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The lived experience of violence in accident and emergency.

AIM: To investigate the lived experience of violence of nurses in one A&E department. RATIONALE: Following an extensive literature review, it was elicited that there was very little evidence of the psychological impact of violence in A&E. BACKGROUND/INTRODUCTION: Violence in the health service has increased over the last decade associated with a corresponding increase in the published literature on this topic. While violence in A&E departments would appear common, little evidence exists on the psychosocial impact of these incidents on A&E nurses. RESEARCH METHODS: A qualitative domain using a phenomenological philosophy was utilised. Sampling was of a volunteer nature and data were collected using interview. Nurses were sampled from one major acute hospital in Northern Ireland. RESULTS: Participants expressed feelings of frustration, anger, and fear. Support from colleagues was greatly valued and lack of feedback from management was cited as being common. DISCUSSION: Frustration and anger were synthesised into the "why me" principle with nurses not knowing why they were the focus for attack. Violent incidents were associated with a sense of isolation but colleague support developed a sense of belonging. CONCLUSIONS: Whilst a useful insight was provided, more research is essential into this emotive topic.

Emergency Nursing↗

Emotional and affective disturbances in patients with epilepsy.

We sought to assess whether epilepsy is associated with a higher risk of emotional reactions to frustrating stimuli, aggressive behavior, apathy, and depression, and whether these psychiatric patterns are specific to the epileptic condition. The study population consisted of referral patients 17 years and older with idiopathic or cryptogenic epilepsy (i.e., epilepsy not caused by a detectable brain lesion) without significant cognitive dysfunction. A first control was selected for each patient among patients with insulin-dependent diabetes and a second among normal blood donors. Aggressiveness in response to stressful stimuli was assessed with the Picture Frustration Study (PFS). Depression was tested by the Beck Depression Inventory. The Aggressive Behavior Scale (assessing irritability and rumination) and the Apathy Scale were also used. Odds Ratios (ORs) with 95% Confidence Intervals (95% CI) were used as the risk measure. Statistical analysis included between-group comparisons. In patients with epilepsy, the test scores were correlated to the main demographic (age, sex, education, marital status, and occupation) and clinical features (seizure types, disease duration, seizure control, and treatments). The sample included 55 patients with epilepsy, 56 diabetics, and 59 normal individuals. Patients with epilepsy and the two control groups had similar PFS scores and similar aggressiveness. Scores were also similar for the Aggressive Behavior and Apathy Scales, with similar numbers of individuals with aggressive conduct and excess rumination. Patients with epilepsy had higher depression scores. Moderate to severe depression was present in 9 cases (diabetes, 2; blood donors, 1) (P=0.004). Relative to blood donors, the OR for moderate to severe depression (95% CI) was 2.1 (0.1-61.7) for diabetes and 11.3 (1.4-247.8) for epilepsy. No significant correlation was detectable between test scores and patient and disease characteristics.

Journal Article↗

Large spin differences in structurally related Fe6 molecular clusters and their magnetostructural explanation.

The syntheses, crystal structures, and magnetic characterizations of three new hexanuclear iron(III) compounds are reported. Known [Fe(6)O(2)(OH)(2)(O(2)CBu(t))(10)(hep)(2)] (1) is converted to new [Fe(6)O(2)(OH)(O(2)CBu(t))(9)(hep)(4)] (3) when treated with an excess of 2-(2-hydroxyethyl)-pyridine (hepH). Similarly, the new compound [Fe(6)O(2)(OH)(2)(O(2)CPh)(10)(hep)(2)] (2), obtained from the reaction of [Fe(3)O(O(2)CPh)(6)(H(2)O)(3)] with hepH, is converted to [Fe(6)O(2)(OH)(O(2)CPh)(9)(hep)(4)] (4) when treated with an excess of hepH. This can be reversed by recrystallization from MeCN. The cores of the four Fe(6) complexes all comprise two triangular [Fe(3)(mu(3)-O)(O(2)CR)(3)(hep)](+3) units connected at two of their apices by two sets of bridging ligands. However, 1 and 2 differ slightly from 3 and 4 in the precise way the two Fe(3) units are linked together. In 1 and 2, the two sets of bridging ligands are identical, consisting of one mu-hydroxo and two mu-carboxylate groups bridging each Fe(2) pair, i.e., a (mu-OH(-))(mu-O(2)CR(-))(2) set. In contrast, 3 and 4 have two different sets of bridging ligands, a (mu-OH(-))(mu-O(2)CR(-))(2) set as in 1 and 2, and a (mu-OR(-))(2)(mu-O(2)CR(-)) set, where RO(-) refers to the alkoxide arm of the hep(-) chelate. Variable-field and -temperature dc magnetization measurements establish that 1 and 2 have S = 5 ground states and significant and positive zero-field splitting parameters (D), whereas 3 and 4 have S = 0 ground states. This dramatic difference of 10 unpaired electrons in the ground state S values for near-isomeric compounds demonstrates an acute sensitivity of the magnetic properties to small structural changes. The factors leading to this have been quantitatively analyzed. The semiempirical method ZILSH, based on unrestricted molecular orbital calculations, was used to obtain initial estimates of the Fe(2) pairwise exchange interaction constants (J). These calculated values were then improved by fitting the experimental susceptibility versus T data, using a genetic algorithm approach. The final J values were then employed to rationalize the observed magnetic properties as a function of the core topologies and the presence of spin frustration effects. The large difference in ground state spin value was identified as resulting from a single structural difference between the two types of complexes, the different relative dispositions (cis vs trans) of two frustrated exchange pathways. In addition, use of the structural information and corresponding J values allowed a magnetostructural correlation to be established between the J values and both the Fe-O bond distances and the Fe-O-Fe angles at the bridging ligands.

