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Trends in Cardiovascular Medicine Jan 2018Burnout is rising in all physicians, and cardiologists are not an exemption. Cardiology is a very popular specialty among medical students as it is associated with... (Review)
Review
Burnout is rising in all physicians, and cardiologists are not an exemption. Cardiology is a very popular specialty among medical students as it is associated with outstanding training standards and high prestige and income. In this review, we critically summarize the evidence on consequences, causes, and evidence-based interventions for burnout with a view toward recommending the best strategies for promoting wellness in cardiologists. Only a handful of studies have examined burnout specifically in cardiologists. Evidence therefore was mainly extrapolated by larger studies in all physicians and other physician specialties. Burnout in cardiologists has serious negative personal and professional consequences and is associated with suboptimal healthcare outcomes for patients. Burnout in cardiologists is primarily driven by professional and healthcare system demands and inefficiencies such as excessive workload and role complexity, training and certification demands, inefficient compensation models and lack of resources, computerization, and loss of autonomy. Moreover, loss of connectedness with patients, difficulties in balancing work and personal life and overvaluing compulsiveness and perfectionism in medical practice further increase the risk for burnout. Burnout among cardiologists may be best mitigated by organizational strategies complemented by individual stress reduction and reflection techniques under the resilience-based approach. Large-scale strategies are needed to mitigate burnout and promote physician wellness as a shared responsibility of healthcare systems and individuals and be committed in creating a new culture in medicine.
Topics: Adaptation, Psychological; Attitude of Health Personnel; Burnout, Professional; Cardiologists; Evidence-Based Medicine; Health Knowledge, Attitudes, Practice; Health Status; Humans; Job Description; Mental Health; Occupational Health; Quality of Life; Risk Factors; Work-Life Balance; Workload
PubMed: 28716506
DOI: 10.1016/j.tcm.2017.06.018 -
Heliyon May 2023Ghana's economy is climate sensitive as more than 80% of its agricultural production is rainfall dependent, with only 2% of irrigation potential used. This has... (Review)
Review
Ghana's economy is climate sensitive as more than 80% of its agricultural production is rainfall dependent, with only 2% of irrigation potential used. This has consequences under changing climate, with the impact projected to intensify if things go in a business-as-usual scenario. The manifestation of climate change impact is evident in other sectors of the economy, which requires proactiveness to adapt and mitigate through the development and execution of national adaptation strategies. This research reviews the impact of climate change and some interventions made toward its management. The study explored peer-reviewed journals, policy documents, and technical reports for relevant materials that chronicle programmes and measures to address the challenges of climate change. The research revealed that Ghana had experienced about 1 °C rise in temperature over the past four decades and sea level rise with socioeconomic consequences including decreased agricultural productivity and inundation of coastal communities. Policy interventions have resulted in the introduction of several mitigative and adaptation programmes, such as building resilience in various economic sectors. The study highlighted the progress and challenges to climate change implementation programmes and future policy implementation plans. Inadequate funding of programmes and projects was identified as a critical challenge to achieving climate change policy goals and objectives. We recommend more political will from the government and stakeholders towards policy implementation and greater commitment to providing adequate funding for programmes and project implementation to ensure the success of local climate action for adaptation and mitigation, as well as for sustainable development.
PubMed: 37131451
DOI: 10.1016/j.heliyon.2023.e15491 -
EFSA Journal. European Food Safety... Sep 2022This opinion, produced upon a request from the European Commission, focuses on transport of domestic birds and rabbits in containers (e.g. any crate, box, receptacle or...
