4252Additional value of stress testing for evaluation of ventricular arrhythmias in athletes undergoing preparticipation screening

Introduction The optimal protocol of athletes pre-participation screening is a matter of debate. The aim of this study is to test the additional value of exercise testing (ET) for evaluation of ventricular arrhythmias (VA) in athletes with otherwise normal findings. Methods The study included 10,975 competitive athletes who underwent preparticipation screening including ECG and stress testing. Athletes with ≥3 isolated premature ventricular beats or ≥1 repetitive VA underwent second-line investigations (echocardiography and 24-hour ambulatory ECG monitoring with a training session) and, in case of frequent, complex or exercise-induced VA or echocardiographic abnormalities, also cardiac magnetic resonance (CMR). Results 451 (4,1%) athletes were excluded for abnormalities at history, physical examination and baseline ECG. Among the remaining 10524 athletes, 524 (5%)showed VA at ET, 87 of whom underwent CMR.Echocardiography identified major cardiac abnormalities in 5 athletes and regional ventricular systolic dysfunction in 7, which were confirmed by CMR in 6. Other 12 patients with normal echocardiography had a positive CMR. In particular, in 16 subjects the CMR showed left ventricular late gadolinium enhancement suggesting myocardial fibrosis with a non-ischemic distribution. At multivariate analysis, VA observed at high work load at ET, the presence of complex VA at ET and the presence of a morphology other than infundibular or fascicular predicted an underlying pathological myocardial substrate while the presence of frequent (>500/24-hour) premature ventricular beats did not. Predictors of underlying pathological myocardial substrate Substrate Univariate Multivariable YES (n=23) NO (n=501) OR (95% IC) P OR (95% IC) P Age 17 [13–43] 15 [14–17] 1.03 [0.98 -1.06] 0.18 – Male gender 15 (65%) 184 (37%) 3.2 [1.3–7.7] <0.001 1.6 [0.7–4.8] 0.28 >500 PVBs/24-hour 7 (30%) 98 (20%) 1.8 [0.7–4.5] 0.21 – VA at high work-load 10 (44%) 78 (16%) 4.2 [1.8–9.8] <0.001 1.6 [1.1–4.7] 0.02 Couplets/NSVT at ET 14 (61%) 117 (23%) 6.2 [2.5–15] <0.001 8.5 [2.5–29] 0.01 PVBs other than infundibular/fascicular 17 (74%) 118 (24%) 6.1 [2.4–16] <0.001 3.9 [1.4–11] 0.008 Conclusions VA at ET may represent the only sign of a pathological myocardial abnormalities, such as the “isolated nonischemic left ventricular scar”, that could be the substrate for life-threatening ventricular arrhythmias. Addition of ET to baseline ECG may increase the sensitivity of PPE of competitive athletes.

Improvement of learning outcome in material science through inverted classroom techniques and alternative course assessment

Material Science is known to first year mechanical engineering students as one of the fundamental courses with high work load. The knowledge of the complex science of materials enables students to select appropriate engineering materials in different designs due to acquired knowledge on the correlation of materials properties, microstructure and their intended manipulation. These abilities are not well constituted in one final exam. Therefore peer-to-peer lecture film supported inverted classroom szenarios were estabilished to work in the course. These were accompanied by a newly developed moodle course following the blended learning approach that gives students the chance to cumulative accomplish micro-grades via multiple activities, such as tests, lectures, presentations, forum discussions, written homeworks and glossary entries. These grades are summed to obtain the overall course grade. Improved learing outcomes are demonstrated in high quality class discussions and most -important to students- in better grades (average 43/60=B) compared to those being assessed by one final exam only (average 39/69=C+). The majority of students agreed on enhanced study skills when forced to study throughout the entire semester instead of learing intensely towards the end of the semester. This paper introduces the learning structure as well as graded activities, evaluates the course and compares activity results to former class results.

Give me a break: Laughing with colleagues guards against ego depletion

Job demands, like time pressure, consume employees’ limited resources, which need to be restored through recovery in order to maintain psychological well-being and work performance. Employees in high-strain jobs need to replenish their emotional resources throughout the work day. This can take place during breaks if employees are able to psychologically detach from the work demands. Given the stress-relieving functions of humour, we hypothesised that affiliative humour during breaks would attenuate affective impairments related to time pressure and would decrease negative emotional spillover from breaks to subsequent work. We conducted moderated mediation analyses with bootstrapping based on a cross-sectional sample of 170 employees working at four retail stores. Time pressure was positively related to affective irritation, which in turn was related to more spillover of negative (and less spillover of positive) mood from breaks to work. Laughing with colleagues during breaks moderated the link between time pressure and affective irritation, such that this relation became nonsignificant when the frequency of joint laughter during breaks increased. Hence, pleasurable social break activities appear to be important for within-workday recovery. Employers should encourage their employees to take their breaks consistently and to socialise with likable colleagues, especially during periods of high work load.

