Understanding the regulator-regulatee relationship for developing safety culture.

Regulatory authorities in safety-critical industries typically seek to influence the safety culture of the organizations they oversee. However, we know little about how regulatory authorities achieve this influence (e.g., what roles are adopted, relationship characteristics) and, more generally, about how external actors shape an organization's safety culture. Using a qualitative design in the nuclear industry, we developed our conceptual and empirical understanding of the roles through which a regulator influences the safety culture of their regulated organizations and what characteristics within the regulator-regulatee relationship facilitate positive safety culture developments. Data were collected through interviews with inspectors from a nuclear regulator and employees of regulated nuclear organizations, and from an inspection of regulatory documents. The findings identified that the regulator was perceived to hold three complementary roles for safety culture development: being an enforcer, working as a partner (providing opportunities for licenseholders to improve beyond compliance), and acting as an advisor to regulated organizations. Analysis also showed that effective relationships in these roles, and which were central to influencing safety culture, were perceived to be characterized by professionalism, transparency, and balance between formal enforcement and informal exchange. Theoretical implications to advance conceptualizations of safety culture as well as practical implications for risk regulators are discussed.

Occupational and Physical Therapists' Use of Intrapersonal and Interpersonal Emotion Regulation Strategies During Patient Interactions: A Qualitative Study.

IMPORTANCE: Occupational and physical therapists' use of intrapersonal and interpersonal emotion regulation strategies may play an important role in building therapeutic relationships, but little is known about how they use these strategies during patient interactions. OBJECTIVE: To understand how therapists use intrapersonal and interpersonal emotion regulation strategies during their patient interactions. DESIGN: This qualitative study consisted of two stages of data collection. In Stage 1, therapists were interviewed regarding how they use emotion regulation strategies in their therapeutic relationships. In Stage 2, patient-therapist dyads were observed during treatment sessions and then interviewed at the end of the therapeutic relationship. SETTING: Inpatient and outpatient rehabilitation hospitals and clinics in the United Kingdom. PARTICIPANTS: In Stage 1, 13 occupational therapists and 9 physical therapists participated; in Stage 2, 14 patient-therapist dyads participated. OUTCOME AND MEASURES: A semistructured interview guide was used to ask therapists how they use emotion regulation strategies during patient interactions. RESULTS: Therapists used a wide range of interpersonal and intrapersonal emotion regulation strategies that can be categorized in prominent emotion regulation strategy taxonomies. They used these strategies both proactively, in anticipation of emotional events, and reactively, in response to emotional events. Their use helped them to build and maintain the therapeutic relationship and to protect themselves, feel better, and get their jobs done. CONCLUSIONS AND RELEVANCE: The ability to regulate one's own and others' emotions is an essential part of therapists' work. In this study, therapists used a wide range of emotion regulation strategies to benefit themselves and their patients. What This Article Adds: This is the first study to identify the specific intrapersonal and interpersonal emotion regulation strategies used by occupational and physical therapists during patient-therapist interactions. This study makes an important contribution to understanding therapists' use of proactive and reactive emotion regulation strategies to build and maintain therapeutic relationships.

Theorising the hospice gaze: A Foucauldian collaborative ethnography of a palliative day care service.

Foucault's medical gaze has only been minimally applied to palliative care through the analysis of key policy documents. This paper develops the conceptualisation of Foucault's medical gaze using empirical data gathered from a group ethnography of a hospice daycare centre. Using Foucault's medical gaze as a theoretical aporia we conceptualise the "hospice gaze". We argue the hospice gaze is the antithesis of the Foucauldian medical gaze, suggesting it operates reflexively so that professionals adapt to patients, rather than patients to professionals; that it is directed towards enabling patients and their loved ones to narrate severe illness and death in ways that develop more patient-centred narratives; and, structures the processes of care in direct resistance to the neoliberalisation of healthcare by engaging in slow practices of care with patient's bodies and minds. Finally, key to all of this is how the hospice gaze manages the spaces of care to ensure that it always and already appears slow to the patients. Therefore, the hospice gaze ensures a (re)distribution of power and knowledge that minimises the corrosive qualities of busyness and maximises the ethical potentials of slowness. We conclude by arguing that the operation of the hospice gaze should be examined in other settings where palliative care is practiced such as in-patient and home care services.

