-
Current Topics in Developmental Biology 2024The salivary gland undergoes branching morphogenesis to elaborate into a tree-like structure with numerous saliva-secreting acinar units, all joined by a hierarchical... (Review)
Review
The salivary gland undergoes branching morphogenesis to elaborate into a tree-like structure with numerous saliva-secreting acinar units, all joined by a hierarchical ductal system. The expansive epithelial surface generated by branching morphogenesis serves as the structural basis for the efficient production and delivery of saliva. Here, we elucidate the process of salivary gland morphogenesis, emphasizing the role of mechanics. Structurally, the developing salivary gland is characterized by a stratified epithelium tightly encased by the basement membrane, which is in turn surrounded by a mesenchyme consisting of a dense network of interstitial matrix and mesenchymal cells. Diverse cell types and extracellular matrices bestow this developing organ with organized, yet spatially varied mechanical properties. For instance, the surface epithelial sheet of the bud is highly fluidic due to its high cell motility and weak cell-cell adhesion, rendering it highly pliable. In contrast, the inner core of the bud is more rigid, characterized by reduced cell motility and strong cell-cell adhesion, which likely provide structural support for the tissue. The interactions between the surface epithelial sheet and the inner core give rise to budding morphogenesis. Furthermore, the basement membrane and the mesenchyme offer mechanical constraints that could play a pivotal role in determining the higher-order architecture of a fully mature salivary gland.
Topics: Salivary Glands; Animals; Morphogenesis; Humans; Basement Membrane; Cell Movement; Biomechanical Phenomena; Mesoderm; Cell Adhesion
PubMed: 38937029
DOI: 10.1016/bs.ctdb.2024.05.002 -
In Vivo (Athens, Greece) 2024ClFdA is a second-generation antineoplastic agent that has demonstrated significant anticancer activity, particularly against acute lymphoblastic leukemia and has been... (Review)
Review
BACKGROUND/AIM
ClFdA is a second-generation antineoplastic agent that has demonstrated significant anticancer activity, particularly against acute lymphoblastic leukemia and has been shown to have radiosensitizing activity. The aim of the study was to explore the genotoxic, cytotoxic and radiosensitizing effects of clofarabine (ClFdA) on bone marrow cells (BMCs), normoblasts and leukocytes of mice in vivo.
MATERIALS AND METHODS
Cytotoxicity was determined by the reduction in reticulocytes (RET), and genotoxicity was determined by the induction of micronucleated reticulocytes (MN-RET) in the peripheral blood and by DNA break induction in leukocytes determined by single-cell gel electrophoresis (SCGE). The radiosensitizing capacity of ClFdA was determined in leukocytes and BMCs by SCGE.
RESULTS
Two mechanisms of MN-RET induction were identified according to the antecedents, that could be due to inhibition of DNA synthesis and demethylation of G-C regions, and subsequent chromosome fragility. ClFdA cytotoxicity causes two contiguous peaks, an early peak that seems to inhibit MN-RET induction and a second peak that seems to be caused by ribonucleotide reductase (RR) and/or DNA synthesis inhibitions. ClFdA induced early DNA damage in noncycling leukocytes, and also radiosensitizes leukocytes immediately after treatment. ClFdA-ionizing radiation (IR) causes two time-dependent episodes of DNA damage, the latest after 80 min triggers a major breakage of DNA. In terms of the number of damaged cells, leukocytes and BMCs are similarly sensitive to ionizing radiation; BMCs are slightly more sensitive than leukocytes to ClFdA, but BMCs are doubly sensitive to combined treatment.
CONCLUSION
ClFdA causes early DNA damage and radiosensitivity in non-proliferating leukocytes, which rules out the most favored hypotheses of the participation of RR and DNA polymerase inhibition.
Topics: Animals; Clofarabine; Mice; Radiation-Sensitizing Agents; Leukocytes; DNA Damage; Arabinonucleosides; Bone Marrow Cells; Adenine Nucleotides; Male; Reticulocytes; Antineoplastic Agents; Micronucleus Tests
PubMed: 38936939
DOI: 10.21873/invivo.13622 -
Epilepsy & Behavior : E&B Jun 2024Sensitivity to moral and conventional rules (SMCR) is supported by bilateral brain networks and psychosocial input both of which may be altered in temporal lobe epilepsy...
OBJECTIVES
Sensitivity to moral and conventional rules (SMCR) is supported by bilateral brain networks and psychosocial input both of which may be altered in temporal lobe epilepsy (TLE). This study evaluated the components of SMCR in patients with TLE, aiming to clarify their preservation and link to psychopathological and cognitive aspects.
METHODS
Adult patients with unilateral TLE and healthy controls were evaluated using neuropsychological tests for SMCR, memory, language, and executive functions, the Empathy Questionnaire (EQ), and the Symptom Checklist-90-R (SCL-90-R).
