NETosis induction reflects COVID-19 severity and long COVID: insights from a 2-center patient cohort study in Israel

BACKGROUND

COVID-19 severity and its late complications continue to be poorly understood. Neutrophil extracellular traps (NETs) form in acute COVID-19, likely contributing to morbidity and mortality.

OBJECTIVES

This study evaluated immunothrombosis markers in a comprehensive cohort of acute and recovered COVID-19 patients, including the association of NETs with long COVID.

METHODS

One-hundred-seventy-seven patients were recruited from clinical cohorts at 2 Israeli centers: acute COVID-19 (mild/moderate, severe/critical), convalescent COVID-19 (recovered and long COVID), along with 54 non-COVID controls. Plasma was examined for markers of platelet activation, coagulation, and NETs. Ex vivo NETosis induction capability was evaluated after neutrophil incubation with patient plasma.

RESULTS

Soluble P-selectin, factor VIII, von Willebrand factor, and platelet factor 4 were significantly elevated in patients with COVID-19 versus controls. Myeloperoxidase (MPO)-DNA complex levels were increased only in severe COVID-19 and did not differentiate between COVID-19 severities or correlate with thrombotic markers. NETosis induction levels strongly correlated with illness severity/duration, platelet activation markers, and coagulation factors, and were significantly reduced upon dexamethasone treatment and recovery. Patients with long COVID maintained higher NETosis induction, but not NET fragments, compared to recovered convalescent patients.

CONCLUSIONS

Increased NETosis induction can be detected in patients with long COVID. NETosis induction appears to be a more sensitive NET measurement than MPO-DNA levels in COVID-19, differentiating between disease severity and patients with long COVID. Ongoing NETosis induction capability in long COVID may provide insights into pathogenesis and serve as a surrogate marker for persistent pathology. This study emphasizes the need to explore neutrophil-targeted therapies in acute and chronic COVID-19.

Views about perceived training needs of health care professionals in relation to socially assistive robots: an international online survey

BACKGROUND

As Artificial Intelligence and social robots are increasingly used in health and social care, it is imperative to explore the training needs of the workforce, factoring in their cultural background.

OBJECTIVES

Explore views on perceived training needs among professionals around the world and how these related to country cultures.

DESIGN

Cross-sectional, descriptive, mixed-methods international online survey.

METHODS

Descriptive statistical analysis explored the ranking across countries and relationships with three Hofstede cultural dimensions. Thematic analysis was conducted on the open-ended text responses.

RESULTS

A sample of N = 1284 participants from eighteen countries. Knowing the capabilities of the robots was ranked as the top training need across all participating countries and this was also reflected in the thematic analysis. Participants' culture, expressed through three Hofstede's dimensions, revealed statistically significant ranking differences.

CONCLUSIONS

Future research should further explore other factors such as the level of digital maturity of the workplace.

IMPACT STATEMENT

Training needs of health and social care staff to use robotics are fast growing and preparation should factor in patient safety and be based on the principles of person- and culture-centred care.

Evaluating the intensity of the 803-keV γ ray of 210Po using a 4παβ(LS)-γ(HPGe) measurement system

The absolute intensity for the 803-keV γ ray of ²¹⁰Po was evaluated by α-γ coincidence technique. A liquid sample with a known amount of ²¹⁰Po embedded in scintillation fluid was measured in a coincidence-based system that comprises a Liquid Scintillator (LS) detector and a High-Purity Germanium (HPGe) detector. A photo-reflector assembly that contains the ²¹⁰Po sample provides 100% efficiency for detecting the α particles. The combination between the HPGe and the LS detectors allows to reject non-coincident α-γ events while maintaining high resolution γ spectroscopy. Consequently, the faint 803-keV photopeak from ²¹⁰Po could be observed in a background-free environment, and its intensity could be evaluated with good accuracy. Sample measurements were carried out over nine months to gather statistics and verify the reliability of the experimental procedure. The absolute intensity of the 803-keV line was found to be (1.22 ± 0.03) × 10^-5, in excellent agreement with the adopted value in a recent data compilation and consistent with previous experimental works.

