Occupational burnout among radiation therapists in Australia: Findings from a mixed methods study.

INTRODUCTION: Evidence demonstrates that health care professionals in the palliative care context are more burned out than other health professionals. The aims of this study were to examine: (1) occupational burnout levels among radiation therapists in Australia, (2) association between demographic factors on burnout and (3) radiation therapists' perceptions of burnout. METHODS: A cross-sectional online survey including the Maslach Burnout Inventory was administered to Radiation Therapists in Australia. Data were analysed using SPSS Ver 20 and open ended comments were analysed thematically using Nvivo 10. RESULTS: A total of 200 radiation therapists participated in the survey. RTs had a high mean (±SD) burnout score for emotional exhaustion (38.5 ± 8.2), depersonalisation (17.5 ± 4.7) and personal achievement (30.5.3 ± 4.3) compared to RTs and health workers in other studies. High levels of emotional exhaustion, depersonalisation and low levels of personal achievement were present in 93% (186/200), 87% (174/200) and 61% (122/200) of participants respectively. RTs identified high workload and staff shortages, interpersonal conflict and technology as key sources of stress in the RT work environment. CONCLUSION: Australian RTs' level of burnout on all three stages of burnout exceed previously reported burnout levels for similar cohorts both locally and internationally. It is important that future interventions aimed at minimising or preventing stressors are identified and implemented in the radiation therapy work environment.

Generalized Hyperalgesia in Children and Adults Diagnosed With Hypermobility Syndrome and Ehlers-Danlos Syndrome Hypermobility Type: A Discriminative Analysis.

OBJECTIVE: Lowered pressure-pain thresholds have been demonstrated in adults with Ehlers-Danlos syndrome hypermobility type (EDS-HT), but whether these findings are also present in children is unclear. Therefore, the objectives of the study were to determine whether generalized hyperalgesia is present in children with hypermobility syndrome (HMS)/EDS-HT, explore potential differences in pressure-pain thresholds between children and adults with HMS/EDS-HT, and determine the discriminative value of generalized hyperalgesia. METHODS: Patients were classified in 1 of 3 groups: HMS/EDS-HT, hypermobile (Beighton score ≥4 of 9), and healthy controls. Descriptive data of age, sex, body mass index, Beighton score, skin laxity, and medication usage were collected. Generalized hyperalgesia was quantified by the average pressure-pain thresholds collected from 12 locations. Confounders collected were pain locations/intensity, fatigue, and psychological distress. Comparisons between children with HMS/EDS-HT and normative values, between children and adults with HMS/EDS-HT, and corrected confounders were analyzed with multivariate analysis of covariance. The discriminative value of generalized hyperalgesia employed to differentiate between HMS/EDS-HT, hypermobility, and controls was quantified with logistic regression. RESULTS: Significantly lower pressure-pain thresholds were found in children with HMS/EDS-HT compared to normative values (range -22.0% to -59.0%; P ≤ 0.05). When applying a threshold of 30.8 N/cm2 for males and 29.0 N/cm2 for females, the presence of generalized hyperalgesia discriminated between individuals with HMS/EDS-HT, hypermobility, and healthy controls (odds ratio 6.0). CONCLUSION: Children and adults with HMS/EDS-HT are characterized by hypermobility, chronic pain, and generalized hyperalgesia. The presence of generalized hyperalgesia may indicate involvement of the central nervous system in the development of chronic pain.

National toxicovigilance for pesticide exposures resulting in health care contact - An example from the UK's National Poisons Information Service.

