Exploring COVID-19 patient's dignity and satisfaction: A cross-sectional study.

AIM: With the outbreak of COVID-19 and associated challenges such as increased workload for health providers and shortage of equipment, it became more challenging to maintain patients' dignity and satisfaction. This study evaluated the patients' dignity and satisfaction with COVID-19 in Kashan, Iran, in 2021. DESIGN: A cross-sectional descriptive study. METHODS: In total, 385 patients recovered from COVID-19 were selected through sequential sampling method. Data were collected using demographic, patient dignity inventory, and patient satisfaction questionnaires. Data were analysed using descriptive analysis, independent t-test, ANOVA, and Spearman-Brown coefficient. RESULTS: The mean age of patients was 50.57. The mean scores of patients' dignity and satisfaction were 1.622 ± 0.653 and 3.851 ± 0.548 (out of 5), respectively. The dignity rating was associated with age, gender, education, underlying disease, and length of hospital stay (p < 0.05); but patient satisfaction was only associated with education (p = 0.002). The results indicated that dignity and satisfaction have a significant direct correlation (r = -0.23, p < 0.001). PATIENT OR PUBLIC CONTRIBUTION: This study was designed based on the research priorities and needs in the field of clinical research and patients were involved in conducting the study via participating in data collection.

Impacts of recent climate change on crop yield can depend on local conditions in climatically diverse regions of Norway.

Globally, climate change greatly impacts the production of major crops, and there have been many attempts to model future yields under warming scenarios in recent years. However, projections of future yields may not be generalisable to all crop growing regions, particularly those with diverse topography and bioclimates. In this study, we demonstrate this by evaluating the links between changes in temperature and precipitation and changes in wheat, barley, and potato yields at the county-level during 1980-2019 in Norway, a Nordic country with a range of climates across a relatively small spatial scale. The results show that the impacts of climate variables on yield vary widely by county, and that for some crops, the strength and direction of the link depends on underlying local bioclimate. In addition, our analysis demonstrates the need for some counties to focus on weather changes during specific crucial months corresponding with certain crop growth stages. Furthermore, due to the local climatic conditions and varying projected climate changes, different production opportunities are likely to occur in each county.

Effectiveness of kangaroo mother care on maternal resilience and breastfeeding self-efficacy using the role-play method in a neonatal intensive care unit.

BACKGROUND: Kangaroo mother care (KMC) offers several benefits for neonates and mothers. Although many studies have evaluated the effectiveness of KMC on infants, only few studies have examined the effects on mothers. This study aimed to evaluate the effectiveness of KMC on maternal resilience and breastfeeding self-efficacy via the role-play method in a neonatal intensive care unit. METHODS: We conducted a randomized controlled trial. Mothers were randomized into two groups. Mothers in the intervention group were trained using the role-play method. Questionnaires were administered before and after the intervention. Data were analyzed with SPSS version 22. RESULTS: The training demonstrated a statistically significant difference in resilience score and breastfeeding self-efficacy in each group after the intervention. In addition, a statistically significant difference was revealed between both groups in resilience scores and breastfeeding self-efficacy after the intervention. CONCLUSIONS: KMC training with the role-play method was most effective. Role-play and routine methods are recommended as methods of therapeutic care in clinical settings to improve maternal resilience and breastfeeding self-efficacy.

INTRODUCCIÓN: El cuidado madre canguro ofrece una gran cantidad de beneficios para el neonato y la madre. Aunque muchos estudios han evaluado la eficacia del cuidado madre canguro en los bebés, solo pocos estudios han examinado los efectos en las madres. El propósito del presente estudio fue evaluar la efectividad del cuidado madre canguro sobre la resiliencia de la madre y la autoeficacia de la lactancia mediante el método de juego de roles en la unidad de cuidados intensivos neonatales. MÉTODOS: Se llevó a cabo un ensayo controlado aleatorio. Las madres se asignaron en dos grupos al azar. Las madres del grupo de intervención fueron capacitadas mediante el método de juego de roles. Se aplicaron cuestionarios antes y después de la intervención. Los datos se analizaron utilizando SPSS versión 22. RESULTADOS: El entrenamiento demostró una diferencia estadísticamente significativa en la puntuación de la resiliencia y la autoeficacia de la lactancia en cada grupo después de la intervención. Además, se reveló una diferencia estadísticamente significativa entre ambos grupos en la puntuación de resiliencia y la autoeficacia de la lactancia después de la intervención. CONCLUSIONES: La capacitación del cuidado madre canguro mediante el método de juego de roles fue más efectiva. Se recomienda el juego de roles y los métodos de rutina como métodos de atención terapéutica en entornos clínicos para mejorar la resiliencia de la madre y la autoeficacia de la lactancia.

