Decreased circulating IPA levels identify subjects with metabolic comorbidities: A multi-omics study

In recent years several experimental observations demonstrated that the gut microbiome plays a role in regulating positively or negatively metabolic homeostasis. Indole-3-propionic acid (IPA), a Tryptophan catabolic product mainly produced by C. Sporogenes, has been recently shown to exert either favorable or unfavorable effects in the context of metabolic and cardiovascular diseases. We performed a study to delineate clinical and multiomics characteristics of human subjects characterized by low and high IPA levels. Subjects with low IPA blood levels showed insulin resistance, overweight, low-grade inflammation, and features of metabolic syndrome compared to those with high IPA. Metabolomics analysis revealed that IPA was negatively correlated with leucine, isoleucine, and valine metabolism. Transcriptomics analysis in colon tissue revealed the enrichment of several signaling, regulatory, and metabolic processes. Metagenomics revealed several OTU of ruminococcus, alistipes, blautia, butyrivibrio and akkermansia were significantly enriched in highIPA group while in lowIPA group Escherichia-Shigella, megasphera, and Desulfovibrio genus were more abundant. Next, we tested the hypothesis that treatment with IPA in a mouse model may recapitulate the observations of human subjects, at least in part. We found that a short treatment with IPA (4 days at 20/mg/kg) improved glucose tolerance and Akt phosphorylation in the skeletal muscle level, while regulating blood BCAA levels and gene expression in colon tissue, all consistent with results observed in human subjects stratified for IPA levels. Our results suggest that treatment with IPA may be considered a potential strategy to improve insulin resistance in subjects with dysbiosis.

High-throughput mRNA sequencing of human placenta shows sex differences across gestation

INTRODUCTION

Fetal sex affects fetal and maternal health outcomes in pregnancy, but this connection remains poorly understood. As the placenta is the route of fetomaternal communication and derives from the fetal genome, placental gene expression sex differences may explain these outcomes.

OBJECTIVES

We utilized next generation sequencing to study the normal human placenta in both sexes in first and third trimester to generate a normative transcriptome based on sex and gestation.

STUDY DESIGN

We analyzed 124 first trimester (T1, 59 female and 65 male) and 43 third trimester (T3, 18 female and 25 male) samples for sex differences within each trimester and sex-specific gestational differences.

RESULTS

Placenta shows more significant sexual dimorphism in T1, with 94 T1 and 26 T3 differentially expressed genes (DEGs). The sex chromosomes contributed 60.6% of DEGs in T1 and 80.8% of DEGs in T3, excluding X/Y pseudoautosomal regions. There were 6 DEGs from the pseudoautosomal regions, only significant in T1 and all upregulated in males. The distribution of DEGs on the X chromosome suggests genes on Xp (the short arm) may be particularly important in placental sex differences. Dosage compensation analysis of X/Y homolog genes shows expression is primarily contributed by the X chromosome. In sex-specific analyses of first versus third trimester, there were 2815 DEGs common to both sexes upregulated in T1, and 3263 common DEGs upregulated in T3. There were 7 female-exclusive DEGs upregulated in T1, 15 female-exclusive DEGs upregulated in T3, 10 male-exclusive DEGs upregulated in T1, and 20 male-exclusive DEGs upregulated in T3.

DISCUSSION

This is the largest cohort of placentas across gestation from healthy pregnancies defining the normative sex dimorphic gene expression and sex common, sex specific and sex exclusive gene expression across gestation. The first trimester has the most sexually dimorphic transcripts, and the majority were upregulated in females compared to males in both trimesters. The short arm of the X chromosome and the pseudoautosomal region is particularly critical in defining sex differences in the first trimester placenta. As pregnancy is a dynamic state, sex specific DEGs across gestation may contribute to sex dimorphic changes in overall outcomes.

Risk factors for invasive pulmonary aspergillosis in patients with severe fever with thrombocytopenia syndrome: A multicenter retrospective study

Invasive pulmonary aspergillosis (IPA) is a life-threatening complication in patients with severe fever with thrombocytopenia syndrome (SFTS), yet SFTS-associated IPA (SAPA)'s risk factors remain undefined. A multicenter retrospective cohort study across Hubei and Anhui provinces (May 2013-September 2022) utilized least absolute shrinkage and selection operator (LASSO) regression for variable selection. Multivariable logistic regression identified independent predictors of SAPA, Cox regression highlighted mortality-related risk factors. Of the 1775 screened SFTS patients, 1650 were included, with 169 developing IPA, leading to a 42-day mortality rate of 26.6% among SAPA patients. Multivariable logistic regression revealed SAPA risk factors including advanced age, petechia, hemoptysis, tremor, low albumin levels, elongated activated partial thromboplastin time (APTT), intensive care unit (ICU) admission, glucocorticoid usage, intravenous immunoglobulin (IVIG) and prolonged hospital stays. Cox regression identified predictors of 42-day mortality, including ecchymosis at venipuncture sites, absence of ICU admission, elongated prothrombin time (PT), vasopressor and glucocorticoid use, non-antifungals. Nomograms constructed on these predictors registered concordance indexes of 0.855 (95% CI: 0.826-0.884) and 0.778 (95% CI: 0.702-0.854) for SAPA onset and 42-day mortality, respectively. Lower survival rates for SAPA patients treated with glucocorticoids (p < 0.001) and improved 14-day survival with antifungal therapy (p = 0.036). Improving IPA management in SFTS-endemic areas is crucial, with effective predictive tool.

Whole transcriptome sequencing identifies key lncRNAs,circRNAs, and mRNAs for exploring the pathogenesis and therapeutic target of mouse pneumoconiosis

BACKGROUND

Pneumoconiosis is a kind of lung dysfunction caused by the inhalation of mineral dust. However, the potential molecular mechanism of pneumoconiosis have not been fully elucidated.

METHODS

In this study, the silica-treated pneumoconiosis mice model was constructed and the transcriptome sequencing data including lncRNA, circRNA, and mRNA were obtained. Firstly, differentially expressed lncRNA, circRNA, and mRNA (DElncRNA, DEcircRNA, DEGs) between control and pneumoconiosis/silicosis samples were screened, the target miRNAs (co-pre-miRNAs) were obtained by intersecting the miRNAs predicted by DElncRNA and DEcircRNA, respectively, and the target mRNAs (co-mRNA) were obtained by intersecting the mRNAs predicted by target miRNA and DEGs. Then, the lncRNA/circRNA-miRNA-mRNA networks were constructed by Cytoscape. Next, the key mRNAs were obtained by protein-protein interaction (PPI) analysis, and the key lncRNAs/circRNAs were selected by correlation analysis. Moreover, the expression of the key lncRNAs, circRNAs and mRNAs on chromosome were studied by the "circlize" package. Furthermore, the TFs-miRNA-mRNA network was constructed and the function of DEGs were explored by Ingenuity Pathway Analysis (IPA). To demonstrate the feasibility and value of the constructed ceRNA networks, we validated key genes and mmu-miR-682 pathway. Finally, We used the Drug-Gene Interaction database to predict potential drugs that could interfere with key genes,which may help to find promising treatment.

RESULTS

There were 427 DElncRNAs, 107 DEcircRNAs and 1,597 DEGs between silicosis and control groups. Totals of 77 co-pre-miRNAs and 96 co-mRNA were screened, and the lncRNA/circRNA-miRNA-mRNA networks were constructed with 27 lncRNA/25 circRNAs, 74 miRNAs and 96 mRNAs. Then, 6 key mRNAs including Igf1, Klf4, Ptgs2, Epas1, Gnao1, and Il1a were obtained by PPI, and all of these key mRNAs and 10 key lncRNAs and 8 circRNAs were significantly different between the pneumoconiosis and normal groups, in which 10 lncRNAs and 9 circRNA that have not been previously studied in pneumoconiosis/silicosis can be used as new potential therapeutic targets. Moreover, the TFs-miRNA-mRNA network were constructed with 11 TFs, 1 key miRNA (mmu-miR-682) and 3 key mRNAs (Igf1, Epas1, Ptgs2). And the validation of key genes revealing by RNA-seq through experimental approaches shows the the predictive power of this study. Finally, IPA results indicated that 41 pathways were activated and 2 pathways were suppressed in pneumoconiosis/silicosis groups, and Pathogen Induced Cytokine Storm Signaling Pathway was the most significant pathway affected by pneumoconiosis/silicosis. In addition, 93 drugs were screened out by Drug-Gene Interaction database. Among them, Hydroxychloroquine was a kind of drug which associated with Il1a and Ptgs2, may be a promising treatment.

CONCLUSION

This study constructed the lncRNA/circRNA-miRNA-mRNA and TFs-miRNA-mRNA networks, which could deepen the potential molecular regulatory mechanism of pneumoconiosis/silicosis.

"It's changed forever": the lived experience of sexuality and sexual functioning in women with cauda equina syndrome (CES)

PURPOSE

To explore women's lived experiences of intimacy, sexuality and sexual functioning in the context of cauda equina syndrome (CES).

METHODS

Ten women completed an in-depth semi-structured interview exploring the psychosocial impact of CES on their sexuality and data were analyzed using Interpretative Phenomenological Analysis (IPA).