BACKGROUND: Although there are extensive systems in place for pharmacovigilance, similar systems for detecting adverse health effects relating to pesticide exposure are rare. In 2004, the National Poisons Information Service (NPIS) pesticide surveillance study was implemented to identify cases requiring health care contact in the UK. This report describes the epidemiology of pesticide exposures reported to poison centres in the UK over a 9-year period. METHODS: Data on exposures were gathered through monitoring access to the NPIS's online clinical toxicology database TOXBASE(®) and through monitoring calls to the four NPIS units (Edinburgh, Cardiff, Newcastle and Birmingham). Severity was judged by both caller and NPIS staff. RESULTS: During the 9 years, 34,092 enquiries concerning pesticides were recorded; 7,804 cases of pesticide exposure were derived from these enquiries. Exposures were predominantly unintentional and acute (6,789; 87.0%); 217 (2.8%) and 755 (9.7%) were chronic unintentional and acute deliberate self-harm exposures, respectively. The majority of cases occurred in children, especially the 0-4 year age group The minimum incidence of pesticide exposure requiring health care contact was 2.0 cases/100,000 population per year. Reported numbers were 6- to 25-fold greater than those picked up through other UK pesticide toxicovigilance schemes. There were 81 cases of severe toxicity and 38 cases of fatal exposure. Deliberate self-harm accounted for 62.3% of severe cases and 79% of deaths. Aluminium phosphide, paraquat, diquat and glyphosate were responsible for most severe and fatal cases. CONCLUSIONS: The data gathered from this pesticide surveillance study indicate that poison centre resources can usefully monitor pesticide exposures resulting in health care contact in the UK. The NPIS may usefully be one component of the UK's response to European legislation requiring surveillance of complications resulting from pesticide use.

Using the unbiased perspectives of people living with a spinal cord injury in assessments of mobility.

STUDY DESIGN: Clinometrics study. OBJECTIVE: To devise a way of capturing the unbiased perspectives of people living with a spinal cord injury (SCI) in assessments of mobility. SETTING: SCI unit and community. METHODS: Three groups of raters used the Global Impression of Change Scale (GICS) to rate change in mobility of a cohort of patients with a recent SCI. The three groups of raters were as follows: 10 people with a recent SCI, 10 people with an established SCI and 10 physiotherapists. The ratings were done after viewing 51 pairs of videos depicting one of three motor tasks: sitting unsupported, transferring and walking. Each pair of videos showed the same person performing the same motor task on two occasions. The videos were taken between 1 h and 5 months apart and presented side by side, randomly left or right, on the screen. Raters were asked to score the amount of change in performance between the two videos on a 7-point Global Impression of Change Scale (GICS). Intra-rater reliability for the three motor tasks and three groups of raters was determined using intra-class correlation coefficients. RESULTS: People with an SCI were reliable at rating change in patients' abilities to transfer and walk with ICC's ranging from 0.66 to 0.81 (95% Confidence interval bounds ranging from 0.51 to 0.94). Physiotherapists were consistently but only marginally more reliable at rating than people with an SCI. CONCLUSIONS: Videos and the GICS may provide a way of using the unbiased perspectives of people living with spinal cord injury in assessments of mobility.

Clinical characteristics of mephedrone toxicity reported to the U.K. National Poisons Information Service.

OBJECTIVE: To describe the patterns and clinical features of toxicity related to recreational use of mephedrone and other cathinones in the U.K. using data collected by the National Poisons Information Service (NPIS). METHODS: The number of accesses to TOXBASE, the NPIS online poisons information database, details of consecutive cases uploaded onto TOXBASE and the number and details of telephone enquiries made to the NPIS by health professionals in the U.K. were collected for the period March 2009 to February 2010. RESULTS: Over the year of study there were 2901 TOXBASE accesses and 188 telephone enquiries relating to cathinones, the majority relating to mephedrone (TOXBASE 1664, telephone 157), with a month-on-month increase in numbers. In 131 telephone enquiries concerning mephedrone, alone or in combination with alcohol, common clinical features reported included agitation or aggression (n=32, 24%, 95% CI 18% to 33%), tachycardia (n=29, 22%, 95% CI 16% to 30%), confusion or psychosis (n=18, 14%, 95% CI 9% to 21%), chest pain (n=17, 13%, 95% CI 8% to 20%), nausea (n=15, 11%, 95% CI 7% to 18%), palpitations (n=14, 11%, 95% CI 6% to 18%), peripheral vasoconstriction (n=10, 8%, 95% CI 4% to 14%) and headache (n=7, 5%, 95% CI 2% to 11%). Convulsions were reported in four cases (3%, 95% CI 1% to 8%). One exposed person died following cardiac arrest (1%, 95% CI 0% to 4%), although subsequent investigation suggested that mephedrone was not responsible. CONCLUSIONS: Toxicity associated with recreational mephedrone use is increasingly common in the UK. Sympathomimetic adverse effects are common and severe effects are also reported. Structured data collected by the NPIS may be of use in identifying trends in poisoning and in establishing toxidromes for new drugs of abuse.

