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Please see the correct Figure 2 here: thumbnail Download: * PPT PowerPoint slide * PNG larger image * TIFF original image Figures Citation: Hasson D, Theorell T, Bergquist J, Canlon B (2013) Correction: Acute Stress Induces Hyperacusis in Women with High Levels of Emotional Exhaustion. PLoS ONE 8(4): 10.1371/annotation/6a09a2e1-5c83-4ae7-859b-454de3e21814. https://doi.org/10.1371/annotation/6a09a2e1-5c83-4ae7-859b-454de3e21814

Heat-related illnesses comprise a spectrum of syndromes resulting from disruption of thermoregulation in people exposed to high environmental heat. Symptoms range from heat edema and exercise-associated muscle cramps to exercise-associated collapse, heat exhaustion, and life-threatening heat stroke. Athletes, outdoor laborers, and military personnel are at greatest risk. Several intrinsic and extrinsic factors increase the risk of heat-related illness, including medical conditions, environmental factors, medication use, and inadequate acclimatization. Proper recognition and treatment are effective in preventing adverse outcomes. Management of the mildest forms of heat-related illness (e.g., heat edema, exercise-associated muscle cramps) is largely supportive, and sequelae are rare. Heat exhaustion is characterized by cardiovascular hypoperfusion and a rectal core temperature up to 104°F without central nervous dysfunction. Mild cooling, rest, and hydration are recommended. Heat stroke is a medical emergency in which patients present with rectal core temperature of 105°F or greater, multiorgan damage, and central nervous dysfunction. Ice water or cold water immersion is recommended. Patients adequately cooled within 30 minutes have excellent outcomes. Patients with heat stroke generally require hospitalization to monitor for medical complications despite rapid cooling. People diagnosed with heat stroke or severe heat-related illness should refrain from physical activity for at least seven days after release from medical care, then gradually begin activity over two to four weeks. Acclimatization, adequate hydration, and avoidance of activities during extreme heat are the most effective measures to reduce the incidence of heat-related illnesses.

‘Exhaustion’ is a term used to describe a state of native and redirected T-cell hypo-responsiveness resulting from persistent antigen exposure during chronic viral infections or cancer. Although a well-established phenotype across mice and humans, exhaustion at the molecular level remains poorly defined and inconsistent across the literature. This is, in part, due to an overreliance on surface receptors to define these cells and explain exhaustive behaviours, an incomplete understanding of how exhaustion arises, and a lack of clarity over whether exhaustion is the same across contexts, e.g. chronic viral infections versus cancer. With the development of systems-based genetic approaches such as single-cell RNA-seq and CRISPR screens applied to in vivo data, we are moving closer to a consensus view of exhaustion, although understanding how it arises remains challenging given the difficulty in manipulating the in vivo setting. Accordingly, producing and studying exhausted T-cells ex vivo are burgeoning, allowing experiments to be conducted at scale up and with high throughput. Here, we first review what is currently known about T-cell exhaustion and how it’s being studied. We then discuss how improvements in their method of isolation/production and examining the impact of different microenvironmental signals and cell interactions have now become an active area of research. Finally, we discuss what the future holds for the analysis of this physiological condition and, given the diversity of ways in which exhausted cells are now being generated, propose the adoption of a unified approach to clearly defining exhaustion using a set of metabolic-, epigenetic-, transcriptional-, and activation-based phenotypic markers, that we call ‘M.E.T.A’.

[This corrects the article DOI: 10.1371/journal.pone.0209510.].

This paper examines the role of parenting behaviors in influencing children’s Internet addiction and the consequences of children’s Internet addiction on parents’ job outcomes. First, we draw on attachment theory to theorize that five parenting behaviors (i.e., parental control, monitoring, unstructured time, dissuasion, and rationalization) affect children’s Internet addiction and their effects are moderated by the children’s views of parent–child attachment. Second, we draw on research on the work–family interface to theorize that children’s Internet addiction affects parents’ job outcomes (i.e., job satisfaction, organizational commitment, and work exhaustion) and the effects are mediated by family-to-work conflict. We tested our hypotheses using an integrated research approach that includes quantitative and qualitative data. We conducted an online survey to collect quantitative responses from 776 parent–child dyads. The results of our model showed that the effects of parenting behaviors on children’s Internet addiction, except for dissuasion, were moderated by the children’s views of parent–child attachment. Also, family-to-work conflict mediated the effects of children’s Internet addiction on parents’ job satisfaction, organizational commitment, and work exhaustion. We collected qualitative data via interviews from 50 parents to cross-validate the results from the quantitative study.

