Human Neuroimaging Reveals Differences in Activation and Connectivity between Real and Pantomimed Tool Use.

Because the sophistication of tool use is vastly enhanced in humans compared with other species, a rich understanding of its neural substrates requires neuroscientific experiments in humans. Although functional magnetic resonance imaging (fMRI) has enabled many studies of tool-related neural processing, surprisingly few studies have examined real tool use. Rather, because of the many constraints of fMRI, past research has typically used proxies such as pantomiming despite neuropsychological dissociations between pantomimed and real tool use. We compared univariate activation levels, multivariate activation patterns, and functional connectivity when participants used real tools (a plastic knife or fork) to act on a target object (scoring or poking a piece of putty) or pantomimed the same actions with similar movements and timing. During the Execute phase, we found higher activation for real versus pantomimed tool use in sensorimotor regions and the anterior supramarginal gyrus, and higher activation for pantomimed than real tool use in classic tool-selective areas. Although no regions showed significant differences in activation magnitude during the Plan phase, activation patterns differed between real versus pantomimed tool use and motor cortex showed differential functional connectivity. These results reflect important differences between real tool use, a closed-loop process constrained by real consequences, and pantomimed tool use, a symbolic gesture that requires conceptual knowledge of tools but with limited consequences. These results highlight the feasibility and added value of employing natural tool use tasks in functional imaging, inform neuropsychological dissociations, and advance our theoretical understanding of the neural substrates of natural tool use.SIGNIFICANCE STATEMENT The study of tool use offers unique insights into how the human brain synthesizes perceptual, cognitive, and sensorimotor functions to accomplish a goal. We suggest that the reliance on proxies, such as pantomiming, for real tool use has (1) overestimated the contribution of cognitive networks, because of the indirect, symbolic nature of pantomiming; and (2) underestimated the contribution of sensorimotor networks necessary for predicting and monitoring the consequences of real interactions between hand, tool, and the target object. These results enhance our theoretical understanding of the full range of human tool functions and inform our understanding of neuropsychological dissociations between real and pantomimed tool use.

Perspectives of healthcare practitioners on environmental sustainability in healthcare: A qualitative study.

AIM: To explore the perspectives of Kazakhstani healthcare professionals on environmental sustainability in healthcare. DESIGN: An exploratory qualitative design. METHODS: Four focus group discussions (FGDs) on environmental sustainability in healthcare were conducted among healthcare professionals (nurses, physicians, midwives and physical therapists) from June to August 2023 in three cities of Kazakhstan. Each FGD consisted of at least 6 to 11 participants and lasted between 60 and 90 minutes. The collected data were analysed using the thematic analysis. RESULTS: A total of 137 initial codes were identified and further organized into 22 sub-themes based on similarities in codes and meanings, and then 5 significant themes were identified. The five main themes are 'Environmental Sustainability Practices in Healthcare', 'Purposes of Environmental Sustainability in Healthcare', 'Impact of Environmental Sustainability in Healthcare in Patients', 'Challenges in Implementing Environmental Sustainability in Healthcare' and 'The Role of Healthcare Leadership in Improving Environmental Sustainability in Healthcare'. CONCLUSIONS: The findings highlighted the perceptions and practices of healthcare professionals on environmental sustainability's purposes in healthcare, its impacts on patients and its implementation challenges. The study also underscored the critical role of strong and active leadership in ensuring a sustainable implementation of green policies in healthcare facilities and achieving successful results of environmentally conscious healthcare practices. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: The findings provide invaluable information that can be used by policymakers and healthcare organization leaders to create a sustainable healthcare system. Implementing environmental sustainability practices in healthcare should be widespread, intentional, and sustainable, entailing strong leadership and unwavering personal and organizational commitment. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution. REPORTING METHOD: We adhered to relevant EQUATOR guidelines, specifically the Consolidated Criteria for Reporting Qualitative Research.

Effect of COVID-19 Pandemic on Utilization of Paediatric Health Services at the Federal Medical Centre, Asaba, Nigeria.