RESULTS

One superordinate theme was generated: "Sexuality forever altered, it's changed completely," reflecting the enduring impact of CES on women's sexuality. Five subordinate themes emerged reflecting a range of changed roles and relationships, primarily associated with loss of sexual identity and a sense that health professionals did not prioritize sexual functioning (1): Loss of worth as a sexual being: "Feel like a nothing" (2) Relationships have changed: "It's not a meeting of equals anymore" (3) Lack of professional support: "We don't like to talk about anything below the waist" (4) Challenges for motherhood: "What kind of future will they have with a mother like me…" and (5) Finding ways of coping: "Closed the door on it."

CONCLUSION

Findings highlight the detrimental effect of CES, directly and indirectly, on women's sexuality. There is a need for a multidisciplinary approach to address the physical, emotional, cognitive, and behavioural effects experienced in relation to sexuality as part of a rehabilitative process.

Facilitating transformative endings: Therapists' experience of ending therapy with people with intellectual disabilities-An interpretative phenomenological analysis

BACKGROUND

Endings in therapy are discussed widely in mainstream literature, however, there is only a small amount of research that considers endings in therapy for people with intellectual disabilities.

METHODS

Eight therapists were interviewed about their experience of ending therapy with people with intellectual disabilities. Interviews were analysed using Interpretative Phenomenological Analysis (IPA).

RESULTS

Four superordinate themes associated with endings that go well were identified: 'recognising', 'readying', 'reframing' and reflecting', with a fifth theme reflecting endings that were less successful. Participants worked hard to offer transformative experiences of endings and an overarching 'super-superordinate' theme of 'facilitating transformative endings' encompassed the findings.

CONCLUSIONS

Endings are a multi-faceted component of psychological therapy with people with intellectual disabilities and are significant for both client and therapist. We discuss implications for therapy adaptations and future research.

Exploring Autistic College Students' Perceptions and Management of Peer Stigma: An Interpretative Phenomenological Analysis

Autistic college students are often forced to navigate stigma on campus, but little is known about how autistic college students manage communicated stigma. Semi-structured interviews with ten autistic college students were conducted to explore how they manage peer stigma. Interpretative Phenomenological Analysis (IPA) was used to identify three themes from the data: First, participants seek to avoid peer stigma by concealing attributes associated with autism. Next, participants buffer against peer stigma by engaging in favorable social comparison. Finally, participants perceive the autism label as highly stigmatizing, necessitating limited disclosure on campus. These results can help researchers and practitioners focus efforts to promote neurodiversity to both autistic students and their peers on campus.

Transcriptomic Analysis of the Rat Dorsal Root Ganglion After Fracture

In fractures, pain signals are transmitted from the dorsal root ganglion (DRG) to the brain, and the DRG generates efferent signals to the injured bone to participate in the injury response. However, little is known about how this process occurs. We analyzed DRG transcriptome at 3, 7, 14, and 28 days after fracture. We identified the key pathways through KEGG and GO enrichment analysis. We then used IPA analysis to obtain upstream regulators and disease pathways. Finally, we compared the sequencing results with those of nerve injury to identify the unique transcriptome changes in DRG after fracture. We found that the first 14 days after fracture were the main repair response period, the 3rd day was the peak of repair activity, the 14th day was dominated by the stimulus response, and on the 28th day, the repair response had reached a plateau. ECM-receptor interaction, protein digestion and absorption, and the PI3K-Akt signaling pathway were most significantly enriched, which may be involved in repair regeneration, injury response, and pain transmission. Compared with the nerve injury model, DRG after fracture produced specific alterations related to bone repair, and the bone density function was the most widely activated bone-related function. Our results obtained some important genes and pathways in DRG after fracture, and we also summarized the main features of transcriptome function at each time point through functional annotation clustering of GO pathway, which gave us a deeper understanding of the role played by DRG in fracture.

"It's a learning curve throughout your entire life": Experiences and impact of FASD in adolescence explored in online photovoice research

BACKGROUND

Research into the lived experience and disability of Fetal Alcohol Spectrum Disorder (FASD) is sparse in adolescence, despite its relevance to supports and life outcomes.

AIMS

The study explored adolescents' lived experiences of FASD and access to support across home, school, and community.

METHODS AND PROCEDURES

An online photovoice study was undertaken with eight young people (age 12-19, in education), integrating an Interpretative Phenomenological Analysis (IPA) approach. The research process comprised two individual interviews, group training, individual photo-taking, and group sessions for photo analysis/ dissemination.

OUTCOMES AND RESULTS

Participant-led analysis of their photos identified how activities at home and in the community had functions of relaxation, sensory gratification, and enabled concentration. Researcher-led analysis found that young people identified with the disability of FASD through experiences at home and school. While they acknowledged the value of support and relationships, education was not always an inclusive experience.

CONCLUSIONS AND IMPLICATIONS

Participatory online research allowed insight into the impact of FASD as a disability and underlines a consistent need for support in adolescence and the transition into adulthood. Young people with FASD require explicit support to develop their advocacy skills to improve educational outcomes.

Stigma experienced as worse than symptoms of schizophrenia: A qualitative study about The OpusPanel

AIM

Former patients and relatives of people who have received treatment in OPUS, a Danish specialized early intervention for first episode psychosis, have since 2009 worked to reduce stigma and increase hope related to schizophrenia and psychosis. They established The OpusPanel to share their own stories of living with an invisible disorder with new patients, health care professionals, politicians, and members of the public. The impact of The OpusPanel on stigma has not previously been explored or evaluated. The article aims to evaluate and gain an in-depth understanding of The OpusPanel's anti-stigma impact.

METHODS

In a qualitative design, 27 people with different affiliations to The OpusPanel were interviewed using semi-structured interview guides to capture their individual experiences of listening to, interacting with, or being part of The OpusPanel. Interview guides were constructed following a focus group interview with members of The OpusPanel. Analysis of the multi-perspectival dataset was facilitated through an interpretative phenomenological approach with investigator triangulation. Preliminary results were returned to the focus group members to ensure relevance and accuracy.

RESULTS

The study found that almost all interviewees described a sense of hopefulness and decreased stigma after having experienced a member from The OpusPanel present their story or participating as panel members themselves.

CONCLUSION

The findings suggest that attending presentations or participating in The OpusPanel reduces stigmatizing views about others or oneself. The study may inform The OpusPanel and similar initiatives for challenging stigma related to schizophrenia or psychosis.

Exploring the Lived Experiences of Caregiving for Older Family Members by Young Caregivers in Singapore: Transition, Trials, and Tribulations

Amidst population ageing trends and epidemiological transitions, there has been a growing emergence of young family caregivers, about whom most studies have been conducted in Western countries. Their subjective experiences and perceptions toward caregiving remain underexplored in Asia. This qualitative study explored the lived experiences of caregiving for older family members by young caregivers in Singapore. Interpretative phenomenological analysis was employed to collect and analyse data from semi-structured, in-depth interviews with six young adult caregivers aged between 23 and 29. Interviews were supplemented with photo-elicitation techniques to deepen interview discussions and uncover experiential significance. Findings illustrated transitions into caregiving, challenges across role conflicts and expectations amidst developmental tasks and transitions, and navigation of intergenerational conflicts and ambivalence. Although no definitive conclusions can be reached from this small-scale study, the findings offer important insights into the convergence and intensity of young caregivers' experiences. Given that caregiving challenges are likely to continue amidst Singapore's rapidly ageing population, these necessitate further in-depth research efforts. Implications for policy and practice across multiple stakeholders interfacing with youth and older adults are presented. A whole-of-society approach is called for to enable young caregivers to realise their full potential while contributing to their ageing families and nation.

Is It Safe Enough? An IPA Study of How Couple Therapists Make Sense of Their Decision to Either Stop or Continue with Couple Therapy When Violence Becomes the Issue

BACKGROUND

Couple therapists will encounter couple violence in their practice at some point. In this context, one of the main questions they must address is whether to continue with conjoint sessions. This study explores how couple therapists make sense of their decision whether or not to continue with conjoint sessions when violence has become an issue.

METHODS

This qualitative study used four semi-structured focus groups and Interpretative Phenomenological Analysis (IPA) to analyse the data from the twelve experienced couple therapist participants.

RESULTS

Our IPA analysis led to three main group experiential themes across the focus groups: (1) Is it safe enough? (2) Do we have a joint and regenerative project? (3) Three key sources for sense making.

CONCLUSION

Partner violence challenges the realm of couple therapy. This article explored how the couple therapists orient themselves and grapple with decision making when violence becomes an issue. The article offers unique insights regarding what the therapists orient themselves towards and how they try to form an impression of whether to continue conjoint sessions. We outline immediate clinical implications and propose measures for building individual and organisational capacity regarding "clinical sense making". Suggestions for further research are also addressed.

Microbiota-derived tryptophan metabolism: Impacts on health, aging, and disease

The intricate interplay between gut microbiota and the host is pivotal in maintaining homeostasis and health. Dietary tryptophan (TRP) metabolism initiates a cascade of essential endogenous metabolites, including kynurenine, kynurenic acid, serotonin, and melatonin, as well as microbiota-derived Trp metabolites like tryptamine, indole propionic acid (IPA), and other indole derivatives. Notably, tryptamine and IPA, among the indole metabolites, exert crucial roles in modulating immune, metabolic, and neuronal responses at both local and distant sites. Additionally, these metabolites demonstrate potent antioxidant and anti-inflammatory activities. The levels of microbiota-derived TRP metabolites are intricately linked to the gut microbiota's health, which, in turn, can be influenced by age-related changes. This review aims to comprehensively summarize the cellular and molecular impacts of tryptamine and IPA on health and aging-related complications. Furthermore, we explore the levels of tryptamine and IPA and their corresponding bacteria in select diseased conditions, shedding light on their potential significance as biomarkers and therapeutic targets.

