Outflows from the youngest stars are mostly molecular.

The formation of stars and planets is accompanied not only by the build-up of matter, namely accretion, but also by its expulsion in the form of highly supersonic jets that can stretch for several parsecs1,2. As accretion and jet activity are correlated and because young stars acquire most of their mass rapidly early on, the most powerful jets are associated with the youngest protostars3. This period, however, coincides with the time when the protostar and its surroundings are hidden behind many magnitudes of visual extinction. Millimetre interferometers can probe this stage but only for the coolest components3. No information is provided on the hottest (greater than 1,000 K) constituents of the jet, that is, the atomic, ionized and high-temperature molecular gases that are thought to make up the jet's backbone. Detecting such a spine relies on observing in the infrared that can penetrate through the shroud of dust. Here we report near-infrared observations of Herbig-Haro 211 from the James Webb Space Telescope, an outflow from an analogue of our Sun when it was, at most, a few times 104 years old. These observations reveal copious emission from hot molecules, explaining the origin of the 'green fuzzies'4-7 discovered nearly two decades ago by the Spitzer Space Telescope8. This outflow is found to be propagating slowly in comparison to its more evolved counterparts and, surprisingly, almost no trace of atomic or ionized emission is seen, suggesting its spine is almost purely molecular.

Sense of coherence moderates job demand-resources and impact on burnout among nurses and midwives in the context of the COVID-19 pandemic: A cross-sectional survey.

AIM: This study aimed to test the propositions using the job demands-resources (JD-R) model for main/moderation/mediation effects of a sense of coherence and practice environment support on mental well-being (anxiety, depression and burnout) outcomes in nurses and midwives in Australia during the COVID-19 pandemic. DESIGN: Cross-sectional quantitative survey. DATA SOURCES: The study was a cross-sectional design using self-report questionnaires reported as per the Reporting of Observational Studies in Epidemiology Guidelines. Following human research ethics approval (2020.ETH.00121) participants were recruited to take part in an online anonymous survey using self-report instruments to test the JD-R model in Australia. RESULTS: 156 participant nurses and midwives experienced anxiety, depression and emotional burnout during COVID-19. While a considerable proportion of participants indicated high levels of emotional exhaustion, their responses showed low levels of depersonalization (detached response to other people) and high levels of personal accomplishment (high levels of work performance and competence). A sense of coherence was a significant protective factor for mental health well-being for the participants, which is to say, high levels of sense of coherence were predictive of lower levels of anxiety, depression and burnout in this study sample. CONCLUSION: It is evident that both nursing and midwifery professions require psychosocial support to preserve their health both in the short and long term. Ensuring individualized tailored support will require a layered response within organizations aimed at individual self-care and collegial peer support. PATIENT OR PUBLIC CONTRIBUTION: There was no patient or public contribution in this study, as the focus was on nurses and midwives.

Understanding the needs and preferences for cancer care among First Nations people: An integrative review.

AIM: This systematic review aimed to identify the needs and preferences for cancer care services among Australian First Nations people. DESIGN: Integrative review. DATA SOURCES: An integrative review was conducted. A wide range of search terms were used to increase the sensitivity and specificity of the searches in electronic databases. Methodological quality assessment, data extraction, was conducted independently by two reviewers, and a narrative synthesis was conducted. RESULTS: Forty-two studies were included. A total of 2965 Australian First Nations adults, both men and women of various ages across the lifespan, were represented; no First Nations children affected by cancer were represented in the studies. Three themes emerged which included: (1) discrimination, racism and trauma, resulting from colonization, directly impacted First National people's cancer care experience; (2) cultural ways of knowing, being and doing are fundamental to how First Nations people engage with cancer care services; and (3) First Nations people need culturally safe person-centred cancer care services that address practical needs. CONCLUSION: Most participants represented in this review experienced discrimination, racism and trauma, resulting from colonization, which directly negatively impacted Aboriginal peoples' cancer care experience. While the Optimal Cancer Pathway (OCP) was launched in Australia several years ago, people with cancer may continue to experience distressing unmet care needs. PATIENT OR PUBLIC CONTRIBUTION: Our team includes both First Nations people, non-First Nations researchers and healthcare professionals with expertise in cancer care. The researchers employed decolonizing restorative approaches to ensure voice, respect, accountability and reciprocity in this review work. IMPLICATIONS FOR NURSING PRACTICE: Members of the multidisciplinary team including nurses and policymakers should reflect on these findings, ensure that they have up-to-date cultural safety training and stand together with Indigenous and non-Indigenous cancer leaders to take proactive steps to stamp out and dismantle oppression in health, and safely implement the OCP.