BACKGROUND AND OBJECTIVES: Corona virus disease was declared a global pandemic in March 2020 and it precipitated unprecedented and devastating crisis on non-COVID hospital visits in almost all the countries within the globe, with a downward slide in the number of paediatric consultations and emergency admissions. Thus, we assessed the utilization of services offered in the department of Paediatrics and the observed mortality rates in comparison to similar non-pandemic period. METHODS: This study was carried out in the department of Pediatrics, Federal Medical Center Asaba. All the admissions at the children's ward and emergency, then visits at clinics and the immunization center were reviewed using a consecutive sampling method from April 2019 to September 2019 (pre COVID-19) and April 2020 to September 2020 (during COVID-19 pandemic). RESULTS: The total number of vaccines given in the immunization clinic was higher during the pre-COVID-19 period, so also the number of clinic visits. There was a decline in admission by 68.2% from the pre-COVID period to the pandemic period and this decline was across all age groups and gender. Also, a 60.8% increase in mortality was observed during the COVID-19 period and mortality pattern showed no gender difference across both study periods. CONCLUSION: There was a decline in the utilization of health services at the Department of Paediatrics, Federal Medical Center Asaba, during the COVID-19 pandemic, with a rise in mortality, despite the fact that all the units of the department were fully operational within the period of pandemic.

CONTEXTE ET OBJECTIFS: La maladie à virus Corona a été déclarée pandémie mondiale en mars 2020 et a précipité une crise sans précédent et dévastatrice sur les visites hospitalières non COVID dans presque tous les pays du globe, avec une baisse du nombre de consultations pédiatriques et d'admissions d'urgence. Nous avons donc évalué l'utilisation des services offerts dans le département de pédiatrie et les taux de mortalité observés par rapport à une période non pandémique similaire. MÉTHODES: Cette étude a été réalisée dans le département de pédiatrie du Centre médical fédéral d'Asaba. Toutes les admissions au service pédiatrique et aux urgences, puis les visites dans les cliniques et au centre de vaccination ont été examinées selon une méthode d'échantillonnage consécutif d'avril 2019 à septembre 2019 (avant COVID-19) et d'avril 2020 à septembre 2020 (pendant la pandémie de COVID-19). RÉSULTATS: Le nombre total de vaccins administrés dans le centre de vaccination était plus élevé pendant la période pré-COVID-19, de même que le nombre de visites au centre. Le nombre d'admissions a diminué de 68,2 % entre la période pré-COVID et la période pandémique, et cette baisse a concerné tous les groupes d'âge et tous les sexes. Par ailleurs, une augmentation de 60,8 % de la mortalité a été observée au cours de la période COVID-19 et le schéma de mortalité n'a montré aucune différence entre les sexes au cours des deux périodes d'étude. CONCLUSION: Il y a eu une baisse de l'utilisation des services de santé au département de pédiatrie du Federal Medical Center Asaba pendant la pandémie de COVID-19, avec une augmentation de la mortalité, malgré le fait que toutes les unités du département étaient pleinement opérationnelles pendant la période de la pandémie. Mots-clés: Pandémie, Covid-19, Enfants, Mortalité, Clinique, Admission, Services de santé, Effet, Utilisation.

Predictors of nursing students' intention to receive COVID-19 vaccination: A multi-university study in Saudi Arabia.

AIMS: This study examined the predictors of student nurses' intention to vaccinate against COVID-19. We measured the nursing students' risk perceptions, anxiety, fears and beliefs on COVID-19 vaccine; attitudes towards it and vaccine literacy (VL). DESIGN: This study is a multi-university study utilizing the quantitative, cross-sectional and predictive approach. METHODS: Using convenience sampling (n = 1170), we surveyed 10 Saudi universities from November 26, 2020, to December 31, 2020. Forward stepwise multinomial logistic regression was performed in identifying the factors predicting student nurses' intention to vaccinate against COVID-19. RESULTS: The overall mean in the risk perception, anxiety and fear was 9.59 (SD = 2.82, possible range = 1-15), 3.95 (SD = 4.77, possible range = 0-20) and 18.17 (SD = 6.65, possible range = 7-35) respectively. They also reported a mean of 29.90 (SD = 6.56, possible range = 8-40) on COVID-19 belief. COVID-19 positive and negative attitudes mean score was 3.64 (SD = 0.92) and 2.72 (SD = 0.90) in a 1-4 range of scores respectively. The functional and interactive-critical COVID-19 VL of the students were at moderate levels. More than half of the respondents (55.9%) intended to be vaccinated against COVID-19, 17.6% did not intend to do so and 26.5% were unsure. High-risk perceptions, low levels of COVID-19 anxiety, positive beliefs and attitudes towards COVID-19 vaccine, and high levels of interactive-critical COVID-19 VL were significant predictors of student nurses' intentions to vaccinate against COVID-19. CONCLUSION: Policymakers could consider the factors identified in this study and why the students did not intend to receive the vaccine in planning a nationwide vaccination program. The colleges of nursing could also utilize the findings in developing educational programs that aim to improve VL and beliefs and attitudes towards COVID-19 vaccine.