Effectiveness of kangaroo mother care on maternal resilience and breastfeeding self-efficacy using the role-play method in a neonatal intensive care unit / Eficacia de los cuidados madre canguro sobre la resiliencia de la madre y la autoeficacia de la lactancia materna mediante el método de juego de roles en una unidad de cuidados intensivos neonatales

Abstract Background: Kangaroo mother care (KMC) offers several benefits for neonates and mothers. Although many studies have evaluated the effectiveness of KMC on infants, only few studies have examined the effects on mothers. This study aimed to evaluate the effectiveness of KMC on maternal resilience and breastfeeding self-efficacy via the role-play method in a neonatal intensive care unit. Methods: We conducted a randomized controlled trial. Mothers were randomized into two groups. Mothers in the intervention group were trained using the role-play method. Questionnaires were administered before and after the intervention. Data were analyzed with SPSS version 22. Results: The training demonstrated a statistically significant difference in resilience score and breastfeeding self-efficacy in each group after the intervention. In addition, a statistically significant difference was revealed between both groups in resilience scores and breastfeeding self-efficacy after the intervention. Conclusions: KMC training with the role-play method was most effective. Role-play and routine methods are recommended as methods of therapeutic care in clinical settings to improve maternal resilience and breastfeeding self-efficacy.

Resumen Introducción: El cuidado madre canguro ofrece una gran cantidad de beneficios para el neonato y la madre. Aunque muchos estudios han evaluado la eficacia del cuidado madre canguro en los bebés, solo pocos estudios han examinado los efectos en las madres. El propósito del presente estudio fue evaluar la efectividad del cuidado madre canguro sobre la resiliencia de la madre y la autoeficacia de la lactancia mediante el método de juego de roles en la unidad de cuidados intensivos neonatales. Métodos: Se llevó a cabo un ensayo controlado aleatorio. Las madres se asignaron en dos grupos al azar. Las madres del grupo de intervención fueron capacitadas mediante el método de juego de roles. Se aplicaron cuestionarios antes y después de la intervención. Los datos se analizaron utilizando SPSS versión 22. Resultados: El entrenamiento demostró una diferencia estadísticamente significativa en la puntuación de la resiliencia y la autoeficacia de la lactancia en cada grupo después de la intervención. Además, se reveló una diferencia estadísticamente significativa entre ambos grupos en la puntuación de resiliencia y la autoeficacia de la lactancia después de la intervención. Conclusiones: La capacitación del cuidado madre canguro mediante el método de juego de roles fue más efectiva. Se recomienda el juego de roles y los métodos de rutina como métodos de atención terapéutica en entornos clínicos para mejorar la resiliencia de la madre y la autoeficacia de la lactancia.

Absolute quantification of plasma mitochondrial DNA by droplet digital PCR marks COVID-19 severity over time during intensive care unit admissions.

