JWST detection of a supernova associated with GRB 221009A without an r-process signature.

Identifying the sites of r-process nucleosynthesis, a primary mechanism of heavy element production, is a key goal of astrophysics. The discovery of the brightest gamma-ray burst (GRB) to date, GRB 221009A, presented an opportunity to spectroscopically test the idea that r-process elements are produced following the collapse of rapidly rotating massive stars. Here we present James Webb Space Telescope observations of GRB 221009A obtained +168 and +170 rest-frame days after the gamma-ray trigger, and demonstrate that they are well described by a SN 1998bw-like supernova (SN) and power-law afterglow, with no evidence for a component from r-process emission. The SN, with a nickel mass of approximately 0.09 M ⊙, is only slightly fainter than the brightness of SN 1998bw at this phase, which indicates that the SN is not an unusual GRB-SN. This demonstrates that the GRB and SN mechanisms are decoupled and that highly energetic GRBs are not likely to produce significant quantities of r-process material, which leaves open the question of whether explosions of massive stars are key sources of r-process elements. Moreover, the host galaxy of GRB 221009A has a very low metallicity of approximately 0.12 Z ⊙ and strong H2 emission at the explosion site, which is consistent with recent star formation, hinting that environmental factors are responsible for its extreme energetics.

The benefits of contributing to the citizen science platform iNaturalist as an identifier.

As the number of observations submitted to the citizen science platform iNaturalist continues to grow, it is increasingly important that these observations can be identified to the finest taxonomic level, maximizing their value for biodiversity research. Here, we explore the benefits of acting as an identifier on iNaturalist.

A qualitative evaluation of the hot debrief/follow-up initiative: Implications of readily identifying positive outcomes in an Australian emergency department.

AIM: To gain insight into how emergency department nurses and doctors perceive the experience of being offered the opportunity to request a patient follow-up as part of a structured debrief initiative. BACKGROUND: An increased prevalence of burnout and compassion fatigue amongst emergency clinicians is being recognized globally. A wellbeing initiative has been implemented within a large public hospital emergency department to combat these phenomena. METHOD: A qualitative research approach using semi-structured interviews was carried out to explore the participants' views relating to the debrief/follow-up initiative. RESULTS: A total of 17 face-to-face semi-structured interviews were conducted. This research highlighted a number of common themes including the participants understanding and perception of the follow up initiative, the barriers and enablers of effective implementation, and the perceived benefits of following up on patient outcomes in the emergency setting. This research identified unanimous support for the initiative. No negative implications relating to the initiative were identified. CONCLUSIONS: This study indicates the positive impacts of employing a deliberate and formalized approach to enabling staff to access follow-up information about the patients for whom they provide life-giving care. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse Unit Managers should consider the findings of this research and understand the crucial role that nursing leadership can play in fostering the design and implementation of similar initiatives.

The attenuation of spider avoidance action tendencies in spider-fearful individuals and its impact on explicit evaluation of spider stimuli.

Researchers have demonstrated that individuals with heightened levels of spider-fear, as compared to relatively lower levels of spider-fear, are characterised a pattern of action tendencies that facilitates the speed to complete 'avoidance' movements, as compared to 'approach movements, in the face of spider-stimuli. However, research has not determined whether such tendencies are able to be manipulated, and the impact of their manipulation, in individuals with heightened spider-fear. Seventy-one participants who reported relatively high levels of spider-fear completed an action tendency manipulation procedure. The procedure was designed to attenuate avoidance action tendencies, by repeatedly requiring completion of approach actions in response to images of spiders (Approach Spider Condition), or to have no impact on action tendencies (Control Condition). Participants completed an assessment of approach and avoidance action tendencies to images of spiders and butterflies, and rated the unpleasantness and disgust of images of spiders and butterflies, before and after completion of the manipulation procedure. Analyses revealed that avoidance action tendencies to spider stimuli were attenuated in the Approach Spider Condition as compared to the Control Condition as intended. However, conditions did not differ in the evaluation of spider stimuli following the manipulation procedure. The findings demonstrate that avoidance action tendencies to spider stimuli can be manipulated amongst individuals with heightened spider-fear, though their manipulation does not lead to change in explicit evaluation of spider stimuli. The implications of these findings and avenues for future research are discussed.

Delivering cognitive behaviour therapy informed by a contemporary framework of psychotherapy treatment selection and adaptation.

Research into cognitive behaviour therapy can be viewed through a contemporary framework of psychotherapy delivery. This model divides psychotherapy decision-making into two phases: selection and adaptation. In the first, selection phase, clinicians consider the evidence-base of therapies for a clinical presentation and choose which to implement first. The second element of the contemporary framework of psychotherapy delivery is adaptation. Thus, psychotherapy research needs to go beyond a demonstration of the effectiveness of CBT to understanding the processes of psychotherapy.

Origins of Gender Affirmation Surgery: The History of the First Gender Identity Clinic in the United States at Johns Hopkins.

