Rewriting burnout as metaphor

2020 ◽  
Vol 10 (2) ◽  
pp. 320-337
Author(s):  
Melissa Johnson Carissimo
Keyword(s):  
Phase 1 ◽  
Present Moment ◽  
Budget Cuts ◽  
Dialysis Unit ◽  
Kidney Dialysis ◽  
Three Phase ◽  
The Subject ◽  
Achievement Assessment ◽  
Reducing Stress ◽  
Weekly Group

Abstract Today’s healthcare professionals shoulder consequences of budget cuts, staff shortages, longer hours and a growing, aging patient population. To address support for both patients and staff in this challenging context, the kidney dialysis unit of a major Italian hospital was chosen for a three-phase pilot study of Metaphoric Affect Processing (MAP). MAP is a metaphor-based interview technique designed to enhance wellbeing in hospital settings by facilitating the identification, verbalization and regulation of affect as metaphor. The subject of this article is Phase 1 of the study, which focused on mitigation of burnout symptoms among peritoneal and hemodialysis nurses. In Phase 1, nurses were offered weekly group sessions of MAP training. All participants learned to use codified, “poetic” dialogue to explore, share and metaphorically “rewrite” present-moment feelings. By the end of training, a number of nurses also qualified as MAP facilitators themselves. Nurses’ pre-training burnout levels were measured in subcategories of depressive anxiety, loss of empathy, and reduced sense of personal achievement. Assessment after MAP training confirmed nurses’ self-reports of having engaged metaphor to address these aspects of burnout, reducing stress levels, increasing empathy among colleagues and expanding perspective. Phase 1 outcomes suggest that MAP may be an effective intervention to boost wellbeing for healthcare workers at high risk for burnout, and merits further study. This article also offers an overview of MAP’s early development with patient populations in cancer treatment and acute care psychiatric settings.

scholarly journals I.—The Metamorphosis of the Lizard Gabbros

1886 ◽  
Vol 3 (11) ◽  
pp. 481-489 ◽  
Author(s):  
J. J. H. Teall
Keyword(s):  
Mechanical Energy ◽  
Earth Pressure ◽  
Careful Consideration ◽  
Point Of View ◽  
Igneous Rocks ◽  
General Point ◽  
Present Moment ◽  
General View ◽  
Original Rock ◽  
The Subject

If we take a general view of the present position of geological science, we are struck by the fact that, although there is substantial agreement amongst geologists on matters relating to the origin of the rocks usually designated as aqueous and igneous, the greatest diversity of opinion prevails with regard to the circumstances under which the so-called metamorphic rocks have been produced. Every fragment of evidence calculated to throw light on the origin of these rocks, therefore, deserves the most careful consideration. Of recent years special attention has been directed to the effects of mechanical energy in modifying the mineralogical and structural characters of rocks originally formed by aqueous and igneous agencies; and a suspicion has been aroused that it is in this direction that we must look for a solution of many of the problems connected with the origin of the crystalline schists. A visit to the Lizard Peninsula of Cornwall during the present summer has convinced me of the immense importance of this view so far as that district is concerned. That portion of the peninsula which lies south of a line drawn from Porthalla on the east to Polurrian Cove on the west is formed.partly of igneous rocks—such as gabbro, greenstone, serpentine, and granite—and partly of crystalline schists. The igneous rocks, in certain places, become foliated and sohistose and sometimes show a definite banding due to a variation in the relative proportions of the different constituents. In other words they present characters which are usually regarded as distinctive of the crystalline schists. There is, moreover, evidence to show that these characters are mainly the result of a yielding to earth-pressure subsequent to the consolidation of the original rock. At the present moment, having just returned from the district, I am unable to treat the subject from a general point of view with any prospect of success; but it has occurred to me that some details with regard to one of the rocks may not be without interest to members of the Association.

