Assessment of burnout and pandemic fatigue among pharmacy leadership in the Veterans Health Administration healthcare system.

PURPOSE: Factors associated with burnout in Veterans Health Administration (VHA) pharmacy leadership positions were examined during the coronavirus disease 2019 (COVID-19) pandemic. METHODS: A questionnaire was distributed to all pharmacy executives of the VHA healthcare system. It collected demographic and employment characteristics, career satisfaction and work-related variables, indicators of burnout using validated single-item measures adapted from the Maslach Burnout Inventory, and the impact of the COVID-19 pandemic on psychosocial and work-related variables. A χ2 test with Bonferroni correction was used to evaluate the data. Burnout was defined as a score of 4 or greater on either of the 2 single-item validated statements adapted from the Maslach Burnout Inventory to assess emotional exhaustion and depersonalization. RESULTS: In total, 407 (of 1,027; 39.6%) VHA pharmacy leaders representing Veterans Integrated Service Network pharmacy executives, chiefs of pharmacy, associate chiefs of pharmacy, and inpatient and outpatient supervisors completed the survey. The overall prevalence of burnout was 68.6% using the aggregate measure of emotional exhaustion or depersonalization. Pharmacy leaders who worked more than 60 hours a week reported significantly greater rates of burnout than those who worked 40 to 60 hours a week (86.7% vs 66.9%, χ2 = 7.34, degrees of freedom = 1, P < 0.05). Those experiencing increased workload related to COVID-19 also reported high burnout rates (72.1%, χ2 = 16.40, degrees of freedom = 1, P < 0.001). Burnout scores were similar across groups when respondents were stratified by leadership position, gender, age, or years in position. CONCLUSION: As of March 2021, two-thirds of pharmacy leaders were experiencing burnout. It is important for healthcare system leadership to identify patterns of burnout among their pharmacy leaders to ensure a productive and sustainable workforce.

Playing Recognition Politics: Queer Theoretical Reflections on Lesbian, Gay, and Queer Youth Social Policy in Australia in the 1980s and 1990s.

This article provides a queer theoretical reflection on the emergence of lesbian, gay, and queer (LGQ) youth as subjects of policy attention in Australia in the late twentieth century. In particular, it focuses on the ways in which specific forms of social, bureaucratic, and organizational recognition have given shape to LGQ youth as categorical policy objects. To this end, this article critically interrogates social policy related to the provision of funding for LGQ youth support during the 1980s and 1990s in two Australian states: New South Wales and Western Australia. More specifically, it focuses on some of the ways in which LGQ youth have been discursively shaped and materially supported in three different organizations, two of which continue to be strongly associated with support of LGQ youth in Australia. This study of the emergence of these organizations, resourced by three different sectors-the state, the church, and the LGQ community itself-necessarily draws on ephemeral resources, reflecting the conditions of possibility in which this work was being enacted. We conclude with an analysis of the necessity for situating policy recognitions within specific contexts to examine the implications for LGQ youth as the subjects such recognitions simultaneously seek to constitute and serve.

The myth of LGBTQ mobilities: framing the lives of gender- and sexually diverse Australians between regional and urban contexts.

Gender- and sexually diverse youth are often represented in popular discourses through concepts of movement and mobility. Conceptual stories of LGBTQ youth transitions to adulthood in particular are marked by narratives of movement from regional (rural and/or small towns) to major urban areas. Although not wholly outside lived experience, a cultural myth that portrays the experience of gender- and sexually diverse young people entering into 'adulthood' via such mobility continues to circulate in scholarship, popular media, personal accounts of coming out, support resources and self-help guidance documents. This paper draws on a recent study of gender and sexual diversity, support and belonging to examine instances of LGBTQ youth mobility in relation to participant interviews and focus groups undertaken in an Australian project examining two generations of sexually diverse subjects' views on growing up, support and belonging. Participants differed generationally in how they experienced mobility from regional to urban settings, demonstrating that contemporary real-world accounts of such mobility are complex, nuanced and diverse and that the felt 'expectation' that one should migrate to a city in order to live a full gender- or sexually diverse life has waned among young people in the more recent generation.