Crystallography, X-Ray↗

Static magnetization of V15 cluster at ultra-low temperatures: precise estimation of antisymmetric exchange.

In this article, the low-temperature static (adiabatic) magnetization data of the nanoscopic V15 cluster present in K6[VIV15As6O42(H2O)] x 8H2O is analyzed. The cluster anion, which attracted much attention in the past, contains a triangular VIV3 array causing frustration as a function of applied field and temperature. In the analysis, a three-spin (S = 1/2) model of V15 was employed that includes isotropic antiferromagnetic exchange interaction and antisymmetric (AS) exchange in the most general form compatible with the trigonal symmetry of the system. It was shown that, along with the absolute value of AS exchange, the orientation of the AS vector plays a significant physical role in spin-frustrated systems. In this context, the role of the different components of the AS in the low-temperature magnetic behavior of V15 was analyzed, and we were able to reach a perfect fit to the experimental data on the staircaselike dependence of magnetization versus field in the whole temperature range including extremely low temperature. Furthermore, it was possible for the first time to precisely estimate the two components of the AS vector coupling constant in a triangular unit, namely, the effective in-plane component, Dperpendicular, and the perpendicular part, Dn.

Journal Article↗

Emotion regulation and parenting in AD/HD and comparison boys: linkages with social behaviors and peer preference.

Children's emotion regulation strategies and parenting responses in a family task that elicited frustration are investigated by comparing core attention-deficit/hyperactivity disorder (AD/HD) symptomatology, emotional reactivity, and emotional regulation in the prediction of social behaviors and peer social preference. Participants were boys, ages 6-12 years, either with AD/HD (n = 45) or without problem behaviors (comparison; n = 34). A high-aggressive subgroup of AD/HD boys showed a significantly less constructive pattern of emotional coping than did both a low-aggressive AD/HD subgroup of boys and nondiagnosed comparison boys, who did not differ. With statistical control of core AD/HD symptomatology, noncompliance in a naturalistic summer camp was predicted by boys' overall emotion regulation and three specific strategies (emotional accommodation, problem solving, negative responses) during the parent-child interaction. Emotional accommodation and negative responses to the frustration task also marginally predicted social preference at the camp. These emotion regulation variables outperformed emotional reactivity in predicting such outcomes. Some emotion-related parenting behaviors were associated with child coping in the task. We discuss the relationship of emotion regulation to core AD/HD symptomatology and emotional reactivity, and the role of parents' behaviors in influencing children's emotional responses.

Affect↗

Interpreting diabetes mellitus: differences between patient and provider models of disease and their implications for clinical practice.

Current medical literature suggests that Type 2 diabetes mellitus can be controlled by diet and hypoglycemic agents or diet and insulin therapy. Nevertheless, adhering to a low glucose dietary regimen remains problematic for a majority of patients, and management of the disease is an ongoing source of frustration for physicians and other providers. While calling for more research on the physician's experience of treating chronic conditions like diabetes, the authors argue that much of the current frustration stems from the different frames or explanatory models that physicians and patients use to understand the disease. By comparing physician narratives collected in several clinical contexts (e.g., medical lectures, precepting sessions, patient care sessions and personal interviews) with patient stories obtained primarily through narrative interviews, the authors highlight crucial differences in the way physicians and patients experience and think about the disease. In particular, the authors highlight differences between physicians and patients across five dimensions: etiology, symptoms/signs, factors which affect blood sugar, ideal blood sugar, and future prospects. In concluding, the authors sketch out elements of a theory of clinical practice involving diabetes care. Data for the study was collected at two family practice training sites in Chicago.

