Work Index Research Articles

Modernizing Measure of the Nurse Work Environment.

Research has established a relationship between favorable nurse work environments and better nurse, patient, and organizational outcomes. However, the instrument most frequently used to measure the nurse work environment, the Practice Environment Scale of the Nursing Work Index (PES-NWI), has not had its items significantly re-evaluated since the 1980s. We sought to examine the psychometric properties of an updated PES-NWI and create an instrument suitable for further testing and refinement to measure the present-day nurse work environment. Specifically, we sought to establish construct, structural, discriminative, and concurrent validity. For reliability, we desired to establish interrater reliability and internal consistency reliability. We administered a modified PES-NWI to a national sample of direct-care hospital nurses (n = 818) in the United States. We then assessed the psychometric properties of the instrument. While the modified PES-NWI displayed adequate validity and reliability properties, further testing and refinement of the instrument is necessary. With this updated measure of the nurse work environment, researchers and hospital leaders can identify modifiable opportunities for improvement in contemporary hospital nurse work environments which may enhance nurse and patient outcomes.

CERCETĂRI PRIVIND TESTAREA APARATELOR DE TREIER CU FLUX AXIAL ÎN VEDEREA ÎMBUNĂTĂŢIRII INDICILOR CALITATIVI DE LUCRU AI ACESTORA

The working process of the threshing apparatus is characterized by the qualitative working indices they achieve during operation. In order to maximize them with effect on reducing the percentage of seed losses, damaged seeds and impurities in the seed mass, respectively increasing the percentage of separated seeds, certain adjustments can be made on the component elements of a threshing apparatus in accordance with the type, quality and the condition of the material subjected to the threshing operation. In this paper, a n axial flow threshing apparatus was tested under different conditions, in order to be able to obtain the data necessary to adjust the working parameters, which would allow it to be operated at the desired quality indices (losses, injuries and minimal impurities together with separation of seeds from ears and straw almost completely).

Myocardial work in patients with heart failure and ischemic cardiomyopathy according to the mode of coronary revascularization

BackgroundThe association of percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) on myocardial function, as reflected in myocardial work (MyW) parameters, in patients with ischemic cardiomyopathy and heart failure (HF) is unknown. MethodsWe analyzed data from 68 patients who were hospitalized with chronic HF due to ischemic cardiomyopathy and stratified them according to the mode of revascularization. All patients underwent a 2D speckle tracking echocardiography exam performed by the same expert sonographer and had complete MyW data including global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE). ResultsThe mean age of patients was 70 ± 10 years and 86.8% were men. The mean left ventricular ejection fraction (LVEF) in overall cohort was 31.6 ± 9.5%. Both subgroups did not significantly differ in terms of baseline LVEF, comorbidities, and pharmacotherapy. Compared with those who received PCI, patients revascularized with CABG had significantly greater GWI (821 vs. 555 mmHg%, p = 0.002), GCW (1101 vs. 794 mmHg%, p = 0.001), GWE (78 vs. 72.6%, p = 0.025), and global longitudinal strain (−8.7 vs. −6.7%, p = 0.004). Both patient subgroups did not significantly differ with respect to GWW (273 vs. 245 mmHg%, p = 0.410 for CABG and PCI, respectively) and survival during the median follow-up of 18 months (log-rank p = 0.813). ConclusionPatients with HF and ischemic cardiomyopathy revascularized with CABG had greater myocardial work performance when compared with those revascularized with PCI. This might suggest a higher degree of functional myocardial revascularization associated with the CABG procedure.

Incremental value of non-invasive myocardial work for the evaluation and prediction of coronary microvascular dysfunction in angina with no obstructive coronary artery disease.