Teaching Short - Circuit Calculation with Off - Nominal Turns Ratio Transformers

TEM Journal ◽  
2021 ◽  
pp. 1525-1533
Author(s):  
Allen A. Castillo ◽  
M. Natalia Galván Osuna ◽  
Norma A. Barboza Tello ◽  
Alejandra J. Vega
Keyword(s):  
Case Studies ◽  
Short Circuit ◽  
Circuit Analysis ◽  
Industrial System ◽  
Software Simulation ◽  
Three Phase ◽  
Short Circuit Calculation ◽  
The Subject ◽  
Ieee Standards ◽  
Short Circuit Analysis

Teaching short-circuit analysis is conducted primarily through case studies; however, there are not many validated short-circuit studies available on the subject, especially when considering off-nominal turns ratio transformers. In order to improve the teaching of short-circuit analysis, a three phase short-circuit study in an industrial system according to ANSI/IEEE standards by means of Zmatrix method is presented; two case studies are considered: the industrial system with nominal and offnominal turns ratio transformers, in both cases the step by step solution is given in an explicit manner and the analytical results are validated through software simulation.

scholarly journals MP09: Canadian Community Utilization of Stroke Prevention Pilot Study-Emergency Department (C-CUSP ED)

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S68 ◽  
Author(s):  
R. Parkash ◽  
K. Magee ◽  
M. McMullen ◽  
M.B. Clory ◽  
M. D’Astous ◽  
...  
Keyword(s):  
Stroke Prevention ◽  
Phase 1 ◽  
Retrospective Chart Review ◽  
Phase 2 ◽  
Phase 3 ◽  
Three Phase ◽  
Rigorous Study ◽  
The Mean ◽  
Prior Risk

Introduction: Atrial fibrillation (AF) is the most common sustained arrhythmia affecting 1-2% of the population. Oral anticoagulation (OAC) reduces stroke risk by 60-80% in AF patients, but only 50% of indicated patients receive OAC. Many patients present to the ED with AF due to arrhythmia symptoms, however; lack of OAC prescription in the ED has been identified as a significant gap in the care of AF patients. Methods: This was a multi-center, pragmatic, three-phase before-after study, in three Canadian sites. Patients who presented to the ED with electrocardiographically (ECG) documented, nonvalvular AF and were discharged home were included. Phase 1 was a retrospective chart review to determine OAC prescription of AF patients in each ED; Phase 2 was a low-intensity knowledge translation intervention where a simple OAC-prescription tool for ED physicians with subsequent short-term OAC prescription was used, as well as an AF patient education package and a letter to family physicians; phase 3 incorporated Phase 2 interventions, but added immediate follow-up in a community AF clinic. The primary outcome of the study was the rate of new OAC prescriptions at ED discharge in AF patients who were OAC eligible and were not on OAC at presentation. Results: A total of 632 patients were included from June, 2015-November, 2016. ED census ranged from 30000-68000 annual visits. Mean age was 71±15, 67±12, 67±13 years, respectively. 47.5% were women, most responsible ED diagnosis was AF in 75.8%. The mean CHA2DS2-VASc score was 2.6±1.8, with no difference amongst groups. There were 266 patients eligible for OAC and were not on this at presentation. In this group, the prescription of new OAC was 15.8% in Phase 1 as compared to 54% and 47%, in Phases 2 and 3, respectively. After adjustment for center, components of the CHA2DS2-VASc score, prior risk of bleeding and most responsible ED diagnosis, the odds ratio for new OAC prescription was 8.0 (95%CI (3.5,18.3) p<0.001) for Phase 3 vs 1, and 10.0 (95%CI (4.4,22.9) p<0.001), for Phase 2 vs 1). No difference in OAC prescription was seen between Phases 2 and 3. Conclusion: Use of a simple OAC-prescription tool was associated with an increase in new OAC prescription in the ED for eligible patients with AF. Further testing in a rigorous study design to assess the effect of this practice on stroke prevention in the AF patients who present to the ED is indicated.