UK childhood exposures to pesticides 2004-2007: a TOXBASE toxicovigilance study.

OBJECTIVE: There are no systematic methods for toxicovigilance of non-medicinal products in the UK. This is particularly relevant for pesticides, where there is significant public concern about potential adverse effects. This study describes a prospective toxicovigilance scheme based on follow-up of enquiries to the National Poisons Information Service (NPIS) through its online poisons information system TOXBASE. These enquiries reflect acute exposures and the patterns of acute illness that result. RESULTS: A total of 10 061 pesticide-related enquiries were identified. After follow-up, data were gathered on 2364 suspected exposures, of which 1162 involved children. After exclusions, 1147 exposures are reported here. No deaths were reported and only 37 children were admitted to hospital. The majority were considered to have either minimal or no features (925, 80.6%). Symptoms for 38 children were unknown. Symptoms reported in the other 184 children included nausea or vomiting (58), eye irritation, pain or conjunctivitis (29), skin irritation (28), abdominal pain (24), mouth or throat irritation (18) and diarrhoea (15). Where age was recorded, 60.5% (680) of children involved in suspected pesticide exposures were aged 2 years or less. The most common scenario for acute accidental exposure to pesticide in children was exposure after application (329, 28.7%) or due to poor storage (228, 19.9%). CONCLUSIONS: Areas of potential concern identified included storage, access of young children to "laid" baits and pesticides, and exposures as a result of medication errors, with liquid head lice preparations being confused with other medicines. Use of NPIS systems provides a potentially useful method of toxicovigilance.

Shoulder proprioception is associated with humeral torsion in adolescent baseball players.

OBJECTIVES: To determine the relationship between the amount of humeral torsion and a measure of active proprioception in adolescent male throwing athletes. DESIGN: Cross-sectional laboratory study with uninjured subjects. SETTING: University of Sydney and NSW Institute of Sport. PARTICIPANTS: Participants were 16 adolescent male baseball players (15.0-18.1 years old, SD=16.3) holding baseball scholarships at the NSW Institute of Sport. MAIN OUTCOME MEASURES: The main outcome measures, active proprioception (shoulder rotation, in 90 degrees of arm abduction moving towards external rotation, using the Active Movement Extent Discriminating Apparatus) and humeral torsion (using an ultrasound-assisted method), were measured bilaterally. RESULTS: A strong (r=0.88) and significant (p=0.001) correlation was found between increasing humeral retrotorsion and better active proprioceptive acuity in the non-dominant arm, while the relation was weaker (r=0.41) and did not reach statistical significance (p=0.120) for the dominant arm. CONCLUSIONS: A cognitive processing capacity model, which suggests that greater humeral retrotorsion reduces neural processing requirements, has been proposed to explain the direct relationship between proprioceptive acuity and humeral retrotorsion.

Functional strength training in cerebral palsy: a pilot study of a group circuit training class for children aged 4-8 years.

OBJECTIVE: To determine the effects of intensive task-specific strength training on lower limb strength and functional performance in children with cerebral palsy. DESIGN: A nonrandomized ABA trial. SETTING: Sydney school. SUBJECTS: Eight children with cerebral palsy, aged 4-8 years, seven with diagnosis of spastic diplegia, one of spastic/ataxic quadriplegia. INTERVENTION: Four weeks of after-school exercise class, conducted for one hour twice weekly as group circuit training. Each work station was set up for intensive repetitive practice of an exercise. Children moved between stations, practising functionally based exercises including treadmill walking, step-ups, sit-to-stands and leg presses. MAIN OUTCOME MEASURES: Baseline test obtained two weeks before training, a pre-test immediately before and a post-test following training, with follow-up eight weeks later. Lower limb muscle strength was tested by dynamometry and Lateral Step-up Test; functional performance by Motor Assessment Scale (Sit-to-Stand), minimum chair height test, timed 10-m test, and 2-minute walk test. RESULTS: Isometric strength improved pre- to post-training by a mean of 47% (SD 16) and functional strength, on Lateral Step-up Test, by 150% (SD 15). Children walked faster over 10 m, with longer strides, improvements of 22% and 38% respectively. Sit-to-stand performance had improved, with a reduction of seat height from 27 (SD 15) to 17 (SD 11) cm. Eight weeks following cessation of training all improvements had been maintained. CONCLUSIONS: A short programme of task-specific strengthening exercise and training for children with cerebral palsy, run as a group circuit class, resulted in improved strength and functional performance that was maintained over time.

