OBJECTIVES: The Veterans Affairs (VA) healthcare system is one of the main providers of substance use treatment within the United States, and many veterans with a substance use disorder (SUD) present with co-occurring diagnoses or other concerns. Though there has been increasing recognition of the need for integration of treatments for SUD and comorbid mental illness, there have been limited studies of such programs, particularly within the VA healthcare system. To address that gap in the literature, this paper examines treatment outcomes in an integrated model of dual diagnosis residential treatment for veterans: the Individualized Addictions Consultation Team (I-ACT) program. Methods: The current paper draws from clinical outcome evaluation data within a residential treatment program at a large Midwestern VA Medical Center (VAMC). The I-ACT program provides residential substance abuse treatment to individuals with a primary SUD and other factors that interfere with the successful completion of a traditional residential rehabilitation program. Between 2017 and 2018, 130 individuals (97.7% men, average age = 60.62 years) entered the I-ACT program. As part of standard measurement-based care, veterans were administered the Brief Addiction Monitor and the Patient Health Questionnaire-9 at admission and discharge. Results: Most individuals (74.6%) who entered I-ACT completed the residential program (average length of stay 34.2 days). Scores on both measures significantly decreased from intake to discharge (p < .001), with the change in depression scores indicating clinically significant improvement. Those with an additional mental health diagnosis achieved similar decreases in substance use symptoms and had lower depression scores at discharge than those with a SUD alone. Conclusions: Our results indicate that even for veterans who may not benefit from traditional SUD treatment programs, a more integrated and personalized residential program can be effective.

VA Interprofessional Fellowship in Palliative Care: 15 Years of Training Excellence.

Since 2002, the Department of Veterans Affairs (VA) has provided a unique training opportunity in palliative care at six VA medical centers. The VA Interprofessional Fellowship in Palliative Care has trained chaplains, nurses, pharmacists, physicians, psychologists, and social workers to provide clinical palliative care and to develop as leaders in the profession. This article describes the program's origin, mission, outcomes, and lessons learned.

Serving All Who Served: Piloting an Online Tool to Support Cultural Competency with LGBT U.S. Military Veterans in Long-Term Care.

OBJECTIVE: Given health disparities between lesbian, gay, bisexual, and transgender (LGBT) and non-LGBT older adults, ensuring that the care provided in long-term care (LTC) settings is both supportive and sensitive to their unique needs and challenges is essential. This has become a matter of increasing priority in the United States Department of Veterans Affairs (VA), which in recent years has stated its mission to "serve all who served," including LGBT Veterans. With this in mind, we piloted an online training tool designed to enhance the LGBT cultural competence of interdisciplinary staff working in geriatric extended care units. METHOD: Interdisciplinary LTC staff participated in an online training module that contained information on unique factors that affect the lives of older LGBT Veterans, and provided considerations and strategies to assist staff in working with them. RESULTS: Following participation in the training, staff showed a significant increase in knowledge about LGBT Veterans, but not in skills or attitudes. CONCLUSIONS: Online-based LGBT cultural-competency training is useful in providing LTC staff with foundational knowledge that can help them work more competently with LGBT residents. CLINICAL IMPLICATIONS: LTC facilities can develop brief yet effective cultural competency trainings that increase the visibility of LGBT concerns in order to enhance clinical care.

Haemodynamics during dialysis and cognitive performance.

BACKGROUND AND AIMS: Persons receiving haemodialysis (HD) are at increased risk of cognitive impairment (CI). Since blood pressure (BP) fluctuations during HD may affect cerebral perfusion - and subsequently cognitive function - we examined the relationship between dialytic BP fluctuation and cognitive outcomes. METHODS: We included HD patients without diagnosed dementia who were 50 years or older. Using established methods, we classified participants' in CI categories (none to mild and moderate to severe) based on results of a neurocognitive battery. We collected demographic and laboratory data from dialysis unit records, as well as all BP measurements from 12 dialysis sessions. We tested the association between CI and BP fluctuation, adjusting for demographic and laboratory variables. RESULTS: Our study enrolled 39 patients; 25 had moderate to severe CI. The normal to mild CI group and the moderate to severe patients had similar degrees of BP fluctuation (average minimum systolic BP (SBP): 107.6 ± 18.7 vs 110.2 ± 18.6 mmHg, maximum drop in SBP: 32.6 ± 10.2 vs 35.4 ± 15.0 mmHg; proportion of sessions with SBP < 90 mmHg: 0.2 ± 0.3 vs 0.2 ± 0.3; average change in SBP, pre to post HD: 10.2 ± 12.4 vs 11.8 ± 16.4 mmHg, all P > 0.55). There was no association between BP variables and performance on individual cognitive tests. Multivariable analysis showed that older age and non-Caucasian race were associated with a reduction in cognitive scores. CONCLUSIONS: There was no cross-sectional association between dialytic BP changes and cognitive performance.