Apical acidification induces paracellular injury in canine gastric mucosal monolayers

1994 ◽  
Vol 267 (6) ◽  
pp. G1012-G1020 ◽  
Author(s):  
M. C. Chen ◽  
A. Chang ◽  
T. Buhl ◽  
M. Tanner ◽  
A. H. Soll
Keyword(s):  
Short Circuit ◽  
Phase 1 ◽  
Short Circuit Current ◽  
Paracellular Permeability ◽  
Ussing Chambers ◽  
Low Concentrations ◽  
Three Phase ◽  
Mucosal Cells ◽  
Primary Monolayer ◽  
Primary Monolayer Cultures

We used primary monolayer cultures of enzyme-dispersed canine oxyntic mucosal cells mounted in Ussing chambers to characterize the apical barrier to H+. [3H]mannitol flux (MF) and [14C]inulin flux (IF) were used as size probes for tight junctions. Apical H+ produced a three-phase effect. In phase 1, as the apical pH was decreased from 7 to about 2.5, resistance (R) increased, but short-circuit current (Isc) did not change. In phase 2, an increased paracellular permeability developed at pH below 2.5-1.7, evidenced by decreased R and increased MF but not IF. Size sieving and monolayer integrity were preserved, and this paracellular leak was either fully reversed or stabilized by apical neutralization, depending on the duration of the paracellular leak. In phase 3, after sustained exposure to an apical pH below approximately 2, transepithelial integrity was lost; R decreased to fluid R, and both MF and IF increased. Basolateral acidification below pH 5.5 produced rapid monolayer disruption. Low concentrations of cytochalasin D (CD) decreased R and increased MF but not IF; apical acidification to pH 4 after CD increased R and decreased the MF, indicating reduced paracellular permeability by apical H+. Apical amiloride did not alter Isc; however, after 48 h of treatment with hydrocortisone and insulin, an amiloride-sensitive Isc component became evident. Our data indicate that the increase in R observed with apical acidification reflects decreased paracellular permeability and that the earliest injury with apical acidification is a selective paracellular leak.

scholarly journals ATIM-05. COMPLEMENTARY CLINICAL AND ANCILLARY DATA FROM 123 PATIENTS WITH RECURRENT HIGH GRADE GLIOMA FROM THREE PHASE 1 TRIALS OF TOCA 511 AND TOCA FC: UPDATE AND JUSTIFICATION FOR A PHASE 2/3 TRIAL

2016 ◽  
Vol 18 (suppl_6) ◽  
pp. vi18-vi18 ◽  
Author(s):  
Manish Aghi ◽  
Michael Vogelbaum ◽  
Steven Kalkanis ◽  
Daniela Bota ◽  
Bob Carter ◽  
...  
Keyword(s):  
Phase 1 ◽  
High Grade Glioma ◽  
High Grade ◽  
Phase 2 ◽  
Ancillary Data ◽  
Phase 1 Trials ◽  
Three Phase

Single-dose pharmacokinetics of pediatric and adult formulations of etravirine and swallowability of the 200-mg tablet: results from three Phase 1 studies

2013 ◽  
Vol 51 (09) ◽  
pp. 725-736 ◽  
Author(s):  
Thomas N. Kakuda ◽  
Cindy Berckmans ◽  
Goedele De Smedt ◽  
Ruud Leemans ◽  
Lorant Leopold ◽  
...  
Keyword(s):  
Single Dose ◽  
Phase 1 ◽  
Three Phase

scholarly journals Population Pharmacokinetics of Fusidic Acid: Rationale for Front-Loaded Dosing Regimens Due to Autoinhibition of Clearance

2012 ◽  
Vol 57 (1) ◽  
pp. 498-507 ◽  
Author(s):  
Jürgen B. Bulitta ◽  
Olanrewaju O. Okusanya ◽  
Alan Forrest ◽  
Sujata M. Bhavnani ◽  
Kay Clark ◽  
...  
Keyword(s):  
Fusidic Acid ◽  
Phase 1 ◽  
Population Pharmacokinetic ◽  
Multiple Doses ◽  
Three Phase ◽  
Turnover Process ◽  
Dosing Regimens ◽  
Effect Of Food ◽  
Oral Doses ◽  
Higher Doses

