Perceptions of spirituality and predictors of competence in spiritual care among nursing students in five middle eastern countries: A cross-sectional survey.

BACKGROUND: Spiritual Care is integral to holistic nursing; however, it often remains underprovided due to a lack of education. OBJECTIVE: This study examined perceptions of spirituality and predictors of competence in spiritual care among nursing students in Middle Eastern countries. DESIGN: A cross-sectional survey was used. PARTICIPANT/SETTING: Nursing students (n = 785) from five universities in Middle Eastern countries were included. METHODS: Participants completed the Spiritual Care-Giving Scale-Arabic and Spiritual Care Competency Scale. Multiple linear regression analysis was used to identify the predictors of perceived competence in spiritual care. RESULTS: Nursing students showed positive attitudes towards spirituality, with a mean score of 5.1 (SD = 0.60) on the Spiritual Care-Giving Scale-Arabic. However, their perceived competence in providing spiritual care was low to moderate with a mean score of 79.0 (SD = 32.0) on the Spiritual Care Competency Scale. The bivariate analysis indicated significant relationships between students' spiritual care competence and gender, previous exposure to spirituality education, willingness to undergo spirituality training, and total spirituality score. Finally, significant predictors of higher competence included regular admission status, prior spiritual education, willingness to undergo spiritual care training, and higher personal spirituality scores. CONCLUSION: Nursing students in the Middle East have positive attitudes towards spirituality, but low to moderate competence in providing spiritual care. The influence of personal spirituality on competence underscores the importance of fostering a supportive environment for students to reflect on their beliefs. Comprehensive curriculum revisions and training programs, along with the recognition of the impact of personal spirituality, are essential to prepare future nurses for holistic people's care.

Design and synthesis of synthetic promoters for consistency of gene expression across growth phases and scale in S. cerevisiae.

Metabolic engineering and synthetic biology endeavors benefit from promoters that perform consistently (or robustly) with respect to cellular growth phase (exponential and stationary) and fermentation scale (microtiter plates, tubes, flasks, and bioreactors). However, nearly all endogenous promoters (especially in Saccharomyces cerevisiae) do not perform in this manner. In this work, a hybrid promoter engineering strategy is leveraged to create novel synthetic promoters with robustness across these conditions. Using a multi-dimensional RNA-seq dataset, promoters with specific phase dependencies were identified. Fragments enriched with functional transcription factors were identified using MEME suite. These motif-containing fragments could impart activity dependence in the opposing condition. Specifically, we obtain two new promoters with high and consistent expression across both phases by increasing the exponential phase activity of the starting stationary-phase scaffold by 38 and 23-fold respectively. Further, we show that these promoters function consistently across various laboratory growth scales over time in a microtiter plate and in flasks. Overall, this work presents and validates a new strategy for engineering promoters in S. cerevisiae with high levels of expression that are robust to cellular growth phase and the scale of the culture.

Modular, Synthetic Boolean Logic Gates Enabled in Saccharomyces cerevisiae through T7 Polymerases/CRISPR dCas9 Designs.

Synthetic control of gene expression, whether simply promoter selection or higher-order Boolean-style logic, is an important tool for metabolic engineering and synthetic biology. This work develops a suite of orthogonal T7 RNA polymerase systems capable of exerting AND/OR switchlike control over transcription in the yeastSaccharomyces cerevisiae. When linked with CRISPR dCas9-based regulation systems, more complex circuitry is possible including AND/OR/NAND/NOR style control in response to combinations of extracellular copper and galactose. Additionally, we demonstrate that these T7 system designs are modular and can accommodate alternative stimuli sensing as demonstrated through blue light induction. These designs should greatly reduce the time and labor necessary for developing Boolean gene circuits in yeast with novel applications including metabolic pathway control in the future.

Mediterranean Fast Food: A Leading Cause of Hypercholesterolemia among University Students in Northern Jordan.