A qualitative study of an undergraduate online emergency medicine education program at a teaching Hospital in Kampala, Uganda.

BACKGROUND: Globally, half of all years of life lost is due to emergency medical conditions, with low- and middle-income countries (LMICs) facing a disproportionate burden of these conditions. There is an urgent need to train the future physicians in LMICs in the identification and stabilization of patients with emergency medical conditions. Little research focuses on the development of effective emergency medicine (EM) medical education resources in LMICs and the perspectives of the students themselves. One emerging tool is the use of electronic learning (e-learning) and blended learning courses. We aimed to understand Uganda medical trainees' use of learning materials, perception of current e-learning resources, and perceived needs regarding EM skills acquisition during participation in an app-based EM course. METHODS: We conducted semi-structured interviews and focus groups of medical students and EM residents. Participants were recruited using convenience sampling. All sessions were audio recorded and transcribed verbatim. The final codebook was approved by three separate investigators, transcripts were coded after reaching consensus by all members of the coding team, and coded data were thematically analyzed. RESULTS: Twenty-six medical trainees were included in the study. Analysis of the transcripts revealed three major themes: [1] medical trainees want education in EM and actively seek EM training opportunities; [2] although the e-learning course supplements knowledge acquisition, medical students are most interested in hands-on EM-related training experiences; and [3] medical students want increased time with local physician educators that blended courses provide. CONCLUSIONS: Our findings show that while students lack access to structured EM education, they actively seek EM knowledge and practice experiences through self-identified, unstructured learning opportunities. Students value high quality, easily accessible EM education resources and employ e-learning resources to bridge gaps in their learning opportunities. However, students desire that these resources be complemented by in-person educational sessions and executed in collaboration with local EM experts who are able to contextualize materials, offer mentorship, and help students develop their interest in EM to continue the growth of the EM specialty.

Nursing care toward older adults with dementia: An integrative review.

BACKGROUND: Dementia among older adults is receiving increase attention due to its neurodegenerative pathologies and poses a significant challenge for healthcare services systems. Caring for older adults with dementia is frequently challenging. This integrative review appraised and synthesised the existing literature describing the nursing care given to older adults with dementia. METHODS: An integrative review was used using six electronic databases (CINAHL, Medline, Science direct-Elsevier, Proquest, Pubmed and Web of Science). The search terms that were included in various combinations using mesh terms were as follows: nurse* OR nursing staff* AND caring OR care OR caring behavior OR affectionate OR compassionate AND older person* OR aging* OR elder* OR geriatric patient* OR older adult* OR gerontology* OR aged* OR old age. A standardised review by Kmet et al. instrument was utilised for appraising the quality of selected 13 articles. RESULTS: The results were presented based on the two major themes: challenges in providing care and identifying and managing older adults' difficult behaviours. CONCLUSION: The findings of an integrative review can be used as a foundation for formulating recommendations for how dementia care by nurses can be improved and highlighting where policy development and further research are needed.

Whole-Person Development of Undergraduate Nursing Students: A Multi-University Study.