Adult↗

Effects and aftereffects of stressor expectations.

Is stressor exposure necessary to produce "stress" effects, or can these effects result from stressor anticipation alone? The present research explores whether it is possible to obtain "stress responses" during and after the period in which stressor exposure is being anticipated. In the first study, the expectation of submerging one's hand in ice water resulted in decreased frustration tolerance and increased blood pressure when compared with control groups not expecting this stressor. A second study replicated and extended these results to show that the expectation of control over the stressor ameliorates the negative impact of stressor expectation. The second study also examined the aftereffects of expectations. Particularly, it found that despite being relieved of the expectation that they would immerse their hand in ice water, subjects who had expected stressor exposure had decreased frustration tolerance when compared with either subjects who had expected a nonstressful procedure or those who had expected to have control over stressor termination. A third study, using noise as the expected stressor, replicated both the aftereffect of the anticipation period and the moderation of that effect by perceived control. The discussion (a) focuses on the implications of this work for understanding why aftereffects occur and (b) proposes that previously observed stressor exposure effects may in fact be postexpectation effects.

Adult↗

Type A and type B attentional responses to aesthetic stimuli: effects on mood and performance.

Recent investigations of the Type A coronary-prone behavior pattern have found that Type A's focus their attention on a central task and actively inhibit attention to peripheral distracting stimuli. This attentional difference has resulted in greater performance for Type A's than for Type B's. However, research on aesthetic stimuli suggests that the focused attention of Type A's may not always be adaptive for solving frustrating cognitive tasks, particularly when paying attention to a peripheral stimulus could enhance performance by reducing negative emotions. Simple, predictable, aesthetic stimuli can have a soothing effect, which reduces negative emotions and enhances performance. The present study found that Type B's had improved affect and performance from attending to a soothing peripheral stimulus (simplex melodies) while working on a frustrating cognitive task. Neither the performance nor the affect of Type A's was influenced by the simplex music, because they apparently suppressed paying attention to these melodies.

Achievement↗

Magnetic control of ferroelectric polarization.

The magnetoelectric effect--the induction of magnetization by means of an electric field and induction of polarization by means of a magnetic field--was first presumed to exist by Pierre Curie, and subsequently attracted a great deal of interest in the 1960s and 1970s (refs 2-4). More recently, related studies on magnetic ferroelectrics have signalled a revival of interest in this phenomenon. From a technological point of view, the mutual control of electric and magnetic properties is an attractive possibility, but the number of candidate materials is limited and the effects are typically too small to be useful in applications. Here we report the discovery of ferroelectricity in a perovskite manganite, TbMnO3, where the effect of spin frustration causes sinusoidal antiferromagnetic ordering. The modulated magnetic structure is accompanied by a magnetoelastically induced lattice modulation, and with the emergence of a spontaneous polarization. In the magnetic ferroelectric TbMnO3, we found gigantic magnetoelectric and magnetocapacitance effects, which can be attributed to switching of the electric polarization induced by magnetic fields. Frustrated spin systems therefore provide a new area to search for magnetoelectric media.

Journal Article↗

Fiesta as tradition, fiesta as change: ritual, alcohol and violence in a Mexican community.

AIMS: To explore the traditional Mexican religious fiesta as a primary locus for community-based excessive drinking and violence against women. The research argues that the pattern of drinking and violence cannot be placed within explanations that tie a breakdown in social norms to drinking nor drinking to a breakdown in social norms. DESIGN: The data were gathered over 14 continuous months of participant observation in 1995 and 1996, followed by two summer research projects in 1997 and 1998. The researcher documented the activities of the participants at each fiesta and followed-up each event with interviews of the parties involved in violent confrontations. In addition, life stories and archival data on violence were conducted and used to situate current findings against historical data. SETTING: All data were collected in the community of Santa Maria Atzompa. Atzompa is a cabécera or municipal seat, for six colonias (large neighborhoods), and three ranchos (agriculturally based communities) and has a population of just over 5200. The main community of Atzompa, where most of the research was conducted, has a population of 2700+. PARTICIPANTS: Over 1000 individuals participated in community religious fiestas that the researcher attended. More than half of these were men, and almost all the men present participated in the binge drinking. MEASUREMENTS: Sixteen religious fiestas and 13 non-religious fiestas were documented through participant observation and photographs. FINDINGS: In every religious-based fiesta, violence erupted and was directed primarily against women. Husband and wife abuse accounted for 10 of the 16 violent disruptions (63%) while male/male abuse accounted for six (38%). CONCLUSIONS: The perpetuation of binge drinking and violence are part of a historic cycle of male dominance that dates back to the introduction of alcohol distillation during colonization by the Spaniards in the 16th century, compounded today by frustration over their inability to control the economic and political aspects of their households and community. Women's acquiescence to the violence is a form of mediation over male frustrations that allow women to continue in their roles as economic providers.