Characterization of a 4παβ(LS)-γ(HPGe) prototype system for low-background measurements

A ground-level prototype system for low-background measurements was developed and tested. The system consists of a high-purity germanium (HPGe) detector used for detecting γ rays and coupled to a liquid scintillator (LS) used for detecting α and β particles. Both detectors are surrounded by shielding materials and anti-cosmic detectors ("veto") used to suppress background events. The energy and timestamp of detected α, β and γ emissions are recorded event-by-event and analyzed offline. By requiring timing coincidence between the HPGe and LS detectors, background events originating from outside the volume of the measured sample can be effectively rejected. The system performance was evaluated using liquid samples containing known activities of an α emitter (²⁴¹Am) or a β emitter (⁶⁰Co) whose decays are accompanied by γ rays. The LS detector was found to provide a solid angle of almost 4π for α and β particles. Compared to the traditional γ-singles mode, operating the system in coincidence mode (i.e., α-γ or β-γ) reduced the background counts by a factor of ∼100. Consequently, the minimal detectable activity for ²⁴¹Am and ⁶⁰Co was improved by a factor of 9, being 4 mBq and 1 mBq for an 11-d measurement, respectively. Furthermore, by applying a spectrometric cut in the LS spectrum that corresponds to α emission from ²⁴¹Am, a background reduction factor of ∼2400 (compared to γ-singles mode) was achieved. Beyond low-background measurements, this prototype exhibits additional compelling features, such as the ability to focus on certain decay channels and study their properties. This concept for a measurement system may be of interest to laboratories that monitor environmental radioactivity, studies involving environmental measurements and/or trace-level radioactivity.

Evaluating the intensity of the 'prompt' 140.5 keV γ-ray of 99Mo using a 4παβ(LS)-γ(HPGe) measurement system

The absolute intensity for the 'prompt' 140.5 keV gamma-ray of ⁹⁹Mo was evaluated using the β-γ coincidence technique. A liquid sample of ⁹⁹Mo was prepared from a⁹⁹Mo/^99mTc generator and measured in a 4παβ(LS)-γ(HPGe) system that comprises a Liquid Scintillator (LS) detector and a High-Purity Germanium (HPGe) detector. The sample was introduced into scintillation fluid embedded in a photo-reflector assembly that provides almost 100% efficiency for detecting β particles (in the energy range of intreset). The combination of the HPGe and the LS detectors provided a highly effective rejection mechanism for non-coincident events. Thereby, the distinction between the detected 140.5 keV events originating from decays of ^99mTc (IT) and those from transitions bypassing the metastable state could be obtained and the 'prompt' intensity was evaluated directly. The system was calibrated for detecting β particles and γ-rays using radioactive sources of known activities and having identical geometry as the sample containing ⁹⁹Mo. The absolute intensity of the 'prompt' 140.5 keV was found to be (5.21 ± 0.02_stat±0.16_sys)%, in good agreement with results from more recently reported works.

Obstacles to compassion-giving among nursing and midwifery managers: an international study

AIM

To explore nursing and midwifery managers' views regarding obstacles to compassion-giving across country cultures.

BACKGROUND

The benefit of compassionate leadership is being advocated, but despite the fact that health care is invariably conducted within culturally diverse workplaces, the interconnection of culture, compassion and leadership is rarely addressed. Furthermore, evidence on how cultural factors hinder the expression of compassion among nursing and midwifery managers is lacking.

METHODS

Cross-sectional, exploratory, international online survey involving 1 217 participants from 17 countries. Managers' responses on open-ended questions related to barriers for providing compassion were entered and thematically analysed through NVivo.

RESULTS

Three key themes related to compassion-giving obstacles emerged across countries: 1. related to the managers' personal characteristics and experiences; 2. system-related; and 3. staff-related.

CONCLUSIONS

Obstacles to compassion-giving among managers vary across countries. An understanding of the variations across countries and cultures of what impedes compassion to flourish in health care is important.

IMPLICATIONS FOR NURSING PRACTICE AND POLICY

Nursing mangers should wisely use their power by adopting leadership styles that promote culturally competent and compassionate workplaces with respect for human rights. Policymakers should identify training and mentoring needs to enable the development of managers' practical wisdom. Appropriate national and international policies should facilitate the establishment of standards and guidelines for compassionate leadership, in the face of distorted organizational cultures and system-related obstacles to compassion-giving.