AIM: This study examines how nursing students in Saudi Arabia view their holistic development during university study and the association between their perceptions and academic performance. BACKGROUND: Holistic nursing education fosters broad development and emphasizes students' cognitive, emotional, social, physical, and spiritual potentials. METHOD: This descriptive and correlational study utilizes the Whole Person Development Inventory to collect data from 998 student nurses enrolled in six governmental universities in Saudi Arabia. RESULTS: The professional dimension recorded the highest mean, followed by the intellectual, spiritual, physical, and psychological dimensions. The social dimension received the lowest overall mean. Intellectual, psychological, social, and spiritual development has an association with high academic performance. CONCLUSION: This study encourages policymakers and various stakeholders concerned with nursing education in the country and worldwide to be intentional and systematic in adapting the whole-person development approach in nursing education.

Nurses' Perception of Safety Culture in Medical-Surgical Units in Hospitals in Saudi Arabia.

Introduction: Patient safety captures the essence of the primary principle of medical ethics, primum non nocere, first do no harm; this is an important concern in the health care system. Nurses are indispensable members of this system and are the largest group of health care providers involved in the direct delivery of patient care. As an integral part of the health care system, it is important to know nurses' opinions on patient safety culture. Objectives: First, to evaluate and measure the existing safety culture and safety of patients in medical-surgical wards (MSW) in hospitals located in the Qassim region, in the Kingdom of Saudi Arabia. Second, to survey the opinion of registered nurses and supervisors/managers about safety culture and issues concerned with safety in hospitals in the region. Materials and Methods: A validated cross-sectional survey, namely the Hospital Survey on Patient Safety Culture (HSOPSC), was used. This survey queried 300 nurses in different MSWs in four hospitals in the Qassim Region. Results: Overall, a positive culture of safety exists in MSWs, with 69% of RNs rating their wards as having great/excellent safety culture. Notably, some participants felt it was problematic that blame was assigned to nurses for reported errors. While 55.9% of participants noted that all errors or narrowly avoided errors had been reported, less than half actually reported errors in the last year. Conclusion: The perceived safety culture was largely positive; however, the results also indicated that a culture of safety comes with some risk and blame.

Measuring mental well-being among frontline nurses during the COVID-19 crisis: Evidence from Saudi Arabia.

In the days of the COVID-19 pandemic, frontline nurses providing care to different communities face are particularly vulnerable to the mental health threats of the crisis. The objective of this study was to examine the structural validity, convergent validity, and reliability of the Warwick-Edinburgh Mental Well-Being Scale (WEMWBS) in professional nurses amidst the COVID-19 crisis in Saudi Arabia. Data were collected from 413 nurses in Saudi Arabia using a cross-sectional online survey. Consistent with the original version, results of the confirmatory factor analysis revealed a unidimensional structure of the WEMWBS. Support for convergent validity was found as the WEMWBS significantly correlated with measures of burnout and compassion satisfaction. In terms of reliability, all WEMWBS items yielded high internal consistencies suggesting that the 14 items were robust indicators of mental well-being. In response to the challenges of the COVID-19 crisis, the current study offers a psychometrically sound instrument that can be utilized in screening the mental well-being of nurses in the days of a public health crisis. Preserving the positive aspect of mental health among frontline healthcare workers and promoting quality of care for communities requires a contextualized measurement tool that efficiently assesses mental well-being.

Feasibility and prognostic role of machine learning-based FFRCT in patients with stent implantation.