Prevalence of clinically significant red blood cell alloantibodies in pregnant women at a large tertiary-care facility.

More than 50 red blood cell (RBC) alloantibodies are known to cause hemolytic disease of the fetus and newborn (HDFN).Although Rh immune globulin (RhiG) prophylaxis has significantly reduced the incidence of pregnancies complicated by anti-D, the need to detect and monitor maternal allo antibodies capable of causing HDFN is still a concern. The prevalence and specificity of these alloantibodies were determined. In this retrospective study, the prevalence and specificities of unexpected RBC alloantibodies known to cause HDFN in pregnant women at a tertiary-care facility during a 5-year period were compiled and analyzed. Patient selection was carried out by computerized search of patient data based on an obstetric location and the presence or history of RBC antibody between January 1, 2007,and December 31, 2011. The information was organized by ABO and D status of the patient, antibody specificity, and transfusion needs. Of the 8894 obstetric patients identified during the 5-year period, 264 (3.0%) had one or more unexpected RBC antibodies.Of these 264 women, 107 (40.5%), or 1.2 percent overall, had an alloantibody known to cause HDFN, with a total of 15 different alloantibodies identified. The most common alloantibody found was anti-E (n = 33), followed by anti-M (n = 26) and anti-D (n= 20). In pregnancies of D- women, the most common clinically significant antibodies found were anti-D (n = 20), anti-C (n = 11),and anti-E (n = 2). In pregnancies of D+ women, the most common antibodies were anti-E (n = 31), anti-M (n = 25), and anti-K (n= 16). A total of eight pregnancies with alloantibodies required intrauterine transfusions with the specificities of anti-D; anti-D,-C(n = 2); anti-D,-C,-E; anti-D,-C,-K; anti-D,-C,-Jkb; anti-D,-S; and anti-E,-c. At a large academic tertiary-care center, approximately 1 in 83 obstetric patients had one or more RBC alloantibodies capable of causing HDFN. Anti-E, -M, and -D were the most frequent specificities, respectively.

"Paper in a day": A model to encourage psychology collaboration and participation in research/program evaluation.

Although psychologists are trained to conduct research as well as clinical work, it can be challenging for psychologists outside of traditional academia to find the time or capacity to engage in research. Providing opportunities for practicing psychologists to conduct research may enhance the generalizability of psychological research, as well as provide benefits to psychologists in terms of collaboration, promotion, and engagement. Yet, several barriers exist, including competing demands on time, lack of institutional support, and limited research confidence. This article describes "Paper in a Day" (PiaD), a novel approach to research engagement that is well-suited for busy practitioners. PiaD considers many of the aforementioned factors and provides a method to navigate the often-daunting prospect of research involvement for the practicing clinician. Through PiaD, two Department of Veterans Affairs (VA) Medical Centers engaged clinicians and trainees in collaborating in a time-limited way to write and publish peer-reviewed articles. The current article outlines the process by which clinicians at these two sites structured research engagement utilizing PiaD, and it was also written utilizing the PiaD model. The authors have now led or participated in the PiaD process five times, with 13 teams of clinicians producing nine peer-reviewed articles and five conference presentations. A brief survey indicated that participants felt engaged in the process and would participate again if given the opportunity. This article outlines barriers and facilitators of the PiaD process, with the hope of encouraging other settings to consider using such a method to enhance research productivity and engagement for psychologists. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Horizontal and Vertical Transport of Uranium in an Arid Weapon-Tested Ecosystem.