Increased plasma mitochondrial DNA concentrations are associated with poor outcomes in multiple critical illnesses, including COVID-19. However, current methods of cell-free mitochondrial DNA quantification in plasma are time-consuming and lack reproducibility. Here, we used next-generation sequencing to characterize the size and genome location of circulating mitochondrial DNA in critically ill subjects with COVID-19 to develop a facile and optimal method of quantification by droplet digital PCR. Sequencing revealed a large percentage of small mitochondrial DNA fragments in plasma with wide variability in coverage by genome location. We identified probes for the mitochondrial DNA genes, cytochrome B and NADH dehydrogenase 1, in regions of relatively high coverage that target small sequences potentially missed by other methods. Serial assessments of absolute mitochondrial DNA concentrations were then determined in plasma from 20 critically ill subjects with COVID-19 without a DNA isolation step. Mitochondrial DNA concentrations on the day of enrollment were increased significantly in patients with moderate or severe acute respiratory distress syndrome (ARDS) compared with those with no or mild ARDS. Comparisons of mitochondrial DNA concentrations over time between patients with no/mild ARDS who survived, patients with moderate/severe ARDS who survived, and nonsurvivors showed the highest concentrations in patients with more severe disease. Absolute mitochondrial DNA quantification by droplet digital PCR is time-efficient and reproducible; thus, we provide a valuable tool and rationale for future studies evaluating mitochondrial DNA as a real-time biomarker to guide clinical decision-making in critically ill subjects with COVID-19.

Landscape-scale drivers of pollinator communities may depend on land-use configuration.

Research into pollinators in managed landscapes has recently combined approaches of pollination ecology and landscape ecology, because key stressors are likely to interact across wide areas. While laboratory and field experiments are valuable for furthering understanding, studies are required to investigate the interacting drivers of pollinator health and diversity across a broader range of landscapes and a wider array of taxa. Here, we use a network of 96 study landscapes in six topographically diverse regions of Britain, to test the combined importance of honeybee density, insecticide loadings, floral resource availability and habitat diversity to pollinator communities. We also explore the interactions between these drivers and the cover and proximity of semi-natural habitat. We found that among our four drivers, only honeybee density was positively related to wild pollinator abundance and diversity, and the positive association between abundance and floral resources depended on insecticide loadings and habitat diversity. By contrast, our exploratory models including habitat composition metrics revealed a complex suite of interactive effects. These results demonstrate that improving pollinator community composition and health is unlikely to be achieved with general resource enhancements only. Rather, local land-use context should be considered in fine-tuning pollinator management and conservation. This article is part of the theme issue 'Natural processes influencing pollinator health: from chemistry to landscapes'.

PARK7/DJ-1 promotes pyruvate dehydrogenase activity and maintains Treg homeostasis during ageing.

Pyruvate dehydrogenase (PDH) is the gatekeeper enzyme of the tricarboxylic acid (TCA) cycle. Here we show that the deglycase DJ-1 (encoded by PARK7, a key familial Parkinson's disease gene) is a pacemaker regulating PDH activity in CD4+ regulatory T cells (Treg cells). DJ-1 binds to PDHE1-ß (PDHB), inhibiting phosphorylation of PDHE1-α (PDHA), thus promoting PDH activity and oxidative phosphorylation (OXPHOS). Park7 (Dj-1) deletion impairs Treg survival starting in young mice and reduces Treg homeostatic proliferation and cellularity only in aged mice. This leads to increased severity in aged mice during the remission of experimental autoimmune encephalomyelitis (EAE). Dj-1 deletion also compromises differentiation of inducible Treg cells especially in aged mice, and the impairment occurs via regulation of PDHB. These findings provide unforeseen insight into the complicated regulatory machinery of the PDH complex. As Treg homeostasis is dysregulated in many complex diseases, the DJ-1-PDHB axis represents a potential target to maintain or re-establish Treg homeostasis.

Effectiveness of sodium bicarbonate and zinc chloride mouthwashes in the treatment of oral mucositis and quality of life in patients with cancer under chemotherapy.