OBJECTIVES: To investigate the feasibility and prognostic implications of coronary CT angiography (CCTA) derived fractional flow reserve (FFRCT) in patients who have undergone stents implantation. METHODS: Firstly, the feasibility of FFRCT in stented vessels was validated. The diagnostic performance of FFRCT in identifying hemodynamically in-stent restenosis (ISR) in 33 patients with invasive FFR ≤ 0.88 as reference standard, intra-group correlation coefficient (ICC) between FFRCT and FFR was calculated. Secondly, prognostic value was assessed with 115 patients with serial CCTA scans after PCI. Stent characteristics (location, diameter, length, etc.), CCTA measurements (minimum lumen diameter [MLD], minimum lumen area [MLA], ISR), and FFRCT measurements (FFRCT, ΔFFRCT, ΔFFRCT/stent length) both at baseline and follow-up were recorded. Longitudinal analysis included changes of MLD, MLA, ISR, and FFRCT. The primary endpoint was major adverse cardiovascular events (MACE). RESULTS: Per-patient accuracy of FFRCT was 0.85 in identifying hemodynamically ISR. FFRCT had a good correlation with FFR (ICC = 0.84). 15.7% (18/115) developed MACE during 25 months since follow-up CCTA. Lasso regression identified age and follow-up ΔFFRCT/length as candidate variables. In the Cox proportional hazards model, age (hazard ratio [HR], 1.102 [95% CI, 1.032-1.177]; p = 0.004) and follow-up ΔFFRCT/length (HR, 1.014 [95% CI, 1.006-1.023]; p = 0.001) were independently associated with MACE (c-index = 0.856). Time-dependent ROC analysis showed AUC was 0.787 (95% CI, 0.594-0.980) at 25 months to predict adverse outcome. After bootstrap validation with 1000 resamplings, the bias-corrected c-index was 0.846. CONCLUSIONS: Noninvasive ML-based FFRCT is feasible in patients following stents implantation and shows prognostic value in predicting adverse events after stents implantation in low-moderate risk patients. KEY POINTS: • Machine-learning-based FFRCT is feasible to evaluate the functional significance of in-stent restenosis in patients with stent implantation. • Follow-up △FFRCT along with the stent length might have prognostic implication in patients with stent implantation and low-to-moderate risk after 2 years follow-up. The prognostic role of FFRCT in patients with moderate-to-high or high risk needs to be further studied. • FFRCT might refine the clinical pathway of patients with stent implantation to invasive catheterization.

Challenges of nurses and care management of depressed older adults: a narrative literature review.

BACKGROUND: The number of older adults with depression has increased in recent years. In relation to this, conducting a narrative review helps provide a better understanding of the adaptive functioning of depressed older adults and the significance of interventions in reducing depression. This narrative review investigates the nurses' management of depressed older adult patients. It also presents a detailed investigation of the barriers preventing nurses from successfully implementing nursing care for older adults. METHODS: A narrative literature review was performed on four electronic databases, namely, (i) Cumulative Index of Nursing and Allied Health Literature, (ii) Pubmed, (iii) PsycINFO and (iv) Taylor and Francis. English language and peer-reviewed journal articles were included. RESULTS: A total of 19 articles were selected for the review, and four main themes were generated: (i) the challenges in implementing depression care management, (ii) the role of social support in depression treatment, (iii) the pharmacological management approach and (iv) the health care management process. CONCLUSION: Nurses experience several challenges in implementing depression care management. The role of social support in the treatment of depression, pharmacological management and different types of health care management strategies all provide solutions for depressed older adults. The review findings provide insights for improving health care nursing services for depressed older adults and reducing the negative health outcomes in this population.

Epidermal Growth Factor Receptor and Transforming Growth Factor ß Signaling Pathways Cooperate To Mediate Chlamydia Pathogenesis.

Human genital Chlamydia infection is a major public health concern due to the serious reproductive system complications. Chlamydia binds several receptor tyrosine kinases (RTKs) on host cells, including the epidermal growth factor receptor (EGFR), and activates cellular signaling cascades for host invasion, cytoskeletal remodeling, optimal inclusion development, and induction of pathogenic epithelial-mesenchyme transition (EMT). Chlamydia also upregulates transforming growth factor beta (TGF-ß) expression, whose signaling pathway synergizes with the EGFR cascade, but its role in infectivity, inclusions, and EMT induction is unknown. We hypothesized that the EGFR and TGF-ß signaling pathways cooperate during chlamydial infection for optimal inclusion development and stable EMT induction. The results revealed that Chlamydia upregulated TGF-ß expression as early as 6 h postinfection of epithelial cells and stimulated both the EGFR and TGF-ß signaling pathways. Inhibition of either the EGFR or TGF-ßR1 signaling substantially reduced inclusion development; however, the combined inhibition of both EGFR and TGF-ßR1 signaling reduced inclusions by over 90% and prevented EMT induction. Importantly, EGFR inhibition suppressed TGF-ß expression, and an inhibitory thrombospondin-1 (Tsp1)-based peptide inhibited chlamydia-induced EMT, revealing a major source of active TGF-ß during infection. Finally, TGF-ßR signaling inhibition suppressed the expression of transforming acidic coiled-coil protein-3 (TACC3), which stabilizes EGFR signaling, suggesting reciprocal regulation between TGF-ß and EGFR signaling during chlamydial infection. Thus, RTK-mediated host invasion by chlamydia upregulated TGF-ß expression and signaling, which cooperated with other cellular signaling cascades and cytoskeletal remodeling to support optimal inclusion development and EMT induction. This finding may provide new targets for chlamydial disease biomarkers and prevention.

