Incident Stress Research Articles

Physical Activity, Diet, and Incident Urinary Incontinence in Postmenopausal Women: Women's Health Initiative Observational Study.

Physical activity and macronutrient intake, important contributors to energy balance, may be independently associated with female urinary incontinence (UI). We evaluated the association of baseline self-reported physical activity and macronutrient intake, via food frequency questionnaire, with incident UI subtypes after 3 years among 19 741 postmenopausal women in the Women's Health Initiative Observational Study. Odds ratios (ORs) for incident urgency, stress, and mixed UI were calculated using multivariable logistic regression. Women who reported total physical activity (metabolic equivalent task [MET]-hours/week) ≥30 versus <0.1 were 16% less likely to develop urgency UI (OR = 0.84; 95% CI 0.70, 1.00) and 34% less likely for mixed UI (OR = 0.66; 95% CI 0.46, 0.95), although linear trends were no longer statistically significant after adjusting for baseline weight and weight change (p trend = .15 and .16, respectively). The association between physical activity and incident stress UI was less consistent. Higher uncalibrated protein intake was associated with increased odds of incident urgency UI (≥19.4% vs <14.1% of energy intake OR = 1.14; 95% CI 0.99, 1.30; p trend = .02), while CIs were wide and included 1.0 for calibrated protein intake. Other macronutrients were not associated with urgency UI and macronutrient intake was not associated with incident stress or mixed UI (p trend > .05 for all). Among postmenopausal women, higher physical activity was associated with lower risk of incident urgency and mixed UI, but not stress UI, independent of baseline weight and weight change. Higher protein intake was associated with increased risk of urgency UI, but no associations were observed between other macronutrient and UI subtypes.

Crisis Intervention Psychotherapy in the Age of COVID-19.

Crisis intervention psychotherapy (CIP) is an underutilized form of therapy that can be offered as a treatment during psychiatric disasters and emergencies, and it may be especially useful during the age of Coronavirus Disease 2019 (COVID-19). CIP is a problem-solving, solution-focused, trauma-informed treatment, utilizing an individual or systemic/family-centered approach. CIP is a brief form of psychotherapy delivered as a companion or follow-up to psychological first aid. Crisis psychotherapy is designed to resolve a crisis and restore daily functioning. CIP can be adapted as a single session for a COVID-19 mental health emergency or for a hotline or as 2 to 20 sessions of treatment with COVID-19 patients and families offered virtually on a psychiatric inpatient unit, through a consultation-liaison service, or in outpatient settings. This article reviews the history of critical incident stress management and the use of its replacement, psychological first aid. The history and core principles of crisis psychotherapy and 8 core elements of treatment are described. The use of digital and virtual technology has enabled the delivery of crisis psychotherapy during the COVID-19 pandemic. A case study of a family impacted by COVID-19 is reported as an illustration. The use of a 6-week timeline, an ecological map, and a problem-solving wheel-and-spoke treatment plan are demonstrated.

Why Critical Incident Stress Management Teams Matter in Primary Care

ObjectiveCritical incident stress management (CISM) teams can be adapted in urban primary care clinics to address and process traumatic events in primary care. A guide for implementing the CISM team model within this setting is delineated.MethodsReview of existing literature and guide to implementation of CISM team in primary care.ResultsRespondents reported the team validated their reactions to the critical incident and were grateful for CISM presence.ConclusionDespite indications that vicarious traumatization, burnout, and compassion fatigue are rising (Bodenheimer &amp; Sinsky, 2014; Coles et al., 2013; Woolhouse et al., 2012), there is little information about efforts to address this. Operating and emergency rooms and intensive care units utilize CISM (Maloney 2012; Powers, 2015); however, it's overlooked in primary care (Blacklock, 2012; Naish et al., 2002).

