Exploring work-related stressors experienced by mental health nurses: A qualitative descriptive study.

Introduction: The challenging work environments mental health nurses (MHNs) encounter can negatively impact their mental health, psychological well-being and physical health. While these impacts have been investigated in quantitative research, little is known about work-related stress from the perspective of MHNs.

Aim: To explore the stresses faced by nurses working in mental health settings and to gain an understanding of the underlying workplace context.

Comparative Effectiveness of Ranolazine Versus Traditional Therapies in Chronic Stable Angina Pectoris and Concomitant Diabetes Mellitus and Impact on Health Care Resource Utilization and Cardiac Interventions.

Comparative studies evaluating traditional versus newer antianginal (AA) medications in chronic stable angina pectoris (CSA) on cardiovascular (CV) outcomes and utilization are limited, particularly in patients with diabetes mellitus (DM). Claims data (2008 to 2012) were analyzed using a commercial database. Patients with CSA receiving a β blocker (BB), calcium channel blocker (CCB), long-acting nitrate (LAN), or ranolazine were identified and followed for 12 months after a change in AA therapy.

Hidden costs associated with venous thromboembolism: impact of lost productivity on employers and employees.

Objective: To determine productivity loss and indirect costs with deep vein thrombosis (DVT) and pulmonary embolism (PE).

Methods: Medical and pharmacy claims with short-term disability (STD) and long-term disability (LTD) claims from 2007 to 2010 were analyzed from the Integrated Benefits Institute's Health and Productivity Benchmarking (IBI-HPB) database (STD and LTD claims) and IMS LifeLink™ data (medical and pharmacy claims), which were indirectly linked using a weighting approach matching from IBI-HPB patients' demographic distribution.

Results: A total of 5442 DVT and 6199 PE claims were identified.

The economic burden of acute coronary syndromes for employees and their dependents: medical and productivity costs.

Objective: To determine the total burden of illness, including direct and indirect costs for employees and their dependents with acute coronary syndrome (ACS).

Methods: Medical and pharmacy claims along with short-term disability (STD) and long-term disability (LTD) claims from 2007 to 2010 were analyzed using two data sets: Integrated Benefits Institute's Health and Productivity Benchmarking Database (STD and LTD claims) and IMS LifeLink™ Health Plan Data (medical and pharmacy claims).

Results: Employees with ACS lost 60.

A method for determining optimal mean airway pressure in high-frequency oscillatory ventilation.

Background: "Optimal" mean airway pressure (MAP) during high-frequency oscillatory ventilation (HFOV) can be defined as the pressure that allows for maximal alveolar recruitment while minimizing alveolar overdistension. Choosing a MAP near or just below the point of maximal curvature (PMC) of the volume-pressure characteristics of the lung can serve as a guide to avoid overdistention during HFOV, while simultaneously preventing derecruitment. The purpose of this study was to assess whether optimal MAP at the PMC can be determined by using measures of PaO(2) in patients with acute respiratory distress syndrome (ARDS) undergoing HFOV.

1H NMR spectroscopy of serum reveals unique metabolic fingerprints associated with subtypes of surgically induced osteoarthritis in sheep.

Osteoarthritis (OA) is a highly prevalent joint disease. Its slow progressive nature and the correlation between pathological changes and clinical symptoms mean that OA is often well advanced by the time of diagnosis. In the absence of any specific pharmacological treatments, there is a pressing need to develop robust biomarkers for OA.

Perceived effects of attending physician workload in academic medical intensive care units: a national survey of training program directors.

Background: Increases in the size and number of American intensive care units have not been accompanied by a comparable increase in the critical care physician workforce, raising concerns that intensivists are becoming overburdened by workload. This is especially concerning in academic intensive care units where attending physicians must couple teaching duties with patient care.

Methods: We performed an in-person and electronic survey of the membership of the Association of Pulmonary and Critical Care Medicine Program Directors, soliciting information about patient workload, other hospital and medical education duties, and perceptions of the workplace and teaching environment of their intensive care units.

Multimarker panels in sepsis.

Biomarkers differentiate between 2 or more biologic states. The complexity of diseases like sepsis makes it unlikely that any single marker will allow for precise disease specification. Combining several biomarkers into a single classification rule should help to improve their accuracy and, therefore, their usefulness.

Hemodynamic monitoring in sepsis.

Arterial waveform analysis that does not require continuous calibration, impedance cardiography, electrical cardiometry, velocity-encoded phase contrast magnetic resonance imaging (MRI), pulsed dye densitometry, noninvasive pulse pressure analysis using tonometry, suprasternal Doppler, partial CO2 rebreathing techniques, and transcutaneous Doppler are just some of the other emerging technologies not described in this review that may be used routinely in the management of sepsis and septic shock in the very near future. These innovative approaches may further increase our ability to optimize patients' fluid status and hemodynamics. We also have ability to monitor the microcirculation.

Hemodynamic monitoring in sepsis.

Tissue hypoperfusion is an important factor in the development of multiple organ failure. Therefore, recognition of sepsis-induced tissue hypoperfusion and timely clinical intervention to prevent and correct this are fundamental aspects of managing patients with sepsis and septic shock. Hemodynamic monitoring plays a key role in the management of the critically ill and is used to identify hemodynamic instability and its cause and to monitor response to therapy.