AIM: The purpose of the study is to evaluate the effectiveness of sodium bicarbonate and zinc chloride mouthwashes on oral mucositis and quality of life in patients undergoing chemotherapy. DESIGN: The present study was a randomized controlled trial study. METHODS: One hundred forty-four patients with a cancer diagnosis were randomly assigned into three groups: sodium bicarbonate mouthwash (n = 48), zinc chloride mouthwash (n = 48) and placebo group (n = 48). The severity of mucositis and quality of life were examined blindly at the baseline and 3-week follow-up. RESULTS: The grade of oral mucositis decreased at the end of the third weeks in the sodium bicarbonate and zinc chloride groups rather than the placebo group (p < .001). The severity of oral mucositis in the sodium bicarbonate and zinc chloride groups decreased from end of the first week until third week (p < .001). In addition, there was significant difference in the severity of oral mucositis among the groups at the end of the second (p = .014) and the third weeks (p < .001). Also, there was a statistically significant difference in quality of life scores between the sodium bicarbonate and zinc chloride mouthwash with the placebo group (p < .001). CONCLUSION: Zinc chloride and sodium bicarbonate mouthwashes were effective in treating and reducing the severity of oral mucositis, and subsequently improving quality of life in patients with cancer under chemotherapy. Therefore, we can recommend zinc chloride and sodium bicarbonate at the beginning of chemotherapy to improve oral health and promoting quality of life in these patients.

Mitochondrial Damage-associated Molecular Patterns as Potential Biomarkers in DCD Heart Transplantation: Lessons From Myocardial Infarction and Cardiac Arrest.

Heart transplantation with donation after circulatory death (DCD) has become a real option to increase graft availability. However, given that DCD organs are exposed to the potentially damaging conditions of warm ischemia before procurement, new strategies for graft evaluation are of particular value for the safe expansion of DCD heart transplantation. Mitochondria-related parameters are very attractive as biomarkers because of their intimate association with cardiac ischemia-reperfusion injury. In this context, a group of mitochondrial components, called mitochondrial damage-associated molecular patterns (mtDAMPs), released by stressed cells, holds great promise. mtDAMPs may be released at different stages of DCD cardiac donation and may act as indicators of graft quality. Because of the lack of information available for DCD grafts, we consider that relevant information can be obtained from other acute cardiac ischemic conditions. Thus, we conducted a systematic review of original research articles in which mtDAMP levels were assessed in the circulation of patients with acute myocardial infarction and cardiac arrest. We conclude that 4 mtDAMPs, ATP, cytochrome c, mitochondrial DNA, and succinate, are rapidly released into the circulation after the onset of ischemia, and their concentrations increase with reperfusion. Importantly, circulating levels of mtDAMPs correlate with cardiac damage and may be used as prognostic markers for patient survival in these conditions. Taken together, these findings support the concept that mtDAMPs may be of use as biomarkers to assess the transplant suitability of procured DCD hearts, and ultimately aid in facilitating the safe, widespread adoption of DCD heart transplantation.

Development and assessment of the psychometric properties of a compassionate care questionnaire for nurses.

BACKGROUND: Compassionate care is emphasized within professional ethics codes for nursing and is a key indicator of care quality. The purpose of the present study is to develop and assess the psychometric properties of a compassionate care instrument for nurses. METHODS: This methodological study was carried out in two phases -qualitative and quantitative-from February 2016 to October 2018. In the qualitative stage of the study, a content analysis approach was used to establish the concept of compassionate care through interviews with nurses, patients, and family caregivers. The initial draft of the questionnaire was developed based on the qualitative findings and a subsequent review of the literature. In the second phase, the psychometric properties of the questionnaire were assessed for validity and reliability. Data analysis was performed using descriptive and inferential statistics in SPSS v.16. RESULTS: From the results of the qualitative phase and review of literature, 80 items were extracted. In the quantitative phase, after evaluation of the face and content validity, 40 items were kept. After measurement of the construct validity, 28 items whose factor loading was above 0.4 were retained. Measurement of convergent validity showed a moderate correlation between the questionnaire and the nurses' caring behaviors scale (r = 0.67, P = 0.01). The reliability of the 28-item questionnaire was tested by measuring its Cronbach's alpha coefficient and intra-class correlation coefficient which were found to be 0.91 and 0.94 for the whole questionnaire, respectively. CONCLUSION: The questionnaire has enough validity and reliability to be used for measuring the nurses' compassionate care. Therefore, the instrument can be used to measure and record the quality of nursing care.

The dignity of burn patients: a qualitative descriptive study of nurses, family caregivers, and patients.