RESULTS
The SMCR test items showed good reliability and validity, yielding the Severity and Rules factors distinct from the Executive, Lexical and Memory factors. Patients with right TLE scored worse in moral rules recognition than controls, but this difference was nullified by a significant influence for age and sex. The Severity and Rules factors related to semantic fluency and age and, respectively, TLE side and psychoticism. However, these factors did predict TLE membership.
CONCLUSIONS
In adult patients with TLE, the SMCR test reflects a distinct cognitive domain. Conventional rules are well-retained, while moral reasoning may be only affected in right TLE if unfavorable demographics coexist. Although age, TLE side, semantic abilities, and psychoticism cooperate to determine SMCR, impairment of such domain is not a distinctive feature of TLE.
PubMed: 38936307
DOI: 10.1016/j.yebeh.2024.109889 -
Nurses' moral judgements during emergency department triage - A prospective mixed multicenter study.International Emergency Nursing Jun 2024In EDs, triage ensures that patients whose condition requires immediate care are prioritized while reducing overcrowding. Previous studies have described the...
INTRODUCTION
In EDs, triage ensures that patients whose condition requires immediate care are prioritized while reducing overcrowding. Previous studies have described the manifestation of caregivers' moral judgements of patients in EDs. The equal treatment of patients in clinical practice presents a major issue. Studying the impact of prejudice on clinical practice in the ED setting provides an opportunity to rethink clinical tools, organizations and future training needs. Our study sought to describe the moral judgements expressed by triage nurses during admission interviews in emergency departments and to assess their impact on patient management.
METHODS
An exploratory sequential mixed-method study was performed. The study was conducted between January 1, 2018, and February 18, 2018, in the EDs of three French hospitals. Five hundred and three patients and 79 triage nurses participated in the study. Audio recordings, observations and written handover reports made by nurses during admission triage interviews were analyzed with a view to discerning whether moral judgements were expressed in them. We studied the impact of moral judgements on patient management in the emergency department.
RESULTS
Abstract Moral judgements were made in 70% of the triage situations studied (n=351/503). They could be classified in seven categories. Patients were more likely to be subjected to moral judgements if they were over 75 years old, visibly disabled or if they had visible signs of alcohol intoxication. Being subjected to moral judgement was associated with differential treatment, including assignment of a triage score that differed from the theoretical triage score.
CONCLUSION
More than two thirds of patients admitted to EDs were triaged using moral criteria. Patients who were morally judged at the admission interview were more likely to be treated differently.
PubMed: 38936277
DOI: 10.1016/j.ienj.2024.101479 -
International Emergency Nursing Jun 2024Nurses' sensitivity to moral issues, especially in emergency and intensive care units is essential for providing complex nursing care. Therefore, the present study aimed...
INTRODUCTION
Nurses' sensitivity to moral issues, especially in emergency and intensive care units is essential for providing complex nursing care. Therefore, the present study aimed to determine the correlation between moral sensitivity and clinical competence in emergency and intensive care nurses.
METHODS
The present multi-center cross-sectional correlational study was conducted in 2022 on 180 nurses in five emergency departments and four intensive care units of general hospitals affiliated to Semnan University of Medical sciences. The study tools include a demographic questionnaire, 25 item Lutzen Moral Sensitivity Questionnaire (MSQ), and a standardized Competency Inventory for Registered Nurses (CIRN). Data were analyzed by mean, standard deviation and MANOVA, Pearson's correlation coefficient test.
RESULTS
The two groups did not have significant differences in demographic characteristics (p < 0.05). Majority of two emergency department nurses (83.9%) and Intensive care nurses (81.8%) had a moderate level of moral sensitivity. Also, clinical competence of majority of emergency department nurses (73.3%) and Intensive care nurses (75.8%) were in moderate level. There was significant positive relationship between moral sensitivity with Clinical competence in emergency department nurses (p ≤ 0.01, r = 0.61). No significant relationship was observed between moral sensitivity and the clinical competence of intensive care nurses (p > 0.05, r = 0.15).
CONCLUSIONS
There is need for improving the level of knowledge of nurses about moral principles and increasing moral sensitivity which can expand the components of clinical competence, especially in intensive care units.
PubMed: 38936275
DOI: 10.1016/j.ienj.2024.101483 -
Semergen Jun 2024Self-reported penicillin allergy is highly prevalent. Different studies estimate that 10% of the population is labeled as such. This label, confirmed or suspected,...