Armor-penetrating projectiles and fragments of depleted uranium (DU) have been deposited in soils at weapon-tested sites. Soil samples from these military facilities were analyzed by inductively coupled plasma-optical emission spectroscopy and X-ray diffraction to determine U concentrations and transport across an arid ecosystem. Under arid conditions, both vertical transport driven by evaporation (upward) and leaching (downward) and horizontal transport of U driven by surface runoff in the summer were observed. Upward vertical transport was simulated and confirmed under laboratory-controlled conditions, to be leading to the surface due to capillary action via evaporation during alternating wetting and drying conditions. In the field, the 92.8% of U from DU penetrators and fragments remained in the top 5 cm of soil and decreased to background concentrations in less than 20 cm. In locations prone to high amounts of water runoff, U concentrations were reduced significantly after 20 m from the source due to high surface runoff. Uranium was also transported throughout the ecosystem via plant uptake and wild animal consumption between trophic levels, but with limited accumulation in edible portions in plants and animals.

An Instrument to Assess Self-Perceived Competencies in End-of-Life Care for Health Care Professionals: The End-of-Life Care Questionnaire.

PURPOSE: We describe the development and the psychometric properties of an instrument to assess self-perceived EOL care competencies for healthcare professionals: The End-of-Life Care Questionnaire (EOL-Q). METHODS: The EOL-Q consists of 28 questions assessing knowledge, attitudes and behaviors with subscale items addressing seven domains of care: decision-making, communication, continuity of care, emotional support for patients/families, symptom management, spiritual support for patients/families, and support for clinicians. The EOL-Q was used to assess competencies of 1,197 healthcare professionals from multiple work units at a large medical center. Cronbach's alpha coefficients were calculated for the survey and subscales. A factor analysis was also conducted. RESULTS: Internal consistency reliability was for was high for the total scale (0.93) and for the subscales addressing knowledge, behaviors, decision-making, communication, emotional support and symptom management (0.84-0.92); and moderate (>0.68) for the attitudes and continuity of care subscales. The factor analysis demonstrated robust consolidation of the communication and continuity of care subscales (eigenvalue 9.47), decision-making subscale (eigenvalue 3.38), symptom management subscale (eigenvalue 1.51), and emotional and spiritual support subscales (eigenvalue 1.13). CONCLUSION: Analysis of the psychometric properties of the EOL-Q care across settings supports its reliability and validity as a measure of self-perceived EOL care competencies in the domains of communication and continuity of care, decision-making, symptom management, and emotional and spiritual support. The EOL-Q displays promise as a tool for use in a variety of educational, research, and program development initiatives in EOL care.

Distribution and Fractionation of Uranium in Weapon Tested Range Soils.

Uranium is a chemically toxic and radioactive heavy metal. Depleted uranium (DU) is the byproduct of the uranium enrichment process, with a majority of U as uranium-238, and a lower content of the fissile isotope uranium-235 than natural uranium. Uranium-235 is mainly used in nuclear reactors and in the manufacture of nuclear weapons. Exposure is likely to have an impact on humans or the ecosystem where military operations have used DU. Yuma Proving Ground in Arizona, USA has been using depleted uranium ballistics for 36 years. At a contaminated site in the Proving Grounds, soil samples were collected from the flat, open field and lower elevated trenches that typically collect summer runoff. Spatial distribution and fractionation of uranium in the fields were analyzed with total acid digestion and selective sequential dissolution with eight operationally defined solid-phase fractions. In addition to uranium, other trace elements (As, Ba, Co, Cr, Cu, Hg, Mo, Nb, Pd, Pb, V, Zn, Zr) were also assessed. Results show that the trench area in the testing site had a higher accumulation of total U (12.4%) compared to the open-field soil with 279 mg/kg U. Among the eight solid-phase components in the open-field samples, U demonstrated stronger affinities for the amorphous iron-oxide bound, followed by the carbonate bound, and the residual fractions. However, U in the trench area had a stronger binding to the easily reducible oxide bound fraction, followed by the carbonate-bound and amorphous iron-oxide-bound fractions. Among other trace elements, Nb, As, and Zr exhibited the strongest correlations with U distribution among solid-phase components. This study indicates a significant spatial variation of U distribution in the shooting range site. Fe/Mn oxides and carbonate were the major solid-phase components for binding U in the weapon test site.