A novel clinical evaluation of childhood incontinence and urinary urgency.

PURPOSE: There are few clinic based objective tools for the evaluation of urinary urgency and incontinence in children. We report on the known method of frequency volume chart, and describe 2 new tools to determine their effectiveness and reliability. MATERIALS AND METHODS: The mean and standard deviation values for affected children in each age group from 5 to 12 years were calculated from 321 consecutive frequency volume charts. Two new child-based scoring tools quantifying urinary urgency were developed to measure the sensation of urgency and the intensity of response at urge (visual analog score 1 and 2). These tools were tested for reliability. As the quantification of incontinence is problematic in children, a new system of documenting functional severity of leakage per day was designed (Dry Pie) and also tested for reliability. RESULTS: Age related mean bladder storage volumes and standard deviations were established for children with incontinence. The novel urgency visual analog measure proved reliable, although only scale 2 would be useful in clinical practice. The incontinence Dry Pie diary was also shown to be reliable for 2 weeks and easily completed at home by the children. CONCLUSIONS: As a result of this study clinic based intervention can include reliable quantification of urinary urgency (visual analog scale 2) and a functional measure of the severity of incontinence (Dry Pie).

A pilot study of the home application of transcutaneous neuromodulation in children with urgency or urge incontinence.

PURPOSE: We evaluated the efficacy of transcutaneous neuromodulation to treat urinary urgency and urge incontinence in children with nonneurological bladder dysfunction. MATERIALS AND METHODS: Surface neuromodulation was delivered via skin electrodes away from the genital region for a short duration daily on a home treatment basis. Clinical outcome was measured by 3 tools previously tested for reliability including the frequency volume chart, urgency visual analog scale and accident diary ("Dry Pie"). RESULTS: After at least 1 month of application dryness had improved in 73.3% of children, mean urgency score had improved to equate action at urge as being 'easy to hold on' and there was a significant increase in mean voided volume. CONCLUSIONS: Initial evaluation of the home application of surface neuromodulation in children with urgency and/or urge incontinence revealed positive results and warrants a randomized controlled investigation. The finding that children were not completely dry with this treatment in isolation suggests that further study is needed to identify optimal treatment duration and stimulus intensity.

Indenter head area and testing frequency effects on posteroanterior lumbar stiffness and subjects' rated comfort.

Although several mechanical devices have been developed to objectively assess posteroanterior (PA) stiffness of the lumbar spine, no standardized testing protocol has been adopted. Two factors that may vary across protocols, and that effect measured stiffness and the comfort of the test subject, are the size of the indenter head used to apply the PA pressure, and indenting frequency. Three variables; PA stiffness, defined as the slope of the stiffness curve (K), the displacement of the indenter at 30N (D30), and rating of perceived comfort, were measured in 36 subjects asymptomatic for low back pain. For each subject nine tests were conducted, using three different indenter head sizes (300mm(2), 720mm(2)and 1564mm(2)) at each of three different testing frequencies (0.25 Hz, 0.5 Hz and 2 Hz). Machine testing with a large indenter head produced a lower K value, an increased D30 value and higher perceived comfort, while a fast testing frequency produced a higher K value and a lower D30 value. An indenter size by frequency interaction showed small indenter heads to be least comfortable at slow speed. The differences found suggest that the indenter head size and the testing frequency should be standardized during mechanical spinal stiffness testing.

Relationships among age-associated strength changes and physical activity level, limb dominance, and muscle group in women.