Self-reported penicillin allergy is highly prevalent. Different studies estimate that 10% of the population is labeled as such. This label, confirmed or suspected, forces us to take precautions and replace the antibiotic treatment of choice (frequently beta-lactams) with other 2nd or 3rd choice alternatives with worse overall results: side effects, resistance, costs, etc. The penicillin allergy label, once placed, remains in the medical record. It is only confirmed in less than 5% of patients, either because it has been placed inappropriately or because over time the sensitivity decreases and may disappear. Penicillin Allergy Decision Rule -PEN-FAST- is a validated and simple clinical prediction rule that estimates the risk of presenting an allergic reaction. Its use, together with algorithms that involve primary care in the study and delabeling of low-risk patients, can change our clinical practice.
PubMed: 38936101
DOI: 10.1016/j.semerg.2024.102280 -
PloS One 2024In the context of the United Nations Sustainable Development Goals (UN-SDGs), this study accentuates the role of the tourism and hospitality sector in promoting...
In the context of the United Nations Sustainable Development Goals (UN-SDGs), this study accentuates the role of the tourism and hospitality sector in promoting sustainability. The primary purpose is to unravel the relationship between corporate social responsibility (CSR) and energy-specific sustainable behavior of employees (ESBE), with particular emphasis on the mediating roles of green intrinsic motivation and personal environmental norms. Utilizing a three-wave data collection approach, we secured 325 valid responses from sector employees at various levels (manager-non managers) and applied Structural Equation Modeling through the SMART-PLS tool to assess the hypothesized relationships. The findings highlight a pronounced interconnection between CSR, ESBE, and the designated mediating variables. These results not only augment the academic literature by illustrating the psychological underpinnings bridging CSR to ESBE, but also equip the tourism and hospitality industry with actionable insights. Through informed CSR initiatives aligned with employee values, the sector can galvanize sustainable behaviors and create business models that resonate with the aspirations of the UN-SDGs, pointing the way to a more sustainable industry.
Topics: Motivation; Humans; Sustainable Development; Social Responsibility; Conservation of Natural Resources; Male; Female; Adult; Tourism
PubMed: 38935798
DOI: 10.1371/journal.pone.0295850 -
PloS One 2024Health technology assessment uses a multidisciplinary approach to support health benefits package design towards universal health coverage. The evidence-informed... (Review)
Review
Health technology assessment for sexual reproductive health and rights benefits package design in sub-Saharan Africa: A scoping review of evidence-informed deliberative processes.
BACKGROUND
Health technology assessment uses a multidisciplinary approach to support health benefits package design towards universal health coverage. The evidence-informed deliberative process framework has been used alongside Health technology assessment to enhance stakeholder participation and deliberations in health benefits package design. Applying the evidence-informed deliberative framework for Health assessment could support the morally diverse sexual reproductive health and rights (SRHR) benefits package design process. However, evidence on participation and deliberations for stakeholders in health technology assessment for SRHR benefits package design has not been curated in sub-Saharan Africa. This study synthesises literature to fill this gap.
METHODS
This scoping review applies the preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews, and deductive analysis following the evidence-informed deliberative processes framework. The search strategy uses the Guttmacher-Lancet Commission-proposed comprehensive definition of SRHR and the World Health Organisation's universal health coverage compendium of SRHR interventions to generate search terms. Six databases and biographical hand searches were used to identify studies in Sub-Saharan Africa from 1994.
RESULTS
A total of 14 studies met the inclusion criteria. Evidence for yearly public budgets and explicit SRHR health technology assessment processes was not found. In 12 of the studies reviewed, new advisory committees were set up specifically for health technology assessment for SRHR priority-setting and benefits package design. In all decision-making processes reviewed, the committee member roles, participation and deliberations processes, and stakeholder veto powers were not clearly defined. Patients, the public, and producers of health technology were often excluded in the health technology assessment for the SRHR benefits package design. Most health technology assessment processes identified at least one decision-making criterion but failed to use this in their selection and appraisal stages for SRHR benefits design. The identification, selection, and scoping stages in health technology assessment for SRHR were non-existent in most studies. In 11 of the 14 processes of the included studies, stakeholders were dissatisfied with the health policy recommendation from the appraisal process in health technology assessment. Perceived benefits for evidence-informed deliberative processes included increased stakeholder engagement and fairness in decision-making.
CONCLUSION
To support the integration of diverse social values in health technology assessment for fairer SRHR benefits package design, evidence from this review suggests the need to institutionalise health technology assessment, establish prioritisation decision criteria, involve all relevant stakeholders, and standardise the process and assessment methodological approaches.
Topics: Africa South of the Sahara; Humans; Technology Assessment, Biomedical; Reproductive Health; Sexual Health
PubMed: 38935794
DOI: 10.1371/journal.pone.0306042 -
PloS One 2024At some point in their career, many healthcare workers will experience psychological distress associated with being unable to take morally or ethically correct action,...