BACKGROUND: As an ethical principle, showing respect for human dignity is a professional duty of all nurses. The aggressive nature of severe burn injuries makes it hard to respect the existential values and dignity of burn patients. However, only a few studies have been conducted on the preservation of the dignity of burn patients. The purpose of this study is to identify and describe burn patients' dignity as perceived by nurses, family caregivers, and burn patients. METHODS: The present study has a descriptive, qualitative research design. Nurses, family caregivers and patients in the biggest burns hospital in the south of Iran were selected via purposeful sampling from October 2017 to August 2018 (n = 25). Data were collected using semi-structured, in-depth, individual interviews. Thereafter, data analysis was performed through conventional content analysis. RESULTS: Three main themes were extracted from the information obtained in the interviews: empathic communication, showing respect, and providing comprehensive support. CONCLUSION: The care provided to burn patients should be combined with effective communication, spending time with them, and attending to their repetitive requests, so that they can freely express their feelings and concerns. In addition, the patients' human values and beliefs should be respected and all aspects of their existence should be taken into account to preserve their dignity. Workshops designed based on the findings of the present study can help with improving the quality of burn nursing care.

A metabolomic endotype of bioenergetic dysfunction predicts mortality in critically ill patients with acute respiratory failure.

Acute respiratory failure (ARF) requiring mechanical ventilation, a complicating factor in sepsis and other disorders, is associated with high morbidity and mortality. Despite its severity and prevalence, treatment options are limited. In light of accumulating evidence that mitochondrial abnormalities are common in ARF, here we applied broad spectrum quantitative and semiquantitative metabolomic analyses of serum from ARF patients to detect bioenergetic dysfunction and determine its association with survival. Plasma samples from surviving and non-surviving patients (N = 15/group) were taken at day 1 and day 3 after admission to the medical intensive care unit and, in survivors, at hospital discharge. Significant differences between survivors and non-survivors (ANOVA, 5% FDR) include bioenergetically relevant intermediates of redox cofactors nicotinamide adenine dinucleotide (NAD) and NAD phosphate (NADP), increased acyl-carnitines, bile acids, and decreased acyl-glycerophosphocholines. Many metabolites associated with poor outcomes are substrates of NAD(P)-dependent enzymatic processes, while alterations in NAD cofactors rely on bioavailability of dietary B-vitamins thiamine, riboflavin and pyridoxine. Changes in the efficiency of the nicotinamide-derived cofactors' biosynthetic pathways also associate with alterations in glutathione-dependent drug metabolism characterized by substantial differences observed in the acetaminophen metabolome. Based on these findings, a four-feature model developed with semi-quantitative and quantitative metabolomic results predicted patient outcomes with high accuracy (AUROC = 0.91). Collectively, this metabolomic endotype points to a close association between mitochondrial and bioenergetic dysfunction and mortality in human ARF, thus pointing to new pharmacologic targets to reduce mortality in this condition.

Moral courage, moral sensitivity and safe nursing care in nurses caring of patients with COVID-19.

AIM: Evaluation the moral courage, moral sensitivity and safe nursing care in nurses caring of infected patients by the COVID-19. DESIGN: This study employed cross-sectional research. METHODS: 520 nurses caring for COVID-19 patients in 5 hospitals were selected via convenience sampling. They completed questionnaires online. Data were analysed by SPSS software version 22. RESULTS: Findings showed that moral courage has a strong and direct correlation with moral sensitivity (p < .001, r = 0-.70) and safe nursing care (p < .001, r = 0-.74). Variables of moral sensitivity, safe nursing care, work experience, age and employment status can predict 64.76% of the variance in moral courage in these nurses. Nursing care of patients with COVID-19 have reported high moral courage in recent months, and in spite of the numerous tensions and stresses in terms of caring these patients during this relative long period, they are still diligent in providing safe and high sensitive care to these patients.

Chromatin-Associated Protein Complexes Link DNA Base J and Transcription Termination in Leishmania.