Background: Consumption of fast food is pervasive among young adults. This research aimed to assess the impact of consuming fast foods on total cholesterol level among university students in Northern Jordan. Methods: Using a cross-sectional design, a blood sample to investigate cholesterol level was drawn from a sample of university students in Northern Jordan. Besides, students' dietary habits and anthropometric measurements were obtained. Results: Out of 201 participants, 57% (n=115) were male and 43% (n=86) were female. More than three quarters of the sample ate shawarma (Mediterranean fast food) at least once per week. About 44% of the study subjects had increased BMI and about 37% had increased serum cholesterol level. Participants' gender, age, marital status, physical activity, BMI, living status, and daily pocket money significantly correlated with cholesterol level (P<0.05). In the regression analysis, eating fast foods and increased BMI were strong predictors of high cholesterol level. Students who ate shawarma more than 3 times a week had more than 8 folds to have hypercholesterolemia (OR=8.4; CI: 2.62-26.72), and obese students were more than 14 folds at higher risk to have hypercholesterolemia compared to those with normal BMI (OR=14.2; CI: 4.80-42.29). In addition, male students had doubled odds for having abnormal cholesterol level compared to females (OR=2.1; CI: 1.10-4.44). Conclusion: Fast food consumption among university students in Jordan was significantly associated with increased total cholesterol level. Encouraging healthy diet and lifestyle are the basis for prevention of dyslipidemia.

Children's rates of COVID-19 vaccination as reported by parents, vaccine hesitancy, and determinants of COVID-19 vaccine uptake among children: a multi-country study from the Eastern Mediterranean Region.

BACKGROUND: Huge efforts are being made to control the spread and impacts of the coronavirus pandemic using vaccines. However, willingness to be vaccinated depends on factors beyond the availability of vaccines. The aim of this study was three-folded: to assess children's rates of COVID-19 Vaccination as reported by parents, to explore parents' attitudes towards children's COVID-19 vaccination, and to examine the factors associated with parents' hesitancy towards children's vaccination in several countries in the Eastern Mediterranean Region (EMR). METHODS: This study utilized a cross-sectional descriptive design. A sample of 3744 parents from eight countries, namely, Iraq, Jordan, Kuwait, Lebanon, Palestine, Qatar, Saudi Arabia (KSA), and the United Arab Emirates (UAE), was conveniently approached and surveyed using Google forms from November to December 2021. The participants have responded to a 42-item questionnaire pertaining to socio-demographics, children vaccination status, knowledge about COVID-19 vaccines, and attitudes towards vaccinating children and the vaccine itself. The Statistical Package for Social Sciences (SPSS- IBM, Chicago, IL, USA) was used to analyze the data. A cross-tabulation analysis using the chi-square test was employed to assess significant differences between categorical variables and a backward Wald stepwise binary logistic regression analysis was performed to assess the independent effect of each factor after controlling for potential confounders. RESULTS: The prevalence of vaccinated children against COVID-19 was 32% as reported by the parents. Concerning parents' attitudes towards vaccines safety, about one third of participants (32.5%) believe that all vaccines are not safe. In the regression analysis, children's vaccination was significantly correlated with parents' age, education, occupation, parents' previous COVID-19 infection, and their vaccination status. Participants aged ≥50 years and those aged 40-50 years had an odds ratio of 17.9 (OR = 17.9, CI: 11.16-28.97) and 13.2 (OR = 13.2, CI: 8.42-20.88); respectively, for vaccinating their children compared to those aged 18-29 years. Parents who had COVID-19 vaccine were about five folds more likely to vaccinate their children compared with parents who did not receive the vaccine (OR = 4.9, CI: 3.12-7.70). The prevalence of children's vaccination in the participating Arab countries is still not promising. CONCLUSION: To encourage parents, vaccinate their children against COVID-19, Arab governments should strategize accordingly. Reassurance of the efficacy and effectiveness of the vaccine should target the general population using educational campaigns, social media, and official TV and radio channels.

Symptom burden and functional performance in patients with chronic obstructive pulmonary disease.