The diverse chemistry of protoplanetary disks as revealed by JWST.

Early results from the James Webb Space Telescope-Mid-InfraRed Instrument (JWST-MIRI) guaranteed time programs on protostars (JOYS) and disks (MINDS) are presented. Thanks to the increased sensitivity, spectral and spatial resolution of the MIRI spectrometer, the chemical inventory of the planet-forming zones in disks can be investigated with unprecedented detail across stellar mass range and age. Here, data are presented for five disks, four around low-mass stars and one around a very young high-mass star. The mid-infrared spectra show some similarities but also significant diversity: some sources are rich in CO2, others in H2O or C2H2. In one disk around a very low-mass star, booming C2H2 emission provides evidence for a "soot" line at which carbon grains are eroded and sublimated, leading to a rich hydrocarbon chemistry in which even di-acetylene (C4H2) and benzene (C6H6) are detected. Together the data point to an active inner disk gas-phase chemistry that is closely linked to the physical structure (temperature, snowlines, presence of cavities and dust traps) of the entire disk and which may result in varying CO2/H2O abundances and high C/O ratios >1 in some cases. Ultimately, this diversity in disk chemistry will also be reflected in the diversity of the chemical composition of exoplanets.

Just a bad flu? Tackling the "infodemic" in Ireland through a comparative analysis of hospitalised cases of COVID-19 and influenza.

OBJECTIVES: COVID-19 infection has been compared to seasonal influenza as an argument against non-pharmacological population-based infection control measures known as "lockdowns". Our study sought to compare disease severity measures for patients in Ireland hospitalised with COVID-19 against those hospitalised with seasonal influenza. STUDY DESIGN: This is a retrospective population-based cohort study. METHODS: COVID-19 hospital episodes and seasonal influenza hospital episodes were identified using relevant International Classification of Disease (ICD-10) codes from the Irish national hospitalisation dataset. The occurrences of key metrics of disease severity, length of stay, intensive care admission, ventilatory support, haemodialysis and in-hospital mortality were measured and compared between the two groups using odds ratios with 95% confidence intervals (CIs), stratified by age. RESULTS: Hospitalised COVID-19 episodes had a mean length of stay more than twice as long as hospitalised influenza episodes (17.7 days vs 8.3 days). The likelihood of all measures of disease severity was greater in COVID-19 episodes, and the odds of in-hospital mortality were five-fold higher in this group compared with seasonal influenza episodes (OR 5.07, 95% CI 4.29-5.99, P < 0.001). Greater likelihood of increased disease severity was observed for COVID-19 episodes in most age groups. CONCLUSIONS: COVID-19 is a more severe illness than seasonal influenza in hospitalised cohorts. It is imperative that public health professionals ensure that evidence-based advocacy is part of the response to COVID-19 to tackle a dangerous "infodemic" that can undermine public health control measures.

Routine testing of close contacts of confirmed COVID-19 cases - National COVID-19 Contact Management Programme, Ireland, May to August 2020.

OBJECTIVES: The objective of this study was to inform public health practitioners who are designing, adapting and implementing testing and tracing strategies for Coronavirus disease (COVID-19) control. STUDY DESIGN: The study design is monitoring and evaluation of a national public health protection programme. METHODS: All close contacts of laboratory-confirmed cases of COVID-19 identified between the 19th May and 2nd August were included; secondary attack rates and numbers needed to test were estimated. RESULTS: Four thousand five hundred eighty six of 7272 (63%) close contacts of cases were tested with at least one test. The secondary attack rate in close contacts who were tested was 7% (95% Confidence Interval [CI]: 6.3 - 7.8%). At the 'day 0' test, 14.6% (95% CI: 11.6-17.6%) of symptomatic close contacts tested positive compared with 5.2% (95% CI: 4.4-5.9%) of asymptomatic close contacts. CONCLUSIONS: The application of additional symptom-based criteria for testing in this high-incidence population (close contacts) is of limited utility because of the low negative predictive value of absence of symptoms.