Unlike most other eukaryotes, Leishmania and other trypanosomatid protozoa have largely eschewed transcriptional control of gene expression, relying instead on posttranscriptional regulation of mRNAs derived from polycistronic transcription units (PTUs). In these parasites, a novel modified nucleotide base (ß-d-glucopyranosyloxymethyluracil) known as J plays a critical role in ensuring that transcription termination occurs only at the end of each PTU, rather than at the polyadenylation sites of individual genes. To further understand the biology of J-associated processes, we used tandem affinity purification (TAP) tagging and mass spectrometry to reveal proteins that interact with the glucosyltransferase performing the final step in J synthesis. These studies identified four proteins reminiscent of subunits in the PTW/PP1 complex that controls transcription termination in higher eukaryotes. Moreover, bioinformatic analyses identified the DNA-binding subunit of Leishmania PTW/PP1 as a novel J-binding protein (JBP3), which is also part of another complex containing proteins with domains suggestive of a role in chromatin modification/remodeling. Additionally, JBP3 associates (albeit transiently and/or indirectly) with the trypanosomatid equivalent of the PAF1 complex involved in the regulation of transcription in other eukaryotes. The downregulation of JBP3 expression levels in Leishmania resulted in a substantial increase in transcriptional readthrough at the 3' end of most PTUs. We propose that JBP3 recruits one or more of these complexes to the J-containing regions at the end of PTUs, where they halt the progression of the RNA polymerase. This decoupling of transcription termination from the splicing of individual genes enables the parasites' unique reliance on polycistronic transcription and posttranscriptional regulation of gene expression.IMPORTANCELeishmania parasites cause a variety of serious human diseases, with no effective vaccine and emerging resistance to current drug therapy. We have previously shown that a novel DNA base called J is critical for transcription termination at the ends of the polycistronic gene clusters that are a hallmark of Leishmania and related trypanosomatids. Here, we describe a new J-binding protein (JBP3) associated with three different protein complexes that are reminiscent of those involved in the control of transcription in other eukaryotes. However, the parasite complexes have been reprogrammed to regulate transcription and gene expression in trypanosomatids differently than in the mammalian hosts, providing new opportunities to develop novel chemotherapeutic treatments against these important pathogens.

Nonlinear trends in abundance and diversity and complex responses to climate change in Arctic arthropods.

Time series data on arthropod populations are critical for understanding the magnitude, direction, and drivers of change. However, most arthropod monitoring programs are short-lived and restricted in taxonomic resolution. Monitoring data from the Arctic are especially underrepresented, yet critical to uncovering and understanding some of the earliest biological responses to rapid environmental change. Clear imprints of climate on the behavior and life history of some Arctic arthropods have been demonstrated, but a synthesis of population-level abundance changes across taxa is lacking. We utilized 24 y of abundance data from Zackenberg in High-Arctic Greenland to assess trends in abundance and diversity and identify potential climatic drivers of abundance changes. Unlike findings from temperate systems, we found a nonlinear pattern, with total arthropod abundance gradually declining during 1996 to 2014, followed by a sharp increase. Family-level diversity showed the opposite pattern, suggesting increasing dominance of a small number of taxa. Total abundance masked more complicated trajectories of family-level abundance, which also frequently varied among habitats. Contrary to expectation in this extreme polar environment, winter and fall conditions and positive density-dependent feedbacks were more common determinants of arthropod dynamics than summer temperature. Together, these data highlight the complexity of characterizing climate change responses even in relatively simple Arctic food webs. Our results underscore the need for data reporting beyond overall trends in biomass or abundance and for including basic research on life history and ecology to achieve a more nuanced understanding of the sensitivity of Arctic and other arthropods to global changes.

Absolute quantification of transcription factors in human erythropoiesis using selected reaction monitoring mass spectrometry.

Quantitative changes in transcription factor (TF) abundance regulate dynamic cellular processes, including cell fate decisions. Protein copy number provides information about the relative stoichiometry of TFs that can be used to determine how quantitative changes in TF abundance influence gene regulatory networks. In this protocol, we describe a targeted selected reaction monitoring (SRM)-based mass-spectrometry method to systematically measure the absolute protein concentration of nuclear TFs as human hematopoietic stem and progenitor cells differentiate along the erythropoietic lineage. For complete details on the use and execution of this protocol, please refer to Gillespie et al. (2020).