Depression and Cognitive Control across the Lifespan: a Systematic Review and Meta-Analysis.

Depression has been shown to negatively impact neurocognitive functions, particularly those governed by fronto-subcortical networks, such as executive functions. Converging evidence suggests that depression-related executive dysfunction is greater at older ages, however, this has not been previously confirmed by meta-analysis. We performed a systematic review and meta-analysis, using three-level models, on peer-reviewed studies that examined depression-related differences in cognitive control in healthy community-dwelling individuals of any age. We focused on studies of cognitive control as defined by the National Institute of Mental Health (NIMH) Research Domain Criteria (RDoC) framework, which centers on goal-directed behavior, such as goal selection (updating, representations, maintenance), response selection (inhibition or suppression), and performance monitoring. In 16,806 participants aged 7 to 97 across 76 studies, both clinical depression and subthreshold depressive symptoms were associated with cognitive control deficits (Hedges' g = -0.31). This relationship was stronger in study samples with an older mean age. Within studies with a mean age of 39 years or higher, which represents the median age in our analyses, the relationship was stronger in clinical compared to subthreshold depression and in individuals taking antidepressant medication. These findings highlight the importance of clinicians screening for cognitive control dysfunction in patients with depression, particularly in later stages of adulthood.

Nurses' Kangaroo Mother Care practice implementation and future challenges: an integrative review.

BACKGROUND: Nurses play a crucial role in Kangaroo Mother Care practice, but their application in specific policies and practices involves challenges. A comprehensive literature review is needed to improve understanding of specific barriers that are most relevant to nurses and the improvement of this practice. This review investigates nurses' barriers in implementing Kangaroo Mother Care, in order to illustrate directions for future research. METHODS: This study was based on integrative review method and exploring nurses' barriers in implementing Kangaroo Mother Care, strategies to reduce its barriers. CINAHL, Medline, Web of Science, ProQuest Nursing and Allied Health Database, PubMed and Science Direct Taylor & Francis databases were searched for the following: (i) studies with no year restrictions, (ii) peer-reviewed journal articles, (iii) original research and (iv) articles written in English. Each article was appraised for methodological validity review using critical appraisal checklist. RESULTS: The search revealed 19 articles from diverse countries. Four main themes were generated from the synthesis of the findings: (i) barriers related to nurses' perspective and emotion towards KMC, (ii) healthcare institution barriers towards KMC, (iii) barriers related to parental experience in providing KMC and (iv) strategy to improve KMC implementation. CONCLUSIONS: Nurses experience several barriers in successfully implementing KMC in healthcare settings. This review reported strategies to reduce KMC barriers and to improve its utilisation in healthcare settings. Hospitals should establish adequate manpower, clear guidelines, sufficient supplies and equipment, capacity building among staff and proper Kangaroo Mother Care information dissemination for patients.

Influence of Religiosity on the Saudi Nursing Students' Attitudes Toward Older People and Perceptions on Elderly Care.

This cross-sectional study examined the influence of Saudi nursing students' religiosity on their attitudes toward older people and on their perceptions of elderly care. A sample of 175 nursing students of a government university in Saudi Arabia was surveyed using the Kogan's Attitudes toward Older People Scale, the Perspectives on Caring for Older Adults Scale, and the Muslim Religious Index. The students reported they are religious, they have modest attitudes toward older people, and they have neutral perception about elderly care. Religiosity showed a positive influence on the students' attitudes toward older people and on their perceptions about elderly care.

A unique insight into the MiRNA profile during genital chlamydial infection.