BACKGROUND: The burden of COPD is growing, and it is one of the leading disease burdens worldwide. Studies on symptom burden as a multidimensional concept in COPD and functional performance are lacking, and little is known about the effect of multiple symptoms and symptom burden on functional performance. METHODS: A descriptive, cross-sectional correlational survey design was used. The Memorial Symptom Assessment Scale (MSAS) and the Functional Performance Inventory-Short Form (FPI-SF) were used to measure the symptom burden and functional performance. Data were analyzed using descriptive and inferential statistics. Participants (n = 214) were recruited from the respiratory outpatient clinic in one of the teaching hospitals in Ireland. RESULTS: Patients with COPD, regardless of classification, experienced significant physical and psychological symptom burden. A total of 20 symptoms were negatively correlated with overall functional performance, indicating a high symptom burden for those symptoms was associated with low overall functional performance. A statistically significant negative correlation between physical symptom burden, psychological symptom burden, total symptom burden, and functional performance was found. CONCLUSION: Patients with COPD experience a significant symptom burden and low functional performance. Decreased functional performance was not related only to a single burdensome symptom, but may also be related to the contribution of several physical/psychological burdensome symptoms, or both. Assessment and management of these symptoms are essential and imply that alleviating these symptoms' burden may promote improved functional performance. This study supported the growing body of evidence of the need for patients with advanced COPD to receive palliative care.

Implementing dedicated nursing clinical education unit: Nursing students' and preceptors' perspectives.

BACKGROUND: The Dedicated Education Unit is a clinical learning model designated to deliver more targeted learning opportunities and enhance student nurses learning capacity. It provides students with more opportunities to develop their skills, experience different learning events, consolidate their knowledge, and build their professional nursing identity. METHODS: The study followed a convergent parallel mixed-method design to investigate the nursing students and the nursing preceptors' perceptions of the Dedicated Education Unit model at Mafraq hospital. Quantitative and qualitative data were collected from a sample of sixty-seven nursing students and 20 nursing preceptors from March to May 2019. RESULTS: The overall results of the study were positive. Nursing preceptors were confident to communicate and constructively interact, motivate, and facilitate students' learning. However, they requested better support and more free time to supervise and answer students' questions. Nursing students reported positive learning at the dedicated units. However, they requested more support from nursing preceptors. CONCLUSION: Implementing a Dedicated Education Unit model supported the nursing preceptors' role and enhanced nursing students' learning opportunities and hands-on experiences. Achieving a positive effect of the dedicated nursing clinical education unit requires constant collaboration between healthcare facilities and nursing education programs to maximize nursing students learning.

Symptom burden in patients with chronic obstructive pulmonary disease.

BACKGROUND: There is now a growing body of evidence to suggest that patients with chronic disease experience their symptoms as a burden. Although symptoms are a principal focus for diagnosis and treatment of chronic obstructive pulmonary disease (COPD), there has been little research to date on symptom burden with reference to frequency, severity, and distress of symptoms. METHODS: A descriptive, cross-sectional survey design was used. Symptom burden was measured using the Memorial Symptom Assessment Scale (MSAS). A sample of 214 patients with COPD, recruited from one of the major teaching hospitals in Ireland. RESULTS: Patients experienced a median of 13 symptoms. Patients with 'very severe' COPD experienced the greatest number, with a median of 15 symptoms, followed by those with 'severe' COPD, with a median of 14 symptoms. Patients with 'mild' and 'moderate' COPD reported a median of 10 symptoms each. The most burdensome symptoms were shortness of breath, lack of energy, difficulty sleeping, worrying, dry mouth, feeling nervous, and feeling irritable. Total symptom burden was found to be low. Patients with 'very severe' COPD had the greatest symptom burden, followed by those with 'severe', 'moderate', and 'mild' COPD. Symptom burden was higher for psychological symptoms, with a mean score of 1.60 compared to the physical symptoms (mean = 0.87). CONCLUSION: Patients with COPD experience a remarkably high number of symptoms, and significant symptom burden of both physical and psychological symptoms. There is a need for early assessment and management of both physical and psychological symptoms in all patients with COPD.