Evidence suggests that patients suffering from angina with no obstructive coronary artery disease (ANOCA) experience coronary microvascular dysfunction (CMD). We aimed to understand the diagnosis value of noninvasive myocardial work indices (MWIs) with left ventricular pressure-strain loop (LV PSL) by echocardiography in ANOCA patients with CMD. 97 patients with ANOCA were recruited. All subjects underwent standard echocardiography with traditional ultrasound parameters, two-dimensional speckle-tracking echocardiography with global longitudinal strain (GLS), LV PSL with MWIs include global work index (GWI), global constructive work (GCW), global waste work (GWW) and global work efficiency (GWE). In addition, all enrolled cases underwent high-dose adenosine stress echocardiography (SE) with coronary flow velocity reserve (CFVR). CMD was defined as CFVR <2.0. Of the 97 patients with ANOCA, 52 were placed in the CMD group and 45 in the control group. GWI and GCW were decreased significantly in the CMD group compared with the control group (P < 0.001 for both). GWI and GCW were moderately correlated with CFVR (r = 0.430, P < 0.001 and r = 0.538, P < 0.001, respectively). In the multiple logistic regression analyses, GCW was identified as the only independent echocardiography parameter associated with CMD after adjusting for age and baseline APV [OR (95%CI) 1.009 (1.005-1.013); P < 0.001]. Moreover, the best predictor of CMD in patients with ANOCA using receiver operating characteristic (ROC) curve was GWI and GCW, with an area under the curve (AUC) of 0.800 and 0.832, sensitivity of 67.3% and 78.8%, specificity of 80.0% and 75.6%, respectively. MWIs with LV PSL is a new method to detect LV systolic function noninvasively in ANOCA patients with CMD.

Ddetermination of bond work index of Bagega gold mineral deposit of Zamfara State, Nigeria

The study determined the bond work index of Begaga gold mineral deposit of Zamfara State Nigeria using Berry and Bruce modified bond method. Sample of gold mineral was sourced using random sampling method. Reference mineral (Granite) of known weight and work index of 15.13Kwh/ton was ground for thirty minutes at a particular speed and power consumed was determined from the power rating of the ball mill. An identical weight of Bagega gold mineral whose work index was to be determined was ground in the same ball mill under same condition as that of reference mineral. Size analysis of the ball mill under same condition as that of the reference mineral was performed. Size analysis of the ball mill feed and discharge for both ores was carried out and 80% passing particle size of the ball mill feed and discharge for the two ores were estimated mathematically using correlation approach. The work index of the Bagega gold mineral was determined by equating the power consumed in the two indexes of the ore. It was found to be approximately 14.24Kwh/ton which is within the acceptable range of 10 - 15.14Kwh/ton indicated in literatures as standard work index range of gold. This value of the work index means that 14.25Kilowatts hour of energy is required to reduced one tonne of the gold ore from 80% passing particle size of 1117.32μm to 80% passing particle size of 800.00μm, it should serve as the work index of Bagega gold.

Chemotherapy-related cardiac dysfunction: the usefulness of myocardial work indices.

The role of left ventricular global longitudinal strain (GLS) in the diagnosis of subclinical cardiac damage induced by anticancer drugs is now consolidated. Considering some strain disadvantages such as the dependence on the haemodynamic loading conditions, the aim of our study was to investigate the usefulness of non-invasive myocardial work indices (MWI) derived from pressure-strain analysis, in the early diagnosis of cardiotoxicity. We enrolled 61 consecutive patients with breast cancer undergoing adjuvant treatment with anthracycline-containing chemotherapy followed by taxane + trastuzumab. Patients underwent a cardiological evaluation with 2D echocardiography including measurement of the left ventricular ejection fraction (LVEF) and other conventional parameters of systolic and diastolic function, GLS and MWI at baseline (T0), 3 months (T1) and 6 months (T2) after starting chemotherapy. At T1 and T2, we did not find a significant reduction in LVEF but we found a significant reduction in GLS and MWI (p value < 0.05). In addition, at T2, 31% of patients developed subclinical cardiac dysfunction defined as a relative decrease ≥ 12% of GLS from baseline. Global work index (GWI), global constructive work (GCW) and global work efficiency (GWE) decreased significantly in both patients with subclinical dysfunction and in those without subclinical dysfunction (p value < 0.05). Patients with subclinical dysfunction at T2 showed lower values of GCW at T0. MWI changed significantly during chemotherapy and appeared to alter precociously compared to GLS. Therefore, a multiparametric approach including left ventricular GLS and MWI measurements should be used in the evaluation of patients undergoing cardiotoxic antineoplastic treatment.