Thrombolysis in acute ischemic stroke is associated with lower long-term hospital bed day use: A nationwide propensity score-matched follow-up study.

Background Thrombolysis with intravenous recombinant tissue-type plasminogen activator improves functional outcome in acute ischemic stroke. Few studies have investigated the effects of thrombolysis in a real-world setting. We evaluated the impact of thrombolysis on long-term hospital bed day use and the risk of readmission due to stroke-related complications. Methods We conducted a register-based nationwide propensity score-matched follow-up study among ischemic stroke patients in Denmark (2004-2011). Thrombolysed patients were propensity-score matched with non-thrombolysed acute ischemic stroke patients admitted to stroke centers not yet offering thrombolysis in 2004-2006. The outcomes were length of the stroke admission, total all-cause hospital bed day use during the first year after the stroke, and the long-term risk of readmissions. Thrombolysed and non-thrombolysed patients were compared using multivariable log-linear regression and Cox regression. Results We identified 1095 thrombolysed and 1095 propensity score matched eligible but non-thrombolysed acute ischemic stroke patients. The median length of the stroke admission was 9 days in the thrombolysed group and 13 days in the non-thrombolysed group (adjusted geometric mean ratio, 0.88; 95% CI: 0.78-1.00). The median all-cause hospital bed day use within the first year was 12 days in the thrombolysed group and 19 days in the non-thrombolysed group (adjusted geometric mean ratio, 0.82; 95% CI: 0.73-0.92). There was no significant difference in the overall risk of readmission (adjusted hazard ratio, 0.91; 95% CI: 0.79-1.04); however, thrombolysis was associated with reduced risk of pneumonia (adjusted hazard ratio, 0.59; 95% CI: 0.35-0.97). Conclusions Thrombolysis in ischemic stroke was associated with lower long-term hospital bed day use and decreased risk of readmission due to pneumonia.

Reducing bacterial contamination in fuel ethanol fermentations by ozone treatment of uncooked corn mash.

Ozonation of uncooked corn mash from the POET BPX process was investigated as a potential disinfection method for reducing bacterial contamination prior to ethanol fermentation. Corn mash (200 g) was prepared from POET ground corn and POET corn slurry and was ozonated in 250 mL polypropylene bottles. Lactic and acetic acid levels were monitored daily during the fermentation of ozonated, aerated, and nontreated corn mash samples to evaluate bacterial activity. Glycerol and ethanol contents of fermentation samples were checked daily to assess yeast activity. No yeast supplementation, no addition of other antimicrobial agents (such as antibiotics), and spiking with a common lactic acid bacterium found in corn ethanol plants, Lactobacillus plantarum, amplified the treatment effects. The laboratory-scale ozone dosages ranged from 26-188 mg/L, with very low estimated costs of $0.0008-0.006/gal ($0.21-1.6/m(3)) of ethanol. Ozonation was found to decrease the initial pH of ground corn mash samples, which could reduce the sulfuric acid required to adjust the pH prior to ethanol fermentation. Lactic and acetic acid levels tended to be lower for samples subjected to increasing ozone dosages, indicating less bacterial activity. The lower ozone dosages in the range applied achieved higher ethanol yields. Preliminary experiments on ozonating POET corn slurry at low ozone dosages were not as effective as using POET ground corn, possibly because corn slurry samples contained recycled antimicrobials from the backset. The data suggest additional dissolved and suspended organic materials from the backset consumed the ozone or shielded the bacteria.

Acute ischemic stroke and long-term outcome after thrombolysis: nationwide propensity score-matched follow-up study.