Alcohol Drinking↗

Surface-related triggering of the neutrophil respiratory burst. Characterization of the response induced by IgG adsorbed to hydrophilic and hydrophobic glass surfaces.

Hydrophilic and hydrophobic glass surfaces precoated with human albumin, fibrinogen, or IgG were investigated with respect to their ability to activate the neutrophil NADPH-oxidase. We found that IgG-coated surfaces induced a substantial and prolonged neutrophil production of reactive oxygen species (ROS). When a hydrophilic surface was used to support protein binding, a somewhat lower neutrophil response (around 35%) was obtained, compared with the response induced by IgG on a hydrophobic surface. The production of ROS was completely eliminated when cytochalasin B was added to the measuring system, suggesting the involvement of the cell cytoskeleton in the activation process. The relation between the intra- and extracellular generation of ROS was further assessed, and we found that most of the ROS produced were released from the cells, in agreement with a model in which the activating surfaces induce a 'frustrated' phagocytic response. Serum totally inhibited 'frustrated' phagocytosis provided that the IgG molecules were sticking to a hydrophilic surface.

Albumins↗

Stories seldom told: paediatric nurses' experiences of caring for hospitalized children with special needs and their families.

AIMS OF THE STUDY: This study explored paediatric nurses' experiences of caring for children with special needs and their families in an acute care setting. The aim of the study was to increase understanding of nurses' experiences of caring for these children and their families. The study was designed to reveal the caring practices embedded within these relationships through exploring nurses' stories. STUDY DESIGN/METHODS: Gadamerian hermeneutic phenomenology and feminist research principles were the approaches used to guide the study. Interviews were held with experienced paediatric nurses and interpretation of interview transcripts using a Gadamerian hermeneutic phenomenological approach resulted in the identification of four themes. FINDINGS: The four themes revealed were: Special Relationships; Multiple Dimensions of Who is Expert; Development of Trust Between Nurses and Families; and Feelings of Frustration and Guilt. CONCLUSIONS: The study emphasized the context-specific nature of relationships between nurses and children and their families. The nurses spoke about the difficulties they encountered in their practice and some of the ways that they dealt with these problems. They discussed the things that they valued and those that made them feel guilty and frustrated. In doing so, they revealed their warmth, strength, humanity and caring.

Acute Disease↗

Parental bonding and personality in relation to a lifetime history of depression.

This study explores whether personality is mediating the effects of adverse parenting on having had a lifetime history of major depressive disorder and whether personality dimensions, related to the development of lifetime depression, are disposed by adverse parenting in cross-sectional data derived from an epidemiological sample of volunteer workers. Of 447 individuals who were asked to complete the Munich Personality Test (MPT), the Parental Bonding Instrument (PBI) and the Inventory to Diagnose Depression Lifetime version (IDDL), 322 subjects were included in the analyses (150 male and 172 female; and 38 were diagnosed as having had a history of depression). Comparisons in fit between logistic regression models revealed that a combination of frustration tolerance and rigidity among personality dimensions, as measured by the MPT, and maternal care among the PBI scales were most primary in predicting a lifetime history of depression. Maternal care was, however, not significantly predictive of dimensional scores on the personality dimensions. Neither frustration tolerance nor rigidity was predicted by any PBI scale. When entering the variables sequentially, maternal care and the personality variables were additive and independent risk factors in predicting a lifetime history of depression. The results of this preliminary study raised an objection to a hypothesis that adverse parenting experienced in childhood disposes one to a dysfunctional personality, which then predisposes one to the development of depression in adulthood.

Adolescent↗

Interleukin-8: A pathogenetic role in antineutrophil cytoplasmic autoantibody-associated glomerulonephritis.