Grindability characterization and work index determination of alluvial ferro-columbite deposits for efficient mineral processing

This study emphasizes on the physicochemical and grindability characteristics and work index of an alluvial formed silica dominated ferro-columbite mineral from Rayfield-Jos minefields in Plateau state, Nigeria. Investigations were also carried out in order to determine the mineralogy of the mineral deposits and most essentially the actual energy consumed during comminution and milling of the mineral so as to achieve the liberation size prior to high efficient mineral processing or beneficiation and the extraction of value metals. The distribution of the mineral particles as well as their sizes was determined, with a mineral liberation size fraction range essentially established as -150+90 µm particle sizes. Mass percentage of each size fraction obtained from PSD analysis conducted before and after comminution was also determined, obtaining 80% passing for both the mineral feeds and comminuted products. Berry and Bruce modified Bond’s work index was therefore obtained, and was determined to be within the range of 2.0414 to 2.5667 kWh/ton. Hence, the energy consumed or required to comminute or grind the Fe-columbite mineral to 80% passing is expected to fall within the range of 0.3613 to 0.4543 kWh. Thus, it could be said that a low milling work index as well as moderately low energy is required for comminution and this can be attributed to the mineralogy, mineral source and alluvial formation of the mineral reserve. Therefore, the grindability/PSD result of the mineral sample indicates that its mineralogy is considered a class of moderately soft mineral type in terms of texture with easy grindability.

Phenotyping heart failure by echocardiography: imaging of ventricular function and haemodynamics at rest and exercise.

Traditionally, congestive heart failure (HF) was phenotyped by echocardiography or other imaging techniques according to left ventricular (LV) ejection fraction (LVEF). The more recent echocardiographic modality speckle tracking strain is complementary to LVEF, as it is more sensitive to diagnose mild systolic dysfunction. Furthermore, when LV systolic dysfunction is associated with a small, hypertrophic ventricle, EF is often normal or supernormal, whereas LV global longitudinal strain can reveal reduced contractility. In addition, segmental strain patterns may be used to identify specific cardiomyopathies, which in some cases can be treated with patient-specific medicine. In HF with preserved EF (HFpEF), a diagnostic hallmark is elevated LV filling pressure, which can be diagnosed with good accuracy by applying a set of echocardiographic parameters. Patients with HFpEF often have normal filling pressure at rest, and a non-invasive or invasive diastolic stress test may be used to identify abnormal elevation of filling pressure during exercise. The novel parameter LV work index, which incorporates afterload, is a promising tool for quantification of LV contractile function and efficiency. Another novel modality is shear wave imaging for diagnosing stiff ventricles, but clinical utility remains to be determined. In conclusion, echocardiographic imaging of cardiac function should include LV strain as a supplementary method to LVEF. Echocardiographic parameters can identify elevated LV filling pressure with good accuracy and may be applied in the diagnostic workup of patients suspected of HFpEF.

Relationship between Level of Physical Activity and Subjective Musculoskeletal Pain among Work from Home Adults

Introduction: World Health Organization has defined physical activity as any physiological movement that needs energy expenditure and is produced by skeletal muscles. Due to the COVID-19 Pandemic, the government has imposed a lockdown to reduce the infection rate. Hence, many industries have moved to work from home platforms. Based on the studies, it is believed that these restrictions have caused a reduction in physical activity and an increase in sedentary behavior, which leads to musculoskeletal disorders. Objective: The purpose of this study is to determine the relationship between level of physical activity and subjective musculoskeletal pain in adults who work from home. Methodology: An online questionnaire distributed via Google Form links was sent to those who have been working from home (WFH) during and after COVID-19 in the past few years in Malaysia. The collected data was then analysed using the Pearson chi-square test using SPSS version 26 Mac OS. The Baecke Physical Activity Questionnaire and the Nordic Questionnaire were used to determine the participants' levels of physical activity and musculoskeletal pain. Result: This study found that many of the respondents experienced neck pain (n = 98, 54%), shoulder pain (n = 75, 41%), and low back pain (n = 94, 51.9%) during the past year. Further, the study findings revealed a significant relationship between neck (p = 0.014) and hip pain (p = 0.004) with the work index, wrist pain (p = 0.002) with the leisure index, and ankle joint pain (p = 0.024) with the work and sport index. Conclusion: According to the findings, WFH decrease the level of participants' physical activity, thus leading to an increase in musculoskeletal pain over the neck, shoulder, and low back.

