Performing under Pressure: Insights into the Diagnostic Testing Burden at a UK National Health Service Clinical Virology Laboratory during the SARS-CoV-2 Pandemic.

UK National Health Service (NHS) Clinical Virology Departments provide a repertoire of tests on clinical samples to detect the presence of viral genomic material or host immune responses to viral infection. In December 2019, a novel coronavirus (SARS-CoV-2) emerged which quickly developed into a global pandemic; NHS laboratories responded rapidly to upscale their testing capabilities. To date, there is little information on the impact of increased SARS-CoV-2 screening on non-SARS-CoV-2 testing within NHS laboratories. This report details the virology test requests received by the Leicester-based NHS Virology laboratory from January 2018 to May 2022. Data show that in spite of a dramatic increase in screening, along with multiple logistic and staffing issues, the Leicester Virology Department was mostly able to maintain the same level of service for non-respiratory virus testing while meeting the new increase in SARS-CoV-2 testing.

Ca2+ imaging of self and other in medial prefrontal cortex during social dominance interactions in a tube test.

The study of social dominance interactions between animals offers a window onto the decision-making involved in establishing dominance hierarchies and an opportunity to examine changes in social behavior observed in certain neurogenetic disorders. Competitive social interactions, such as in the widely used tube test, reflect this decision-making. Previous studies have focused on the different patterns of behavior seen in the dominant and submissive animal, neural correlates of effortful behavior believed to mediate the outcome of such encounters, and interbrain correlations of neural activity. Using a rigorous mutual information criterion, we now report that neural responses recorded with endoscopic calcium imaging in the prelimbic zone of the medial prefrontal cortex show unique correlations to specific dominance-related behaviors. Interanimal analyses revealed cell/behavior correlations that are primarily with an animal's own behavior or with the other animal's behavior, or the coincident behavior of both animals (such as pushing by one and resisting by the other). The comparison of unique and coincident cells helps to disentangle cell firing that reflects an animal's own or the other's specific behavior from situations reflecting conjoint action. These correlates point to a more cognitive rather than a solely behavioral dimension of social interactions that needs to be considered in the design of neurobiological studies of social behavior. These could prove useful in studies of disorders affecting social recognition and social engagement, and the treatment of disorders of social interaction.

A lysozyme with altered substrate specificity facilitates prey cell exit by the periplasmic predator Bdellovibrio bacteriovorus.

Lysozymes are among the best-characterized enzymes, acting upon the cell wall substrate peptidoglycan. Here, examining the invasive bacterial periplasmic predator Bdellovibrio bacteriovorus, we report a diversified lysozyme, DslA, which acts, unusually, upon (GlcNAc-) deacetylated peptidoglycan. B. bacteriovorus are known to deacetylate the peptidoglycan of the prey bacterium, generating an important chemical difference between prey and self walls and implying usage of a putative deacetyl-specific "exit enzyme". DslA performs this role, and ΔDslA strains exhibit a delay in leaving from prey. The structure of DslA reveals a modified lysozyme superfamily fold, with several adaptations. Biochemical assays confirm DslA specificity for deacetylated cell wall, and usage of two glutamate residues for catalysis. Exogenous DslA, added ex vivo, is able to prematurely liberate B. bacteriovorus from prey, part-way through the predatory lifecycle. We define a mechanism for specificity that invokes steric selection, and use the resultant motif to identify wider DslA homologues.

Practicalities in doctorate research of using grounded theory methodology in understanding nurses' behaviours when caring for culturally diverse patients.

This article provides a critical review of how grounded theory methodology was used to explore student and registered nurses' experiences of caring for culturally diverse patients, as part of a doctorate of philosophy. It illustrates how a continuous cycle of data collection, constant comparative analysis and theoretical sampling was operationalised and explains how these methods were consistent with classic grounded theory methodology. It describes how a theory of resigned Indifference was generated, which explains how nurses used a raft of disengagement strategies as a means of dealing with their uncertainties, during cross cultural encounters. Disengagement was allowed and sometimes even facilitated within clinical practice and as a result nurses became indifferent to people they knew little about and appeared resigned that this was acceptable. This study highlights the need for greater consideration into how cultural competence development is taught, learnt and more importantly, applied in clinical practice. The detailed explanation of the methodology and methods used is intended to provide a practical guide for researchers considering using the methodology. It describes how new insights into nurses' behaviours towards culturally diverse patients were generated, which has relevance and utility for practising nurses and nurse educators.

Resigned indifference: An explanation of gaps in care for culturally and linguistically diverse patients'.