Counting the Toll of Smoking-Attributable Hospitalisations.

Aim In Ireland, 20% of adults smoke. Many current and ex-smokers live with ill-health and disability as a result of smoking, and this study aimed to quantify the extent of smoking-related hospitalisations in Irish publicly-funded hospitals. Methods A population attributable fractions approach was used in this analysis utilising smoking prevalence data from the Healthy Ireland Survey and combining this with internationally-recognised relative-risks for current and past smoking, and hospitalisation data and hospital base costs data sourced from HIPE, for the years 2011-2016. Results In 2016, there were 21,486 day case admissions, 33,615 inpatient hospital admissions consuming 309,117 bed days, attributable to smoking and exposure to second-hand smoke, with an estimated cost of €172 million in publicly funded hospitals. This represents 2% of day case admissions, 5% of inpatient admissions, and 8% of inpatient bed days for that year. Conclusion Smoking continues to cause a considerable impact on hospital services in Ireland.

Appraisal of International Guidelines on Smoking Cessation using the AGREE II Assessment Tool

Aims Several international professional bodies have produced and disseminated clinical practice guidelines (CPGs) for smoking cessation. However, to date, the quality of guidelines for use in the Irish context has never been appraised and explored. The aim of this study was to identify and evaluate the quality of methodological rigours and transparency used in guidelines for smoking cessation (for speciô€‚¡c groups including: general adult population; persons with mental illness; and pregnant women). Methods The research for the relevant smoking cessation guidelines was conducted using a systematic search strategy of scientiô€‚¡c databases (including guideline websites; PubMed; and Google ®) from January 2006 to June 2017. The quality of the CPGs was independently assessed by at least two assessors using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) instrument, and speciô€‚¡c recommendations in guidelines were evaluated. Domain scores were considered of suô€‚£cient quality when ≥ 60% and of good quality when ≥ 80%. Results Nine guidelines were retrieved. Five guidelines scored ≥ 60% in at least four domains. The median score for the scope and purpose domain was 80% (Range: 61 to 94%). The median score for the stakeholder involvement domain was 63% (Range: 26 to 85%), and six guidelines scored ≥ 60%. The median score for the rigour of development domain was 39% (Range: 23 to 77%), and four guidelines scored ≥ 60%. The median score for clarity of presentation domain was 89% (Range: 56 to 96%), and eight guidelines scored ≥ 60%. The median score the applicability domain was 39% (Range: 21 to 57%). None of guidelines scored ≥ 60%. The median score for the editorial independence domain was 78% (Range: 0 to 90%); only seven guidelines scored ≥ 60%. Conclusions Smoking cessation guideline quality assessment varied across all six AGREE II domains, demonstrating the importance of using a formal appraisal tool prior to guideline adaptation and implementation into clinical settings. Our ô€‚¡ndings have demonstrated higher scores among the most recent guidelines, reô€‚¢ecting improvement in the quality of guideline development over time. Methodology and editorial independence were particular concerns and this assessment also highlighted a need for contextualisation to the Irish healthcare system. In conclusion, the plan for Ireland is to adapt rather than simply adopt existing guidelines.

A Comparison of Summer and Winter Emergency Hospitalisations in Ireland

There is increasing demand on the Irish health service, particularly in winter months. This study described and compared acute hospitals admissions across summer and winter periods from 2015 to 2018. The analysis used Hospital In-Patient Enquiry data accessed through the National Quality Assurance Information System ­ NQAIS Clinical. There were 84 additional emergency hospitalisations in winter per week compared with summer (1.2% increase). Across diagnostic categories, emergency hospitalisations reduced in winter, except respiratory conditions which increased by 379 per week representing a 40.5% increase. The profile of emergency respiratory admissions were similar in summer and winter in terms of age, length of stay, day of week and medical card status. Length of stay was approximately one day longer for weekend admissions in both seasons. This research highlights the importance of taking a whole-population approach to winter resilience planning, focussing on prevention and optimal management of respiratory conditions.