Colorectal cancer (CRC) is one of the most common cancer worldwide, with a growing impact on public health and clinical management. Immunotherapy has shown promise in the treatment of advanced cancers, but needs to be improved for CRC, since only a limited fraction of patients is eligible for treatment, and most of them develop resistance due to progressive immune exhaustion. Here, we identify the transcriptional, molecular, and cellular traits of the immune exhaustion associated with CRC and determine their relationships with the patient’s clinic-pathological profile. Bioinformatic analyses of RNA-sequencing data of 594 CRCs from TCGA PanCancer collection, revealed that, in the wide range of immune exhaustion genes, those coding for PD-L1 , LAG3 and T-bet were associated (Cramér’s V=0.3) with MSI/dMMR tumors and with a shorter overall survival (log-rank test: p= 0.0004, p =0.0014 and p =0.0043, respectively), whereas high levels of expression of EOMES , TRAF1 , PD-L1 , FCRL4, BTLA and SIGLEC6 were associated with a shorter overall survival (log-rank test: p =0.0003, p =0.0188, p =0.0004, p =0.0303, p =0.0052 and p =0.0033, respectively), independently from the molecular subtype of CRC. Expression levels of PD-L1, PD-1, LAG3, EOMES, T-bet , and TIGIT were significantly correlated with each other and associated with genes coding for CD4 + and CD8 + CD3 + T cell markers and NKp46 + CD94 + EOMES + T-bet + cell markers, (OR >1.5, p <0.05), which identify a subset of group 1 innate lymphoid cells, namely conventional (c)NK cells. Expression of TRAF1 and BTLA co-occurred with both T cell markers, CD3γ, CD3δ, CD3ε, CD4 , and B cell markers, CD19, CD20 and CD79a (OR >2, p <0.05). Expression of TGFβ1 was associated only with CD4 + and CD8 + CD3ε + T cell markers (odds ratio >2, p <0.05). Expression of PD-L2 and IDO1 was associated (OR >1.5, p <0.05) only with cNK cell markers, whereas expression of FCRL4, SIGLEC2 and SIGLEC6 was associated (OR >2.5; p <0.05) with CD19 + CD20 + CD79a + B cell markers. Morphometric examination of immunostained CRC tissue sections, obtained from a validation cohort of 53 CRC patients, substantiated the biostatistical findings, showing that the highest percentage of immune exhaustion gene expressing cells were found in tumors from short-term survivors and that functional exhaustion is not confined to T lymphocytes, but also involves B cells, and cNK cells. This concept was strengthened by CYBERSORTx analysis, which revealed the expression of additional immune exhaustion genes, in particular FOXP1, SIRT1, BATF, NR4A1 and TOX , by subpopulations of T, B and NK cells. This study provides novel insight into the immune exhaustion landscape of CRC and emphasizes the need for a customized multi-targeted therapeutic approach to overcome resistance to current immunotherapy.

In hot environments, the American football uniform predisposes athletes to exertional heat exhaustion or exercise-induced hyperthermia at the threshold for heat stroke (rectal temperature [T(re)] > 39 degrees C). To evaluate the differential effects of 2 American football uniform configurations on exercise, thermal, cardiovascular, hematologic, and perceptual responses in a hot, humid environment. Randomized controlled trial. Human Performance Laboratory. Ten men with more than 3 years of competitive experience as football linemen (age = 23.8 +/- 4.3 years, height = 183.9 +/- 6.3 cm, mass = 117.41 +/- 12.59 kg, body fat = 30.1% +/- 5.5%). Participants completed 3 controlled exercise protocols consisting of repetitive box lifting (lifting, carrying, and depositing a 20.4-kg box at a rate of 10 lifts per minute for 10 minutes), seated recovery (10 minutes), and up to 60 minutes of treadmill walking. They wore one of the following: a partial uniform (PART) that included the National Football League (NFL) uniform without a helmet and shoulder pads; a full uniform (FULL) that included the full NFL uniform; or control clothing (CON) that included socks, sneakers, and shorts. Exercise, meals, and hydration status were controlled. We assessed sweat rate, T(re), heart rate, blood pressure, treadmill exercise time, perceptual measurements, plasma volume, plasma lactate, plasma glucose, plasma osmolality, body mass, and fat mass. During 19 of 30 experiments, participants halted exercise as a result of volitional exhaustion. Mean sweat rate, T(re), heart rate, and treadmill exercise time during the CON condition were different from those measures during the PART (P range, .04-.001; d range, 0.42-0.92) and FULL (P range, .04-.003; d range, 1.04-1.17) conditions; no differences were detected for perceptual measurements, plasma volume, plasma lactate, plasma glucose, or plasma osmolality. Exhaustion occurred during the FULL and PART conditions at the same T(re) (39.2 degrees C). Systolic and diastolic blood pressures (n = 9) indicated that hypotension developed throughout exercise (all treatments). Compared with the PART condition, the FULL condition resulted in a faster rate of T(re) increase (P < .001, d = 0.79), decreased treadmill exercise time (P = .005, d = 0.48), and fewer completed exercise bouts. Interestingly, T(re) increase was correlated with lean body mass during the FULL condition (R(2) = 0.71, P = .005), and treadmill exercise time was correlated with total fat mass during the CON (R(2) = 0.90, P < .001) and PART (R(2) = 0.69, P = .005) conditions. The FULL and PART conditions resulted in greater physiologic strain than the CON condition. These findings indicated that critical internal temperature and hypotension were concurrent with exhaustion during uncompensable (FULL) or nearly uncompensable (PART) heat stress and that anthropomorphic characteristics influenced heat storage and exercise time to exhaustion.