Experimental Investigation of Obliquely Incident Blast Wave Effect on Deflection of Running Cracks

Abstract Dynamic caustics in conjunction with high-speed photography were used in experiments to investigate the interaction of obliquely incident blast stress waves with running cracks. The dynamic photoelastic experiment method was used to supplement and improve the effects of different blast stress wave properties on the running crack. This indicated that the crack-tip mode II stress field affected the crack deflection direction. When the moving crack-tip mode II stress intensity factor KII was positive, the crack deflected clockwise. When the stress intensity factor KII was negative, the crack deflected in the counterclockwise direction. The incident direction of the blast stress wave affected the deflection of the crack. When the direction of the blast stress wave was the same as the direction of the moving crack propagation, the moving crack deflected away from the blast wave source. When the blast stress wave propagation direction was opposite to the crack propagation direction, the crack deflected toward the blast wave source. During the interaction of an obliquely incident blast stress wave with a moving crack, the P wave caused the deflection of the crack. The tails of the P wave and S wave interacted with the kinked crack to increase the mode I stress intensity factor KI and the crack propagation velocity.

The impact of care environment on the mental health of orphaned, separated and street-connected children and adolescents in western Kenya: a prospective cohort analysis

IntroductionThe effect of care environment on orphaned and separated children and adolescents’ (OSCA) mental health is not well characterised in sub-Saharan Africa. We compared the risk of incident post-traumatic stress...

Reflective Debriefs as a Response to Moral Distress: Two Case Study Examples.

Within this paper, we discuss Moral Distress Reflective Debriefs as a promising approach to address and mitigate moral distress experienced by healthcare professionals. We briefly review the empirical and theoretical literature on critical incident stress debriefing and psychological debriefing to highlight the potential benefits of this modality. We then describe the approach that we take to facilitating reflective group discussions in response to morally distressing patient cases ("Moral Distress Reflective Debriefs"). We discuss how the debriefing literature and other clinical ethics activities influenced the development of our approach. In particular, we focus on the role of the clinical ethicist as a facilitator with particular emphasis on encouraging perspective-taking and nurturing ethical attunement in a supportive manner. We suggest that this approach reduces the narrowing effects of frustration and anger that are often reported when individuals experience moral-constraint distress. Finally, we provide an example of Moral Distress Reflective Debriefs, elucidating how this supportive process complements ethics consultation and can mitigate the negative effects of moral distress.

First Responder Peer Support: An Evidence-Informed Approach

First responders may be exposed to intensely traumatic incidents, with the potential to result in adverse psychological and physiological reactions. Peer support programs have been employed to mitigate these potential effects. Critical Incident Stress Management (CISM) has been widely employed as a means of responding to emergency services’ stress responses. This incorporates the use of “Critical Incident Stress Debriefing” (CISD), a technique in which a facilitator helps the rescuer talk about their feelings regarding the incident. Inherent in CISD, psychological debriefing has been described as a brief crisis intervention usually administered within days of a traumatic event. Controversy has arisen over the use of psychological debriefing as a safe and effective tool for peer support. Organizations may be exposed to liability when offering “a practice that is not supported by the preponderance of the available scientific evidence.” Psychological First Aid has been described as an alternative modality, broadly endorsed by expert consensus, which can be readily learned and employed by peer support teams. “Listen, Protect, Connect” is an easy-to-remember means to summarize and approach the concept of Psychological First Aid.

Modified mixed-mode caustics interpretation to study a running crack subjected to obliquely incident blast stress waves

Crack-wave interaction is common in blast, producing mixed-mode cracks when stress waves are oblique to cracks. How to measure mixed-mode crack-tip stress under blast stress waves is difficult. To this end, optical caustics method was employed to study a running crack in a PMMA plate subjected to obliquely incident blast stress waves, by which stress problem was transformed into optical problem. Incident P and S waves, as well as reflected waves, were visualized as fringe patterns, and mixed-mode crack-tip stress was represented by a caustics pattern (shadow spot). However, mixed-mode caustics patterns under P waves were not consistent with the classical interpretation, hence a modified mixed-mode caustics interpretation was proposed and then verified by P-wave compression and tension loading cases. In modified interpretation, an iteration procedure was proposed to obtain modified stress intensity factors, i.e. KI and KII, and crack-tip positions which were more precise than those by the classical interpretation. P-wave compression phase decreased KI and crack velocity sharply but produced the largest KII, while the following P-wave tension phase had an opposite effect. S waves and reflected waves produced higher KI and crack velocity with lower KII. KII and crack velocity histories explained curved crack path and microscopic fracture surface. Finally, the reason for the success of the modified interpretation was discussed, and it is indicated that transient stress superposition and delayed redistribution in the crack tip are the mechanism underlying the modified interpretation.