Non-interpretive radiology: an Irish perspective.

AIM: To describe and quantify the range of non-interpretive tasks engaged in by consultant radiologists in Ireland today. MATERIALS AND METHODS: A multiple-choice electronic survey was circulated to over 200 Irish consultant radiologists and results were analysed. RESULTS: Responses were received from approximately 40% of the 267 full-time equivalent consultants in Ireland at the time of the survey. There was a wide sub-specialty mix, and responses from both clinical directors and those without designated administrative responsibility. Overall, the three most time-consuming activities were reported to be multidisciplinary meetings, vetting, and informal consultations. Non-interpretive tasks were estimated to account for 35% of the working week, with higher figures (up to 60%) for clinical directors. CONCLUSION: Consultant radiologists in Ireland spend a significant proportion of their time engaged in non-interpretive radiology; acknowledgement and scheduling of non-interpretive tasks will need to be supported by appropriate workforce planning. Non-interpretive skills will also need to be addressed during training to adequately prepare trainees for the reality of the workplace.

Attitudes and Uptake of Seasonal Influenza Vaccination for Health Service Executive (HSE) Staff.

Aims Annual seasonal influenza (flu) vaccination is recommended for all healthcare workers (HCW) in the Health Service Executive (HSE) in Ireland. This is to reduce the risk of HCW contracting the flu and onward transmission to their patients. HCW uptake remains less than ideal, despite extensive seasonal influenza campaigns and vaccination promotions. The aim of this study was to investigate the attitudes and uptake to flu vaccination among HCW, and to determine how much these influence their decision to be vaccinated. Methods A survey was sent to HCWs working in three healthcare facilities within HSE North-East following an outbreak of seasonal influenza in a local long-term care facility (LTCF), asking if HCW had been vaccinated for the 2016 to 2017 influenza season; the survey additionally included questions about attitudes and beliefs with respect to vaccination. Results Seventy HSE-employed HCWs in the North-East counties of Ireland responded to survey (93.3% responded to survey; 61.4% were based in long-term care facilties; 80.0% were female; and 35.7% were vaccinated for 2016 to 2017 influenza season). Most respondents reported that HCW flu vaccination was good example for patients (87.1%), while 92.9% acknowledged that it was important in healthcare facilities. The majority of HCW supported annual HCW flu vaccination (68.6%), with 52.9% of respondents reporting that they would be vaccinated for the 2017 to 2018 influenza season. However, only 35.7% agreed with mandatory HCW vaccination. Furthermore, 28.6% of respondents were concerned that flu vaccination was associated with side effects, and 22.9% were not aware that flu vaccination protected their patients. Previous flu vaccination was shown to be the only statistically significant predictor for HCW vaccination (p < 0.001). Discussion These results suggest there is need to address some attitudes and beliefs around HCW vaccination for seasonal influenza, in addition to removing some practical barriers to having vaccination, may help contribute to an improvement in vaccination uptake. It might be useful to focus on specific topics, to create a vaccine promotion culture, like adverse effects of vaccination, and collective benefits for patients in HSE to help improve HCW staff vaccination uptake.

Emission lines due to ionizing radiation from a compact object in the remnant of Supernova 1987A.

The nearby Supernova 1987A was accompanied by a burst of neutrino emission, which indicates that a compact object (a neutron star or black hole) was formed in the explosion. There has been no direct observation of this compact object. In this work, we observe the supernova remnant with JWST spectroscopy, finding narrow infrared emission lines of argon and sulfur. The line emission is spatially unresolved and blueshifted in velocity relative to the supernova rest frame. We interpret the lines as gas illuminated by a source of ionizing photons located close to the center of the expanding ejecta. Photoionization models show that the line ratios are consistent with ionization by a cooling neutron star or a pulsar wind nebula. The velocity shift could be evidence for a neutron star natal kick.

Development and preliminary validation of a plate-based CB1/CB2 receptor functional assay.