Work index evaluation of Rayfield-Jos columbite mineral for effective processing and recovery of niobium and tantalum

Physicalcharacterization on primary or secondary minerals is imperative. One of such physical analyses is the grindability characteristics and/or work index determination. This, as well asenergy required to comminute certain critical minerals is key and has been de-emphasized in recent time. In this regard, this study is focused on investigating the work index of alluvial columbite tailings to determine the actual energy consumed during milling to the liberation size prior to beneficiation and metal extraction. Alluvial columbite tailing test samples was sourced froman abandoned mine-field, inRayfield, Jos South,Plateau state, Nigeria.Reference mineral sample with a known grindability/work index was also utilized in this study. Reference sample was Gyel-Bukuru columbite mineral ore, sourced from Gyel town,Eastern Jos, Plateau state, Nigeria. Both test and reference samples wereground, with their weights known. 80% passing particle size were obtained for both test and reference samples. The obtained grindability values were used in determining work index of test sample. Mean work index value of ̴ 2.3041 kWh/ton was determined. Thus, this indicates that a minimum average energy amount of ̴ 2.3041 kWh was required to grind/comminute one ton ofthe alluvial ferro-columbite mineral tailing test sample. This is significant in the sustainability in processing, mining, and metallurgical engineering and especially in the columbite mineral liberation and design/development of effective mineral processing/beneficiation routes for overall efficiency of recovery, separation and extraction of value metals such as Nb and Ta. This will therefore act as a deciphering factor to be considered when choosing/selecting suitable comminution equipment and design system. The grindability data can also be utilized by the mining sector and mineral processing industries for efficient beneficiation, separation, and Nb/Ta recoveries as well as the knowledge of energy quantity consumed during mechanical activation of the mineral for effective processing or concentration.

Characterizing stenosis severity of coronary heart disease by myocardial work measurement in patients with preserved ejection fraction.

The novel echocardiographic parameter of myocardial work incorporates left ventricular pressure into the assessment of left ventricular systolic function and thereby corrects for afterload. We sought to investigate the diagnostic value of myocardial work to identify different grades of stenosis severity in coronary heart disease (CHD) patients with preserved left ventricular ejection fraction and without regional wall motion abnormalities. One hundred and seventeen consecutive subjects with preserved ejection fraction referred for coronary angiography were randomized and prospectively included in this study. Forty-six in the control group, and 25, 24, and 22 in each of the grade-1, grade-2, and grade-3 CHD groups as classified by the Gensini score. The following indices of myocardial work were assessed with a Vivid E95 Version 203 instrument: global work index (GWI), global constructive work (GCW), global wasted work (GWW), global work efficiency (GWE). Both GWI (P<0.001) and GCW (P<0.001) decreased significantly in CHD grade-1, increased slightly in CHD grade-2 compared with CHD grade-1, and decreased significantly in CHD grade-3. GWW (P<0.001) increased significantly from CHD grade-1 to CHD grade-3, while GWE (P<0.001) decreased significantly from CHD grade-1 to CHD grade-3. Receiver operating characteristic curves analysis revealed good discrimination between the control group and CHD grade-3 for GWI [area under the curve (AUC): 0.810; 95% confidence interval (CI): 0.691-0.930], GCW (AUC: 0.758; 95% CI: 0.631-0.885), GWW (AUC: 0.754; 95% CI: 0.624-0.885) and GWE (AUC: 0.817; 95% CI: 0.709-0.926). The assessment of intraobserver and interobserver variability in the MW echocardiographic data documented good interclass correlation coefficients (all >0.85). Myocardial work incorporates left ventricular pressure into the assessment of left ventricular systolic function and thereby corrects for afterload. It identifies patients with incipient left ventricular dysfunction caused by chronic ischemia due to CHD. A gradual worsening of myocardial work parameters was observed when comparing patients with higher degrees of stenosis severity. Therefore, adding myocardial work when evaluating patients with suspected CHD may help increase diagnostic accuracy.