Farming systems in sheep rearing: Impact on growth and reproductive performance, nutrient digestibility, disease incidence and heat stress indices.

The experiment was conducted with an intent to know the effect of different farming systems on the growth performance, nutrient digestibility coefficients, reproductive traits, disease incidence, heat stress indices, and cost economics of Nellore sheep. The study includes two parallel trials to prevent the influence of age on heat stress indices (panting score and erythrocyte osmotic fragility (EOF)). One hundred and twenty lambs (60 ram-lambs and 60 ewe-lambs) were allotted in a randomized block design under extensive, semi-intensive, and intensive systems for trial I, whereas trial II include eighteen rams assigned to the three respective farming systems in a completely randomised design. Both, season (summer) and grazing practice increased the panting score and EOF. The heat stress indices were positively correlated (P<0.01) with dry-bulb temperature and temperature-humidity index (THI) and inversely correlated (P<0.01) to relative humidity. Allotting the sheep to intensive system increased (P<0.001) weight gain and average daily gain with higher effect in males compared to females. The parameters of asymptotic weight (A), integration constant (B), and maturation rate were higher for intensive males. The male Nellore lambs had higher asymptotic weight and lower maturity rate than females, irrespective of the rearing system. Intensive sheep revealed a higher dry matter intake, digestibility coefficients, feed conversion ratio. The instantaneous bite mass (IBM) was higher for Commelina benghalensis, while instantaneous bite frequency (IBF), instantaneous intake rate (IIR) were higher for Cyanodon dactylon and amaranthus viridis, respectively. The proportion of intakes were highest for Stylo hemata followed by Cynodon dactylon and Tridax procumbens species. No differences were observed for the weight at puberty, oestrus cycle length, oestrus duration, conception percent, gestation period, and lambing percent in three rearing systems; however, the age at puberty was lower (P<0.001) and the birth weight was higher (P<0.001) for sheep reared under intensive farming system. Highest disease incidence was observed in rainy and winter seasons, particularly in sheep reared under extensive system. The capital expenditure was same for the three rearing systems, while the recurring expenditure was higher for Intensive farming system. The gross income and net income were higher for intensive system on account of higher weight gains. However, the higher returns per rupee of expenditure project the extensive farming as an ideal rearing system for small farmers and entrepreneurs with a low initial capital.

Critical incident stress management for municipal employees at the deceased-related operations and supports for the bereaved families: A review on introduction of the DMORT training program

Critical incident stress management for municipal employees at the deceased-related operations and supports for the bereaved families: A review on introduction of the DMORT training program

Effect of Nonlinear Deformational Macrojoint on Stress Wave Propagation Through a Double-Scale Discontinuous Rock Mass

The overall dynamic mechanical behavior of a double-scale discontinuous rock mass with a nonlinear deformational macrojoint was investigated. A method of combining the split three characteristic lines with the piecewise linear displacement discontinuity model (DDM) was proposed. The method was applied to investigate the transmission coefficient of P-wave propagation normally through a double-scale discontinuous rock mass with a nonlinear deformational macrojoint. The results were verified by comparison with the results of P-wave propagation normally through a double-scale discontinuous rock mass with a linear deformational macrojoint. The results showed that for a small amplitude stress wave, the nonlinear deformational macrojoint can be simplified as a linear deformational form to study the stress wave propagation, whereas for a large amplitude stress wave, the effects of the nonlinear deformational behavior of the macrojoint must be considered. The difference of the effects of nonlinear and linear deformational macrojoints on large amplitude stress wave propagation can be overlooked in the low-frequency or high-frequency regions. In addition, when the incident stress wave amplitude and initial macrojoint stiffness are sufficiently large, the effects of the nonlinear deformational macrojoint on stress wave propagation can be overlooked, and the effects of microdefects must be considered. The influence degree of microdefects on the stress wave propagation increases with the increase of incident stress wave frequency.