This opinion, produced upon a request from the European Commission, focuses on transport of domestic birds and rabbits in containers (e.g. any crate, box, receptacle or other rigid structure used for the transport of animals, but not the means of transport itself). It describes and assesses current transport practices in the EU, based on data from literature, Member States and expert opinion. The species and categories of domestic birds assessed were mainly chickens for meat (broilers), end-of-lay hens and day-old chicks. They included to a lesser extent pullets, turkeys, ducks, geese, quails and game birds, due to limited scientific evidence. The opinion focuses on road transport to slaughterhouses or to production sites. For day-old chicks, air transport is also addressed. The relevant stages of transport considered are preparation, loading, journey, arrival and uncrating. Welfare consequences associated with current transport practices were identified for each stage. For loading and uncrating, the highly relevant welfare consequences identified are handling stress, injuries, restriction of movement and sensory overstimulation. For the journey and arrival, injuries, restriction of movement, sensory overstimulation, motion stress, heat stress, cold stress, prolonged hunger and prolonged thirst are identified as highly relevant. For each welfare consequence, animal-based measures (ABMs) and hazards were identified and assessed, and both preventive and corrective or mitigative measures proposed. Recommendations on quantitative criteria to prevent or mitigate welfare consequences are provided for microclimatic conditions, space allowances and journey times for all categories of animals, where scientific evidence and expert opinion support such outcomes.
PubMed: 36092767
DOI: 10.2903/j.efsa.2022.7441 -
Neuroscience and Biobehavioral Reviews Aug 2015Menopause involves dramatic declines in estradiol production and levels. Importantly, estradiol and the class of stress hormones known as glucocorticoids exert... (Review)
Review
Menopause involves dramatic declines in estradiol production and levels. Importantly, estradiol and the class of stress hormones known as glucocorticoids exert countervailing effects throughout the body, with estradiol exerting positive effects on the brain and cognition, glucocorticoids exerting negative effects on the brain and cognition, and estradiol able to mitigate negative effects of glucocorticoids. Although the effects of these hormones in isolation have been extensively studied, the effects of estradiol on the stress response and the neuroprotection offered against glucocorticoid exposure in humans are less well known. Here we review evidence suggesting that estradiol-related protection against glucocorticoids mitigates stress-induced interference with cognitive processes. Animal and human research indicates that estradiol-related mitigation of glucocorticoid damage and interference is one benefit of estradiol supplementation during peri-menopause or soon after menopause. The evidence for estradiol-related protection against glucocorticoids suggests that maintaining estradiol levels in post-menopausal women could protect them from stress-induced declines in neural and cognitive integrity.
Topics: Aging; Animals; Brain; Cognition; Estradiol; Female; Glucocorticoids; Humans
PubMed: 25929443
DOI: 10.1016/j.neubiorev.2015.04.005 -
IScience Sep 2023Radiation therapy can lead to late radiation-induced skin fibrosis (RISF), causing movement restriction, pain, and organ dysfunction. This study evaluated...
Radiation therapy can lead to late radiation-induced skin fibrosis (RISF), causing movement restriction, pain, and organ dysfunction. This study evaluated adipose-derived extracellular matrix (Ad-ECM) as a mitigator of RISF. Female C57BL/6J mice that were irradiated developed fibrosis, which was mitigated by a single local Ad-ECM injection, improving limb movement and reducing epithelium thickness and collagen deposition. Ad-ECM treatment resulted in decreased expression of pro-inflammatory and fibrotic genes, and upregulation of anti-inflammatory cytokines, promoting M2 macrophage polarization. Co-culture of irradiated human fibroblasts with Ad-ECM down-modulated fibrotic gene expression and enhanced bone marrow cell migration. Ad-ECM treatment also increased interleukin (IL)-4, IL-5, and IL-15 expression in endothelial cells, stimulating M2 macrophage polarization and alleviating RISF. Prophylactic use of Ad-ECM showed effectiveness in mitigation. This study suggests Ad-ECM's potential in treating chronic-stage fibrosis.