BACKGROUND: In neutrophil trafficking, the role of interleukin-8 (IL-8) is location dependent. Tissue IL-8 directs transmigration, whereas intravascular IL-8 frustrates this process. The bystander damage of glomerular endothelium by antineutrophil cytoplasmic autoantibody (ANCA)-activated neutrophils is believed to be an early event in the pathogenesis of ANCA-associated glomerulonephritis. We have studied the role of IL-8 in this process. METHODS: Intraglomerular expression of IL-8 in patients with ANCA-associated glomerulonephritis was studied by in situ hybridization and immunohistochemistry and location of neutrophils by serial section immunohistochemistry. In vitro, we analyzed ANCA-stimulated neutrophil IL-8 production by enzyme-linked immunosorbent assay, and the IL-8 attributable effect of ANCA-stimulated neutrophil supernatant by chemotactic and transendothelial assays. RESULTS: There was intraglomerular expression of IL-8 at segmental, crescentic, and parietal epithelial sites. IL-8 protein expression colocalized to intraglomerular neutrophils; many localized within glomerular capillary loops, suggesting failed trafficking to tissue IL-8. ANCAs differentially stimulated time- and dose-dependent neutrophil IL-8 production, and ANCA-stimulated neutrophil supernatant demonstrated potent IL-8-dependent chemotactic activity and inhibited transendothelial migration of normal human neutrophils toward an IL-8 gradient. CONCLUSION: Despite heavy tissue expression of IL-8 in ANCA-associated GN, the production of IL-8 by ANCA-stimulated neutrophils within the intravascular compartment may frustrate neutrophil transmigration, encourage intravascular stasis, and contribute to bystander damage of glomerular endothelial cells.

Antibodies, Antineutrophil Cytoplasmic↗

Irritable bowel syndrome: making sense of it all.

Though the basic science of the irritable bowel syndrome is far from certain, and the clinical science is often confusing, it is still possible to make some sense of the syndrome in a clinical context. These common complaints of altered bowel patterns, pain and bloating are extremely common and vary greatly in the impact they have on person's lives. From 'non-patients' who do not present for medical care to those who seek referral to multiple specialists, the spectrum is well known. If sense is to be made, the physician must understand the patient's major symptoms, how and to what degree they disturb their lifestyle, what is the patient's knowledge about and understanding of the syndrome, what has been done before, and why the patient is now presenting. What are the expectations and potential frustrations anticipated with this present consultation? A positive diagnostic approach can be taken but care is necessary to assuage lingering fears of organic disease, to correct misconceptions of the syndrome, to settle existing frustrations of the patient, and to educate. With these approaches, managing irritable bowel syndrome can be rewarding, though demanding.

Colonic Diseases, Functional↗

Tail biting in pigs.

One of the costly and welfare-reducing problems in modern pig production is tail biting. Tail biting is an abnormal behaviour, characterized by one pig's dental manipulation of another pig's tail. Tail biting can be classified into two groups: the pre-injury stage, before any wound on the tail is present, and the injury stage, where the tail is wounded and bleeding. Tail biting in the injury stage will reduce welfare of the bitten pig and the possible spread of infection is a health as well as welfare problem. The pigs that become tail biters may also suffer, because they are frustrated due to living in a stressful environment. This frustration may result in an excessive motivation for biting the tails of pen mates. This review aims to summarize recent research and theories in relation to tail biting.

Animal Welfare↗

How many dimensions are required to approximate the potential energy landscape of a model protein?

A scheme to approximate the multidimensional potential energy landscape in terms of a minimal number of degrees of freedom is proposed using a linear transformation of the original atomic Cartesian coordinates. For one particular off-lattice model protein the inherent frustration can only be reproduced satisfactorily when a relatively large number of coordinates are employed. However, when this frustration is removed in a Go-type model, the number of coordinates required is significantly lower, especially around the global potential energy minimum. To aid our interpretation of the results we consider modified disconnectivity graphs where a measure of the structural diversity and a metric relation between the stationary points are incorporated.

Computer Simulation↗

Psychosocial implications of clinical trials on patients with age-related macular degeneration and pathologic myopia as seen in the photodynamic therapy trials.

Photodynamic therapy is a combination of the systemically injected photosensitizing drug, verteporfin, and the subsequent exposure of the affected retina to a low-beam diode laser. Eligible participants in the photodynamic therapy clinical trial were those with "wet" cases of age-related macular degeneration with subfoveal, predominantly classic lesions. The expected outcome of the treatment is to preserve vision, not to restore lost vision. Study participants are frustrated in their performance of daily activities and often have unrealistic expectations of photodynamic therapy treatment outcomes (eg, improved vision). Frustration and fear are evident at visits during which their actual vision loss is measured. One of our goals is to help the patients have realistic expectations of treatment outcomes.

Activities of Daily Living↗