Comparative Study on Dynamic Mechanical Properties and Energy Dissipation of Rocks under Impact Loads

Geological conditions are often complex during rock engineering construction (such as blasting and drilling) and usually involve rocks of several or multiple lithologies. However, comparative studies on the dynamic mechanical response of rocks of different lithologies are relatively few. To study differences in dynamic mechanical properties and energy dissipation of rocks of different lithologies, three kinds of rock that are common in rock engineering and have large differences in wave impedance were selected: red sandstone, gray sandstone, and granite. Samples of these three rocks were subjected to impact compression tests at different impact speeds, and the rock fragments after impact compression were screened to quantify the degree of fragmentation. The characteristics of stress wave propagation, dynamic stress-strain relationships, degree of fragmentation, and energy dissipation laws of the three rock types were compared and studied. The results show the following: (1) affected by the wave impedance matching relationship, the reflected waves, strain rates, and reflected energy of the three kinds of rock showed significant differences under the same incident stress wave. (2) The dynamic mechanical characteristics and energy dissipation laws of the rocks all had obvious strain rate effects, but the dynamic uniaxial compressive strength and energy dissipation density of the three rock types had different sensitivities to the strain rate. (3) The change trend of the energy utilization efficiency of the gray sandstone with incident energy was different from that of the red sandstone and granite; there was no obvious extreme point in the incident energy range. The three kinds of rock required different incident energies to reach maximum energy utilization efficiency. (4) The equivalent average fragment size of the three rock types decreased as a function of power with increasing impact velocity and energy dissipation density. (5) Under the same incident wave, although the reflection energy, transmission energy, and degree of fragmentation of the three kinds of rock showed significant differences, the differences in dissipation energy were small.

Peer Support and Crisis-Focused Psychological Interventions Designed to Mitigate Post-Traumatic Stress Injuries among Public Safety and Frontline Healthcare Personnel: A Systematic Review

Public safety personnel (PSP) and frontline healthcare professionals (FHP) are frequently exposed to potentially psychologically traumatic events (PPTEs), and report increased rates of post-traumatic stress injuries (PTSIs). Despite widespread implementation and repeated calls for research, effectiveness evidence for organizational post-exposure PTSI mitigation services remains lacking. The current systematic review synthesized and appraised recent (2008–December 2019) empirical research from 22 electronic databases following a population–intervention–comparison–outcome framework. Eligible studies investigated the effectiveness of organizational peer support and crisis-focused psychological interventions designed to mitigate PTSIs among PSP, FHP, and other PPTE-exposed workers. The review included 14 eligible studies (n = 18,849 participants) that were synthesized with qualitative narrative analyses. The absence of pre–post-evaluations and the use of inconsistent outcome measures precluded quantitative meta-analysis. Thematic services included diverse programming for critical incident stress debriefing, critical incident stress management, peer support, psychological first aid, and trauma risk management. Designs included randomized control trials, retrospective cohort studies, and cross-sectional studies. Outcome measures included PPTE impacts, absenteeism, substance use, suicide rates, psychiatric symptoms, risk assessments, stigma, and global assessments of functioning. Quality assessment indicated limited strength of evidence and failures to control for pre-existing PTSIs, which would significantly bias program effectiveness evaluations for reducing PTSIs post-PPTE.

45 Helping the Helpers: Peer Critical Incident Stress Management for NICU Health Care Providers to Improve Resilience, Burnout and Patient Safety