BACKGROUND AND PURPOSE: Data on long-term outcome after intravenous tissue-type plasminogen activator (tPA) in ischemic stroke are limited. We examined the risk of long-term mortality, recurrent ischemic stroke, and major bleeding, including intracranial and gastrointestinal bleeding, in intravenous tPA-treated patients when compared with intravenous tPA eligible but nontreated patients with ischemic stroke. METHODS: We conducted a register-based nationwide propensity score-matched follow-up study among patients with ischemic stroke in Denmark (2004-2011). Cox regression analysis was used to compute adjusted hazard ratios for all outcomes. RESULTS: Among 4292 ischemic strokes (2146 intravenous tPA-treated and 2146 propensity score-matched nonintravenous tPA-treated patients), with a follow-up for a median of 1.4 years, treatment with intravenous tPA was associated with a lower risk of long-term mortality (adjusted hazard ratio, 0.66; 95% confidence interval, 0.49-0.88). The long-term risk of recurrent ischemic stroke (adjusted hazard ratio, 1.05; 95% confidence interval, 0.68-1.64) and major bleeding (adjusted hazard ratio, 0.59; 95% confidence interval, 0.24-1.47) did not differ significantly between the intravenous tPA-treated and nontreated patients. CONCLUSIONS: Treatment with intravenous tPA in patients with ischemic stroke was associated with improved long-term survival.

Reference programme: diagnosis and treatment of headache disorders and facial pain. Danish Headache Society, 2nd Edition, 2012.

Headache and facial pain are among the most common, disabling and costly disorders in Europe. Correct diagnosis and treatment is important for achieving a high quality of care. As a national organisation whose role is to educate and advocate for the needs of patients with primary headaches, the Danish Headache Society has set up a task force to develop a set of guidelines for the diagnosis, organisation and treatment of the most common types of headaches and for trigeminal neuralgia in Denmark. The guideline was published in Danish in 2010 and has been a great success. The Danish Headache Society decided to translate and publish our guideline in English to stimulate the discussion on optimal organisation and treatment of headache disorders and to encourage other national headache authorities to produce their own guidelines. The recommendations regarding the most common primary headaches and trigeminal neuralgia are largely in accordance with the European guidelines produced by the European Federation of Neurological Societies. The guideline provides a practical tool for use in daily clinical practice for primary care physicians, neurologists with a common interest in headache, as well as other health-care professionals treating headache patients. The guideline first describes how to examine and diagnose the headache patient and how headache treatment is organised in Denmark. This description is followed by individual sections on the characteristics, diagnosis, differential diagnosis and treatment of each of the major headache disorders and trigeminal neuralgia. The guideline includes many tables to facilitate a quick overview. Finally, the particular problems regarding headache in children and headache in relation to female hormones and pregnancy are described.

Value-added oil and animal feed production from corn-ethanol stillage using the oleaginous fungus Mucor circinelloides.

This study highlights the potential of oleaginous fungus, Mucor circinelloides in adsorbing/assimilating oil and nutrients in thin stillage (TS), and producing lipid and protein-rich fungal biomass. Fungal cultivation on TS for 2 days in a 6-L airlift bioreactor, resulted in a 92% increase in oil yield from TS, and 20 g/L of fungal biomass (dry) with a lipid content of 46% (g of oil per 100g dry biomass). Reduction in suspended solids and soluble chemical oxygen demand (SCOD) in TS were 95% and 89%, respectively. The polyunsaturated fatty acids in fungal oil were 52% of total lipids. Fungal cells grown on Yeast Malt (YM) broth had a higher concentration of γ-linolenic acid (17 wt.%) than those grown on TS (1.4 wt.%). Supplementing TS with crude glycerol (10%, v/v) during the stationary growth phase led to a further 32% increase (from 46% to 61%) in cellular oil content.

Ultrasound improved ethanol fermentation from cassava chips in cassava-based ethanol plants.