Flash Oxidation (FOX) System: A Novel Laser-Free Fast Photochemical Oxidation Protein Footprinting Platform.

Hydroxyl radical protein footprinting (HRPF) is a powerful and flexible technique for probing changes in protein topography. With the development of the fast photochemical oxidation of proteins (FPOP), it became possible for researchers to perform HRPF in their laboratory on a very short time scale. While FPOP has grown significantly in popularity since its inception, adoption remains limited due to technical and safety issues involved in the operation of a hazardous Class IV UV laser and irreproducibility often caused by improper laser operation and/or differential radical scavenging by various sample components. Here, we present a new integrated FOX (Flash OXidation) Protein Footprinting System. This platform delivers sample via flow injection to a facile and safe-to-use high-pressure flash lamp with a flash duration of 10 µs fwhm. Integrated optics collect the radiant light and focus it into the lumen of a capillary flow cell. An inline radical dosimeter measures the hydroxyl radical dose delivered and allows for real-time compensation for differential radical scavenging. A programmable fraction collector collects and quenches only the sample that received the desired effective hydroxyl radical dose, diverting the carrier liquid and improperly oxidized sample to waste. We demonstrate the utility of the FOX Protein Footprinting System by determining the epitope of TNFα recognized by adalimumab. We successfully identify the surface of the protein that serves as the epitope for adalimumab, identifying four of the five regions previously noted by X-ray crystallography while seeing no changes in peptides not involved in the epitope interface. The FOX Protein Footprinting System allows for FPOP-like experiments with real-time dosimetry in a safe, compact, and integrated benchtop platform.

A longitudinal study of the turning points and trajectories of therapeutic relationship development in occupational and physical therapy.

BACKGROUND: The importance of the therapeutic relationship is widely recognised across healthcare professions. Despite the importance of therapeutic relationships, there are significant gaps in the knowledge base on how these relationships develop. To address these gaps, this study explores relationship dynamics by identifying relational turning points and trajectories in therapeutic relationships between occupational therapists and physical therapists and their patients. The implications for how a focus on these relational aspects can enhance clinical practice will be discussed. METHODS: Data collection was based on the Retrospective Interview Technique and consisted of two phases. In the first phase patients and therapists were asked to tell the story of their therapeutic relationship development and as part of this, identify the turning points that occurred. In the second phase, therapists-patient dyads were observed from their first interaction to their last to identify potential turning points and at the end of the relationship a participant verification interview was conducted with both dyadic partners individually. Template analysis was used to analyse the data. RESULTS: Therapists identified 6 distinct categories of turning points; Progress Towards Goals, Set-backs in Progress Towards Goals, Interpersonal Affective Bonding with Patients, Interpersonal Problems with Patients, Positive Feedback, and Negative Feedback. Patients identified 5 categories of turning points; Progress Towards Goals, Set-backs in Progress Towards Goals, Interpersonal Affective Bonding with Therapists, Agreement with Therapist and Change in Treatment. These turning points varied regarding their impact on the trajectory of the therapeutic relationship. The trajectory patterns identified were stable, upward, downward, and multidirectional. CONCLUSION: This study makes an important contribution to our understanding of therapeutic relationship dynamics in the occupational and physical therapy context. The results expose the challenges that therapists and patients face in building high-quality therapeutic relationships, the diversity of therapeutic relationships, and how these relationships develop over time. This is the first study to use a turning point analysis in research on therapeutic relationships.

Personality traits and emotion regulation: A targeted review and recommendations.