BACKGROUND: Genital C. trachomatis infection may cause pelvic inflammatory disease (PID) that can lead to tubal factor infertility (TFI). Understanding the pathogenesis of chlamydial complications including the pathophysiological processes within the female host genital tract is important in preventing adverse pathology. MicroRNAs regulate several pathophysiological processes of infectious and non-infectious etiologies. In this study, we tested the hypothesis that the miRNA profile of single and repeat genital chlamydial infections will be different and that these differences will be time dependent. Thus, we analyzed and compared differentially expressed mice genital tract miRNAs after single and repeat chlamydia infections using a C. muridarum mouse model. Mice were sacrificed and their genital tract tissues were collected at 1, 2, 4, and 8 weeks after a single and repeat chlamydia infections. Histopathology, and miRNA sequencing were performed. RESULTS: Histopathology presentation showed that the oviduct and uterus of reinfected mice were more inflamed, distended and dilated compared to mice infected once. The miRNAs expression profile was different in the reproductive tissues after a reinfection, with a greater number of miRNAs expressed after reinfection. Also, the number of miRNAs expressed each week after chlamydia infection and reinfection varied, with weeks eight and one having the highest number of differentially expressed miRNAs for chlamydia infection and reinfection respectively. Ten miRNAs; mmu-miR-378b, mmu-miR-204-5p, mmu-miR-151-5p, mmu-miR-142-3p, mmu-miR-128-3p, mmu-miR-335-3p, mmu-miR-195a-3p, mmu-miR-142-5p, mmu-miR-106a-5p and mmu-miR-92a-3p were common in both primary chlamydia infection and reinfection. Pathway analysis showed that, amongst other functions, the differentially regulated miRNAs control pathways involved in cellular and tissue development, disease conditions and toxicity. CONCLUSIONS: This study provides insights into the changes in miRNA expression over time after chlamydia infection and reinfection, as well as the pathways they regulate to determine pathological outcomes. The miRNAs networks generated in our study shows that there are differences in the focus molecules involved in significant biological functions in chlamydia infection and reinfection, implying that chlamydial pathogenesis occurs differently for each type of infection and that this could be important when determining treatments regime and disease outcome. The study underscores the crucial role of host factors in chlamydia pathogenesis.

The molecular mechanism of induction of unfolded protein response by Chlamydia.

The unfolded protein response (UPR) contributes to chlamydial pathogenesis, as a source of lipids and ATP during replication, and for establishing the initial anti-apoptotic state of host cell that ensures successful inclusion development. The molecular mechanism(s) of UPR induction by Chlamydia is unknown. Chlamydia use type III secretion system (T3SS) effector proteins (e.g, the Translocated Actin-Recruiting Phosphoprotein (Tarp) to stimulate host cell's cytoskeletal reorganization that facilitates invasion and inclusion development. We investigated the hypothesis that T3SS effector-mediated assembly of myosin-II complex produces activated non-muscle myosin heavy chain II (NMMHC-II), which then binds the UPR master regulator (BiP) and/or transducers to induce UPR. Our results revealed the interaction of the chlamydial effector proteins (CT228 and Tarp) with components of the myosin II complex and UPR regulator and transducer during infection. These interactions caused the activation and binding of NMMHC-II to BiP and IRE1α leading to UPR induction. In addition, specific inhibitors of myosin light chain kinase, Tarp oligomerization and myosin ATPase significantly reduced UPR activation and Chlamydia replication. Thus, Chlamydia induce UPR through T3SS effector-mediated activation of NMMHC-II components of the myosin complex to facilitate infectivity. The finding provides greater insights into chlamydial pathogenesis with the potential to identify therapeutic targets and formulations.

Ventral prefrontal cortex and emotion regulation in aging: A case for utilizing transcranial magnetic stimulation.