Functionalization of clay surface for the removal of uranium from water.

A modification method of clay mineral surface was developed to improve its adsorption capacity of uranium. Uranium is a radionuclide with high toxicity and extremely long half-life, which can pollute the environment and endanger human health. This study proposes a new method of activation of clay mineral surface with phosphoric acid for rapid adsorption of uranium from aqueous solution. Compared with other modification methods, this method has the advantages of availability of raw materials, simple operation and good adsorption effects. It provides a cost-effective material to capture uranium ions from water. The essences of this new development are as following: • Activation and changes of clay minerals' surface functionalities with the treatment of phosphoric acid • Controlled modifications of the surface properties of the clay towards the enhancement of U adsorption capacity • Rapid removal of uranium from water.

Laboratory simulation of uranium metal corrosion in different soil moisture regimes.

A novel laboratory simulation system has been developed for the study of the corrosion of uranium metal in soils. Corrosion and transportation of depleted uranium (DU) as the metal undergoes weathering as a buried material within the soil environment. The corrosion of uranium metal in soil was not well understood due to the gas-liquid-solid phase of the soil. This study presents a novel method to investigate the change of uranium species during the process of process of oxidation of metallic uranium in these environments. Compared with other techniques used for the study of environmental corrosion of metals in soils, this method has the advantage of low secondary uranium pollution, no energy consumption, and ease of operation. The simulation system has been used for the following studies: •Simultaneously simulate the corrosion of uranium metal in different soil moisture regimes•Study the influence of biogeochemical factors on the corrosion of uranium metal•Investigate the change of uranium species during oxidation.

A novel laboratory simulation system to uncover the mechanisms of uranium upward transport in a desert landscape.

After depleted uranium (DU) is deposited in the environment, it corrodes producing mobile uranium species. The upward transport mechanism in a desert landscape is associated with the dissolution/precipitation of uranium minerals that vary in composition and solubility in soil pore water. The objective of this study is to develop the laboratory column simulation to investigate the upward transport mechanism with cyclic capillary wetting and drying moisture regimes. Results showed that evaporation driven upward transport occurred even during the first 2 months of wetting-drying regimes. Evaporation driven upward transport may control the U movement in the soil profile in an arid climate. The new system did not generate any uranium-containing wastewater. •Simulates the upward transport process of pollutants with different pollution levels and species.•Simultaneously simulate the transport process of multiple pollutants simultaneously.•Evaluate the influence of biogeochemical factors on pollutant transport such as various cations and anions (Ca, Mg and carbonates) in water.

A simple method for the synthesis of biochar nanodots using hydrothermal reactor.

Biochar is a stable carbon rich by-product synthesized through pyrolysis of plant and animal based biomass, and nano-biochar material has gained increasing attention due to its unique properties for environmental applications. In the present study, a simple cost-effective method for the synthesis of biochar nanoparticles through hydrothermally using agricultural residuals and by-products was developed. Both soybean straw and cattle manure were selected as the feedstock to produce the bulk-biochar. The synthesis procedure involved the digestion of the bulk-biochar with concentrated nitric acid and sulfuric acid in a high pressure condition using a hydrothermal reactor. The suspension was isolated using vacuum filtration with 0.22-µm membrane followed by drying at 65 °C in an oven. Scanning electron microscopy results revealed that both of the biochars had a well-developed porous structure following pyrolysis. Both transmission electron microscopy and the dynamic light scattering results of the hydrothermally treated biochar indicated that the soybean straw and cattle manure biochar nanodots had an average of 5-nm and 4-nm in size, respectively. Overall two raw materials produced 8.5-10% biochar nanodots. The present method presents a simple, quick and cost-effective method for synthesis of biochar nanodots. The method provided a useful tool discovering the applicability biochar nanodots for environmental applications. • Nano-biochar formation from bulk-biochar using hydrothermal reactor • Evaluate nano-biochar's environmental fate and behavior in soil and water • Synthesize multifunctional adsorbent using nano-biochar as primary material.

Health Professionals Perceived Concerns and Challenges in Providing Palliative and End-of-Life Care: A Qualitative Analysis.