Abstract Introduction/Background Health care providers in neonatal intensive care units (NICU) experience critical or distressing events that can overwhelm their usual coping skills and lead to significant stress. Ineffective support for health care providers dealing with critical incidents can lead to poor unit resilience, staff burnout and compromised patient care behaviours. A formalized peer program and process to address critical workplace incidents and support care providers, “Critical Incident Stress Management (CISM)” is used in many first responder professions. While there is growing interest in implementing peer CISM teams in critical care units, there is a lack of research describing the impact of CISM in NICU. Objectives This study examined the effect of implementing a multidisciplinary NICU health care provider peer CISM team on resilience, burnout, and team/safety culture in a tertiary NICU. Design/Methods Multidisciplinary team members were peer selected and formally CISM trained. Change management strategies were employed to introduce CISM to the NICU. All health care providers were invited to complete an anonymous online or paper survey before and 1 year after NICU CISM team implementation. The survey contained validated measures of resilience, burnout, and team/safety culture that were analyzed pre and post intervention. Results The response rate pre-intervention was 66% (114/172 staff) and 32% post (60/186 staff). Stress recognition significantly improved as fewer staff reported being less effective at work when feeling stressed post incident (74% vs 61%, pre and post CISM respectively, p&amp;lt;0.05) (Table 1). Fewer staff reported feeling burned out from their work (41% vs 31%, p=0.4), trending towards improved resilience (Table 1). Communication in the NICU significantly improved as staff indicated debriefing methods met their needs (38% vs 57%, p&amp;lt;0.05) and felt comfortable speaking up about safety concerns (66% vs 78%) (Table 1). Post-intervention, despite feelings of increased workload indicated by a significant decrease in agreement that “NICU staff levels were sufficient for patient load” (54% vs 33%, p&amp;lt;0.001), a majority of staff reported a supportive environment in the NICU (59% vs 77%, p=0.08) (Table 1). Work culture significantly improved as staff felt rewarded and recognized for improving quality (13% vs 31%, p&amp;lt;0.05) (Table 1). Conclusion Implementation of a peer CISM team led to improved NICU care provider resilience, stress recognition, and team culture, all of which can mitigate the effects of increased patient load. Findings from this research and knowledge gained from the CISM implementation process should be shared with other health care environments.

The Acute Incident Response Program: A Framework Guiding Multidisciplinary Responses to Acutely Traumatic or Stress-Inducing Incidents in the ED Setting

BackgroundClinicians working in the ED setting are exposed to traumatic and stress-inducing incidents, which may increase the incidence of psychological sequelae, including burnout and acute stress disorders. The purpose of this project was to develop and implement a novel debriefing program as an early intervention for acutely stress-inducing events in the emergency department. MethodsThe 2-stage Acute Incident Response program was developed and implemented in the emergency department of the John Hunter Hospital to guide an interprofessional response to acutely stress-inducing incidents. This psychological support framework draws on existing concepts of critical incident stress management along with elements of contemporary “hot debriefing” models to create a concise, clinician-led response program incorporating elements of both work group peer support and clinical team performance improvement. The Acute Incident Response program is novel in its concurrent focus on both salient clinical factors and emotional responses of affected clinicians. ResultsThe developed Acute Incident Response program framework predominantly focuses on the wide dissemination of a peer-driven debriefing model. When additional support is deemed necessary by trained clinical champions after the Hot Acute Incident Response process, escalation to a central response coordinator ensures targeted secondary support follow-up for all affected team members.This program has been introduced at 1 site and warrants further targeted investigation to determine its efficacy and utility in a broad range of clinical contexts. ConclusionThe Acute Incident Response program is an accessible and meaningful model to guide a functional, clinician-led response to acute incidents in the ED setting. The model could feasibly be applied in a wide variety of clinical contexts.

Nonlinear mixing of non-collinear guided waves at a contact interface

Wave mixing offers several practical benefits relative to harmonic generation for detecting both distributed and localised damage. An analytical model is proposed for predicting the frequency, mode and direction of propagation of the mixed modes arising from the nonlinear mixing of two incident guided-wave modes at an interface exhibiting contact acoustic nonlinearity. These predictions are validated by a finite-element (FE) analysis involving a unilateral contact law that models both clapping and frictional sliding at the interface. This analysis also provides quantitative insights regarding the optimal interaction angle between the incident waves in the case of shear-horizontal SH0 modes, and the dependence of the mixed-wave amplitude on the load ratio (i.e. ratio of contact stress to normal stress across the interface due to both incident waves). The non-collinear mixing of guided waves is also investigated experimentally for various values of contact stress and incident stress amplitude, demonstrating the existence of mixed waves, as well as showing that interface mixing leads to a higher amplitude mixed wave than that due to the background material nonlinearity. This higher amplitude combined with great flexibility in the choice of incident wave parameters (frequency, mode and direction) makes wave mixing an attractive practical approach for detecting contact acoustic nonlinearity at crack-like defects and interfaces. Experimentally, the maximum value of mixed-wave amplitude is obtained at the same value of contact stress for the various incident stress amplitudes, whereas the FE model shows a maximum at a unique value of the load ratio. This difference may be a consequence of surface roughness, which is not included in the FE model.