The effects of ultrasound and heat pretreatments on ethanol yields from cassava chips were investigated. Cassava slurries were sonicated for 10 and 30 s at the amplitudes of 80, 160, and 320 microm(pp) (peak to peak amplitude in microm) corresponding to low, medium, and high power levels, respectively. The sonicated and non-sonicated (control) samples were then subjected to simultaneous liquefaction-saccharification and ethanol fermentation. Cassava starch-to-ethanol conversion efficiencies showed that higher ethanol yields were directly related to sonication times, but not to power levels. Significantly higher ethanol yields were observed only for sonicated samples at the high power level. The ethanol yield from the sonicated sample was 2.7-fold higher than yield from the control sample. Starch-to-ethanol conversion rates from sonicated cassava chips were also significantly higher; the fermentation time could be reduced by nearly 24 h for sonicated samples to achieve the same ethanol yield as control samples. Thus, ultrasound pretreatment enhanced both the overall ethanol yield and fermentation rate. When compared to heat-treated samples, the sonicated samples produced nearly 29% more ethanol yield. Combined heat and ultrasound treatment had no significant effect on overall ethanol yields from cassava chips. Ultrasound is also preferable to heat pretreatment because of lower energy requirements, as indicated by energy balances. Integration of ultrasound application in cassava-based ethanol plants can significantly improve ethanol yields and reduce the overall production costs.

Solid-substrate fermentation of corn fiber by Phanerochaete chrysosporium and subsequent fermentation of hydrolysate into ethanol.

The goal of this study was to develop a fungal process for ethanol production from corn fiber. Laboratory-scale solid-substrate fermentation was performed using the white-rot fungus Phanerochaete chrysosporium in 1 L polypropylene bottles as reactors via incubation at 37 degrees C for up to 3 days. Extracellular enzymes produced in situ by P. chrysosporium degraded lignin and enhanced saccharification of polysaccharides in corn fiber. The percentage biomass weight loss and Klason lignin reduction were 34 and 41%, respectively. Anaerobic incubation at 37 degrees C following 2 day incubation reduced the fungal sugar consumption and enhanced the in situ cellulolytic enzyme activities. Two days of aerobic solid-substrate fermentation of corn fiber with P. chrysosporium, followed by anaerobic static submerged-culture fermentation resulted in 1.7 g of ethanol/100 g of corn fiber in 6 days, whereas yeast ( Saccharomyces cerevisiae) cocultured with P. chrysosporium demonstrated enhanced ethanol production of 3 g of ethanol/100 g of corn fiber. Specific enzyme activity assays suggested starch and hemi/cellulose contribution of fermentable sugar.

Cranial implant design using augmented reality immersive system.

Software tools that utilize haptics for sculpting precise fitting cranial implants are utilized in an augmented reality immersive system to create a virtual working environment for the modelers. The virtual environment is designed to mimic the traditional working environment as closely as possible, providing more functionality for the users. The implant design process uses patient CT data of a defective area. This volumetric data is displayed in an implant modeling tele-immersive augmented reality system where the modeler can build a patient specific implant that precisely fits the defect. To mimic the traditional sculpting workspace, the implant modeling augmented reality system includes stereo vision, viewer centered perspective, sense of touch, and collaboration. To achieve optimized performance, this system includes a dual-processor PC, fast volume rendering with three-dimensional texture mapping, the fast haptic rendering algorithm, and a multi-threading architecture. The system replaces the expensive and time consuming traditional sculpting steps such as physical sculpting, mold making, and defect stereolithography. This augmented reality system is part of a comprehensive tele-immersive system that includes a conference-room-sized system for tele-immersive small group consultation and an inexpensive, easily deployable networked desktop virtual reality system for surgical consultation, evaluation and collaboration. This system has been used to design patient-specific cranial implants with precise fit.

Visualization of large-scale confocal data using computer cluster.

A virtual reality system with remote computer cluster for interactive three-dimensional reconstruction and alignment of large confocal microscopy data is presented. It provides the flexibility and the accumulated power of computer cluster for this specific application.

Optimizing therapy for heart failure patients: cardiac resynchronization and defibrillator therapy.

Heart failure continues to be diagnosed at unprecedented rates. It is essential that the affiliated professional, including the nurse practitioner, clinical nurse specialist, and physician assistant, be aware of the current treatments and technology that improve symptoms and reduce mortality rates in patients with heart failure. Medications remain critical in reducing symptoms. New clinical trial data on cardiac resynchronization therapy and cardiac resynchronization therapy with defibrillation reveal improved mortality and quality of life in patients already on optimal drug therapy. This article addresses current treatment strategies with drugs and devices, summarizes therapy efficacy based on clinical trial data, and provides a case study illustrating a typical patient who could benefit from the addition of device therapy. Through awareness of current guidelines and advocacy for the patient, nurses and affiliated professionals have an essential role in reducing mortality and improving outcomes for heart failure patients.