AIMS: To develop a theory that explains students and registered nurses' behaviours when caring for culturally and linguistically diverse patients'. BACKGROUND: Despite ongoing calls for improvements to the quality of patient care, the continued reports of substandard care to patients from diverse cultural and linguistic backgrounds are concerning. METHODS: A classic grounded theory methodology incorporating focus groups (n-10) and individual interviews (n-30) with students and registered nurses in one region of Ireland. FINDINGS: Participants resolved their main concern of uncertainty through disengagement (masking, distancing and fitting in), which was sustained by resigned indifference, resulting in gaps in care. Resigned indifference explains how participants were aware of the consequences of disengagement, but became resigned and accepting of substandard care. CONCLUSION: This study explains how nurses want to provide quality care, but gaps in care to culturally and linguistically diverse patients' are perpetuated through resigned indifference. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers need to understand nurses' behaviours as a means of supporting collective ways of addressing gaps in care for culturally and linguistically diverse patients. Strategic leadership in developing culturally responsive structures is essential. Nurturing nursing values such as commitment, compassion and courage through education and leadership is a priority.

Understanding nurses' concerns when caring for patients from diverse cultural and ethnic backgrounds.

AIMS AND OBJECTIVES: To explore the experiences of both student and qualified nurses of caring for patients from diverse cultural, ethnic and linguistic backgrounds, in one region of Ireland. Hearing the stories, experiences and attitudes of nurses has the potential to influence future clinical practice and has implication for nurses, nurse educators and nurse managers and leaders. BACKGROUND: There is a wealth of international literature highlighting the importance of providing culturally sensitive care. However, global reports of culturally insensitive care continue. There is a paucity of in-depth research exploring the actual concerns and challenges nurses experience when caring for patients from diverse cultural and ethnic backgrounds, as well as what influences their actions and omissions of care in practice. DESIGN: A qualitative exploratory descriptive design adopting the principles of a classic grounded theory approach was used. METHODS: Focus groups (n - 10) and individual face-to-face interviews (n - 30) were conducted with student and qualified nurses studying and working in one region of Ireland. As data were collected, it was simultaneously analysed using the classic grounded theory methodological principles of coding, constant comparison and theoretical sampling. FINDINGS: Uncertainty was the consistent main concern that emerged. Feelings of ambiguity of how to act were further influenced by a lack of knowledge, an awareness of ethnocentric beliefs and the culture of the organisation in which participants learn and work in. Instead of finding answers to uncertainties, participants demonstrated a lack of commitment to meeting patients' needs in a culturally appropriate way. CONCLUSIONS: This study adds new perspectives to our understanding of enablers and barriers to culturally sensitive care. It explains the poignant effect of uncertainty and describes how nurses were unable (or unwilling) to find answers when in doubt. It raises questions that remain unanswered in the existing literature, as to why nurses feel it is acceptable to choose to do nothing about their lack of cultural knowledge and the uncertainties which follow. RELEVANCE TO CLINICAL PRACTICE: Identifying the nature and implications of the uncertainty experienced when providing care for patients from diverse cultural and ethnic backgrounds is an important contributing factor to improving cultural sensitivity and quality care.

Exploring Nurses' Meaning and Experiences of Compassion: An International Online Survey Involving 15 Countries.

PURPOSE: In recent years, there has been much focus on compassion in nursing care, and concern has been raised in a number of reports and media stories regarding decreased compassion. The aim of this study was to explore similarities and differences in the understanding and demonstration of compassion in nursing practice across 15 countries. DESIGN: A total of 1,323 nurses from 15 countries responded to questions in relation to compassion, via an international online survey. RESULTS: The data revealed the impact of sociopolitical influences on perceptions of compassion, and the conscious and intentional nature of compassion. DISCUSSION AND CONCLUSION: The study demonstrated shared understandings of the importance of compassion as well as some common perceptions of the attributes of compassionate care. The differences reported were not as significant as had been expected. IMPLICATIONS FOR PRACTICE: Further research is needed to explore the country and culture differences in the enactment of compassion.

Human podocyte depletion in association with older age and hypertension.

Podocyte depletion plays a major role in the development and progression of glomerulosclerosis. Many kidney diseases are more common in older age and often coexist with hypertension. We hypothesized that podocyte depletion develops in association with older age and is exacerbated by hypertension. Kidneys from 19 adult Caucasian American males without overt renal disease were collected at autopsy in Mississippi. Demographic data were obtained from medical and autopsy records. Subjects were categorized by age and hypertension as potential independent and additive contributors to podocyte depletion. Design-based stereology was used to estimate individual glomerular volume and total podocyte number per glomerulus, which allowed the calculation of podocyte density (number per volume). Podocyte depletion was defined as a reduction in podocyte number (absolute depletion) or podocyte density (relative depletion). The cortical location of glomeruli (outer or inner cortex) and presence of parietal podocytes were also recorded. Older age was an independent contributor to both absolute and relative podocyte depletion, featuring glomerular hypertrophy, podocyte loss, and thus reduced podocyte density. Hypertension was an independent contributor to relative podocyte depletion by exacerbating glomerular hypertrophy, mostly in glomeruli from the inner cortex. However, hypertension was not associated with podocyte loss. Absolute and relative podocyte depletion were exacerbated by the combination of older age and hypertension. The proportion of glomeruli with parietal podocytes increased with age but not with hypertension alone. These findings demonstrate that older age and hypertension are independent and additive contributors to podocyte depletion in white American men without kidney disease.