Where do individual differences in emotion regulation come from? This review examines theoretical and empirical evidence describing the role that personality traits play in shaping individuals' intrapersonal and interpersonal regulation styles. We define and delineate personality traits and emotion regulation and summarize empirical relations between them. Specifically, we review research on the Big Five personality traits in relation to each stage of Gross' (2015) extended process model of emotion regulation. In doing so, we document evidence concerning the relationships between personality traits and three key stages of emotion regulation, namely, identification (i.e., choosing which emotions to regulate), selection (i.e., choosing a broad regulatory approach), and implementation (i.e., adopting specific regulatory tactics). Finally, we make recommendations for future research that we hope will guide researchers in building a systematic understanding of how personality traits shape intrapersonal and interpersonal emotion regulation. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

A Retrospective Review of School Nurse Approaches to Assessing Pain.

BACKGROUND: When students with intellectual disability (ID) experience pain, the pain may limit the extent to which they may engage in school activities. Although school nurses are primarily responsible for addressing students' pain, there are many barriers to identifying pain in students with ID. AIMS: The purpose of the present study was to describe pain assessment practices of school nurses for students with and without ID. DESIGN: A retrospective review was conducted of 4,660 school health office visit records for elementary school students presenting to the health office with headache, stomachache, or sore throat. METHODS: Data were extracted and transcribed to a matrix. Data extracted included school grade, referral source, visit month, gender, cognitive ability, chief concern, pain assessment, external contact, and disposition. Descriptive statistics were calculated. RESULTS: School nurses spent more time on average addressing pain in neurotypical students than in students with ID. Neurotypical students more often presented with a teacher and were dismissed from school, but parents and guardians were contacted less often for these students, when compared to students with ID. Quantified pain ratings were documented for 1% of visits. CONCLUSIONS: Because pain intensity ratings were rarely documented, the utility of such ratings in the school setting may be low. Alternatively, obtaining pain intensity ratings from younger children may be challenging without the use of appropriate tools. Nurses, teachers, and other staff providing education and care to students with ID may require pain training. Implementation of tools that elicit student pain information from parents/guardians in the school setting could decrease point-of-care contact during the school day and proactively provide information on unique child pain behaviors.

A Pain Reporting Tool for School-Aged Baseball Pitchers.

Rates of injury to school-aged athletes are of concern to pediatric providers and can be prevented when players, coaches, and parents recognize and address pain. The aim of the present study was to evaluate the use of a pain-reporting tool. In this study, 34 baseball players aged 10-16 years reported pain surrounding 135 separate pitching experiences. Those participating in another sport on the same day as pitching rated pain intensity as significantly higher than those who did not. Approximately 19 pitches were thrown before participants noticed pain. Ice and analgesics were used appropriately to manage pain. School nurses are well positioned to discuss pain reporting and common injuries with young athletes, parents, and athletic coaches. Sharing proactive ways to elicit information about pain is suggested. Implications for future research include the study of young athlete experiences with pain and development of educational initiatives regarding the importance of reporting pain.

Can job redesign interventions influence a broad range of employee outcomes by changing multiple job characteristics? A quasi-experimental study.

Many job redesign interventions are based on a multiple mediator-multiple outcome model in which the job redesign intervention indirectly influences a broad range of employee outcomes by changing multiple job characteristics. As this model remains untested, the aim of this study is to test a multiple mediator-multiple outcome model of job redesign. Multilevel analysis of data from a quasi-experimental job redesign intervention in a call center confirmed the hypothesized model and showed that the job redesign intervention affected a broad range of employee outcomes (i.e., employee well-being, psychological contract fulfillment, and supervisor-rated job performance) through changes in 2 job characteristics (i.e., job control and feedback). The results provide further evidence for the efficacy and mechanisms of job redesign interventions. (PsycINFO Database Record

Becoming popular: interpersonal emotion regulation predicts relationship formation in real life social networks.

