Genetic determinants of renal scarring in children with febrile UTI.

BACKGROUND: Febrile urinary tract infections (UTIs) are among the most severe bacterial infections in infants, in which a subset of patients develops complications. Identifying infants at risk of recurrent infections or kidney damage based on clinical signs is challenging. Previous observations suggest that genetic factors influence UTI outcomes and could serve as predictors of disease severity. In this study, we conducted a nationwide survey of infant genotypes to develop a strategy for infection management based on individual genetic risk. Our aims were to identify genetic susceptibility variants for renal scarring (RS) and genetic host factors predisposing to dilating vesicoureteral reflux (VUR) and recurrent UTIs. METHODS: To assess genetic susceptibility, we collected and analyzed DNA from blood using exome genotyping. Disease-associated genetic variants were identified through bioinformatics analysis, including allelic frequency tests and odds ratio calculations. Kidney involvement was defined using dimercaptosuccinic acid (DMSA) scintigraphy. RESULTS: In this investigation, a cohort comprising 1087 infants presenting with their first episode of febrile UTI was included. Among this cohort, a subset of 137 infants who underwent DMSA scanning was subjected to gene association analysis. Remarkable genetic distinctions were observed between patients with RS and those exhibiting resolved kidney involvement. Notably, the genetic signature indicative of renal scarring prominently featured mitochondrial genes. CONCLUSIONS: In this nationwide study of genetic susceptibility to RS after febrile UTIs in infancy, we identified a profile dominated by mitochondrial polymorphisms. This profile can serve as a predictor of future complications, including RS and recurrent UTIs.

The abortion divide: Exploring the role of exclusion, loss of significance and identity in the radicalization process.

Introduction: Recently, the abortion issue has entered the spotlight in the USA, leading to potential radical actions. As the majority opinion on the abortion issue vary with state, some individuals will be in the numerical minority within their state, possibly evoking feelings of exclusion. Social exclusion can motivate a radicalization process. The aim of this paper is to explore how individuals in a numerical minority experience feelings of exclusion and significance loss and how this may drive radicalization in the context of the abortion issue. Methods: A quasi-experimental design was used and 534 respondents from naturally occurring numerical minority and majority groups based on state abortion opinion participated in an online survey. Results: Results showed that those in the numerical minority experienced exclusion and were more willing to engage in and endorse radical actions compared to those in the majority, regardless of position on the abortion issue. Serial mediation analysis revealed that the pathway between minority group status and engagement and endorsement of extreme actions was fully mediated by need-threat and ingroup identity. Discussion: Being in the numerical minority is associated with feelings of social exclusion, which may trigger a radicalization process. The results advance our understanding of when and who is vulnerable to radicalization and that social structures that perpetuate marginalization and inequality may contribute to radicalization. Results highlight the need to continue to explore radicalization from a group-based perspective and emphasize exploring mediating factors as a pathway from social experiences to willingness to engage with radical groups.

Ways to improve guideline adherence in the emergency department: an interview study on the management of traumatic brain injuries.

PURPOSE: The aim was to explore factors affecting guideline adherence among doctors in the emergency department and to explore the general perception about local guidelines for traumatic brain injuries. METHODS: Thirty semi-structured interviews were conducted with doctors with experience working in the emergency department regarding different aspects of guideline use, with emphasis on the management of traumatic brain injuries. Twenty-eight interviews were included for analysis. The interviews were recorded, transcribed, and analysed iteratively. Emergent codes were identified and organised into themes and subthemes. RESULTS: Eight themes were identified. Barriers were centred on low availability of local guidelines and guideline document design. Facilitating factors included a concise document, appropriate visual aids, high accessibility, and encouragement by management and senior peers. The local guidelines on traumatic brain injuries were regarded as distinct, but it was occasionally difficult to determine when they were applicable. Mandatory admission of patients on anticoagulants was sometimes perceived as excessive. Biomarker S100b was believed to sometimes lead to delayed care. CONCLUSION: The participants believed that guideline adherence would increase by facilitating guideline availability, by providing concise, easy-to-understand, and well-illustrated guidelines available in printed form, as well as establishing a culture that promotes guideline use. The local guidelines for traumatic brain injuries were appreciated, but could be improved.

How Swedish guidelines on urinary tract infections in children compare to Canadian, American and European guidelines.

Urinary tract infections (UTI) are common in children and the guidelines focus on preventing kidney damage. We compared the 2013 national Swedish guidelines on UTIs in children with the guidelines from America, Canada, UK, Spain, Italy and European urologists. This showed that urinalysis and urine cultures are endorsed by all the guidelines, but sampling techniques and bacteria levels differ. They all recommend initial oral treatment and renal ultrasound to detect major anomalies in infants. The Swedish guidelines are more liberal on antibiotic prophylaxis. CONCLUSION: Differences in diagnostic criteria, workup and accepted methods for urine sampling were noted and are discussed.

How a terror attack affects right-wing authoritarianism, social dominance orientation, and their relationship to torture attitudes.

Self-reported level of right-wing authoritarianism (RWA), the two facets of social dominance orientation (SDO-Dominance and SDO-Egalitarianism) and pro-torture attitudes were measured both in the immediate aftermath (terror salience, N = 152) of the terror attacks in Paris and Brussels and when terrorism was not salient (non-salience, N = 140). Results showed that RWA and pro-torture attitudes, but not SDO-Dominance and SDO-Egalitarianism, were significantly higher immediately after. Furthermore, RWA and SDO both predicted pro-torture attitudes more strongly under terror salience. We argue that the reason why RWA is higher under terror salience is a response to external threat, and that SDO-Dominance may be more clearly related to acceptance of torture and other human-rights violations, across context. Future research on the effects of terror-related events on sociopolitical and pro-torture attitudes should focus on person-situation interactions and also attempt to discriminate between trait and state aspects of authoritarianism.