PubMed: 37705953
DOI: 10.1016/j.isci.2023.107660 -
RSC Chemical Biology Oct 2021This review analyzes the published literature linking the different mechanisms focused on oxidative stress and inflammation that contribute to COVID-19 disease severity.... (Review)
Review
This review analyzes the published literature linking the different mechanisms focused on oxidative stress and inflammation that contribute to COVID-19 disease severity. The objective is to bring together potential proinflammatory mechanisms of COVID-19 pathogenesis and address mitigation strategies using naturally occurring compounds and FDA-approved drugs. Outstanding questions addressed include the following: What is the mechanistic basis for linking enhanced vulnerability in COVID-19 to increased oxidative damage and proinflammatory mediators (, cytokines), especially in high-risk people? Can we repurpose anti-inflammatory and immunomodulatory agents to mitigate inflammation in COVID-19 patients? How does 2-deoxy-d-glucose function as an anti-COVID drug? COVID-19, cancer biology, and immunotherapy share many mechanistic similarities. Repurposing drugs that already have been FDA-approved for mitigating inflammation and immunosuppression in cancer may be a way to counteract disease severity, progression, and chronic inflammation in COVID-19. What are the long-term effects of reactive oxygen species-inducing immune cells and sustained inflammation in so-called long-haulers (long COVID) after recovery from COVID-19? Can we use mitochondria-targeted agents prophylactically to prevent inflammation and boost immunity in long-haulers? Addressing the oxidative chemical biology of COVID-19 and the mechanistic commonalities with cancer may provide new insights potentially leading to appropriate clinical trials and new treatments.
PubMed: 34704045
DOI: 10.1039/d1cb00042j -
JMIR Mental Health Oct 2023Evidence suggests that digital mental health interventions (DMHIs) for common mental health conditions are effective. However, digital interventions, such as... (Review)
Review
BACKGROUND
Evidence suggests that digital mental health interventions (DMHIs) for common mental health conditions are effective. However, digital interventions, such as face-to-face therapies, pose risks to patients. A safe intervention is considered one in which the measured benefits outweigh the identified and mitigated risks.
OBJECTIVE
This study aims to review the literature to assess how DMHIs assess safety, what risks are reported, and how they are mitigated in both the research and postmarket phases and building on existing recommendations for assessing, reporting, and mitigating safety in the DMHI and standardizing practice.
METHODS
PsycINFO, Embase, and MEDLINE databases were searched for studies that addressed the safety of DMHIs. The inclusion criteria were any study that addressed the safety of a clinical DMHI, even if not as a main outcome, in an adult population, and in English. As the outcome data were mainly qualitative in nature, a meta-analysis was not possible, and qualitative analysis was used to collate the results. Quantitative results were synthesized in the form of tables and percentages. To illustrate the use of a single common safety metric across studies, we calculated odds ratios and CIs, wherever possible.
RESULTS
Overall, 23 studies were included in this review. Although many of the included studies assessed safety by actively collecting adverse event (AE) data, over one-third (8/23, 35%) did not assess or collect any safety data. The methods and frequency of safety data collection varied widely, and very few studies have performed formal statistical analyses. The main treatment-related reported AE was symptom deterioration. The main method used to mitigate risk was exclusion of high-risk groups. A secondary web-based search found that 6 DMHIs were available for users or patients to use (postmarket phase), all of which used indications and contraindications to mitigate risk, although there was no evidence of ongoing safety review.
CONCLUSIONS
The findings of this review show the need for a standardized classification of AEs, a standardized method for assessing AEs to statically analyze AE data, and evidence-based practices for mitigating risk in DMHIs, both in the research and postmarket phases. This review produced 7 specific, measurable, and achievable recommendations with the potential to have an immediate impact on the field, which were implemented across ongoing and future research. Improving the quality of DMHI safety data will allow meaningful assessment of the safety of DMHIs and confidence in whether the benefits of a new DMHI outweigh its risks.
TRIAL REGISTRATION
PROSPERO CRD42022333181; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=333181.