Initial perception of the mentoring role and related mentors' approach of autonomy support or control in formal youth mentoring relationships

Mentors' initial perceptions of the mentoring role in formal youth mentoring bonds; and the subsequent characteristics of autonomy support or autonomy control in mentoring interactions developed by mentors after 5 months of mentoring experience are discussed in this paper. The data is drawn from a longitudinal phenomenological study conducted in the Czech mentoring scheme between 2010 and 2017. In-depth semi-structured interviews were collected with 10 mentoring matches over 1 year of mentoring involvement. The results of Interpretive phenomenological analysis showed differences in mentors' initial perceptions of the role, and related autonomy-supportive or autonomy-controlling characteristics in mentors' approach. The benefits and risks of resulting autonomy support or control in mentoring interactions are discussed. The results argue for the theoretical conceptualisation of a child-centred perspective in youth mentoring that aims at mentees' support of autonomy, active agency and empowement, thus arguing for further in-depth exploration of natural mentoring principles in child-centred perspective, supporting approaches such as youth-initiated mentoring, and broadening the discussion on good evidence-based mentoring practice in the EU context.

The Reception of Lacanian Theory and Practice by American Psychoanalytic Training Programs

This paper explores the principal reasons for the exclusion of Lacanian ideas from psychoanalytic training institutes in the United States. The history of Lacan's role in the International Psychoanalytical Association, from which essentially he was expelled, occupies a central place in this story. Significant issues arose also from his practice style and technical innovations, whose rationale remains controversial today. Another major obstacle for the reception of his work is the theoretical framework of Lacanian analysis, so different from that of other schools. Inclusion of its unfamiliar vocabulary and concepts poses practical problems for training programs. At a more fundamental level, the strong antihumanist evolution of Lacan's thought runs contrary to the increasingly relational and intersubjective orientation of American psychoanalysis. The incompatibility between the disparate languages of a scientific theory aiming at objectivity and a phenomenology of personal intentionality and meaning greatly limits the possibilities for dialogue. The tension between these perspectives cannot be resolved, but a productive exchange between them is possible if they are accepted as valid and complementary ways of speaking about human behavior.

Competencies in Pastoral Counseling: The Lived Experiences of Filipino Diocesan Parish Priests

Pastoral counseling has been a significant part of the priestly ministry in the Philippines. Nonetheless, literature about Filipino priests' lived experiences and competencies in counseling is almost non-existent. Using Interpretative Phenomenological Analysis (IPA), the researcher explored the lived experiences and competencies of Filipino diocesan parish priests in their role as pastoral counselors. The study was framed in Phenomenology, the Philippines Psychology Act of 2009, and the 2009 competencies of the Association for Spiritual, Ethical, and Religious Values in Counseling (ASERVIC), a division within the American Counseling Association (ACA). Data were collected using a semi-structured interview, and the analysis yielded seven (7) themes under three (3) clusters. The findings revealed that the participants lack the prerequisites to be rightfully called pastoral counselors. As priests continue to attend to people in need of counseling, the researcher calls on church leaders, the Psychological Association of the Philippines (PAP), and the Professional Regulation Commission (PRC) to address the practice of pastoral counseling in the country.

Analysis of ceRNA Regulatory Mechanism of Rape Pollen Allergy Based on Whole-Transcriptome Sequencing of Peripheral Blood Mononuclear Cells

Background

Rape pollen allergy is a common allergic reaction disorder that affects the health and life of patients seriously. The research on ceRNA regulatory network in rape pollen allergy is poor.

Methods

High throughput whole-transcriptome sequencing was conducted on rape pollen allergic samples and non-allergic samples. Differentially expressed microRNAs (DEmiRNAs), circRNAs (DEcircRNAs), long non-coding RNA (DElncRNAs), mRNA (DEmRNAs) were identified and a ceRNA regulatory network was constructed by Cytoscape. Functional enrichment analyses were performed on DEmRNAs in the ceRNA network. Then, the least absolute shrinkage and selection operator (LASSO) regression model was used to identify characteristic genes for rape pollen allergy. The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic ability of characteristic genes.

Results

A total of 25 DEmiRNAs, 258 DEcircRNAs, 304 DElncRNAs, and 383 DEmRNAs in the allergic group compared with the non-allergic group were uncovered, respectively. A ceRNA network containing 21 miRNAs, 57 circRNAs, 28 lncRNAs, and 33 mRNAs was generated with 139 nodes and 160 edges. The signal transduction-related processes, immune-related processes, the ion, inorganic substance, and hormone regulation processes were associated with mRNAs in the ceRNA network. The results of pathway enrichment illustrated that mRNAs in the ceRNA were significantly linked to IL-17 signaling pathway, inflammatory mediator regulation of trp channels, GMP-PKG signaling pathway, signaling by GPCR, and GPCR downstream signaling pathway. Then, five characteristic genes (KCNQ3, CCR5, FOSB, CFAP43, and PRKG1) were defined by the LASSO algorithm. The AUC values of these genes indicated that these genes had a powerful discrimination ability in discriminating allergic samples from non-allergic samples.

Conclusion

Taken together, we revealed the ceRNA regulatory network in rape pollen allergy and excavated five characteristic genes (KCNQ3, CCR5, FOSB, CFAP43, and PRKG1) with the diagnostic value that may be a potential target in diagnosis and treatment.

Perceptions of social support and relationships while living with a brain tumour: a qualitative study

OBJECTIVE

Having a brain tumour can disrupt social roles and networks. Despite growing evidence on the significance of social support in adjustment to chronic illness, research rarely focuses on the role of relationships when coping with a brain tumour. The current study sought to explore individuals' experiences of social support, and the dynamics within their social relationships, following a diagnosis of a brain tumour.

METHODS

Interpretative Phenomenological Analysis (IPA) was used as a methodological framework. Participants were 12 individuals (83% female) aged 29-54 years diagnosed with primary brain tumour (83% low grade), on average 3.5 years post-diagnosis. In-depth semi-structured interviews were conducted, transcribed verbatim, and analysed using IPA.

RESULTS

Five themes were identified: Coping together in the family; Being concerned about others; Giving and receiving support; Needing to share the experience; and Negotiating independence. The results highlighted that the illness affected a whole network of closest relationships, and that coping was not an individual task.

CONCLUSION

Coping with the condition was deeply socially embedded. There was a cost associated with seeking support and participants did not always ask for it, in order not to burden the caregivers. Talking to others with similar diagnoses provided a sense of validation and belonging.

They have taken out my spinal cord: an interpretative phenomenological analysis of self-boundary in psychotic experience within a sociocentric culture

INTRODUCTION

In the tradition of phenomenological psychiatry, schizophrenia is described as a disturbance of the minimal self, i.e. the most basic form of self-awareness. This disturbance of the minimal self at the individual level is assumed to precede the intersubjective disturbances such as boundary weakening. However, the role of intersubjective disturbances in the emergence and recovery of schizophrenic experience still remains an open question. This phenomenological study focuses on how encounters with others shape self-experience during from psychosis by analyzing this process from the perspective of cultural differences, which in current research is especially under-researched. While most phenomenological accounts are based on first person-accounts from Western, individualist cultures where the self is conceived and experienced as separate to others, the present study qualitatively investigates psychotic experiences of patients from Jaffna, Sri Lanka.

METHOD

Semi-structured interviews were conducted with three participants with a diagnosis of schizophrenia or first episode psychosis. The interviews were transcribed and analyzed using interpretative phenomenological analysis (IPA). Eight group experiential themes were identified across interviews.

RESULTS

The data suggest that intersubjective processes of boundary weakening such as invasiveness and hyperattunement may shape minimal self-experience and more specifically contribute to a mistrust of the own senses and to hyper-reflexivity. Interestingly, boundary weakening yields pervasive emotions and can be experienced as a threat to the whole social unit. On the one hand, the strengthening of self-other-boundary was achieved through opposition, closedness and withdrawal from others. On the other hand, this study suggests that the re-opening of self-other-boundaries in response to the crisis may help establish connectedness and may lead to recovery.

The dynamics of sexual risk amongst South African youth in age-disparate relationships

Introduction

South Africa has the highest burden of HIV in the world with over 8 million people living with HIV. Young women and girls account for a quarter of new HIV infections while making up only 10% of the population. A key driver of HIV incidence is transactional and survival sex between adolescent girls or young women and older men (the latter referred to as 'sugar-daddies' or 'blessers'). This paper expands on the existing literature on age-disparate and intergenerational relationships to provide social and behavioural interpretations of how young men, commonly omitted from studies on this topic, and women in concurrent relationships with both their peers and older partners perceive and navigate sexual risk.