OBJECTIVE
At some point in their career, many healthcare workers will experience psychological distress associated with being unable to take morally or ethically correct action, as it aligns with their own values; a phenomenon known as moral distress. Similarly, there are increasing reports of healthcare workers experiencing long-term mental and psychological pain, alongside internal dissonance, known as moral injury. This review examined the triggers and factors associated with moral distress and injury in Health and Social Care Workers (HSCW) employed across a range of clinical settings with the aim of understanding how to mitigate the effects of moral distress and identify potential preventative interventions.
METHODS
A systematic review was conducted and reported according to recommendations from Cochrane and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Searches were conducted and updated regularly until January 2024 on 2 main databases (CENTRAL, PubMed) and three specialist databases (Scopus, CINAHL, PsycArticles), alongside hand searches of study registration databases and other systematic reviews reference lists. Eligible studies included a HSCW sample, explored moral distress/injury as a main aim, and were written in English or Italian. Verbatim quotes were extracted, and article quality was assessed via the CASP toolkit. Thematic analysis was conducted to identify patterns and arrange codes into themes. Specific factors like culture and diversity were explored, and the effects of exceptional circumstances like the pandemic.
RESULTS
Fifty-one reports of 49 studies were included in the review. Causes and triggers were categorised under three domains: individual, social, and organisational. At the individual level, patients' care options, professionals' beliefs, locus of control, task planning, and the ability to make decisions based on experience, were indicated as elements that can cause or trigger moral distress. In addition, and relevant to the CoVID-19 pandemic, was use/access to personal protection resources. The social or relational factors were linked to the responsibility for advocating for and communication with patients and families, and professionals own support network. At organisational levels, hierarchy, regulations, support, workload, culture, and resources (staff and equipment) were identified as elements that can affect professionals' moral comfort. Patients' care, morals/beliefs/standards, advocacy role and culture of context were the most referenced elements. Data on cultural differences and diversity were not sufficient to make assumptions. Lack of resources and rapid policy changes have emerged as key triggers related to the pandemic. This suggests that those responsible for policy decisions should be mindful of the potential impact on staff of sudden and top-down change.
CONCLUSION
This review indicates that causes and triggers of moral injury are multifactorial and largely influenced by the context and constraints within which professionals work. Moral distress is linked to the duty and responsibility of care, and professionals' disposition to prioritise the wellbeing of patients. If the organisational values and regulations are in contrast with individuals' beliefs, repercussions on professionals' wellbeing and retention are to be expected. Organisational strategies to mitigate against moral distress, or the longer-term sequalae of moral injury, should address the individual, social, and organisational elements identified in this review.
Topics: Humans; Health Personnel; Morals; Social Workers; Qualitative Research; COVID-19; Psychological Distress; Stress, Psychological
PubMed: 38935754
DOI: 10.1371/journal.pone.0303013 -
PloS One 2024Among the consequences of systemic racism in health care are significant health disparities among Black/African American individuals with comorbid physical and mental...
Among the consequences of systemic racism in health care are significant health disparities among Black/African American individuals with comorbid physical and mental health conditions. Despite decades of studies acknowledging health disparities based on race, significant change has not occurred. There are shockingly few evidence-based antiracism interventions. New paradigms are needed to intervene on, and not just document, racism in health care systems. We are developing a transformative paradigm for new antiracism interventions for primary care settings that integrate mental and physical health care. The paradigm is the first of its kind to integrate community-based participatory research and systems science, within an established model of early phase translation to rigorously define new antiracism interventions. This protocol will use a novel application of systems sciences by combining the qualitative systems sciences methods (group model building; GMB) with quantitative methods (simulation modeling) to develop a comprehensive and community-engaged view of both the drivers of racism and the potential impact of antiracism interventions. Community participants from two integrated primary health care systems will engage in group GMB workshops with researchers to 1) Describe and map the complex dynamic systems driving racism in health care practices, 2) Identify leverage points for disruptive antiracism interventions, policies and practices, and 3) Review and prioritize a list of possible intervention strategies. Advisory committees will provide feedback on the design of GMB procedures, screen potential intervention components for impact, feasibility, and acceptability, and identify gaps for further exploration. Simulation models will be generated based on contextual factors and provider/patient characteristics. Using Item Response Theory, we will initiate the process of developing core measures for assessing the effectiveness of interventions at the organizational-systems and provider levels to be tested under a variety of conditions. While we focus on Black/African Americans, we hope that the resulting transformative paradigm can be applied to improve health equity among other marginalized groups.
Topics: Humans; Primary Health Care; Health Equity; Racism; Black or African American; Community-Based Participatory Research; Healthcare Disparities; Antiracism
PubMed: 38935743
DOI: 10.1371/journal.pone.0306185