Work Environment-Mediated Job Burnout and Intention-to-Stay in Registered Nurses

Nurse engagement and retention are critical issues affecting the quality of healthcare. Although the work environment is known to affect nursing performance and patient outcomes, little is known regarding the impact of this environment on nurse burnout and future work intention, especially in non-Western settings. This study explored the extent to which Taiwanese nurses' perceptions of their practice environment mediates burnout levels and intention-to-stay. This descriptive, correlational study, conducted between September and December 2020, recruited nurses employed at a regional teaching hospital located in a relatively rural region in Taiwan. The participants completed standardized questionnaires, including a demographic information form, the 31-item Practice Environment Scale of the Nursing Work Index (PES-NWI), the 22-item Maslach Burnout Inventory (MBI-HSS), and the 6-item Intention-to-stay (ITS) scale. The mediating effect among the variables related to intention-to-stay was examined using Model 4 of the PROCESS macro and tested using the bootstrapping method (repeated 5,000 times) with a p value < .05. The mean age of the 376 participants was 34.3 years (SD = 8.1). Nearly one-third (30.3%) scored > 27 on the emotional exhaustion subscale of the MBI-HSS, indicating they were "highly burned-out". Also, nearly one-third (30.6%) were uncertain about their intention to stay with their current employer. Burnout was associated with intention-to-stay (β = -.088, p < .001), and holding a positive perception toward their practice environment was shown to mediate the relationship between burnout and intention-to-stay (β = -.015; p < .001). Targeted interventions and technical support that promote a collaborative climate and psychological empowerment in clinical practice may alleviate burnout and intention-to-leave in nurses and improve workplace quality.

Assessing Myocardial Strain and Myocardial Work as a Marker for Hypertensive Heart Disease: A Meta-Analysis.

The main objective of this study was to determine whether myocardial strain and myocardial work are altered in hypertension and whether the strain is independent of hypertension-induced left ventricular hypertrophy. Two systematic literature searches were conducted using Medline and EMBASE through to June 30, 2022. In the first, search terms left ventricular strain or speckle tracking AND hypertension and left ventricular hypertrophy were used in conjunction with Boolean operators to identify articles reporting left ventricular strain in patients with hypertension. In the second, the terms Global cardiac or myocardial work AND hypertension were used to identify articles. Publication bias was assessed by examination of funnel plots and calculation of the Failsafe N and Duval and Tweedie's Trim and fill. The results were presented as Forrest plots. Global longitudinal strain (GLS) was significantly lower in patients with hypertension compared to those without hypertension with a mean difference of 2.0 0.1 (standard error of mean(SEM)) in the fixed effect model. Global circumferential strain (GCS) was significantly lower in hypertension. The mean difference between the hypertensive and non-hypertensive groups was 1.37 0.17. Global radial strain (GRS) was significantly (p 0.05) greater in hypertension. However, this difference was significant in only 3 and of borderline significance in 3 of 14 studies where GRS was measured. The mean difference between the hypertensive and non-hypertensive groups was 1.5 0.5 using the fixed effects model. There was a significant relationship between GLS and GCS as well as between GCS and GRS but no significant relationship between GLS and GRS. There was no significant difference in left ventricular ejection fraction (LVEF) between the hypertension and no hypertension groups. There was no significant relationship between LVEF and either GLS or GCS but a significant negative correlation was found between LVEF and GRS. GLS was further reduced in persons with hypertension and left ventricular hypertrophy (LVH) compared to hypertension without LVH. In contrast, there were no or minimal differences in GCS and GRS for individuals with hypertension and LVH compared to those without LVH. Global myocardial work index (GWI) and Global constructive work (GCW) were significantly greater in patients with hypertension compared to controls. Global wasted work (GWW) indicated significantly less wasted work in controls compared to hypertension. In contrast, Global work efficiency (GWE) was significantly lower in hypertension compared to the control. There was a significant reduction in GLS and GCS in hypertension while GRS was increased. The reduction in GLS in hypertension was not dependent on the presence of LVH. GLS was further reduced in persons with hypertension when LVH was present. In contrast, there were no or minimal differences in GCS and GRS for individuals with LVH compared to those without LVH. GLS was independent of left ventricle (LV) ejection fraction. GWI, GCW and GWW were greater in hypertension while GWE was lower in hypertension compared to controls. These data support the contention that GLS and indices of global work are early markers of hypertensive heart disease.