Building relationships is crucial for satisfaction and success, especially when entering new social contexts. In the present paper, we investigate whether attempting to improve others' feelings helps people to make connections in new networks. In Study 1, a social network study following new networks of people for a 12-week period indicated that use of interpersonal emotion regulation (IER) strategies predicted growth in popularity, as indicated by other network members' reports of spending time with the person, in work and non-work interactions. In Study 2, linguistic analysis of the tweets from over 8000 Twitter users from formation of their accounts revealed that use of IER predicted greater popularity in terms of the number of followers gained. However, not all types of IER had positive effects. Behavioral IER strategies (which use behavior to reassure or comfort in order to regulate affect) were associated with greater popularity, while cognitive strategies (which change a person's thoughts about his or her situation or feelings in order to regulate affect) were negatively associated with popularity. Our findings have implications for our understanding of how new relationships are formed, highlighting the important the role played by intentional emotion regulatory processes.

Viral pathogen-associated molecular patterns regulate blood-brain barrier integrity via competing innate cytokine signals.

UNLABELLED: Pattern recognition receptor (PRR) detection of pathogen-associated molecular patterns (PAMPs), such as viral RNA, drives innate immune responses against West Nile virus (WNV), an emerging neurotropic pathogen. Here we demonstrate that WNV PAMPs orchestrate endothelial responses to WNV via competing innate immune cytokine signals at the blood-brain barrier (BBB), a multicellular interface with highly specialized brain endothelial cells that normally prevents pathogen entry. While Th1 cytokines increase the permeability of endothelial barriers, type I interferon (IFN) promoted and stabilized BBB function. Induction of innate cytokines by pattern recognition pathways directly regulated BBB permeability and tight junction formation via balanced activation of the small GTPases Rac1 and RhoA, which in turn regulated the transendothelial trafficking of WNV. In vivo, mice with attenuated type I IFN signaling or IFN induction (Ifnar(-/-) Irf7(-/-)) exhibited enhanced BBB permeability and tight junction dysregulation after WNV infection. Together, these data provide new insight into host-pathogen interactions at the BBB during neurotropic viral infection. IMPORTANCE: West Nile virus (WNV) is an emerging pathogen capable of infecting the central nervous system (CNS), causing fatal encephalitis. However, the mechanisms that control the ability of WNV to cross the blood-brain barrier (BBB) and access the CNS are unclear. In this study, we show that detection of WNV by host tissues induces innate immune cytokine expression at the BBB, regulating BBB structure and function and impacting transendothelial trafficking of WNV. This regulatory effect is shown to happen rapidly following exposure to virus, to occur independently of viral replication within BBB cells, and to require the signaling of cytoskeletal regulatory Rho GTPases. These results provide new understanding of host-pathogen interactions at the BBB during viral encephalitis.

Chemokines in the balance: maintenance of homeostasis and protection at CNS barriers.

In the adult central nervous system (CNS), chemokines and their receptors are involved in developmental, physiological and pathological processes. Although most lines of investigation focus on their ability to induce the migration of cells, recent studies indicate that chemokines also promote cellular interactions and activate signaling pathways that maintain CNS homeostatic functions. Many homeostatic chemokines are expressed on the vasculature of the blood brain barrier (BBB) including CXCL12, CCL19, CCL20, and CCL21. While endothelial cell expression of these chemokines is known to regulate the entry of leukocytes into the CNS during immunosurveillance, new data indicate that CXCL12 is also involved in diverse cellular activities including adult neurogenesis and neuronal survival, having an opposing role to the homeostatic chemokine, CXCL14, which appears to regulate synaptic inputs to neural precursors. Neuronal expression of CX3CL1, yet another homeostatic chemokine that promotes neuronal survival and communication with microglia, is partly regulated by CXCL12. Regulation of CXCL12 is unique in that it may regulate its own expression levels via binding to its scavenger receptor CXCR7/ACKR3. In this review, we explore the diverse roles of these and other homeostatic chemokines expressed within the CNS, including the possible implications of their dysfunction as a cause of neurologic disease.

You spin me right round: cross-relationship variability in interpersonal emotion regulation.