BACKGROUND:: The Institute of Medicine identifies that quality palliative/end-of-life (EOL) care should be provided to patients with serious, life-limiting illnesses and their families by competently prepared health professionals. PURPOSE:: This study assessed perceived concerns of health professionals pertaining to the delivery of palliative/EOL care in the hospital setting. The specific aim was to determine thematic concerns in the delivery of palliative/EOL care which emerged from respondents' impressions of a memorable palliative/EOL patient experience. METHODS:: Interdisciplinary health professionals at a large academic health system in the Midwest were surveyed to reflect upon a memorable palliative/EOL life care patient situation (positive or negative). A Thematic Analysis approach was used to code qualitative responses to 4 open-ended questions and then extract themes and subthemes from the coded data. RESULTS:: Concerns identified by participants (N = 425) emerged around 7 themes including communication (97%), decision-making/care planning (75%), education needs (60%), EOL care (48%), ethics (24%), satisfaction with care (9%), and spiritual/cultural sensitivity (6%). CONCLUSION:: Challenges exist in the delivery of quality palliative/EOL care in the hospital setting which may be addressed through educational initiatives that focus on recognition of cultural influences on care preferences, improving communication between patients/families and providers, education about the differences between palliative and EOL care, and increased competency of health providers in having EOL/goals-of-care discussions. Health professionals must recognize the benefit of collaborative palliative care in order to meet patient and family needs holistically and comprehensively.

Clinical Biopsychosocial Reflection on Coping With Chronic Illness and Reliance Upon Nutrition Support: An Integrated Healthcare Approach.

Nutrition deficits are common in patients with chronic illnesses reliant upon nutrition support and can contribute to an increase in cognitive deficits that impact treatment adherence and challenge patients' abilities to cope and successfully implement appropriate psychological and psychosocial interventions. Adopting a multidisciplinary approach addresses biological, psychological, and social barriers that help patients, families, and caregivers develop and maintain proper nutrition behaviors that can enhance patients' quality of life and reduce frustration and misunderstandings with medical providers. This article is a review of the literature, and it advances the importance of encompassing a biopsychosocial approach when addressing the needs of individuals with nutrition support needs.

Environmental regulation in transition: Policy officials' views of regulatory instruments and their mapping to environmental risks.

This study re-analysed 14 semi-structured interviews with policy officials from the UK Department for Environment, Food and Rural Affairs (Defra) to explore the use of a variety of regulatory instruments and different levels of risk across 14 policy domains and 18 separately named risks. Interviews took place within a policy environment of a better regulation agenda and of broader regulatory reform. Of 619 (n) coded references to 5 categories of regulatory instrument, 'command and control' regulation (n = 257) and support mechanisms (n = 118) dominated the discussions, with a preference for 'command and control' cited in 8 of the policy domains. A framing analysis revealed officials' views on instrument effectiveness, including for sub-categories of the 5 key instruments. Views were mixed, though notably positive for economic instruments including taxation, fiscal instruments and information provision. An overlap analysis explored officials' mapping of public environmental risks to instrument types suited to their management. While officials frequently cite risk concepts generally within discussions, the extent of overlap for risks of specific significance was low across all risks. Only 'command and control' was mapped to risks of moderate significance in likelihood and impact severity. These results show that policy makers still prefer 'command and control' approaches when a certainty of outcome is sought and that alternative means are sought for lower risk situations. The detailed reasons for selection, including the mapping of certain instruments to specific risk characteristics, is still developing.

Commitment, Forgiveness, and Relationship Self-Regulation: An Actor Partner Interdependence Model of Relationship Virtues and Relationship Effort in Couple Relationships.

Dyadic data from 679 committed couples were used to examine associations between commitment, forgiveness, and perceptions of partner's relationship self-regulation (RSR) behaviors-that is effort and strategies that partners exert to maintain the relationship. We found that for both partners, higher self-reports of commitment and forgiveness were associated with higher perceptions of their partner's RSR. For females, higher commitment and forgiveness were associated with higher male perceptions of her RSR, and higher male forgiveness was associated with higher female perceptions of his RSR. These findings demonstrate the importance of marital virtues and relationship work and give credence to the marital competence model of "other-centeredness" by Carroll et al. (2006, Journal of Family Issues, 27(7), 1001). Clinical implications are discussed.