Multi-Solvent Microdroplet Evaporation: Modeling and Measurement of Spray-Drying Kinetics with Inhalable Pharmaceutics.

PURPOSE: Evaporation and particle formation from multi-solvent microdroplets containing solid excipients pertaining to spray-drying of therapeutic agents intended for lung delivery were studied. Various water and ethanol co-solvent systems containing a variety of actives and excipients (beclomethasone, budesonide, leucine, and trehalose) were considered. METHODS: Numerical methods were used to predict the droplet evaporation rates and internal solute transfers, and their results verified and compared with results from two separate experimental setups. In particular, an electrodynamic balance was used to measure the evaporation rates of multicomponent droplets and a monodisperse droplet chain setup collected dried microparticles for further analytical investigations and ultramicroscopy. RESULTS: The numerical results are used to explain the different particle morphologies dried from solutions at different co-solvent compositions. The obtained numerical data clearly show that the two parameters controlling the general morphology of a dried particle, namely the Péclet number and the degree of saturation, can change with time in a multi-solvent droplet. This fact complicates product development for such systems. However, this additional complexity vanishes at what we define as the iso-compositional point, which occurs when the solvent ratios and other composition-dependent properties of the droplet remain constant during evaporation, similar to the azeotrope of such systems during distillation. CONCLUSIONS: Numerical and experimental analysis of multi-solvent systems indicate that spray-drying near the iso-compositional ratio simplifies the design and process development of such systems.

Correction to: Multi-Solvent Microdroplet Evaporation: Modeling and Measurement of Spray-Drying Kinetics with Inhalable Pharmaceutics.

The Publisher regrets having introduced the following errors into the article when performing proof corrections.

Amorphous pullulan trehalose microparticle platform for respiratory delivery.

Spray drying biologics and small-molecule drugs can increase their thermal stability relative to liquid dosage forms and allow for widespread distribution to developing countries without cold chain infrastructure. In this study, pullulan trehalose powder is spray dried for inhalation. The powder is characterized in terms of manufacturability, physical stability, device compatibility, and aerosol performance. The manufacturability is demonstrated by reasonable spray drying yield and powder flowability. The powder has relatively low cohesiveness and high compressibility without semi-elastic deformation. Short-term physical stability for ambient temperature dry storage and 40 °C storage in commercial pressurized metered-dose inhaler propellants HFA 134a and HFA 227 is shown. A theoretical model predicts a high glass transition temperature near the surface of the microparticles where biologics are expected to reside. Emission from a commercial dry powder inhaler demonstrates high dispersibility, optimal size for inhalation, and adequate total lung dose, exceeding many commercial inhalation devices. The powder can be filled, stored, and actuated from a pressurized metered-dose inhaler without changes in particle morphology or solid phase. The pullulan trehalose platform thus appears promising for respiratory delivery.

Exploring the psychological status of Jordanian nurses working with cancer patients.

AIM: This study aims to explore the psychological status of nurses working with cancer patients in Jordan. BACKGROUND: Literature shows that nurses face many stressors in their job, in particular oncology nurses. Some of them have psychiatric illness such as anxiety and depression. Most of the reviewed studies were conducted in developed countries, and none in the Middle East. METHOD: A qualitative descriptive approach was adopted, whereby interviews were conducted with 24 nurses that were selected from the oncology departments of one governmental hospital. RESULTS: Participants identified coping with death and dying in nursing care and some cultural issues (that they encountered) as the main factors that influence their psychological well-being, which in turn may have contributed to a reduced quality of care for patients. CONCLUSION: Findings indicated that the working environment within oncology is highly stressful, which might negatively affect the nurses' job satisfaction and the quality of care that they provided. IMPLICATIONS FOR NURSING MANAGEMENT: Findings of this study could help health care managers to understand the impact of psychological stressors on nurses' performance, and the importance of improving the psychological status of oncology nurses.