Individuals use a range of interpersonal emotion regulation strategies to influence the feelings of others, e.g., friends, family members, romantic partners, work colleagues. But little is known about whether people vary their strategy use across these different relational contexts. We characterize and measure this variability as "spin," i.e., the extent of dispersion in a person's interpersonal emotion regulation strategy use across different relationships, and focus on two key questions. First, is spin adaptive or maladaptive with regard to personal well-being and relationship quality? Second, do personality traits that are considered important for interpersonal functioning (i.e., empathy, attachment style) predict spin? The data used in this study is drawn from a large online survey. A key contribution of this study is to reveal that people who varied the type of strategies they used across relationships (i.e., those with high spin) had lower positive mood, higher emotional exhaustion, and less close relationships. A further key contribution is to show that spin was associated with low empathic concern and perspective taking and high anxious attachment style. High variability in interpersonal emotion regulation strategies across relationships therefore appears to be maladaptive both personally and socially.

Does regulating others' feelings influence people's own affective well-being?

Individuals in a variety of social contexts try to regulate other people's feelings, but how does this process affect the regulators themselves? This research aimed to establish a relationship between people's use of interpersonal affect regulation and their own affective well-being. In a field study, self- and other-reported data were collected from prisoners and staff members in a therapeutic prison using two surveys separated in time. In a laboratory study, a student sample reported their affect before and after attempting to influence the feelings of talent show contestants in a role-play task. The results of both studies indicated congruent associations between the use of affect-improving and affect-worsening interpersonal affect regulation and strategy agents' affective well-being. Our findings highlight that, when performing interpersonal affect regulation, people may not be immune from the effects of their own actions.

CXCR7 influences leukocyte entry into the CNS parenchyma by controlling abluminal CXCL12 abundance during autoimmunity.

Loss of CXCL12, a leukocyte localizing cue, from abluminal surfaces of the blood-brain barrier occurs in multiple sclerosis (MS) lesions. However, the mechanisms and consequences of reduced abluminal CXCL12 abundance remain unclear. Here, we show that activation of CXCR7, which scavenges CXCL12, is essential for leukocyte entry via endothelial barriers into the central nervous system (CNS) parenchyma during experimental autoimmune encephalomyelitis (EAE), a model for MS. CXCR7 expression on endothelial barriers increased during EAE at sites of inflammatory infiltration. Treatment with a CXCR7 antagonist ameliorated EAE, reduced leukocyte infiltration into the CNS parenchyma and parenchymal VCAM-1 expression, and increased abluminal levels of CXCL12. Interleukin 17 and interleukin 1ß increased, whereas interferon-γ decreased, CXCR7 expression on and CXCL12 internalization in primary brain endothelial cells in vitro. These findings identify molecular requirements for the transvascular entry of leukocytes into the CNS and suggest that CXCR7 blockade may have therapeutic utility for the treatment of MS.

The blood-brain barrier, chemokines and multiple sclerosis.

The infiltration of leukocytes into the central nervous system (CNS) is an essential step in the neuropathogenesis of multiple sclerosis (MS). Leukocyte extravasation from the bloodstream is a multistep process that depends on several factors including fluid dynamics within the vasculature and molecular interactions between circulating leukocytes and the vascular endothelium. An important step in this cascade is the presence of chemokines on the vascular endothelial cell surface. Chemokines displayed along the endothelial lumen bind chemokine receptors on circulating leukocytes, initiating intracellular signaling that culminates in integrin activation, leukocyte arrest, and extravasation. The presence of chemokines at the endothelial lumen can help guide the movement of leukocytes through peripheral tissues during normal immune surveillance, host defense or inflammation. The expression and display of homeostatic or inflammatory chemokines therefore critically determine which leukocyte subsets extravasate and enter the peripheral tissues. Within the CNS, however, infiltrating leukocytes that cross the endothelium face additional boundaries to parenchymal entry, including the abluminal presence of localizing cues that prevent egress from perivascular spaces. This review focuses on the differential display of chemokines along endothelial surfaces and how they impact leukocyte extravasation into parenchymal tissues, especially within the CNS. In particular, the display of chemokines by endothelial cells of the blood brain barrier may be altered during CNS autoimmune disease, promoting leukocyte entry into this immunologically distinct site. Recent advances in microscopic techniques, including two-photon and intravital imaging have provided new insights into the mechanisms of chemokine-mediated capture of leukocytes within the CNS.