Method

We conducted a qualitative study in a rural setting of uMgungundlovu District, KwaZulu-Natal Province, with purposively selected male and female participants aged 18-24 years old in age-disparate relationships. Semi-structured in-depth interviews (IDI) were conducted and analysed using interpretative phenomenological analysis (IPA) to explore existing information, motivations, and behavioural practices around relationships and sexual risk.

Results

The themes and related sub-themes found through IPA included the following: (1) navigating dating: narratives that show a strong preference for being in an age-disparate relationship; the challenges that young people face when choosing an older person as a side partner; and social media applications seen as creating opportunities to meet side partners; and (2) the distribution of love and trust in a multi-party sexual network: condom (mis)use differentiates between straights-those in a serious relationship-and sides; and the power of eye-test seroguessing, the praxis of testing people visually for HIV in nullifying existing knowledge about sexual and reproductive health risk.

Discussion

This research offers an understanding of how schemas of non-condom use are organised. We observed that while condom-less sex is often viewed as essential to building social capital in a serious relationship, it is not the only factor that determines sexual relationship power. Eye-test seroguessing not only develops consortium (trust, reciprocity, and solidarity), but it fulfils the psycho-social need to belong to a network of serious relationships. Moreover, it is critical to the enactment of masculinities because it consolidates femininity to keep men happy, i.e., by being passive in the sexual encounter, women constrain their self-efficacy to act contrary to the conventions of reputable women. Therefore, it is plausible that in the serosorting that occurs prior to unprotected sexual acts, the power of eye-test seroguessing limits the ability to engage in safe sexual practices.

Indole-3-propionic acid, a product of intestinal flora, inhibits the HDAC6/NOX2 signaling and relieves doxorubicin-induced cardiomyocyte damage

The heart failure-gut hypothesis indicates that damage to intestinal mucosa leads to increased microbial translocation, resulting in alterations in metabolites entering the blood circulation. This process promotes the development of heart failure. This study aimed to reveal the involvement of indole-3-propionic acid (IPA), a microbiota-derived tryptophan metabolite, in heart failure. Human cardiomyocytes AC16 was treated with doxorubicin to induce in vitro heart failure model, the influences of IPA on the cellular viability, apoptosis, inflammation and oxidative stress were evaluated. Molecular docking and western blotting were used to initially illustrate the potential relationship between IPA and HDAC6. Through HDAC6 overexpression, its mediating role in the regulatory mechanism of IPA in the above aspects was further investigated. IPA was found to reduce the apoptosis, inflammation and oxidative stress in doxorubicin-treated cells. The visualized structure displayed that IPA bound to HDAC6 and that IPA reduced HDAC6 level. Additionally, HDAC6 overexpression reversed the regulation of IPA in the above aspects, indicating the HDAC6/NOX2 signals mediated the mechanism of IPA. Together, the present study revealed that IPA reduced oxidative stress, inflammatory response and apoptosis in cardiomyocytes via inhibiting the HDAC6/NOX2 signaling. The findings suggest that gut microbiota metabolites have potential in the treatment of heart failure.

"It's not about wanting to be thin or look small, it's about the way it feels": an IPA analysis of social and sensory differences in autistic and non-autistic individuals with anorexia and their parents

BACKGROUND

Despite increasing evidence to support an overlap between autism and anorexia nervosa (AN), underlying mechanisms remain poorly understood. Social and sensory factors have emerged as promising targets in both autism and AN, however there remains scope to compare these differences across autistic and non-autistic experiences of AN. Drawing on dyadic multi-perspectives, this study explored experiences of social and sensory differences in autistic and non-autistic adults and their parents and/or carers.

METHODS

Using interpretative phenomenological analysis (IPA), dyadic interviews were conducted with 14 dyads, with seven autistic dyads and seven non-autistic dyads. Data analysis was subjected to a triangulation of interpretations: (1) the participants themselves; (2) a neurotypical researcher; (3) and an Autistic researcher with lived/living experience of AN.

RESULTS

IPA identified three themes in each group, with similarities and differences between autistic and non-autistic dyads. Similar themes were identified regarding the importance of social connectedness and socio-emotional difficulties, as well a common lack of trust in the social and sensory self and body. Autism-specific themes centred on feelings of social 'defectiveness', disparities between sensing and expressing certain cues, and lifelong, multi-sensory processing differences. Non-autistic themes reflected social comparisons and inadequacy, and sensitivities to the learning of ideals and behaviour through early experiences.

CONCLUSIONS

While similarities were observed across both groups, there appeared to be notable differences in the perceived role and influence of social and sensory differences. These findings may have important implications on the delivery and modification of eating disorder interventions. Specifically, they suggest that while treatment targets may look similar, subtle differences in underlying mechanisms and approaches may be required for Autistic individuals with AN across sensory, emotion and communication-based interventions.

Challenges for the Mental Health of Refugee Artists: Perspectives of the ADAPT Model

This study aimed to address the mental health challenges faced by refugee artists who are grantees of ICORN-the International Cities of Refuge Network-from the perspective of the extended conceptual ADAPT model. The study employed exploratory qualitative research, and data were collected through semi-structured interviews with ICORN artists in Poland, Norway, and Sweden. For data analysis, Interpretive Phenomenological Analysis (IPA) was used, whereas for the presentation of the results, the framework of the ADAPT model was applied. The results showed that the super-ordinate themes that emerged from the IPA analysis related directly to the ADAPT model and could mostly be assigned to its basic pillars: (1) Security; (2) Bonds and Networks; (3) Justice; (4) Roles and Identities; and (5) Existential Meaning. However, the model was insufficient for capturing the full diversity of experiences described by the respondents. Therefore, an extension of the model in the form of two additional pillars, Art and Body and Mind, was proposed. The findings confirm that the ADAPT model is adequate for systematizing and depicting in detail the experiences of migrants/refugees. However, further modifications of the model are necessary, particularly the additional pillar Body and Mind, which has the potential to become a separate category in other migrants'/refugees' assessment frameworks. Moreover, Art itself could be seen as a universal bridging factor between the refugee and the host population, contributing to the refugees' adaptation to the host society.

Nature-Based Mindfulness: A Qualitative Study of the Experience of Support for Self-Regulation

Self-regulation is pivotal for human well-being and mental health. In this qualitative study, we followed a randomized controlled trial (RCT) and explored how a five-day residential mindfulness program in a restorative natural setting supported self-regulation among university students experiencing moderate to severe stress. Six participants were interviewed post intervention and at three months' follow-up on how they experienced the retreat. Through interpretative phenomenological analysis, four interrelated themes emerged: "supportive conditions", "attitudes of mindfulness", "connection" and "physical and psychological balance." These themes reflected the outcomes of the retreat that participants valued in stressful situations. A progression occurred during the retreat through the themes, with emphasis developing from the supportive conditions of the setting, to cultivating mindful attitudes, over connection to both self, others and nature, to changes and effects on the physical, psychological and even spiritual level. In addition, participants emphasized experiences of positive emotions, energy, calmness, meta-awareness and the feeling of being part of the web of life. In conclusion, participants' experiences with a five-day nature-based mindfulness intervention revealed a range of qualities of both physical-, psychological-, social- and spiritual nature that are supportive for self-regulation.

Evaluating the quality of the public transport service during the COVID-19 pandemic from the perception of two user groups

The current paper focuses on a comparative analysis of both public transport (PT) and private vehicle (PV) users' perceptions on the quality of the service. To detect the key components of PT attributes a new hybrid methodology is applied, combining the importance-performance analysis and the importance-performance map analysis. The proposed hybrid approach is simpler and more integrated than the existing methods in the literature. The sample comprises an online panel and a total of 1028 questionnaires for PV and PT users surveyed during the pandemic period in Budapest. The results of the applied methods show that among the different groups, the service hour, the proximity, and the frequency attributes are important and performed well in the years of COVID-19. On the other hand, the temperature and the cleanliness factors are not significant predictors of the PV and PT users' general satisfaction. The obtained results can be used by local governments and authorities, who seek to identify areas to enhance the service quality of PT during movement restrictions in a pandemic wave.

Exploring the impact on primary care mental health practitioners of the death of a patient by suicide: An IPA study

OBJECTIVES

There have been numerous qualitative studies into the impact of the death of a patient by suicide on clinicians, but the majority of studies have focussed on psychiatrists and psychologists, primarily in inpatient or secondary care settings. To date, little has been done to explore the impact of such deaths on other mental health practitioners working in primary care, such as those working in Improving Access to Psychological Therapies (IAPT) services.

DESIGN

This qualitative study used purposive sampling and adopted an interpretative phenomenological analysis (IPA) methodology.

METHOD

All participants had experienced the death of a patient in their role as a practitioner in an IAPT service. Seven practitioners were recruited from services across the North of England. Semi-structured, one-hour telephone interviews were audio recorded and then transcribed verbatim.

RESULTS

Analysis of the transcripts identified a number of themes, which were represented in the majority of cases. Specifically, the analyses yielded four superordinate themes: (1) feeling shocked and upset about the death of a patient; (2) attempting to understand the causes of the suicide; (3) learning from the tragic event; and (4) reflections on what helped in coping with the tragic event. The emotional responses of shock, upset, guilt and fear of blame by IAPT practitioners following the death of a patient through suicide is consistent with that found in studies of other mental health practitioners.