Enhancing care for cardiac resynchronization therapy patients: device diagnostics and clinical application.

Implantation of a cardiac resynchronization device in patients with heart failure does not attenuate the vigilant monitoring required by clinicians. Daily information about symptoms, quality of life, and weight are often part of routine care. Cardiac resynchronization devices also contain data on various heart failure parameters that can be obtained in or out of clinic. A number of cardiac resynchronization devices now have the ability to transmit such data to secure Internet sites, which can be accessed by clinicians. Incorporating these device data into daily practice can enhance current care. For instance, such data can confirm subjective patient reporting, help diagnose changes in the patient's condition, assist in deciding what changes to make in pharmacologic therapy, and assess the impact of device or pharmacologic therapy. Reviewing and utilizing device diagnostics may allow clinicians to intervene before a decompensation event and prevent a subsequent hospitalization. It is also likely that these device diagnostics can reduce the amount of time cardiovascular nurses spend on patient follow-up, thus enhancing efficiency in the clinical setting.

New tools for sculpting cranial implants in a shared haptic augmented reality environment.

New volumetric tools were developed for the design and fabrication of high quality cranial implants from patient CT data. These virtual tools replace time consuming physical sculpting, mold making and casting steps. The implant is designed by medical professionals in tele-immersive collaboration. Virtual clay is added in the virtual defect area on the CT data using the adding tool. With force feedback the modeler can feel the edge of the defect and fill only the space where no bone is present. A carving tool and a smoothing tool are then used to sculpt and refine the implant. To make a physical evaluation, the skull with simulated defect and the implant are fabricated via stereolithography to allow neurosurgeons to evaluate the quality of the implant. Initial tests demonstrate a very high quality fit. These new haptic volumetric sculpting tools are a critical component of a comprehensive tele-immersive system.

An affiliated professional group approach to education.

It is challenging to create comprehensive yet flexible continuing education programs for the affiliated professional (AP) about heart failure and sudden cardiac death. This challenge exists due to the varying levels of experience among APs. Yet a group of APs met this challenge by designing such a program in a short time frame. The program included clinical science, drug and device therapies, case studies, content outlines, videos, and handouts. Content could be adapted to the knowledge level of any audience. This unique approach to developing an educational program, and its successful implementation, demonstrates its applicability to other topics in APs' continuing education.

Reconstruction and exploration of three-dimensional confocal microscopy data in an immersive virtual environment.

An immersive virtual environment for interactive three-dimensional reconstruction and exploration of confocal microscopy data is presented. For some structures automatic alignment of serial sections can lead to geometric distortions. The superior visual feedback of a Virtual Reality system is used to aid in registering and aligning serial sections interactively. An ImmersaDesk Virtual Reality display system is used for display and interaction with the volumetric confocal data. Detailed methods for handling both single-section and multi-section confocal data are described.

Desktop and conference room VR for physicians.

Virtual environments such as the CAVE and the ImmersaDesk, which are based on graphics supercomputers or workstations, are large and expensive. Most physicians have no access to such systems. The recent development of small Linux personal computers and high-performance graphics cards has afforded opportunities to implement applications formerly run on graphics supercomputers. Using PC hardware and other affordable devices, a VR system has been developed which can sit on a physician's desktop or be installed in a conference room. Affordable PC-based VR systems are comparable in performance with expensive VR systems formerly based on graphics supercomputers. Such VR systems can now be accessible to most physicians. The lower cost and smaller size of this system greatly expands the range of uses of VR technology in medicine.

Simulation of color deficiency in virtual reality.

Color deficiency protanopia is simulated in a virtual home environment. A color database is created to set the corresponding relation between each color for normal vision and for protanopia. Based on this database, a second texture system is set up for the home model. The proper texture system is used according to the user's choice on the interactive menu.