Cerebrospinal fluid dynamics in the human cranial subarachnoid space: an overlooked mediator of cerebral disease. II. In vitro arachnoid outflow model.

The arachnoid membrane (AM) and granulations (AGs) are important in cerebrospinal fluid (CSF) homeostasis, regulating intracranial pressure in health and disease. We offer a functional perspective of the human AM's transport mechanism to clarify the role of AM in the movement of CSF and metabolites. Using cultures of human AG cells and a specialized perfusion system, we have shown that this in vitro model mimics the in vivo characteristics of unidirectional fluid transport and we present the first report of serum-free permeability values (92.5 microl min(-1) mm Hg(-1) cm(-2)), which in turn are in agreement with the CSF outflow rates derived from a dynamic, in vivo magnetic resonance imaging-based computational model of the subarachnoid cranial space (130.9 microl min(-1) mm Hg(-1) cm(-2)). Lucifer yellow permeability experiments have verified the maintenance of tight junctions by the arachnoidal cells with a peak occurring around 21 days post-seeding, which is when all perfusion experiments were conducted. Addition of ruthenium red to the perfusate, and subsequent analysis of its distribution post-perfusion, has verified the passage of perfusate via both paracellular and transcellular mechanisms with intracellular vacuoles of approximately 1 microm in diameter being the predominant transport mechanism. The comparison of the computational and in vitro models is the first report to measure human CSF dynamics functionally and structurally, enabling the development of innovative approaches to modify CSF outflow and will change concepts and management of neurodegenerative diseases resulting from CSF stagnation.

Protection of nonhuman primates against two species of Ebola virus infection with a single complex adenovirus vector.

Ebola viruses are highly pathogenic viruses that cause outbreaks of hemorrhagic fever in humans and other primates. To meet the need for a vaccine against the several types of Ebola viruses that cause human diseases, we developed a multivalent vaccine candidate (EBO7) that expresses the glycoproteins of Zaire ebolavirus (ZEBOV) and Sudan ebolavirus (SEBOV) in a single complex adenovirus-based vector (CAdVax). We evaluated our vaccine in nonhuman primates against the parenteral and aerosol routes of lethal challenge. EBO7 vaccine provided protection against both Ebola viruses by either route of infection. Significantly, protection against SEBOV given as an aerosol challenge, which has not previously been shown, could be achieved with a boosting vaccination. These results demonstrate the feasibility of creating a robust, multivalent Ebola virus vaccine that would be effective in the event of a natural virus outbreak or biological threat.

The source of display rules and their effects on primary health care professionals' well-being.

Employees' perceptions of the emotional requirements of their work role are considered a necessary antecedent of emotion work. The impact of these requirements on the emotions employees display, their well-being, and their clients' satisfaction has been explored in previous research. Emotional requirements have been characterized as organizationally-based expectations (e.g., Brotheridge & Lee, 2003), formal and informal organizational rules (e.g., Cropanzano, Weiss & Elias, 2004), occupational norms (e.g., Rafaeli & Sutton, 1987; Smith & Kleinman, 1989) and job-based demands (Brotheridge & Lee, 2002). Although all these definitions assume some kind of shared source for perceptions of emotional requirements, it remains unclear to what extent these different sources contribute and to what extent the requirements are shared by different units, teams and individuals in the organization. The present study analyses the perception of emotional requirements from a survey of ninety-seven Primary Health Care teams composed of general practitioners, nurses and administrative staff (N = 1057). The relative contribution of different sources of variance (team, organizational, and occupational) to perceived emotional requirements and the effects on employees' job satisfaction and well being are examined. Results confirm the relevance of the source and show the contribution of emotional demands to prediction of emotional exhaustion and job satisfaction levels.