Changes in gait after bilateral meniscectomy in sheep: effect of two hyaluronan preparations.

Background: This study examined the effect of bilateral meniscectomy on ground reaction forces (GRFs) in sheep, and the therapeutic effect of two hyaluronan (HA) preparations.

Methods: Eighteen sheep were subjected to bilateral lateral meniscectomy and were treated from 16 to 20 weeks postoperatively with intraarticular Hyalgan (Fidia Farmaceutici), HYADD4-G (a novel amide derivative; Fidia Farmaceutici), or saline placebo (n = 6 per group). GRFs were assessed at baseline and 6, 12, 16, 22, and 26 weeks postoperatively.

Vascular foramina of the metacarpophalangeal sesamoid bones of Greyhounds and their relationship to sesamoid disease.

Objective: To apply a novel technique and use the number and size (diameter and mean area) of vascular foramina to estimate potential blood supply in the metacarpophalangeal bones of dogs.

Animals: 28 Greyhounds.

Procedures: The forelimb sesamoid bones of 23 dogs were obtained after dogs were euthanized.

Biodistribution and clearance of intra-articular liposomes in a large animal model using a radiographic marker.

The intra-articular (IA) route of administration in treating arthritis has potential for targeting drug delivery to affected tissues, thereby minimising the attendant side-effects of systemically administered drugs. The ultra-structure of the synovium however facilitates rapid drug efflux from the joint; effectively the IA route is equivalent to other non-IV parenteral routes with regards absorption and redistribution into the systemic circulation. The aim of this study was to extend the drug residence time within the knee joint by using a liposome formulation.

Proteoglycan 4 downregulation in a sheep meniscectomy model of early osteoarthritis.

Osteoarthritis is a disease of multifactorial aetiology characterised by progressive breakdown of articular cartilage. In the early stages of the disease, changes become apparent in the superficial zone of articular cartilage, including fibrillation and fissuring. Normally, a monolayer of lubricating molecules is adsorbed on the surface of cartilage and contributes to the minimal friction and wear properties of synovial joints.

Comparative spatial and temporal localisation of perlecan, aggrecan and type I, II and IV collagen in the ovine meniscus: an ageing study.

This is the first study to immunolocalise perlecan in meniscal tissues and to demonstrate how its localisation varied with ageing relative to aggrecan and type I, II and IV collagen. Perlecan was present in the middle and inner meniscal zones where it was expressed by cells of an oval or rounded morphology. Unlike the other components visualised in this study, perlecan was strongly cell associated and its levels fell significantly with age onset and cell number decline.

Perlecan displays variable spatial and temporal immunolocalisation patterns in the articular and growth plate cartilages of the ovine stifle joint.

Perlecan is a modular heparan sulphate and/or chondroitin sulphate substituted proteoglycan of basement membrane, vascular tissues and cartilage. Perlecan acts as a low affinity co-receptor for fibroblast growth factors 1, 2, 7, 9, binds connective tissue growth factor and co-ordinates chondrogenesis, endochondral ossification and vascular remodelling during skeletal development; however, relatively little is known of its distribution in these tissues during ageing and development. The aim of the present study was to immunolocalise perlecan in the articular and epiphyseal growth plate cartilages of stifle joints in 2-day to 8-year-old pedigree merino sheep.

Regional assessment of articular cartilage gene expression and small proteoglycan metabolism in an animal model of osteoarthritis.

Osteoarthritis (OA), the commonest form of arthritis and a major cause of morbidity, is characterized by progressive degeneration of the articular cartilage. Along with increased production and activation of degradative enzymes, altered synthesis of cartilage matrix molecules and growth factors by resident chondrocytes is believed to play a central role in this pathological process. We used an ovine meniscectomy model of OA to evaluate changes in chondrocyte expression of types I, II and III collagen; aggrecan; the small leucine-rich proteoglycans (SLRPs) biglycan, decorin, lumican and fibromodulin; transforming growth factor-beta; and connective tissue growth factor.

The nitric oxide donor glyceryl trinitrate increases subchondral bone sclerosis and cartilage degeneration following ovine meniscectomy.

Aim: To examine the effect of glyceryl trinitrate (GTN), a nitric oxide (NO) donor compound, on the concurrent progression of cartilage and subchondral bone changes in an ovine meniscectomy model of osteoarthritis (OA).

Methods: Bilateral lateral meniscectomy (MX) was performed on 12 ewes to induce OA. Six were treated with topical GTN (0.

Intact purine biosynthesis pathways are required for wild-type virulence of Brucella abortus 2308 in the BALB/c mouse model.

Brucella abortus 2308 derivatives with mini-Tn5 insertions in purE, purL, and purD display significant attenuation in the BALB/c mouse model, while isogenic mutants with mini-Tn5 insertions in pheA, trpB, and dagA display little or no attenuation in cultured murine macrophages or mice. These experimental findings confirm the importance of the purine biosynthesis pathways for the survival and replication of the brucellae in host macrophages. In contrast to previous reports, however, these results indicate that exogenous tryptophan and phenylalanine are available for use by the brucellae in the phagosomal compartment.