CONCLUSIONS

It is hoped that the current study will help raise awareness amongst primary care mental health practitioners, services and training centres, of the impact of losing a patient to suicide and will encourage them to consider how best to prepare and support practitioners in this eventuality. Recommendations include raising awareness of the potential for patient suicide in primary care services, providing clarity on the individualised support available and on the requirements of investigations.

Optimizing palliative care education through undergraduate nursing students' perceptions: Application of importance-performance analysis and Borich needs assessment model

BACKGROUND

With the aging of the population and the increasing trend of chronic illnesses, the demand for palliative care is growing. Undergraduate nursing students will be the main providers of palliative care in the future. Therefore, it's important to enhance their capability for palliative care.

OBJECTIVES

The purpose of this study was to optimize palliative care education, based on undergraduate nursing students' perceptions and educational needs through the application of the importance-performance analysis and Borich needs assessment model.

DESIGN

A cross-sectional descriptive study.

SETTING

Nursing department in Wenzhou, China.

PARTICIPANTS

A total of 448 full-time undergraduate nursing students were recruited for the study.

METHODS

Importance-performance analysis was used to identify items that obtain high priority for improvement, and the Borich needs assessment model and the Locus for focus model were used to prioritize educational needs. The three methods were integrated to determine the top-priority content to meet undergraduate nursing students' educational needs in palliative care.

RESULTS

The items located in Quadrant II of Importance-performance analysis, ranked in the first 10 in Borich needs assessment, and located in Quadrant I of the Locus for focus model were defined as top-priority content. These included: "respiratory symptoms: pleural effusion, superior vena cava syndrome, respiratory difficulty," "Care of terminal symptoms," "Awareness of dying," "Care of remains," "Cooperation between interdisciplinary teams," and "Rights and interests of dying patients."

CONCLUSION

Several years of development of palliative care education have made nursing students aware of its importance. However, they have reported that education remains insufficient. A greater focus on palliative care education is needed to ensure they are better prepared. Specific attention should be given to cooperation between interdisciplinary teams, dealing with death and dying, rights and interests of people who were dying.

Personal meaning of recovery among persons with schizophrenia

BACKGROUND

Recovery in mental illness is not synonymous with cure. Personal recovery approach consider recovery as a process and not as an outcome. This approach takes into account the subjective meaning of recovery by assessing how a person has learned to accommodate and live with an illness.

AIM

To study the personal meaning of recovery among persons with schizophrenia.

METHOD

This article presents the findings of a qualitative study about what 'recovery' means to persons with schizophrenia. A semi structured interview schedule was prepared based on literature review and expert opinion. Twenty participants who met the inclusion criteria and personally consider themselves recovering/recovered from schizophrenia were selected for the in-depth qualitative interviews. Data was analyzed using Interpretative Phenomenological Analysis (IPA). Meaning of recovery from each participant's perspective was recorded.

FINDINGS

The results indicate factors that patients deem important for their recovery are, absence of symptoms, regaining functioning, being able to work, having adequate emotional stability and not being on medicines. The findings are examined in the background of the previous studies and suggestions for clinical practice and research is also discussed.

CONCLUSION

Recovery is far more than remission of symptoms. Persons with mental illness has their own criteria of recovery, which could be very distinct from the clinical definition. Current study findings can help in identifying meaning of recovery through the perspectives of persons with mental illness and in developing and implementing recovery-oriented services.

Invasive Pulmonary Aspergillosis: Not Only a Disease Affecting Immunosuppressed Patients

Fungal infections have become a common threat in Intensive Care Units (ICU). The epidemiology of invasive fungal diseases (IFD) has been extensively studied in patients severely immunosuppressed over the last 20-30 years, however, the type of patients that have been admitted to hospitals in the last decade has made the healthcare system and ICU a different setting with more vulnerable hosts. Patients admitted to an ICU tend to have older age and higher severity of disease. Moreover, the number of patients being treated in ICU are often immunosuppressed as a result of the widespread use of immunomodulatory agents, such as corticosteroids, chemotherapy, and biological agents. The development of Invasive Pulmonary aspergillosis (IPA) reflects a different clinical trajectory to affected patients. The increasing use of corticosteroids would probably explain the higher incidence of IPA especially in critically ill patients. In refractory septic shock, severe community-acquired pneumonia (SCAP), and acute respiratory distress syndrome (ARDS), the use of corticosteroids has re-emerged in order to decrease unacceptably high mortality rates associated with these clinical conditions. It is also pertinent to note that different reports have used different diagnosis criteria, and this might explain the different incidence rates. Another layer of complexity to better understand current IPA data is related to more aggressive acquisition of samples through invasive respiratory examinations.

Combined analysis of gut microbiome and serum metabolomics reveals novel biomarkers in patients with early-stage non-small cell lung cancer

Non-small cell lung cancer (NSCLC) is the predominant form of lung cancer and is one of the most fatal cancers worldwide. Recently, the International Association for the Study of Lung Cancer (IASLC) proposed a novel grading system based on the predominant and high-grade histological patterns for invasive pulmonary adenocarcinoma (IPA). To improve outcomes for NSCLC patients, we combined serum metabolomics and fecal microbiology to screen biomarkers in patients with early-stage NSCLC and identified characteristic microbial profiles in patients with different grades of IPA. 26 genera and 123 metabolites were significantly altered in the early-stage NSCLC patients. Agathobacter, Blautia, Clostridium, and Muribaculacea were more abundant in the early-stage NSCLC patients compared with healthy controls. For the different grades of IPA, the characteristic microorganisms are as follows: Blautia and Marinobacter in IPA grade type 1; Dorea in IPA grade type 2; and Agathobacter in IPA grade type 3. In the metabolome results, the early-stage NSCLC group mainly included higher levels of sphingolipids (D-erythro-sphingosine 1-phosphate, palmitoyl sphingomyelin), fatty acyl (Avocadyne 1-acetate, 12(S)-HETE, 20-Carboxy-Leukotriene B4, Thromboxane B3, 6-Keto-prostaglandin f1alpha, Sebacic acid, Tetradecanedioic acid) and glycerophospholipids (LPC 20:2, LPC 18:0, LPC 18:4, LPE 20:2, LPC 20:1, LPC 16:1, LPC 20:0, LPA 18:2, LPC 17:1, LPC 17:2, LPC 19:0). Dysregulation of pathways, such as sphingolipid metabolism and sphingolipid signaling pathway may become an emerging therapeutic strategy for early-NSCLC. Correlation analysis showed that gut microbiota and serum metabolic profiles were closely related, while Muribaculacea and Clostridium were the core genera. These findings provide new biomarkers for the diagnosis of early-stage NSCLC and the precise grading assessment of prognostic-related IPAs, which are of clinical importance and warrant further investigation of the underlying molecular mechanisms.

A Safe Place to Learn: Peer Research Qualitative Investigation of gameChange Virtual Reality Therapy

BACKGROUND

Automated virtual reality (VR) therapy has the potential to substantially increase access to evidence-based psychological treatments. The results of a multicenter randomized controlled trial showed that gameChange VR cognitive therapy reduces the agoraphobic avoidance of people diagnosed with psychosis, especially for those with severe avoidance.

OBJECTIVE

We set out to use a peer research approach to explore participants' experiences with gameChange VR therapy. This in-depth experiential exploration of user experience may inform the implementation in clinical services and future VR therapy development.

METHODS

Peer-led semistructured remote interviews were conducted with 20 people with a diagnosis of psychosis who had received gameChange as part of the clinical trial (ISRCTN17308399). Data were analyzed using interpretative phenomenological analysis and template analyses. A multiperspectival approach was taken to explore subgroups. Credibility checks were conducted with the study Lived Experience Advisory Panel.

RESULTS

Participants reported the substantial impact of anxious avoidance on their lives before the VR intervention, leaving some of them housebound and isolated. Those who were struggling the most with agoraphobic avoidance expressed the most appreciation for, and gains from, the gameChange therapy. The VR scenarios provided "a place to practise." Immersion within the VR scenarios triggered anxiety, yet participants were able to observe this and respond in different ways than usual. The "security of knowing the VR scenarios are not real" created a safe place to learn about fears. The "balance of safety and anxiety" could be calibrated to the individual. The new learning made in VR was "taken into the real world" through practice and distilling key messages with support from the delivery staff member.

CONCLUSIONS

Automated VR can provide a therapeutic simulation that allows people diagnosed with psychosis to learn and embed new ways of responding to the situations that challenge them. An important process in anxiety reduction is enabling the presentation of stimuli that induce the original anxious fears yet allow for learning of safety. In gameChange, the interaction of anxiety and safety could be calibrated to provide a safe place to learn about fears and build confidence. This navigation of therapeutic learning can be successfully managed by patients themselves in an automated therapy, with staff support, that provides users with personalized control. The clinical improvements for people with severe anxious avoidance, the positive experience of VR, and the maintenance of a sense of control are likely to facilitate implementation.

Therapeutic work with clients living in poverty

BACKGROUND

Financial inequalities appear to be increasing and poverty is becoming ubiquitous. Poverty affects mental health but its impact on mental health and wellbeing is rarely highlighted within health research.

AIMS

The Covid-19 pandemic, the Ukrainian invasion and other international and national events have led to a cost-of-living crisis for many people. This is likely to lead to an increase in related referrals and therefore active consideration of the relevant issues relating to poverty appears vital. This paper reports a study which sought to understand how therapists experienced their work with clients who self-refer due to living in poverty.