This study investigated the magnitude and rate of age-associated strength reductions in Australian independent urban-dwelling women and the relationship to muscle groups, limb dominance, and physical activity level. Independent urban-dwelling women aged 20 to 89 years (N = 217) performed maximal voluntary contractions with the dominant and nondominant knee extensors, plantar flexors, and handgrip. Anthropometric measurements were made and questionnaire responses used to obtain current physical activity levels. Trend analysis within analysis of variance and regression analysis on strength was performed. Limb muscle strength was found to be associated with increased age, muscle group, limb dominance, and activity. Self-reported physical activity levels declined with age but women who were more physically active for their age group were stronger in all muscle groups and had more lean body mass and lean thigh and leg cross-sectional area than relatively inactive women. Slopes of the linear reductions of maximal voluntary strength of the knee extensors, plantar flexors, and handgrip with age were significantly different (p < .05) at 9.3%, 7.4%, and 6.2% per decade, respectively. The limb muscle strength of healthy Australian independent and urban-dwelling women aged 20 to 89 years was found to be associated with age and three aspects of disuse: muscle group, relative levels of physical activity, and limb dominance.

Catalytic macrocyclizations of thietanes and thiiranes by metal carbonyl complexes.

This Account summarizes our recent studies of the catalytic transformations of thietanes and thiiranes by metal carbonyl complexes of the third row of the transition elements. The goal of the work has been to prepare polythioether macrocycles (thiacrowns) catalytically. This has been achieved with high success for certain thietane reactions. Thiiranes, on the other hand, tend to yield macrocyclic polydisulfides, but it has recently been found that these reactions can be redirected toward the thiacrown products by using certain alkyne carboxylates as cocatalysts. Vinylthiiranes are transformed into 3,6-dihydro-1,2-dithiins catalytically in excellent yield via W(CO)(5)(vinylthiirane) complexes.

Acute angles of head-up tilt do not affect forearm and hand volume.

Physiotherapists utilise the effect of gravity in treatment of conditions associated with increased limb volume. In contrast with knowledge about the relationship between body position and lower limb volume, the effect of body position on arm volume is not well understood. To assess the efficacy of a simple intervention proposed for patients to reduce arm volume during sleep, this study investigated the effects on forearm and hand volume of two hours of head-up tilt in supine at three angles of 8, 11 and 14 degrees. Six asymptomatic subjects were measured at each tilt angle over a three-week period. Data indicated that no angle of head-up lying over a two-hour period was associated with any significant reduction in upper limb volume.

Sitting balance II: reach direction and thigh support affect the contribution of the lower limbs when reaching beyond arm's length in sitting.

The effects of reach direction and extent of thigh support on the contribution of the lower limbs during seated reaching were examined. Twelve healthy subjects aged 59-79 years performed self-paced reaching forwards and diagonally to both sides and under three thigh support conditions. Vertical ground reaction forces (GRF) and leg muscle activity were monitored bilaterally. Reach direction affected both the magnitude of peak vertical GRF and the relative distribution of vertical GRF through the feet, demonstrating that the lower limbs work cooperatively to control the motion of the body mass. Extent of thigh support also affected the magnitude of peak vertical GRF through the feet. In addition, the EMG data confirmed the active contribution of the lower limbs when reaching beyond arm's length, with muscles in both lower limbs activated in all trials.

Human skeletal sarcoplasmic reticulum Ca2+ uptake and muscle function with aging and strength training.

This study investigated the adaptations of skeletal muscle sarcoplasmic reticulum (SR) Ca2+ uptake, relaxation, and fiber types in young (YW) and elderly women (EW) to high-resistance training. Seventeen YW (18-32 yr) and 11 EW (64-79 yr) were assessed for 1) electrically evoked relaxation time and rate of the quadriceps femoris; and 2) maximal rates of SR Ca2+ uptake and Ca2+-ATPase activity and relative fiber-type areas, analyzed from muscle biopsies of the vastus lateralis. EW had significantly slower relaxation rates and times, decreased SR Ca2+ uptake and Ca2+-ATPase activity, and a larger relative type I fiber area than did YW. A subgroup of 9 young (YWT) and 10 elderly women (EWT) performed 12 wk of high-resistance training (8 repetition maximum) of the quadriceps and underwent identical testing procedures pre- and posttraining. EWT significantly increased their SR Ca2+ uptake and Ca2+-ATPase activity in response to training but showed no alterations in speed of relaxation or relative fiber-type areas. In YWT none of the variables was altered after resistance training. These findings suggest that 1) a reduced SR Ca2+ uptake in skeletal muscle of elderly women was partially reversed with resistance training and 2) SR Ca2+ uptake in the vastus lateralis was not the rate-limiting mechanism for the slowing of relaxation measured from electrically evoked quadriceps muscle of elderly women.