Cannabinoid (CB) receptors are being targeted therapeutically for the treatment of anxiety, obesity, movement disorders, glaucoma, and pain. More recently, cannabinoid agonists have displayed antiproliferative activity against breast cancer and prostate cancer in animal models. To study cannabinoid receptor ligands, we have developed a novel plate-based assay that measures internalization of CB1/CB2 receptors by determining the change in the intracellular levels of the radiolabeled agonists: [(3)H]Win55-212-2 for CB1 and [(3)H]CP55-940 for CB2. The developed plate-based assay was validated by determining IC50 values for known antagonists: AM251, AM281, AM630, and AM6545. The data obtained were consistent with previously reported values, thereby confirming that the assay can be used to determine the functional binding activities (IC50) of antagonists for the CB1 and CB2 receptors. In addition, we demonstrated that the plate-based assay may be used for screening against complex matrices. Specifically, we demonstrated that the plate-based assay was able to identify which extracts of several species of the genus Zanthoxylum had activity at the CB1/CB2 receptors.

The unmet supportive care needs of people affected by cancer during the COVID-19 pandemic: an integrative review.

PURPOSE: To critically synthesise evidence regarding the supportive care needs of those living with cancer during the COVID-19 pandemic. METHODS: An integrative systematic review followed a pre-registered protocol, reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) Guidelines. We searched three databases (CINAHL, MEDLINE, and APA PsycINFO) using keywords and included all qualitative, quantitative, and mixed methods studies irrespective of research design published between December 2019 and February 2022. All articles were double screened according to a pre-determined eligibility criterion with reference lists of the final included studies checked for further studies. The review process was managed using Covidence systematic review software. Data from the studies were extracted, methodological quality appraisal conducted, and a narrative synthesis conducted. RESULTS: Eighteen publications were included. The findings identified that individuals affected by cancer reported a range of physical, psychological, social, and health system unmet needs during the global pandemic. Unique to the pandemic itself, there was fear of the unknown of the longer-term impact that the pandemic would have on treatment outcomes, cancer care follow-up, and clinical service delays. CONCLUSION: Many individuals living with cancer experienced unmet needs and distress throughout the different waves of the COVID-19 pandemic, irrespective of cancer type, stage, and demographic factors. IMPLICATIONS FOR CANCER SURVIVORS: We recommend clinicians use these findings to identify the individual person-centred needs to optimise recovery as we transition to the post-pandemic cancer care.

Exploring Experiences Among People Diagnosed With Cancer During the COVID-19 Pandemic: A Qualitative Descriptive Study.

OBJECTIVES: To describe the experiences of people diagnosed with cancer during the COVID-19 pandemic. DATA SOURCES: Qualitative data were collected through semistructured interviews conducted with people affected by cancer in the Australian context. Following institutional ethical approval, interviews were conducted over Microsoft Teams and Zoom platforms and complied with confidentiality requirements. Data were transcribed verbatim and analyzed, and emergent themes were developed using thematic analysis to understand patient experiences of cancer care during the COVID-19 pandemic. CONCLUSIONS: The COVID-19 pandemic was disruptive to the daily experiences of supportive care. Four overarching themes were identified related to: 1) the impact on accessing healthcare services, 2) encounters with healthcare professionals, 3) the impact on daily living, and 4) the impact of COVID on psychological well-being. IMPLICATIONS FOR NURSING PRACTICE: As the COVID-19 pandemic held global consequences on cancer practices, it is recommended that nursing and other multidisciplinary healthcare professionals reflect upon these findings, in the context of planning for future pandemics. We encourage further exploration into the sustainability of telehealth services universally, given the issues highlighted in this study.

To understand the experiences, needs, and preferences for supportive care, among children and adolescents (0-19 years) diagnosed with cancer: a systematic review of qualitative studies.