METHOD

Eight therapists participated in semi-structured interviews analysed using Interpretative Phenomenological Analysis (IPA).

RESULTS

Three superordinate themes were elicited: firstly 'Resilience in the struggle to engage with therapeutic work', secondly 'Struggling to promote social activism' and thirdly, 'Navigating multiple challenges and barriers'. Each superordinate theme contains two or three sub themes.

CONCLUSIONS

Issues of structural inequality (including but not limited to poverty) impact significantly on people's lives but are often ignored or minimised in therapeutic work. It is important that therapists are aware of poverty and take this into account when working with clients.

Family Recovery from Addiction and Trauma: An Interpretative Phenomenological Analysis of Mothers' Lived Experience

INTRODUCTION AND AIMS

Addiction has a devastating impact in the lives of millions of people worldwide. Mothers constitute a hidden population. Previous research did not focus on mothers' experience of recovery.

METHODS

An Interpretative Phenomenological Analysis was used to analyze the experiences of 10 mothers whose young adult son/or daughter was in recovery from addiction.

FINDINGS

Four themes delineated mothers' lived experience of the long journey from traumatic loss and isolation to traumatic growth and connection: (a) Trauma and despair. Loss of relationships and healthy family life, (b) coping strategies, (c) finding meaning and constructing a new identity, and (d) connection and gratitude. Overall, halting the descent into despair involved a perceptual shift that restored meaning, relationships, and hope and alleviated mothers' feelings of chronic grief and distress over their adult child's addiction problems.

CONCLUSIONS

Addiction can have a damaging traumatic impact on mothers which is enhanced by social and self-stigmatizing processes. Ambiguous loss can occur when one's child uses substances, as the child may be physically present yet be psychologically absent in terms of the mother (and the family). Understanding the experience of mothers may help health and social care professionals to develop compassion, patience, and empathy towards mothers of persons with addiction problems. Mental health professionals need to be aware of the devastating impact of addiction problems on all family members in order to validate their experiences and support them in recovering from trauma and loss in the family.

Analysis of risk factors of fungal superinfections in viral pneumonia patients: A systematic review and meta-analysis

BACKGROUND

Infections with fungi, such as Aspergillus species, have been found as common complications of viral pneumonia. This study aims to determine the risk factors of fungal superinfections in viral pneumonia patients using meta-analysis.

OBJECTIVE

This study aims to determine the risk factors of fungal infection s in viral pneumonia patients using meta-analysis.

METHODS

We reviewed primary literature about fungal infection in viral pneumonia patients published between January 1, 2010 and September 30, 2020, in the Chinese Biomedical Literature, Chinese National Knowledge Infrastructure, Wanfang (China), Cochrane Central Library, Embase, PubMed, and Web of Science databases. These studies were subjected to an array of statistical analyses, including risk of bias and sensitivity analyses.

RESULTS

In this study, we found a statistically significant difference in the incidence of fungal infections in viral pneumonia patients that received corticosteroid treatment as compared to those without corticosteroid treatment (p < .00001). Additionally, regarding the severity of fungal infections, we observed significant higher incidence of invasive pulmonary aspergillosis (IPA) in patients with high Acute Physiology and Chronic Health Evaluation (APACHE) II scores (p < .001), tumors (p = .005), or immunocompromised patients (p < .0001).

CONCLUSIONS

Our research shows that corticosteroid treatment was an important risk factor for the development of fungal infection in patients with viral pneumonia. High APACHE II scores, tumors, and immunocompromised condition are also important risk factors of developing IPA. The diagnosis of fungal infection in viral pneumonia patients can be facilitated by early serum galactomannan (GM) testing, bronchoalveolar lavage fluid Aspergillus antigen testing, culture, and biopsy.

"It seems impossible that it's been made so quickly": a qualitative investigation of concerns about the speed of COVID-19 vaccine development and how these may be overcome

The speed of COVID-19 vaccine development has been identified as a central concern contributing to hesitancy in acceptance. We conducted qualitative interviews to gain a greater understanding into these concerns and to identify what might address them. Twelve qualitative interviews were conducted with participants identifying as hesitant for COVID-19 vaccination and reporting concern about the speed of vaccine development. Interpretative Phenomenological Analysis (IPA) was used. Concerns about speed comprised the linked themes of i) difficulty understanding the pace, and, ii) worry about the implications for vaccine safety. Uncertainties concerning the pandemic led to a notable desire for credible and understandable information regarding the vaccines, which many participants felt was not available. Four routes to resolving uncertainty about whether to be vaccinated were identified. First, waiting for more information about the vaccines, such as about their contents and impact on transmission. Second, a growing perception that the vaccines must be safe given the large numbers already vaccinated. Third, viewing the vaccines as necessary - even if unappealing - for ending the pandemic. Finally, a feeling that there would be no choice but to have a vaccine. Examples of what might reduce hesitancy were given, including interviews with vaccine developers and knowing others of similar age having safely been vaccinated. The pace of development broke expectations set earlier in the pandemic. This was interpreted negatively due to a perceived lack of credible information. Most participants could envisage ways their concerns could be resolved, enough for them to have a vaccine.

"It Almost Makes Her Human": How Female Animal Guardians Construct Experiences of Cat and Dog Empathy

Understanding how humans perceive and construct experiences of non-human animal empathy (hereafter, 'animal/s') can provide important information to aid our understanding of how companion animals contribute to social support. This study investigates the phenomenology of animal empathy by examining how humans construct sense-making narratives of these experiences, with the hypothesis that anthropomorphic attributions would play a key role in these constructions. Comprehensive, semi-structured interviews were conducted with six participants, using established interpretative phenomenological analysis methodology to facilitate deep examination of how they interpreted and reacted emotionally. Participants were consistent in reporting changes to their companion animals' normal behaviour as the key to the identification of animal empathy experiences, yet they were highly paradoxical in their constructions of perceived internal drivers within their dogs and cats. Explanations were highly dichotomous, from highly anthropomorphic to highly anthropocentric, and these extremes were combined both within individual participant narratives and within some thematic constructs. This research demonstrates that experiences of companion animal empathy can be powerful and meaningful for humans, but the inconsistent mixture of anthropomorphic and anthropocentric reasoning illustrates the confused nature of human understanding of animals' internal states. Insight into how humans construct animal empathy has implications for the moral status of these animals and an application for companion animals used explicitly for social support, such as in animal-assisted therapy and emotional support animals.

Integrating Pharmacogenomics Data-Driven Computational Drug Prediction with Single-Cell RNAseq to Demonstrate the Efficacy of a NAMPT Inhibitor against Aggressive, Taxane-Resistant, and Stem-like Cells in Lethal Prostate Cancer

Metastatic prostate cancer/PCa is the second leading cause of cancer deaths in US men. Most early-stage PCa are dependent on overexpression of the androgen receptor (AR) and, therefore, androgen deprivation therapies/ADT-sensitive. However, eventual resistance to standard medical castration (AR-inhibitors) and secondary chemotherapies (taxanes) is nearly universal. Further, the presence of cancer stem-like cells (EMT/epithelial-to-mesenchymal transdifferentiation) and neuroendocrine PCa (NEPC) subtypes significantly contribute to aggressive/lethal/advanced variants of PCa (AVPC). In this study, we introduced a pharmacogenomics data-driven optimization-regularization-based computational prediction algorithm ("secDrugs") to predict novel drugs against lethal PCa. Integrating secDrug with single-cell RNA-sequencing/scRNAseq as a 'Double-Hit' drug screening tool, we demonstrated that single-cells representing drug-resistant and stem-cell-like cells showed high expression of the NAMPT pathway genes, indicating potential efficacy of the secDrug FK866 which targets NAMPT. Next, using several cell-based assays, we showed substantial impact of FK866 on clinically advanced PCa as a single agent and in combination with taxanes or AR-inhibitors. Bulk-RNAseq and scRNAseq revealed that, in addition to NAMPT inhibition, FK866 regulates tumor metastasis, cell migration, invasion, DNA repair machinery, redox homeostasis, autophagy, as well as cancer stemness-related genes, HES1 and CD44. Further, we combined a microfluidic chip-based cell migration assay with a traditional cell migration/'scratch' assay and demonstrated that FK866 reduces cancer cell invasion and motility, indicating abrogation of metastasis. Finally, using PCa patient datasets, we showed that FK866 is potentially capable of reversing the expression of several genes associated with biochemical recurrence, including IFITM3 and LTB4R. Thus, using FK866 as a proof-of-concept candidate for drug repurposing, we introduced a novel, universally applicable preclinical drug development pipeline to circumvent subclonal aggressiveness, drug resistance, and stemness in lethal PCa.

Living with functional movement disorders: a tale of three battles. An interpretative phenomenological analysis

OBJECTIVES

Functional movement disorders (FMD) have poor prognosis and high physical and psychological co-morbidity. Their pathogenesis remains unclear, clinicians often find them difficult to treat, and lack of agreement between healthcare providers and patients is common. This study aimed to explore the experiences of living with FMD to improve understanding of its impact and patients' needs.