OBJECTIVES: The ventrolateral prefrontal cortex (vlPFC) has been speculated to play an important role in complex processes that allow emotional factors to influence human cognition. Accumulating evidence from human neuroimaging studies, in conjunction with studies of patients with lesions and animal models, shed light on the role of the vlPFC in emotion regulation (ER). This review aims to discuss and integrate recent findings related to vlPFC's role in ER in the context of aging, drawing from diverse sources, and suggest future directions for research utilizing transcranial magnetic stimulation (TMS). METHODS/DESIGN: We summarize findings from the existing literature investigating the neural basis of frontal-lobe mediated ER and then highlight major findings from recent studies directly comparing healthy younger and older adult groups. We conclude by pointing to unaddressed questions worth pursuing in future research. RESULTS AND DISCUSSION: We propose future research directions utilizing TMS to answer key unaddressed questions. Moreover, we discuss the potential advantages, challenges, and limitations of using TMS as a complement to the existing neuroimaging methods in ER.

Clinical practitioners' perception of the dimensions of patient safety culture in a government hospital: A one-sample correlational survey.

AIMS AND OBJECTIVES: To assess the perceptions of clinical practitioners regarding the different dimensions of patient safety culture in their hospital and examine the work-related predictors of patient safety culture perceptions. BACKGROUND: Patient safety is seen as a progressively critical focus in healthcare areas worldwide. Saudi Arabia aims to improve healthcare quality by providing access to healthcare for its increasing population. Hence, constantly assessing the patient safety culture of healthcare facilities in the country is imperative. DESIGN: One-sample correlational survey design. METHODS: The Hospital Survey of Patients' Safety Culture was used to survey the total population sample of 181 healthcare practitioners in a Saudi hospital from December 2018-January 2019. Strengths and weaknesses on PS culture were identified as perceived by the clinical practitioners. Regression analysis was performed to identify the work-related predictors of patient safety culture perceptions. The study followed the STROBE guideline. RESULTS: Nine of the 12 dimensions measured were identified as patient safety culture weaknesses, including 'management support for patient safety' (49.2%), 'teamwork across unit' (44.2%), 'frequency of events reporting' (43.1%), 'communication openness' (41.3%), 'overall perception of patient safety' (38.7%), 'supervisor/manager expectations and actions promoting patient safety' (32.9%), 'staffing' (23.7%), 'hospital handoffs and transitions' (19.6%) and 'non-punitive response to errors' (15.8%). None of the dimensions were identified as strengths by the respondents. Working hours per week and staff position were identified as significant predictors. CONCLUSIONS: The study underscores the urgent need to improve the patient safety culture of the hospital. RELEVANCE TO CLINICAL PRACTICE: Hospital administrators should highlight initiatives on positive patient safety impact plan for clinical practitioners and patients, such as monitoring, reporting and strictly adhering to hospital activities that reduce the risks associated with exposure to medical care.

A multi-university assessment of patient safety competence during clinical training among baccalaureate nursing students: A cross-sectional study.

AIMS AND OBJECTIVES: To assess the perceived patient safety competence during clinical training of Saudi nursing students. BACKGROUND: Ensuring safety in healthcare settings requires improvements in the educational and clinical practice of professionals. Experts stressed that shared patient safety culture must be of primary importance; they also emphasised the resolute need for theoretically driven research approaches for patient safety competence in healthcare organisations and educational institutions. DESIGN: Descriptive, cross-sectional design. METHODS: This study was conducted in six government universities in Saudi Arabia. A sample of 829 nursing students was surveyed using the health professional education in patient safety survey. Descriptive and inferential statistics were used to analyse the data. The study adhered to the STROBE guideline for cross-sectional studies (See Supporting Information Appendix S1). RESULTS: The percentage of agreement on the items of the health professional education in patient safety survey ranged from 61.5%-76.5%. The dimension "understanding human and environmental factors" received the highest perceived competence, whereas the dimension "working in teams" received the lowest competence. Significant differences in students' patient safety competence from different universities were reported. Male students perceived their competence in "working in teams" higher than the female students. Students in their internship year had significantly higher levels of competence in all the six dimensions of the health professional education in patient safety survey than students in the third- and fourth-year levels. CONCLUSIONS: Saudi nursing students have positive perceptions towards their patient safety competencies. Significant differences were found in the patient safety competence of nursing students between universities, gender and year of study. RELEVANCE TO CLINICAL PRACTICE: The results provide valuable insights and guidance for improving the patient safety competence of nursing students. The findings can be used to guide the creation of policies and interventions that may ensure the continuous development of patient safety competence of nursing students as they navigate the clinical area.