PubMed: 37812471
DOI: 10.2196/47433 -
Journal of Environmental Management May 2023Wildfires usually increase the hydrological and erosive response of forest areas, carrying high environmental, human, cultural, and financial on- and off-site effects.... (Review)
Review
Wildfires usually increase the hydrological and erosive response of forest areas, carrying high environmental, human, cultural, and financial on- and off-site effects. Post-fire soil erosion control measures have been proven effective at mitigating such responses, especially at the slope scale, but there is a knowledge gap as to how cost-effective these treatments are. In this work, we review the effectiveness of post-fire soil erosion mitigation treatments at reducing erosion rates over the first post-fire year and provide their application costs. This allowed assessing the treatments' cost-effectiveness (CE), expressed as the cost of preventing 1 Mg of soil loss. This assessment involved a total of 63 field study cases, extracted from 26 publications from the USA, Spain, Portugal, and Canada, and focused on the role of treatment types and materials, and countries. Treatments providing a protective ground cover showed the best median CE (895 $ Mg), especially agricultural straw mulch (309 $ Mg), followed by wood-residue mulch (940 $ Mg) and hydromulch (2332 $ Mg). Barriers showed a relatively low CE (1386 $ Mg), due to their reduced effectiveness and elevated implementation costs. Seeding showed a good CE (260 $ Mg), but this reflected its low costs rather than its effectiveness to reduce soil erosion. The present results confirmed that post-fire soil erosion mitigation treatments are cost-effective as long as they are applied in areas where the post-fire erosion rates exceed the tolerable erosion rate thresholds (>1 Mg ha y) and are less costly than the loss of on- and off-site values that they are targeted to protect. For this reason, the proper assessment of post-fire soil erosion risk is vital to ensure that the available financial, human and material resources are applied appropriately.
Topics: Humans; Wildfires; Soil Erosion; Fires; Soil; Agriculture
PubMed: 36796191
DOI: 10.1016/j.jenvman.2023.117478 -
Plants (Basel, Switzerland) Dec 2020Plants are often exposed to abiotic stresses such as drought, salinity, heat, cold, and heavy metals that induce complex responses, which result in reduced growth as... (Review)
Review
Plants are often exposed to abiotic stresses such as drought, salinity, heat, cold, and heavy metals that induce complex responses, which result in reduced growth as well as crop yield. Phytohormones are well known for their regulatory role in plant growth and development, and they serve as important chemical messengers, allowing plants to function during exposure to various stresses. Seed priming is a physiological technique involving seed hydration and drying to improve metabolic processes prior to germination, thereby increasing the percentage and rate of germination and improving seedling growth and crop yield under normal and various biotic and abiotic stresses. Seed priming allows plants to obtain an enhanced capacity for rapidly and effectively combating different stresses. Thus, seed priming with phytohormones has emerged as an important tool for mitigating the effects of abiotic stress. Therefore, this review discusses the potential role of priming with phytohormones to mitigate the harmful effects of abiotic stresses, possible mechanisms for how mitigation is accomplished, and roles of priming on the enhancement of crop production.
PubMed: 33375667
DOI: 10.3390/plants10010037 -
Sensors (Basel, Switzerland) Jan 2022Software-defined networking (SDN) is a new networking paradigm that realizes the fast management and optimal configuration of network resources by decoupling control...
Software-defined networking (SDN) is a new networking paradigm that realizes the fast management and optimal configuration of network resources by decoupling control logic and forwarding functions. However, centralized network architecture brings new security problems, and denial-of-service (DoS) attacks are among the most critical threats. Due to the lack of an effective message-verification mechanism in SDN, attackers can easily launch a DoS attack by faking the source address information. This paper presents DoSGuard, an efficient and protocol-independent defense framework for SDN networks to detect and mitigate such attacks. DoSGuard is a lightweight extension module on SDN controllers that mainly consists of three key components: a monitor, a detector, and a mitigator. The monitor maintains the information between the switches and the hosts for anomaly detection. The detector utilizes OpenFlow message and flow features to detect the attack. The mitigator protects networks by filtering malicious packets. We implement a prototype of DoSGuard in the floodlight controller and evaluate its effectiveness in a simulation environment. Experimental results show the DoSGuard achieves 98.72% detecion precision, and the average CPU utilization of the controller is only around 8%. The results demonstrate that DoSGuard can effectively mitigate DoS attacks against SDN with limited overhead.
PubMed: 35161800
DOI: 10.3390/s22031061