METHODS

Ten participants across the UK were recruited online through a charity's social media platforms. Semi structured interviews were conducted via video calls and were audio recorded and verbatim transcripts were analysed using interpretative phenomenological analysis.

RESULTS

Three superordinate themes were generated from the data, representing the three battles fought by the participants: (1) intrapersonal: the tug of war with the secret agent within- the power struggle with symptoms; (2) interpersonal: navigating stigma and self-preservation; (3) systemic: pursuing hope and treatments against helplessness and passivity.

CONCLUSIONS

Loss of control, feelings of powerlessness and oppression by symptoms is often mirrored in participants' experiences of seeking healthcare and navigating societal stigma. Active efforts to regain influence, improve quality of life and maintain hope can be jeopardised by others' dismissive attitudes and lack of knowledge. Antonovsky's model of salutogenesis is proposed as a useful framework for facilitating empowerment in FMD service provision.

"One of Us": Reframed Labels, Compassion and Hope in Voluntary Prison Work With Ex-Servicemen

Despite the growing body of literature on Prison Officers and therapeutic practitioners within correctional facilities, comparatively little research exists into prison volunteers. Using semi-structured interviews with caseworkers (n = 5), analyzed via Interpretative Phenomenological Analysis, this study explores the experience of being a Prison In-Reach Caseworker, supporting the male ex-Armed Forces population in Greater London prisons. Through identifying three superordinate themes of the inherent moral values of the shared past, compassion and "in" versus "out" of the prison system, the study concludes that the caseworkers, working outside the boundaries of the correctional system, reject the label of "criminal" and its associated consequences, choosing instead to attribute value and dignity to the prisoners, both as ex-Armed Forces personnel, and as human beings. The findings offer an insight into the consequences of positive labeling for perspectives of redemption and desistance and suggest the need for further investigation into the experiences and impact of prison volunteers working with different populations.

Emotionally focused therapists' experiences serving interabled couples in couple therapy: An interpretative phenomenological analysis

Interabled couples navigate various systems of care as they respond to the needs of the disabled partner. Interabled couples are defined as one disabled partner and one nondisabled partner. Emotionally focused therapy (EFT) has shown benefits in reducing relationship distress and increasing the experience of security within couples. The study used interpretative phenomenological analysis to address how EFT therapists make sense of their lived experience working with interabled couples in couple therapy. The purpose of the study was to examine the experiences of therapists' serving interabled couples. The study explored the experiences of 10 EFT therapists who served at least one interabled couple in couple therapy. Findings resulted in four superordinate themes, (a) ableism; (b) self-of-the-therapist; (c) reported relationship dynamics of interabled couples; and (d) the "fit" of EFT approach with interabled couples. The themes demonstrate a need to further identify disability-responsive practices within EFT in serving interabled couples.

Study of Microbial Infections and Some Immunological Parameters among Covid-19 in ICU Patients in Najaf Governorate, Iraq

The present study aimed to investigate some microbial infections and immunological parameters associated with Covid-19 patients admitted to the intensive care unit (ICU) of Al-Amal Specialized Hospital in AL-Najaf Governorate during February and March 2021. The study included 50 patients who were assigned to two groups: 20 patients aged ≤70 years and 30 patients aged ≥70 years. The method of microbial culture was adopted to isolate bacteria and yeasts by collecting sputum specimens and oral swabs from patients and cultivating them on diagnostic media and then confirming the diagnosis by Vitek. Moreover, serum samples were collected from patients' blood to diagnose fungal infections. Thereafter, some immunological criteria were assessed, including Covid-19 diagnosis by measuring Immunoglobulin M (IgM) and IgG, as well as examining the concentration of cytokines (Interleukin 6 (IL-6) and IF ) using the enzyme-linked immunosorbent assay (ELISA) method. The results demonstrated that bacterial species Streptococcus pneumonia (n=5; 25%), Haemophilus Influenzae (n=7; 35%), and Moraxella catarrhalis (n=3; 15%) were isolated from the first group of patients (≤70 years). The recorded data pointed out that Streptococcus pneumonia (n=10; 33.3%), Streptococcus pyogenes (n=5; 16.6%), Streptococcus viridans (n=1; 3.3%), Haemophilus Influenzae (n=6; 20%), Mycobacterium tuberculosis (n=2; 6.6%), and Pseudomonas aeruginosa (n=2; 6.6%) were the isolated and identified microorganisms in the second age group (≥ 70 years). The results revealed that the isolated yeast from the first age group was Candida albicans (n=5; 25%) and Candida glabrata (n=3; 10%), while in the second age group, 1 (3.3%) Candida albicans was isolated. The results of this study proved that 30% and 10% of patients in the first and second age groups had invasive pulmonary aspergillosis co-infection by detecting Galactomannan (GM) in the blood serum (1.05±0.59, 1.25±0.38), respectively. The results indicated that IgM and IgG levels in the serum of patients in the first age group were 11.42±6.82 and 0.47±6.82, respectively. Moreover, the levels of IgM and IgG in the second age group were 14.84±9.21 and 0.12±0.11, respectively. Furthermore, IFɤ and IL6 levels were 98.37±65.70, and 146.12±46.35 in the first group, while IFɤ and IL6 were obtained at 110.69±47.60 and 133.28±116.94 in the second group, respectively. Elderly patients with severe COVID-19 are more frequently admitted to ICUs since the proportion of severe cases and comorbidities caused by a weakened immune system is higher among this age group. Secondary bacterial infections can also occur, especially Gram-negative bacteria which are among the most significant public health problems worldwide. Moroever, aspergillosis may infect patients hospitalized with COVID-19 and lead to death.

"I've Got the Energy to Change, But I Haven't Got the Energy for This Kinda Therapy": A Qualitative Analysis of the Motivations Behind Democratic Therapeutic Community Drop-Out for Men With Sexual Convictions

Prison-based democratic therapeutic communities (TCs) provide an alternative to mainstream prison, where prisoners can work on psychological difficulties and address offending behavior. Research demonstrates TCs are effective at reducing reoffending rates for residents who stay in therapy 18+ months, and those who drop out of TCs offend at a significantly higher rate than those who complete therapy. Thus, it is important to reduce attrition in TCs. No research has yet explored the explanations for TC drop out offered by those with sexual convictions. The present study uses Interpretive Phenomenological Analysis to qualitatively explore the accounts of men with sexual convictions (n = 7) who dropped out of a TC in a UK prison. Results highlight that issues surrounding external responsivity, therapeutic relationships, and treatment readiness were salient in the participants' accounts of drop out. This research has implications for TCs seeking to better understand and address attrition of people with sexual convictions.

Analysis of Strategies to Increase User Retention of Fitness Mobile Apps during and after the COVID-19 Pandemic

The COVID-19 pandemic has changed the fitness-related field. More people started working out at home, and the use of fitness mobile apps that can measure the amount of exercise through a scientific method has increased compared to before the COVID-19 pandemic. This phenomenon is likely to continue even after the COVID-19 pandemic, and therefore this study aimed to investigate the importance of and satisfaction with a fitness app's functions according to consumers while using the fitness mobile app. Through this study, we intended to provide data for creating an environment where users can use fitness mobile apps consistently. A total of 420 questionnaires were distributed through Google Survey for about 3 months, from 13 September to 20 November 2020, and a total of 399 complete questionnaires were analyzed in this study. Regarding the data processing methods, frequency analysis, exploratory factor analysis, reliability analysis, descriptive statistical analysis, and IPA were used. The results are as follows. First, the first quadrant of the IPA matrix indicated the high importance of and satisfaction with the fitness mobile app, and included five attributes: cost-effectiveness, easy-to-understand information, ease of use and application, privacy protection, and compatibility with other devices. Second, the second quadrant of the matrix indicated relatively low satisfaction in association to high importance and included five attributes: accurate exercise information provision, design efficiency, daily exercise amount setting, convenient icons and interface, and provision of images and videos in appropriate proportions. Third, the third quadrant of the matrix, indicating low importance and low satisfaction, included five attributes: not sharing personal information, overall design composition and color, customer service, reliable security level, and providing information on goal achievement after exercising. Fourth, in the quadrant of the matrix, indicating low importance and high satisfaction, five attributes were included: exercise notification function, continuous service provision, step count and heart rate information, individual exercise recommendation, and individual body type analysis information.

A Study of Food Safety Knowledge for Sustainable Foodservice Management of Childcare Centers in South Korea Using Importance-Performance Analysis

This study aims to evaluate the importance and performance level of knowledge about sanitary management among foodservice employees in childcare centers that were registered at Center for Children’s Food Service Management in Chungju city according to their work duration, type of childcare center, and number of enrolled children. The self-administered questionnaire was conducted to examine food safety attributes of sanitary management at 150 childcare centers without qualified dietitians registered at Center for Children’s Food Service Management of Chungju city. The questionnaire consisted of 15 questions about perceived importance and performance regarding sanitation management (personal hygiene, ingredient control, temperature control of food, facility, equipment, and utensils sanitation) using IPA (importance−performance analysis). The results show that overall mean scores of the importance and performance of sanitary knowledge were 4.71 and 4.67 out of 5, respectively. ‘Checking the center temperature at 75 °C for 1 min in the thickest part of meat (3 times or more check for each serving)’ (p = 0.047) and ‘Keeping preserved meals (at least 100 g of each menu) for 144 h. with −18 °C or less’ (p < 0.001) show significantly lower scores of performance than those of importance. The results of importance and performance for sanitary management according to work duration of foodservice employees show that those who have worked more than 10 years had the highest scores of importance and performance for overall sanitary management among them. For the types of childcare centers, the overall performance scores of national/public employees for sanitary management were lower than those of private or home type (p < 0.001). Additionally, the result showed that the overall importance (p < 0.001) and performance scores (p < 0.001) of employees for sanitary management in centers with <50 children were higher than those in centers with ≥50 children. This result should provide more useful information to develop food safety programs for employees and sustainable foodservice management in childcare centers.