International study on nurses' views and experiences of compassion

BACKGROUND

Compassion is considered the cornerstone of nursing practice. However, the recent failures in delivering high-quality compassionate nursing care in the UK's National Health Service have brought the topic of compassion to the attention of the public, service providers, policy makers and academics.

AIM

The aim of this study was to explore the nurses' views and experiences of a number of compassion-related issues in nursing and describe similarities and differences at an international level as well as from the different nursing roles of the participating nurses.

METHODS

An exploratory, cross-sectional descriptive study, using the International Online Compassion Questionnaire. A total of 1323 nurses from 15 countries completed the questionnaire.

RESULTS

The majority of participants (59.5%) defined compassion as "Deep awareness of the suffering of others and wish to alleviate it" but definitions of compassion varied by country. Of participants, 69.6% thought compassion was very important in nursing and more than half (59.6%) of them argued that compassion could be taught. However, only 26.8% reported that the correct amount and level of teaching is provided. The majority of the participants (82.6%) stated that their patients prefer knowledgeable nurses with good interpersonal skills. Only 4.3% noted that they are receiving compassion from their managers. A significant relationship was found between nurses' experiences of compassion and their views about teaching of compassion.

CONCLUSION

Our study is unique in identifying the views and experiences of nurses from 15 different countries worldwide. The findings reveal that compassion is neither addressed adequately in nursing education nor supported in the practice environment by managers.

LIMITATIONS

Self-report bias was inherent to our survey study design. Furthermore, the individual cultural differences and similarities in the findings are difficult to extrapolate owing to the fact that our analysis was at country level, as well as at the level of the participating nurses.

IMPLICATIONS FOR NURSING POLICY

Understanding the influence of culture on nurses' views about compassion is critical in the current multicultural healthcare environment and merits further research. This will potentially drive changes in nursing education (ensuring that compassion is taught to nurses) and in the way healthcare leaders and managers foster a compassionate culture within their organizations (e.g. by leading by example and compassionate to their staff).

Transplantation of neural progenitor and stem cells: developmental insights may suggest new therapies for spinal cord and other CNS dysfunction

Multipotent neural progenitors and stem cells may integrate appropriately into the developing and degenerating central nervous system. They may also be effective in the replacement of genes, cells, and nondiffusible factors in either a widespread or a more circumscribed manner, depending on the therapeutic demands of the clinical situation. In addition, they may be uniquely responsive to some types of neurodegenerative conditions. We believe that these various appealing capabilities are the normal expression of basic biologic properties and attributes of a stem cell. The therapeutic utility of some of those properties is illustrated in this review of ongoing work in our laboratory, particularly with regard to spinal dysfunction. In these examples, we believe we have tapped into a mechanism that underlies a remarkable degree of natural plasticity programmed into the nervous system at the cellular level, and we have now exploited those properties for therapeutic ends.

Complete avulsion of the optic nerve. A clinical, angiographic, and electrodiagnostic study

A case of traumatic complete avulsion of the optic nerve is reported together with fluorescein angiography and electrodiagnostic findings. Despite the disappearance of the central vessels, circulation remained in the branch retinal vessels and angiography demonstrated communication between peripapillary choroidal vessels and the superior temporal artery. The visually-evoked cortical response was abolished. Electroretinography showed a normal a-wave but reduced amplitude b-wave, not supporting the theory of the existence of centrifugal retino-suppressive fibres in the optic nerve of man.

Visual evoked responses in the assessment of field defects in glaucoma

A technique for producing steady state visual evoked responses (VERs) to pattern reversal stimulation of retinal areas corresponding to discrete field quadrants is described. Patients examined included 10 normal individuals, 11 patients with ocular hypertension, and 21 with glaucomatous field defects (unilateral except in two cases with bilateral defects). The VERs relating to normal homonymous field quadrants were in phase in all three groups, excluding patients with cataracts. The VERs corresponding to quadrants with small field defects showed a phase shift compared with responses from normal homonymous quadrants in all cases, but were not detectable if the defect filled more than three quarters of the quadrant tested in most cases. The method offers a means for the objective assessment of visual fields in patients with unilateral optic nerve lesions, provided that central visual acuity is 20/80 or better