BACKGROUND: Gender-affirming care, including surgery, has gained more attention recently as third-party payers increasingly recognize that care to address gender dysphoria is medically necessary. As more patients are covered by insurance, they become able to access care, and transgender cultural competence is becoming recognized as a consideration for health care providers. A growing number of academic medical institutions are beginning to offer focused gender-affirming medical and surgical care. In 2017, Johns Hopkins Medicine launched its new Center for Transgender Health. In this context, history and its lessons are important to consider. We sought to evaluate the operation of the first multidisciplinary Gender Identity Clinic in the United States at the Johns Hopkins Hospital, which helped pioneer what was then called "sex reassignment surgery." METHODS: We evaluated the records of the medical archives of the Johns Hopkins University. RESULTS: We report data on the beginning, aim, process, outcomes of the clinic, and the reasons behind its closure. This work reveals the function of, and the successes and challenges faced by, this pioneering clinic based on the official records of the hospital and mail correspondence among the founders of the clinic. CONCLUSION: This is the first study that highlights the role of the Gender Identity Clinic in establishing gender affirmation surgery and reveals the reasons of its closure.

A patient and family data domain collection framework for identifying disparities in pediatrics: results from the pediatric health equity collaborative.

BACKGROUND: By 2020, the child population is projected to have more racial and ethnic minorities make up the majority of the populations and health care organizations will need to have a system in place that collects accurate and reliable demographic data in order to monitor disparities. The goals of this group were to establish sample practices, approaches and lessons learned with regard to race, ethnicity, language, and other demographic data collection in pediatric care setting. METHODS: A panel of 16 research and clinical professional experts working in 10 pediatric care delivery systems in the US and Canada convened twice in person for 3-day consensus development meetings and met multiple times via conference calls over a two year period. Current evidence on adult demographic data collection was systematically reviewed and unique aspects of data collection in the pediatric setting were outlined. Human centered design methods were utilized to facilitate theme development, facilitate constructive and innovative discussion, and generate consensus. RESULTS: Group consensus determined six final data collection domains: 1) caregivers, 2) race and ethnicity, 3) language, 4) sexual orientation and gender identity, 5) disability, and 6) social determinants of health. For each domain, the group defined the domain, established a rational for collection, identified the unique challenges for data collection in a pediatric setting, and developed sample practices which are based on the experience of the members as a starting point to allow for customization unique to each health care organization. Several unique challenges in the pediatric setting across all domains include: data collection on caregivers, determining an age at which it is appropriate to collect data from the patient, collecting and updating data at multiple points across the lifespan, the limits of the electronic health record, and determining the purpose of the data collection before implementation. CONCLUSIONS: There is no single approach that will work for all organizations when collecting race, ethnicity, language and other social determinants of health data. Each organization will need to tailor their data collection based on the population they serve, the financial resources available, and the capacity of the electronic health record.

Self-Assembled Lipid Cubic Phase and Cubosomes for the Delivery of Aspirin as a Model Drug.

Three-dimensionally organized lipid cubic self-assemblies and derived oil-in-water emulsions called "cubosomes" are attractive for various biotechnological applications due to their ability to be loaded with functional molecules and their associated sustained release properties. Here, we employed both of these lipid-based systems for the delivery of a model drug, aspirin, under comparable conditions. Studies were performed by varying drug-to-lipid ratio and the type of release medium, water and phosphate buffer saline (PBS). Release rates were determined using UV-vis spectroscopy, and small-angle X-ray scattering was used to confirm the type of self-assembled nanostructures formed in these lipid systems. The release from the bulk lipid cubic phase was sustained as compared to that of dispersed cubosomes, and the release in PBS was more efficient than in water. The tortuosity of the architecture, length of the diffusion pathway, type of nanostructure, and physicochemical interaction with the release media evidently contribute to these observations. This work is particularly important as it is the first report where both of these nanostructured lipid systems have been studied together under similar conditions. This work provides important insights into understanding and therefore controlling the release behavior of lipid-based drug nanocarriers.

Development and psychometric assessment of the healthcare provider cultural competence instrument.

This study presents the measurement properties of 5 scales used in the Healthcare Provider Cultural Competence Instrument (HPCCI). The HPCCI measures a health care provider's cultural competence along 5 primary dimensions: (1) awareness/sensitivity, (2) behaviors, (3) patient-centered communication, (4) practice orientation, and (5) self-assessment. Exploratory factor analysis demonstrated that the 5 scales were distinct, and within each scale items loaded as expected. Reliability statistics indicated a high level of internal consistency within each scale. The results indicate that the HPCCI effectively measures the cultural competence of health care providers and can provide useful professional feedback for practitioners and organizations seeking to increase a practitioner's cultural competence.

Benign lymphangioendothelioma presenting as a giant flank mass.

Benign lymphangioendothelioma is a rare lesion of controversial etiology and a histopathologic mimic of Kaposi sarcoma and so-called 'well-differentiated' angiosarcoma. Its most typical clinical presentation is as a slowly expanding, erythematous patch or plaque; it rarely presents as a large mass. We report the second case of a giant benign lymphangioendothelioma, which arose as a serpiginous mass involving most of the flank of an elderly male with no prior radiation exposure and with a remote history of herpes zoster infection. A biopsy revealed numerous anastomosing vascular channels extending from the superficial dermis to the subcutis that were dilated to progressively slit-like in architecture. The endothelial cells lacked cytologic atypia, hobnailing, or significant mitotic activity, and human herpesvirus-8 expression was absent. Positivity for podoplanin (D2-40) was observed in the endothelial cells, supporting a lymphatic phenotype. Furthermore, the lesional cells lacked immunohistochemical expression of Wilms tumor 1, providing further support of a malformative - rather than neoplastic - pathogenesis.