PURPOSE: This study aimed to understand the experiences, needs, and preferences for supportive care, among children and adolescents (0-19 years) diagnosed with cancer. METHODS: A qualitative systematic review has been reported according to PRISMA guidelines. A comprehensive search was conducted across multiple databases (APA PsycINFO, CINAHL, and Medline) and citation searches. Studies were screened according to pre-determined inclusion and exclusion criteria. Methodological quality was evaluated. Findings were extracted in relation to the context of interest of experiences, needs, and preferences of supportive care. Each finding was accompanied by a qualitative verbatim illustration representing the participant's voice. RESULTS: 4449 publications were screened, and 44 studies were included. Cancer populations represented in the included studies included lymphoma, leukaemia, brain cancer, sarcomas, and neuroblastoma. Two overarching synthesised findings were identified as (1) coping, caring relationships, communication, and impact of the clinical environment, and (2) experiences of isolation, fear of the unknown, restricted information, and changing self. Children and adolescents articulated that cancer care would be enhanced by developing a sense of control over their body and healthcare, being involved in communication and shared decision-making, and ensuring the clinical environment is age-appropriate. Many experienced a sense of disconnection from the rest of the world (including peers, school, and experiences of prejudice and bullying), and a lack of tailored support and information were identified as key unmet care needs that require further intervention. CONCLUSIONS: Children and adolescent who are diagnosed with cancer are a unique and understudied group in oncological survivorship research, with the slowest progress in improvement of care over time. This review will facilitate the development of future interventions and promote the importance of tailored support for children and adolescents at all stages of the cancer journey. IMPLICATIONS FOR CANCER SURVIVORS: Children and adolescents continue to experience a range of difficulties despite routine contact with cancer healthcare professionals. Children and adolescents should be carefully assessed about their individual circumstances and preferences for support given the clear implications from this review that "one size" does not fit all.

Provision of smoking cessation support for patients following a diagnosis of cancer in Ireland.

There is growing evidence that smoking cessation (SC) improves outcomes following diagnosis of cancer. Notwithstanding adverse outcomes, a significant number of those diagnosed with cancer continue to smoke. Our objective was to document the SC services provided for patients with cancer by specialist adult cancer hospitals across Ireland, a country with a stated tobacco endgame goal. A cross-sectional survey based on recent national clinical guidelines was used to determine SC care delivery across eight adult cancer specialist hospitals, and one specialist radiotherapy centre. Qualtrics was used. The response rate was 88.9% with data reported from seven cancer hospitals and one specialist radiotherapy centre, all indicating they had some SC related provision (100%). Stop smoking medications were provided to cancer inpatients in two hospitals, at outpatients and attending day ward services in one hospital. Smokers with cancer were referred automatically to the SC service in two hospitals at diagnosis. While stop smoking medications were available 24 h a day in five hospitals, most did not stock all three (Nicotine Replacement Therapy, Bupropion, Varenicline). One hospital advised they had data on uptake of SC services for smokers with cancer but were unable to provide detail. There is considerable variation in SC information and services provided to cancer patients across adult cancer specialist centres in Ireland, reflecting the suboptimal practice of smoking cessation for patients with cancer found in the limited international audits. Such audits are essential to demonstrate service gaps and provide a baseline for service improvement.

Allometry of sexual size dimorphism in dioecious plants: do plants obey Rensch's rule?

Rensch's rule refers to a pattern in sexual size dimorphism (SSD) in which SSD decreases with body size when females are the larger sex and increases with body size when males are the larger sex. Many animal taxa conform to Rensch's rule, but it has yet to be investigated in plants. Using herbarium collections from New Zealand, we characterized the size of leaves and stems of 297 individuals from 38 dioecious plant species belonging to three distantly related phylogenetic lineages. Statistical comparisons of leaf sizes between males and females showed evidence for Rensch's rule in two of the three lineages, indicating SSD decreases with leaf size when females produce larger leaves and increases with leaf size when males produce larger leaves. A similar pattern in SSD was observed for stem sizes. However, in this instance, females of small-stemmed species produced much larger stems than did males, but as stem sizes increased, SSD often disappeared. We hypothesize that sexual dimorphism in stem sizes results from selection for larger stems in females, which must provide mechanical support for seeds, fruits, and dispersal vectors, and that scaling relationships in leaf sizes result from correlated evolution with stem sizes. The overall results suggest that selection for larger female stem sizes to support the weight of offspring can give rise to Rensch's rule in dioecious plants.