ABSTRACTThe objectives of this analysis were to develop a population pharmacokinetic (PK) model to describe the absorption and disposition of fusidic acid after single and multiple doses and to determine the effect of food on the rate and extent of bioavailability. Plasma PK data from three phase 1 studies (n= 75;n= 14 with and without food) in which healthy subjects received sodium fusidate (500 to 2,200 mg) as single or multiple oral doses every 8 h (q8h) or q12h for up to 7 days were modeled using S-ADAPT (MCPEM algorithm). Accumulation of fusidic acid after multiple doses was more than that predicted based on single-dose data. The PK of fusidic acid was best described using a time-dependent mixed-order absorption process, two disposition compartments, and a turnover process to describe the autoinhibition of clearance. The mean total clearance (% coefficient of variation) was 1.28 liters/h (33%) and the maximum extent of autoinhibition was 71.0%, with a 50% inhibitory concentration (IC50) of 46.3 mg/liter (36%). Food decreased the extent of bioavailability by 18%. As a result of the autoinhibition of clearance, steady state can be achieved earlier with dosing regimens that contain higher doses (after 8 days for 750 mg q12h and 1 day for 1,500 mg q12h on day 1 followed by 600 mg q12h versus 3 weeks for 500 mg q12h). Given that large initial doses autoinhibit the clearance of fusidic acid, this characteristic provides a basis for the administration of front-loaded dosing regimens of sodium fusidate which would allow for effective concentrations to be achieved early in therapy.

scholarly journals Hospital mealtimes: action research for change?

2005 ◽  
Vol 64 (3) ◽  
pp. 269-275 ◽  
Author(s):  
Angela Dickinson ◽  
Carol Welch ◽  
Laurie Ager ◽  
Aileen Costar
Keyword(s):  
Action Research ◽  
Phase 1 ◽  
Hospital Setting ◽  
Phase Changes ◽  
Research Approach ◽  
Second Phase ◽  
Action Research Approach ◽  
Three Phase ◽  
Two Phases ◽  
Patients Experience

Poor nutritional care within the hospital setting continues despite decades of work chronicling and measuring the problems. To address the problem changes in practice have been attempted to improve the patients’ experience of mealtimes. In order to implement patient-centred mealtimes for older patients by changing the focus from institutional convenience to one that focuses on the requirements of the patients, an action research approach has been used that focuses on action and change, and thus appears to have much to offer those who seek to change practice. The present paper focuses on the first two phases in a three-phase approach. In phase one the nature of everyday mealtime care and the wider context are explored using focus groups, interviews and observations. The data fall into three main themes that all impact on patients’ experiences of mealtimes: institutional and organisational constraints; mealtime care and nursing priorities; eating environment. Following feedback of phase 1 findings to staff and identification of areas of concern a model of practice development was selected to guide the change process of the second phase. Changes to mealtime nursing practice and the ward environment have been made, indicating that action research has the potential to improve the mealtime care of patients.

scholarly journals XXVII. The Bakerian Lecture. On the relations of electrical and chemical changes

1826 ◽  
Vol 116 ◽  
pp. 383-422 ◽  
Keyword(s):  
Present Moment ◽  
Great Activity ◽  
Fundamental Theory ◽  
Chemical Changes ◽  
Chemical Action ◽  
Long Time ◽  
The Subject ◽  
True Knowledge ◽  
In The Beginning ◽  
To Receive

A long time has elapsed since I read before this Society the Bakerian Lecture on the Chemical Agencies of Electricity. The general laws of decomposition developed in that Paper were immediately illustrated by some practical results, which the Society did me the honour to receive in a very favourable manner; and which, by offering a class of new and powerful agents, led me away for many years into a field of pure chemical enquiry: and it is only lately, and on an occasion which is well known, that I have again taken up the subject of the general principles of electro-chemical action. After a number of new experiments, which I shall have the pleasure of laying before the Society, and notwithstanding the various novel views which have been brought forward in this and in other countries, and the great activity and extension of science, it is peculiarly satisfactory to me to find that I have nothing to alter in the fundamental theory laid down in my original communication; and which, after a lapse of twenty years, has continued, as it was in the beginning, the guide and foundation of all my researches. I am the more inclined to bring forward these new labours at the present moment, though they are far from being in a finished state, because the discovery of Oersted and that of Morichini, illustrated by some late ingenious enquiries, connect the electro-chemical changes with entirely new classes of facts, and induce a hope that many of the complicated phenomena of corpuscular changes, now obscure, will ultimately be found to depend upon the same causes, and to be governed by the same laws; and that the simplicity of our scientific arrangements will increase with every advance in the true knowledge of nature.

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