The Combination Treatment of Fosmanogepix and Liposomal Amphotericin B Is Superior to Monotherapy in Treating Experimental Invasive Mold Infections

Invasive pulmonary aspergillosis (IPA), invasive mucormycosis (IM), and invasive fusariosis (IF) are associated with high mortality and morbidity. Fosmanogepix (FMGX) is a first-in-class antifungal in clinical development with demonstrated broad-spectrum activity in animal models of infections. We sought to evaluate the benefit of combination therapy of FMGX plus liposomal amphotericin B (L-AMB) in severe delayed-treatment models of murine IPA, IM, and IF. While FMGX was equally as effective as L-AMB in prolonging the survival of mice infected with IPA, IM, or IF, combination therapy was superior to monotherapy in all three models. These findings were validated by greater reductions in the tissue fungal burdens (determined by quantitative PCR) of target organs in all three models versus the burdens in infected vehicle-treated (placebo) or monotherapy-treated mice. In general, histopathological examination of target organs corroborated the findings for fungal tissue burdens among all treatment arms. Our results show that treatment with the combination of FMGX plus L-AMB demonstrated high survival rates and fungal burden reductions in severe animal models of invasive mold infections, at drug exposures in mice similar to those achieved clinically. These encouraging results warrant further investigation of the FMGX-plus-L-AMB combination treatment for severely ill patients with IPA, IM, and IF.

Adolescents' lived experience of panic disorder: an interpretative phenomenological analysis

Background

Panic disorder is a debilitating anxiety disorder that has a serious impact on adolescents’ social and academic functioning and general wellbeing. Panic disorder is experienced by around 1 to 3% of the adolescent population. The aim of this study was to examine adolescents’ experiences of having panic disorder.

Methods

Semi-structured interviews were conducted with eight adolescents with a primary diagnosis of panic disorder. Interpretative Phenomenological Analysis was used to gain an understanding of adolescents’ lived experience of panic disorder.

Results

Two superordinate themes were identified: (1) Drowning in sensations, and (2) An unacceptable self. The findings show that adolescents experience panic disorder as extremely overwhelming and unpleasant, with debilitating feelings of drowning in sensations. Adolescents’ experiences largely fit with the cognitive model of panic, in which catastrophic misinterpretation of bodily sensations is associated with anxiety, avoidance, and safety behaviours, creating a vicious cycle. Attempts to avoid or prevent the attacks appear to inadvertently make them worse. Social worries, feeling broadly misunderstood, and unhelpful responses from others, contributed to feelings of being different or abnormal and were connected to a negative self-concept. Negative social interactions with teachers and peers in the school environment were particularly damaging.

Conclusions

These findings offer new insight into these adolescents’ lived experience of panic disorder and highlight the need for adolescents to access timely, evidence-based treatment, as well as the need for increased awareness and understanding of panic disorder in schools.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40359-022-00849-x.

An automated tool for comparing phonetic transcriptions

Many computerized tools for comparing phonetic transcriptions have been proposed and shared in the past; however, previous tools are relatively difficult to access and incorporate into clinical and research practice, or require users to learn additional phonetic symbol systems. The purpose of this project was to develop and test a readily available web-based application for quantitatively comparing phonetic transcriptions that are input using International Phonetic Alphabet (IPA) symbols. A web-based computer application was developed to allow for IPA phonetic transcription comparison. A point-and-click keyboard was developed to provide support for character input of the full IPA, as well as most symbols in the extIPA set. The application compares phonetic transcriptions using a modified edit distance algorithm following phonologically informed alignment. Visualizations of the algorithm's optimal alignment and scoring operations are shown for each comparison input by a user. The application, named the Automated Phonetic Transcription Comparison Tool (APTct), was thoroughly tested for accurate implementation of the algorithm principles. Validity tests through two sample use cases were also performed by comparison of hand calculations to APTct calculations. In function testing, the APTct showed excellent agreement with an expert's hand scoring using the same algorithm principles. In a validity test, only minor differences between the APTct and hand calculations were observed, primarily due to errors inputting the transcriptions into the APTct. The web-based APTct is a validated and versatile tool for quantitatively comparing even complex IPA phonetic transcriptions. It is freely available to clinicians and researchers, who may find it useful for a variety of potential scenarios. We invite researchers, clinicians, and other individuals to use the tool in their clinical and research work. The permalink for the website is as follows: https://aptct.auburn.edu.

Understanding online grooming: An interpretative phenomenological analysis of adolescents' offline meetings with adult perpetrators

BACKGROUND

It is the norm for adolescents to form friendships online but connecting with strangers poses risks of online grooming. Adult perpetrators take advantage of the internet's anonymity and accessibility to befriend and groom young people for sexual abuse. Much of the existing research has focused on the offender's perspective and grooming tactics, while extensive studies on victim profiles have focused on risk factors and young people's vulnerabilities to online grooming.

OBJECTIVE

This research takes an in-depth look into grooming processes from the perspective of the adolescent victim and explores how the relationships progressed online-to-offline, resulting in sexual abuse. It aims to understand young people's motivations and mindsets by exploring their lived experiences of offline meeting with adult perpetrators.

PARTICIPANTS AND SETTING

The sample consisted of adolescents aged 14-21 in the UK and EU.

METHODS

Using data from the Risk-taking Online Behavior Empowerment through Research and Training Project, six interviews were examined using an interpretative phenomenological analysis.

RESULTS

Four themes emerged: 1) Varied interpretations of risk 2) Taking control 3) Seeking security and validation; and 4) Shifts in perspective. The subtleties of online grooming were masked by the adolescents' misplaced trust as they displayed agency in pursuing opportunities for online friendships or sexual activities.

CONCLUSIONS

Findings suggest an insufficient knowledge of grooming and the need to more clearly define risks among adolescents. Safety guidelines should highlight the subtleties of grooming tactics and harmful behaviours that may not be readily perceived as abuse.

The impact of Behçet's disease on intimate relationships in women: A qualitative study

OBJECTIVE

Behçet's disease is a rare and incurable condition where the body's immune system attacks healthy tissue. Behçet's can cause blood clots and ulcerations to form in every organ and system in the body, including deep and painful genital ulceration. The psychological impact of the disease on intimacy and relationships is unexplored. This study aimed to explore how the disease impacts on female patients' intimate partner relationships.

METHODS

Participants were seven female, UK patients with Behçet's disease who were in committed relationships. In depth, semi-structured interviews lasting approximately 80 minutes were conducted via video conferencing about participants' sexual functioning and intimate relationships. Data was analysed using Interpretative Phenomenological Analysis.

RESULTS

Patients' sexual relationships and intimacy were impacted by issues due to lack of knowledge of symptoms (misdiagnosis of herpes), issues due to symptoms (genital manifestations, painful sex, exhaustion), difficulties communicating with medical professionals, medication, partner support, and support from fellow Behçet's patients.

DISCUSSION

Female Behçet's patients are at risk of developing psychological problems with intimacy due to symptoms, lack of knowledge of symptoms, and negative impacts of medication. Intimacy needs to be discussed in medical consultations so these issues can be addressed before a lack of intimacy negatively impacts relationships.

Elevated Rates of Ventilator-Associated Pneumonia and COVID-19 Associated Pulmonary Aspergillosis in Critically Ill Patients with SARS-CoV2 Infection in the Second Wave: A Retrospective Chart Review

Due to multiple risk factors, the rate of ventilator-associated pneumonia in critically ill COVID-19 patients has been reported in a range of 7.6% to 86%. The rate of invasive pulmonary aspergillosis in this cohort has been reported at 4% to 30%. We undertook a retrospective chart review of 276 patients who were admitted to intensive care in a large university hospital. The period studied included patients from 23 February 2014 to 12 May 2021. Four groups were collected: COVID-19 Wave 1, COVID-19 Wave 2, influenza, and community-acquired pneumonia. Clinical characteristics, outcomes, and microbiological cultures were recorded. The incidence of ventilator-associated pneumonia in COVID-19 Wave 1, COVID-19 Wave 2, influenza, and community-acquired pneumonia was 5.45%, 27.40%, 16.67%, and 3.41%, respectively (p < 0.001). The rate of invasive pulmonary aspergillosis was 0%, 9.59%, 13.33%, and 6.82%, respectively (p < 0.001). A significantly elevated rate of ventilator-associated pneumonia and invasive pulmonary aspergillosis was noted in the second wave of COVID-19 when compared to the first. This was accompanied by an increase in the mortality rate. Increased steroid use was an independent risk factor for ventilator-associated pneumonia and invasive pulmonary aspergillosis across all four groups. Despite an increased understanding of this disease, no clinical trials have shown any promising therapeutic options at present.