Economic Analysis of the Latent Factors Related to the Nursing Shortage

The aim of the study was, to economically analyze o the latent factors related to nursing shortage at Cairo University Hospitals. Research design: A descriptive, methodological design was utilized. Research Questions: 1) Is the economic analysis of nursing shortage related to the actual auditing records of nursing data at Cairo University Hospitals (2011-2015). 2) What are the contributing factors leading to the nursing shortage at Cairo University Hospitals. 3) What are the economic recommendations for the present concerns related to nursing shortage. Tools of data collection: The researchers used auditing records related to nursing staff at mentioned area (2011-2015) and Questionnaire. Random sample of (N= 179). Cronbach's Alpha was 0.885. The finding revealed that nurses supply, mostly from Secondary School (84%). A critical demand for more nurses 30%-40% in certain units due to high work load. Most of the nurses were not satisfied about monitory compensation, participation in decision making and inadequate supplies.

Stress, Visual and Musculoskeletal Complaints in Open Plan Office Staff

Summary The aim of the study was to identify the main ergonomic and organizational risks contributing to stress, visual and musculoskeletal disorders in open plan office workers. A total of 73 subjects of mean age 28.3 ±4.7 years were studied. Measurements of salivary cortisol and self-ratings for strain, fatigue, stress symptoms, visual and musculoskeletal complaints were performed. The work places were organized well, but the studied staff reported high work load and time pressure. The data showed higher cortisol levels during the workday under time pressure. High incidence of visual and musculoskeletal complaints mainly in the region of the back and the neck were found, associated with flickering and blinks on the screen monitors and overtime. Optimizing workplace organization could help reduce stress and health complaints of office staff.

Nursing Activities Score: nursing work load in a burns Intensive Care Unit

OBJECTIVE: to evaluate the nursing work load in a Burns Intensive Care Unit according to the Nursing Activities Score.METHOD: an exploratory, descriptive cross-sectional study with a quantitative approach. The Nursing Activities Score was used for data collection between October 2011 and May 2012, totalling 1,221 measurements, obtained from 50 patients' hospital records. Data for qualitative variables was described in tables; for the quantitative variables, calculations using statistical measurements were used.RESULTS: the mean score for the Nursing Activities Score was 70.4% and the median was 70.3%, corresponding to the percentage of the time spent on direct care to the patient in 24 hours.CONCLUSION: the Nursing Activities Score provided information which involves the process of caring for patients hospitalized in a Burns Intensive Care Unit, and indicated that there is a high work load for the nursing team of the sector studied.

Factors influencing myocardial response to metabolic acidosis in isolated rat hearts

We assessed the effects of metabolic acidosis in Langendorff rat hearts to identify factors influencing myocardial response to metabolic acidosis. Intracellular pH (pHi), beta-ATP, phosphocreatine, and inorganic phosphate (Pi) content were measured by 31P nuclear magnetic resonance spectroscopy along with simultaneous measurements of coronary flow and developed pressure during 30 min of perfusion at pH = 6.8, followed by 15 min of reequilibration at pH = 7.4. Under high work-load conditions, pHi, high-energy phosphates, coronary flow, and developed pressure were severely reduced during metabolic acidosis. Each of these hearts exhibited a progressive decline in developed pressure and stopped beating during reequilibration. Lowering work load prevented severe biochemical or mechanical deterioration, allowing complete recovery during reequilibration. In the presence of high work load, factors found to improve myocardial tolerance to metabolic acidosis included maintaining base-line or higher levels of coronary flow with vasodilators or substitution of pyruvate for glucose as the energy-producing substrate. Raising perfusate osmolality did not prevent severe decreases in coronary flow and developed pressure during acidosis, but did allow a dramatic recovery during reequilibration. Recovery of biochemical and mechanical performance after 30 min of metabolic acidosis was directly related to 1) ln[ATP]/[ADP]f[Pi] greater than or equal to 4.1, where [ADP]f is the concentration of free ADP; 2) pHi greater than 6.40; and 3) ATP level greater than or equal to 75% of control.

The effect of extracellular calcium and preload on a teleost heart during extracellular hypercapnic acidosis

The effect of extracellular calcium ([Ca2+]e) on the performance of the in situ perfused sea raven heart was evaluated under nonacidotic, acidotic, and high work load conditions. Increases in [Ca2+]e improved power output of the nonacidotic heart and restored control levels of power output to the heart exposed to hypercapnic acidosis (1.8% CO2, pH 7.4). Extracellular acidosis severely curtailed the scope for cardiac work (increased cardiac output and afterload), and only a 50% increase in the control, nonacidotic power output was possible with increases in preload and saturating levels of [Formula: see text]. It is suggested that increases in preload are probably more important than increases in [Ca2+]e to improve cardiac performance in the seas raven heart during extracellular acidosis.