Ameliorating Patient Stigma Amongst Staff Working With Personality Disorder: Randomized Controlled Trial of Self-Management Versus Skills Training.

BACKGROUND: Patients diagnosed with a personality disorder (PD) are often stigmatized by the healthcare staff who treat them. AIMS: This study aimed to compare the impact on front-line staff of a self-management Acceptance and Commitment Therapy-based training intervention (ACTr) with a knowledge- and skills-based Dialectical Behaviour Training intervention (DBTr). METHOD: A service-based randomized controlled trial was conducted comparing the effects of 2-day ACTr (N = 53) and DBTr (N = 47) staff workshops over 6 months. Primary outcome measures were staff attitudes towards patients and staff-patient relationships. RESULTS: For both interventions, staff attitudes, therapeutic relationship, and social distancing all improved pre- to postintervention, and these changes were maintained at 6-month follow-up. CONCLUSIONS: Although offering different resources to staff, both ACTr and DBTr were associated with an improved disposition towards PD patients. Future research could evaluate a combined approach, both for staff working with PD patients and those working with other stigmatized groups.

Acceptance and commitment therapy-based self-management versus psychoeducation training for staff caring for clients with a personality disorder: a randomized controlled trial.

People diagnosed with a personality disorder (PD) are often a stigmatized patient group. This can affect the care they receive, their progression, and the well-being of staff caring for them. Interventions targeted at health care professionals that aim to improve attitudes toward these patients and improve staff well-being do exist; however, evidence for their effectiveness is limited. The present study compared a self-management, Acceptance and Commitment Therapy-based training intervention (ACTr) with a Psychoeducation Training (PETr) intervention in their effectiveness in improving attitudes toward PD patients, staff-patient relations, and staff well-being. Both interventions were successful at improving attitudes and measures of staff-patient relations up to 6 months after training; however, staff well-being did not change for either group. The implications for staff training and future research are discussed.

Reflecting on the challenges of choosing and using a grounded theory approach.

AIM: To explore three different approaches to grounded theory and consider some of the possible philosophical assumptions underpinning them. BACKGROUND: Grounded theory is a comprehensive yet complex methodology that offers a procedural structure that guides the researcher. However, divergent approaches to grounded theory present dilemmas for novice researchers seeking to choose a suitable research method. REVIEW METHODS: This is a methodology paper. DATA SOURCES: This is a reflexive paper that explores some of the challenges experienced by a PhD student when choosing and operationalising a grounded theory approach. DISCUSSION: Before embarking on a study, novice grounded theory researchers should examine their research beliefs to assist them in selecting the most suitable approach. This requires an insight into the approaches' philosophical assumptions, such as those pertaining to ontology and epistemology. Researchers need to be clear about the philosophical assumptions underpinning their studies and the effects that different approaches will have on the research results. CONCLUSION: This paper presents a personal account of the journey of a novice grounded theory researcher who chose a grounded theory approach and worked within its theoretical parameters. IMPLICATIONS FOR RESEARCH/PRACTICE: Novice grounded theory researchers need to understand the different philosophical assumptions that influence the various grounded theory approaches, before choosing one particular approach.

Strategies to surmount the potential barriers to providing anti-discriminatory care in Irish healthcare settings.

AIM: This article aims to explore some of the potential Irish specific barriers to providing anti-discriminatory care to non-Irish nationals in health and social care settings and considers strategies to overcome them. BACKGROUND: There has been a rapid and unprecedented increase in the ethnic and cultural diversity of the population in Ireland over the past 10 years. This brings with it both opportunities and challenges. The challenges that are particularly poignant include Irish nationals adapting to a multicultural society and integrating migrants into mainstream society. Historically, Ireland's relative homogeneity as a nation has been reflected in their health services, suggesting the need for an approach that addresses the more diverse needs of their growing multicultural population. CONCLUSION: Increasing awareness in the Irish health care setting of the complexity of working transculturally is important to interrogate the concept of privilege and the presence of racist practices. Unless practitioners are consciously aware of the personal, social and professional values that inform their attitudes and practices, their ability to be culturally competent will be at best superficial. The need to challenge attitudes, deep rooted social behaviour and misinformation which underline racial hostility is essential. Attention should focus on creating an environment of trust where critical reflection occurs, blame is avoided, risk managed and new ideas developed, tested and evaluated.

Developing a framework for critiquing health research: an early evaluation.

A new framework for critiquing health-related research is presented in this article. More commonly used existing frameworks tend to have been formulated within the quantitative research paradigm. While frameworks for critiquing qualitative research exist, they are often complex and more suited to the needs of students engaged in advanced levels of study. The framework presented in this article addresses both quantitative and qualitative research within one list of questions. It is argued that this assists the 'novice' student of nursing and health-related research with learning about the two approaches to research by giving consideration to aspects of the research process that are common to both approaches and also that differ between quantitative and qualitative research.