Workplace violence against cardiovascular nurses during Covid-19 pandemic

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): The National Federation of Orders for Nursing Professions (FNOPI - Italia) Background Workplace violence (WPV) impacts negatively both healthcare workers and healthcare organizations. Nurses are the most exposed healthcare workers to vertical WPV, also during the COVID-19 pandemic. Purpose Describing the WPV against nurses and its predictive factors in cardiovascular settings during COVID-19 pandemic in Italy. Methods This is a secondary analysis conducted in cardiovascular hospital settings from a larger national study between January and April 2021. Data were collected through the Practice Environment Scale of the Nursing Work Index (PES-NWI; Likert scale 1 to 4) and the adapted version of the Violence in Emergency Nursing and Triage (VENT) Questionnaire. Descriptive and logistic regression analyses were conducted. Results The analysis was conducted on 360 cardiovascular nurses (76.7% female; mean age 42.6 years, SD 10.8). Thirty per cent (n=108) of them reported WPV in last year and/or last week and 14.2% (n=51) only in last week. The number of patients was higher for nurses with WPV (mean difference [MD] +1.9; p = .030). The work environment was significantly worse for nurses with WPV: mean PES-NWI composite score (MD -0.2; p&amp;lt;.001); PES-NWI subscales: staffing and resource adequacy (MD -0.3; p&amp;lt;.001); nursing foundations for quality of care (MD -0.2; p = .005); nurse participation in hospital affairs (MD -0.3; p&amp;lt;.001); physician-nurse relationship (MD -0.2; p = .004). Multiple linear regression demonstrated that the risk of WPV increases when a clear nursing philosophy was not completely implemented in cardiovascular setting (odds ratio [OR] 5.29; 95% confidence interval [CI], 1.07-26.05; p = .040) and the nurses restrain patients (OR 2.49; 95% CI, 1.04-5.97, p = .041). The risk of WPV decreases when protectives glasses were present (OR 0.36; 95% CI 0.19-0.70, p = .003). Conclusion Public healthcare services should reduce WPV by investing in improving the nurse work environment. Integrated and multimodal programs of prevention and management of WPV are useful to address it.

The influence of nurse managers’ authentic leadership style and work environment characteristics on job burnout among emergency nurses

Background: Emergency nurses experience excessive workloads and high job burnout. Limited evidence exists exploring the role of authentic leadership and nurse work environment on job burnout among emergency nurses. Objective: To assess the influence of nurse managers’ authentic leadership and nurse work environment on job burnout among emergency nurses. Methods: A cross-sectional study was conducted among 160 emergency nurses working in six hospitals in the Sultanate of Oman. The Maslach Burnout Inventory, Authentic Leadership Questionnaire, and the Practice Environment Scale of the Nursing Work Index were used to assess study variables. Results: Of the 233 distributed surveys, 160 emergency nurses responded resulting in a response rate of 69%. More than two thirds of emergency nurses (72.1%) reported high levels of burnout. Authentic leadership and a favorable work environment were significantly associated with lower job burnout. Nurse managers’ transparency (β = - 0.481, p = 0.031), ethical/moral conduct (β = - .408, p = 0.043), managerial ability and support (β = - 0.497, p = 0.018), and adequate staffing and resources (β = -.068, p = 0.028) were all associated with lower job burnout. Conclusions: Results suggest the importance of providing effective leadership, adequate support to staff, maintaining optimum staffing and resources, and developing nurse managers' authentic leadership to reduce nurses’ job burnout.

Non-Invasive Myocardial Work Indices in Infants Born to Mothers With Diabetes in Pregnancy.

This study used echocardiography to investigate non-invasive myocardial work (MCW) indices in infants born to mothers with diabetes mellitus (DM) in pregnancy (gestational DM: GDM), including those diagnosed under novel classification criteria and those with pre-existing DM. This single-centered, retrospective study included 25 infants born to mothers with GDM (termed "infant with GDM"), which was diagnosed by oral glucose tolerance test results during pregnancy or the presence of diabetes before the current pregnancy. We evaluated the relationship between the infant's MCW, such as global constructive work (GCW), global work index (GWI), global work efficiency (GWE), and global wasted work (GWW), and the mother's GDM maximal HbA1c during pregnancy. HbA1c level in GDM significantly negatively correlated with GWI* (r=-0.565) and GCW* (r=-0.641). In infants with GDM, GWI and GCW were significantly higher with <6.5% HbA1c than in those with >6.5% HbA1c GDM; however, the specific-layer global longitudinal strain analyses did not show any significant differences between the groups. The pressure-strain loop in infants with >6.5% HbA1c in GDM tended to be smaller than in those infants with <6.5% HbA1c GDM. The hyperglycemic environment of GDM leads to impaired MCW in the infants. MCW is useful for screening for cardiac illnesses among infants with GDM. Appropriate maternal blood glucose management while maintaining HbA1c <6.5% might be beneficial for the cardiac performance of infants with GDM.