What influences safety in paramedicine? Understanding the impact of stress and fatigue on safety outcomes.

ObjectiveThe purpose of this study was to build on extant research linking fatigue to safety outcomes in paramedicine by assessing the influence of a multiplicity of workplace stressors, including chronic and critical incident stresses on safety outcomes.MethodsA cross‐sectional survey was deployed to 10 paramedic services in Ontario. Validated survey instruments measured operational and organizational chronic stress, critical incident stress, post‐traumatic stress symptomatology (PTSS), fatigue, safety outcomes, and demographics. Analysis of covariance assessed associations of workplace stresses with safety outcomes and corroborated findings using hierarchical linear model and generalized estimating equations (GEE) by taking into account paramedic service when assessing the proposed associations. A non‐responder survey was conducted to asses for demographic differences in those who did and did not complete the survey.ResultsThis survey had a response rate of 40.5% (n = 717/1767); 80% of paramedics reported an injury or exposure to pathogen, 95% reported safety compromising behaviors, and 76% reported medical errors. In the GEE analyses, paramedic injury was significantly related to fatigue (0.13, SE = 0.06, P = 0.020), critical incident stress (0.03, SE = 0.01, P < 0.01), and PTSS (0.03, SE = 0.01, P < 0.01). Safety compromising behaviors were significantly associated with fatigue (0.37, SE = 0.06, P < 0.01), organizational stress (0.06, SE = 0.01, P < 0.01), and critical incident stress (0.01. SE = 0.01, P = 0.017). Medication errors were significantly related to fatigue (0.12, SE = 0.05, P < 0.01). Finally, the bivariate analysis showed increased stress factors and fatigue was associated with increased safety outcomes.ConclusionThese findings illustrate that a host of different stressors may influence safety‐related behaviors. For those interested in safety, these findings point to the need for a holistic focus on fatigue and stress in paramedicine.

How I approach peer support in pediatric hematology/oncology.

Peer support has begun to gain traction as a mechanism for improving well-being in medicine. In this paper, we share our experience building, training, and piloting a peer support team based on a "critical incident stress management" model. The HOPES team (Helping Our Peers Endure Stress) is dedicated to, and composed entirely of, members of our division of pediatric hematology/oncology. Peer support will not solve all the well-being problems afflicting medicine. It is, however, a very good place to start.

Research on energy absorption effect of double damping system of high-power hydraulic rock drill

ABSTRACT The high-power hydraulic rock drill is the key to the development of modern hydraulic drill rig. With the increase of power and frequency of new type rock drill, the rebound of drill tool will be obvious during drilling, which will seriously affect the structural safety and operation efficiency. For this phenomenon, it is necessary to research the characteristics of double damping system to absorb the rebound energy of drill tool. A new model of incident stress wave is revised on the basis of rectangular wave. By combining the reflected stress wave with the model of damping system, the pressure fluctuation of damping system is analysed. Based on the theory of stress wave transmission, the rebound model of drill tool is established, and the transmission law of incident wave and reflection wave in drilling process is analysed. The stress wave experiment was designed and the incident wave shape was obtained by testing. Based on the experimental results, the incident wave in the rebound model is corrected by Fourier transform principle. The accumulator model and the double damping internal structure model are established. The two parameters that can independently change the energy absorption effect of the double damping system are summarised.

Exploring the meaning of critical incident stress experienced by intensive care unit nurses.

The complexity of registered nurses' work in the intensive care unit places them at risk of experiencing critical incident stress. Gadamer's philosophical hermeneutics (1960/2013) was used to expand the meanings of work-related critical incident stress for registered nurses working with adults in the intensive care unit. Nine intensive care unit registered nurses participated in unstructured interviews. The interpretations emphasized that morally distressing experiences may lead to critical incident stress. Critical incident stress was influenced by the perception of judgment from co-workers and the organizational culture. Nurses in this study attempted to cope with critical incident stress by functioning in 'autopilot', temporarily altering their ability to critically think and to conceal emotions. Participants emphasized the importance of timely crisis interventions tailored to support their needs. This study highlighted that critical incident stress was transformative in how intensive care unit nurses practiced, potentially altering their professional self-identity. Work-related critical incident stress has implications for nurses, the discipline, and the health care system.