Background Practitioners and decision makers in the medical and insurance systems need knowledge on the relationship between work exposures and burnout. Many burnout studies – original as well as reviews - restricted their analyses to emotional exhaustion or did not report results on cynicism, personal accomplishment or global burnout. To meet this need we carried out this review and meta-analyses with the aim to provide systematically graded evidence for associations between working conditions and near-future development of burnout symptoms. Methods A wide range of work exposure factors was screened. Inclusion criteria were: 1) Study performed in Europe, North America, Australia and New Zealand 1990–2013. 2) Prospective or comparable case control design. 3) Assessments of exposure (work) and outcome at baseline and at least once again during follow up 1–5 years later. Twenty-five articles met the predefined relevance and quality criteria. The GRADE-system with its 4-grade evidence scale was used. Results Most of the 25 studies focused emotional exhaustion, fewer cynicism and still fewer personal accomplishment. Moderately strong evidence (grade 3) was concluded for the association between job control and reduced emotional exhaustion and between low workplace support and increased emotional exhaustion. Limited evidence (grade 2) was found for the associations between workplace justice, demands, high work load, low reward, low supervisor support, low co-worker support, job insecurity and change in emotional exhaustion. Cynicism was associated with most of these work factors. Reduced personal accomplishment was only associated with low reward. There were few prospective studies with sufficient quality on adverse chemical, biological and physical factors and burnout. Conclusion While high levels of job support and workplace justice were protective for emotional exhaustion, high demands, low job control, high work load, low reward and job insecurity increased the risk for developing exhaustion. Our approach with a wide range of work exposure factors analysed in relation to the separate dimensions of burnout expanded the knowledge of associations, evidence as well as research needs. The potential of organizational interventions is illustrated by the findings that burnout symptoms are strongly influenced by structural factors such as job demands, support and the possibility to exert control.

This study responds to a current phenomenon where individuals experience distress and exhaustion caused by cyberbullying and social overload while using social networking sites (SNSs). Social cognitive theory suggests that this phenomenon is caused by the interactive influences of environmental, personal, and behavioral factors, which are key unique drivers of SNS discontinuous usage intentions. This study focuses on how cyberbullying and social overload (environmental) induce distress and SNS exhaustion (personal), thereby affecting an individual’s intention to voluntarily abandon the use of SNSs (behavioral). The purpose model is tested through a sample of 314 SNS users. Empirical results indicate that cyberbullying and social overload exert a considerable impact on distress and SNS exhaustion, both of which further increase users’ intention to discontinue their usage of SNSs. This article concludes with several theoretical and practical contributions, limitations, and future research directions.

Immune-mediated inflammatory diseases(IMIDs) are referred to as highly disabling chronic diseases affecting different organs and systems. Inappropriate or excessive immune responses with chronic inflammation are typical manifestations. Usually in patients with chronic infection and cancer, due to long-term exposure to persistent antigens and inflammation microenvironment, T-cells are continuously stimulated and gradually differentiate into an exhausted state. Exhausted T-cells gradually lose effector function and characteristics of memory T-cells. However, existing studies have found that exhausted T-cells are not only present in the infection and tumor environment, but also in autoimmunity, and are associated with better prognosis of IMIDs. This suggests new prospects for the application of this reversible process of T-cell exhaustion in the treatment of IMID. This review will focus on the research progress of T-cell exhaustion in several IMIDs and its potential application for diagnosis and treatment in IMIDs.