Increased NT-proBNP levels and cardiac ventricular function during aortic valve replacement (pilot study)

The objective was to study the relationship between the increased preoperative N-terminal segment of B-type natriuretic peptide precursor (NT-proBNP) blood levels and the parameters of the heart ventricles function, as well as the conditions for coronary perfusion of their myocardium before and after on-pump aortic valve replacement.Materials and methods. The study involved 27 patients aged 57.7±2.5 years who underwent aortic valve replacement. NT-proBNP blood level was determined before surgery. The level of NT-proBNP &gt; 1000 pg/ml was considered increased. Invasive hemodynamics, including the data of the right ventricle thermodilution volumetry, and transesophageal echocardiography data were analyzed at the stages: the 1st – after anesthesia induction, the 2nd – at the end of surgery. Logistic regression and ROC analysis were used for data processing.Results. Preoperative blood levels of NT-proBNP &gt; 1000 (3163.0[2507.25–7319]) pg/ml were recorded in 55.6% of patients. At the 1st stage, the biomarker increased level was associated with increased index of left ventricular end-systolic volume (OR 1.0955, 95% CI 1.0097–1.1885, p = 0.028, AUC 0.903), decreased left ventricular ejection fraction (OR 0, 9447, 95% CI 0.8949–0.9973, p = 0.040, AUC 0.753) and area contraction fraction (OR 0.8868, 95% CI 0.8086–0.9726, p = 0.011, AUC 0.890), increased mean pulmonary artery pressure (OR 1.1824, 95% CI 1.0020–1.3952, p = 0.047, AUC 0.722), and increased transpulmonary gradient (OR 1.4497, 95% CI 1.0103–2.0802, p = 0.044, AUC 0.810), increased right ventricular stroke work index (OR 1.5151, 95% CI 1.0319–2.2246, p = 0.034, AUC 0.761), and decreased coronary perfusion gradients of the left (OR 0.8961–0.9241, 95% CI 0.8229–0.9459 – 0.8630–0.9896, p = 0.012–0.024, AUC 0.793–0.861) and right (OR 0.9519, 95% CI 0.9136–0.9918, p = 0.019, AUC 0.847) ventricles. At the 2nd stage, NT-proBNP blood values &gt; 1000 pg/ml were associated with impaired left ventricular function, decreased mean arterial pressure (OR 0.9066, 95% CI 0.8264–0.9946, p = 0.038, AUC 0.761), and the vasopressor and inotropic support (OR 8.4000, 95% CI 1.2584–56.0694, p = 0.028, AUC 0.710).Conclusions. Prior to aortic valve replacement, the blood level of NT-proBNP &gt; 1000 pg/ml is associated with a moderate decrease in the left ventricular ejection fraction and area contraction fraction, an increased left ventricular end-systolic volume with a normal end-diastolic volume, an increased index of right ventricular stroke work in combination with moderately increased mean pulmonary artery pressure and increased transpulmonary gradient, as well as a decreased coronary perfusion gradients. At the end of operations, increased NT-proBNP blood level is associated with signs of impaired left ventricular contractility, a tendency to arterial hypotension, and the vasopressor and inotropic support. Increased preoperative NT-proBNP blood level are not associated with right ventricular volumes and ejection fraction both before and after on-pump aortic valve replacement.

Preoperative higher right ventricular stroke work index increases the risk of de novo aortic insufficiency after continuous-flow left ventricular assist device implantation

During continuous-flow left ventricular assist device (CF-LVAD) support, hemodynamic shear stress causes a burden on aortic valve (AV) leaflets, leading to de novo aortic insufficiency (AI). This study investigated the influence of preoperative hemodynamic parameters on de novo AI in CF-LVAD recipients. We reviewed 125 patients who underwent CF-LVAD implantation without concomitant AV surgery between 2005 and 2018. De novo AI was defined as moderate or severe AI in those with none or trivial preoperative AI. During mean 30 ± 16 months of CF-LVAD support, de novo AI-free rate was 86% and 67% at 1 and 2 years, respectively. Multivariable analysis showed that higher right ventricular stroke work index (RVSWI) (hazard ratio, 1.12 /g/m2/beat; 95% confidence interval, 1.00–1.20; p = 0.047) and trivial grade AI (hazard ratio, 2.8; 95% confidence interval, 1.2–6.4; p = 0.020) were independent preoperative risk factors for de novo AI. The longitudinal analysis using generalized mixed effects model showed that higher RVSWI was associated with continuous AV closure after LVAD implantation (Odd ratio, 1.20/g/m2/beat; 95% confidence interval, 1.00–1.43 /g/m2/beat; p = 0.047). Right heart catheterization revealed that preoperative RVSWI was positively correlated with postoperative pump flow index in patients with continuously closed AV (r = 0.44, p = 0.04, n = 22). Preoperative higher RVSWI was a significant risk factor for de novo AI following CF-LVAD implantation. In patients with preserved right ventricular function, postoperative higher pump flow may affect AI development via hemodynamic stress on the AV.

ӘБІШ КЕКІЛБАЕВТЫҢ ТЫРНАҚАЛДЫ ТУЫНДЫЛАРЫ

Abstract. Currently, the literary and creative heritage of a prominent statesman and public figure, people's writer of Kazakhstan Abish Kekilbaev is being studied in detail. Scientific interest in his work began during the life of the artist, many scientific studies were written and dissertations were defended. Today, this process has been found to continue in a vast scientific field called Abishology. There is no doubt that the literary heritage of the writer will continue to be studied from different angles, from the point of view of various scientific paradigms and theoretical and artistic analysis. In the study of personality and literary creativity, the abundance and completeness of sources is important. In this regard, the poems and articles that the writer published for the first time in the newspapers in his early years have their place. Last year, employees of the Mangistau Regional Museum of Local Lore named after A. Kekilbaev prepared a bibliographic index of the short works of the writer, published in the local periodical press in 1953-1958. This work consists of two parts: the first part contains a bibliographic index of the writer's articles and poems, and the second part contains their text. Thus, a total of 42 works were collected (34 articles, 8 poems). The preface of the museum director S. Kudaibergen, given at the beginning of the collection, reveals the purpose and structure of the work. The presentation of the writer's texts, along with a list of his first poems that were not included in previous collections, shows the cumulative nature of the work. In addition to being a bibliographic index, we can say that this is a small collection containing the works of the writer. It can become a necessary source for future researchers of A. Kekilbaev's creativity. Such information and data will be continuously collected and supplemented. This article discusses the first poems and articles of the writer, written in his school years, analyzes their thematic and content orientation and artistic features. It is clear that the scientific study of such poems and articles, which testify to the desire for literature and the creative search for young talent, especially poetry, reveals the beginnings of the poetic formation and creative evolution of the writer. The young author's view of the surrounding world, concern for the country and the future of the region are considered from a theoretical point of view and a scientific assessment is given. Keywords: poetry, poem, article, theme, content, idea, structure of the work, plot, composition, poet, artistry

Levels of burnout and exposure to ethical conflict and assessment of the practice environment in nursing professionals of intensive care

BackgroundNursing professionals working in Intensive Care Units (ICU) are at high risk of developing negative emotional responses as well as emotional and spiritual problems related to ethical issues. The design of effective strategies that improve these aspects is determined by knowing the levels of burnout and ethical conflict of these professionals, as well as the influence that the practice environment might have on them. ObjectivesTo analyze the relationship between levels of burnout, the exposure to ethical conflicts and the perception of the practice environment among themselves and with sociodemographic variables of the different intensive care nursing professionals. MethodsDescriptive, correlational, cross-sectional, observational study in an ICU of a tertiary level university hospital. The level of burnout was evaluated with the Maslach Burnout Inventory Human Services Survey scale; the level of ethical conflict with the Ethical Conflict Questionnaire for Nurses and the perception of the environment with the Practice Environment Scale of the Nursing Work Index. Descriptive and inferential statistics were performed. The association between categorical variables was analyzed using Fisher’s exact chi-square test (χ2) Results31 nurses and 8 nursing assistants were evaluated, which meant a participation rate of 82,93%. 31,10% of the nursing professionals presented signs of burnout, 14,89% considered that they work in an unfavorable environment and 87,23% presented a medium-high index of exposure to ethical conflict.The educational level (χ2=11.084, p=0.011) and the professional category (χ2=5.007, p=0.025) influenced the level of burnout: nursing assistants presented higher levels of this.When comparing the level of burnout with the environment and the index of ethical conflict, there were no statistically significant differences. ConclusionsThe absence of association found in the study between Burnout and ethical conflict with the perception of the practice environment suggests that personal factors may influence its development.