Corrigendum: Wastewater-based surveillance identifies start to the pediatric respiratory syncytial virus season in two cities in Ontario, Canada

[This corrects the article DOI: 10.3389/fpubh.2023.1261165.].

Wastewater-based surveillance identifies start to the pediatric respiratory syncytial virus season in two cities in Ontario, Canada

Introduction

Detection of community respiratory syncytial virus (RSV) infections informs the timing of immunoprophylaxis programs and hospital preparedness for surging pediatric volumes. In many jurisdictions, this relies upon RSV clinical test positivity and hospitalization (RSVH) trends, which are lagging indicators. Wastewater-based surveillance (WBS) may be a novel strategy to accurately identify the start of the RSV season and guide immunoprophylaxis administration and hospital preparedness.

Methods

We compared citywide wastewater samples and pediatric RSVH in Ottawa and Hamilton between August 1, 2022, and March 5, 2023. 24-h composite wastewater samples were collected daily and 5 days a week at the wastewater treatment facilities in Ottawa and Hamilton, Ontario, Canada, respectively. RSV WBS samples were analyzed in real-time for RSV by RT-qPCR.

Results

RSV WBS measurements in both Ottawa and Hamilton showed a lead time of 12 days when comparing the WBS data set to pediatric RSVH data set (Spearman's ρ = 0.90). WBS identify early RSV community transmission and declared the start of the RSV season 36 and 12 days in advance of the provincial RSV season start (October 31) for the city of Ottawa and Hamilton, respectively. The differing RSV start dates in the two cities is likely associated with geographical and regional variation in the incidence of RSV between the cities.

Discussion

Quantifying RSV in municipal wastewater forecasted a 12-day lead time of the pediatric RSVH surge and an earlier season start date compared to the provincial start date. These findings suggest an important role for RSV WBS to inform regional health system preparedness, reduce RSV burden, and understand variations in community-related illness as novel RSV vaccines and monoclonal antibodies become available.

A generalizable pre-clinical research approach for orphan disease therapy

With the advent of next-generation DNA sequencing, the pace of inherited orphan disease gene identification has increased dramatically, a situation that will continue for at least the next several years. At present, the numbers of such identified disease genes significantly outstrips the number of laboratories available to investigate a given disorder, an asymmetry that will only increase over time. The hope for any genetic disorder is, where possible and in addition to accurate diagnostic test formulation, the development of therapeutic approaches. To this end, we propose here the development of a strategic toolbox and preclinical research pathway for inherited orphan disease. Taking much of what has been learned from rare genetic disease research over the past two decades, we propose generalizable methods utilizing transcriptomic, system-wide chemical biology datasets combined with chemical informatics and, where possible, repurposing of FDA approved drugs for pre-clinical orphan disease therapies. It is hoped that this approach may be of utility for the broader orphan disease research community and provide funding organizations and patient advocacy groups with suggestions for the optimal path forward. In addition to enabling academic pre-clinical research, strategies such as this may also aid in seeding startup companies, as well as further engaging the pharmaceutical industry in the treatment of rare genetic disease.

Hypoxia Alters The Expression of Inhibitor of Apoptosis Proteins after Brain Trauma in The Mouse

Hypoxia worsens brain injury following trauma, but the mechanisms remain unclear. The purpose of this study was to determine the effect of traumatic brain injury (TBI) and secondary hypoxia (9% oxygen) on apoptosis-related protein expression, cell death, and behavior. Using a murine weight-drop model, TBI led to an early (6 h) increase followed by a later (24 h) decrease in neuronal apoptosis inhibitor protein (NAIP) expression in the olfactory and motor cortex; in contrast, TBI led to a sustained (6 h to 7 days) increase in NAIP in the striatum. The peak increase in the expression of NAIP (6-12 h) following TBI alone was delayed (1-7 days) when hypoxia was added to TBI. Hypoxia following TBI further depleted other apoptosis inhibitor proteins (IAPs) and activated caspases, as well as increased contusion size and worsened cell death. Hypoxia added to TBI also increased motor and feeding activity on days 2 and 4 compared to TBI alone. Hypoxia without TBI had no effect on the expression of IAPs or cell death. These findings show that IAPs have a potential role in the increased vulnerability of brain cells to hypoxia following TBI, and have implications for configuring future therapies for TBI.

Rapid detection of single nucleotide polymorphisms associated with spinal muscular atrophy by use of a reusable fibre-optic biosensor

Rapid (<2 min) and quantitative genotyping for single nucleotide polymorphisms (SNPs) associated with spinal muscular atrophy was done using a reusable (approximately 80 cycles of application) fibre-optic biosensor over a clinically relevant range (0-4 gene copies). Sensors were functionalized with oligonucleotide probes immobilized at high density (approximately 7 pmol/cm2) to impart enhanced selectivity for SNP discrimination and used in a total internal reflection fluorescence detection motif to detect 202 bp PCR amplicons from patient samples. Real-time detection may be done over a range of ionic strength conditions (0.1-1.0 M) without stringency rinsing to remove non-selectively bound materials and without loss of selectivity, permitting a means for facile sample preparation. By using the time-derivative of fluorescence intensity as the analytical parameter, linearity of response may be maintained while allowing for significant reductions in analysis time (10-100-fold), permitting for the completion of measurements in under 1 min.

Life and death decisions: the role of the IAPs in modulating programmed cell death

Multicellular organisms have evolved elaborate signal transduction pathways for maintaining homeostasis through the control of cell proliferation and death. The recent surge of interest in the regulation of programmed cell death has led to the rapid identification of many proteins involved in controlling and executing apoptosis. The inhibitors of apoptosis proteins (IAPs) constitute a family of highly conserved death suppressing proteins that were first identified in baculoviruses, and that has recently expanded to include at least two homologues in Drosophila melanogaster and four in rodents and humans. In this article we review the current state of IAP research. Two of the IAPs, HIAP-1 and HIAP-2, have been placed within the TNFalpha induced cell death pathway which involves two receptors for TNFalpha and multiple, overlapping signal transduction proteins. A third, X-linked gene termed XIAP, is ubiquitously expressed and appears to have a broad range of suppressor activity to a variety of apoptotic triggers. The fourth member, NAIP, has been identified as the protein product of a candidate gene for the inherited neuromuscular disorder, spinal muscular atrophy (SMA). The neuroprotective activity of NAIP in an in vivo model of cerebral ischemia has also been demonstrated.

Predictors of quality of life following stroke

PURPOSE

To determine the factors predicting quality of life during the course of rehabilitation following stroke.

METHOD

Two hundred and fifteen stroke patients aged 41 93 were studied over a period of three months. Measurement of quality of life, functional ability, social support. demographic and treatment data were taken on admission to the rehabilitation hospital, at two weeks and three months. The instruments used were the Sickness Impact Profile (SIP), the Modified Barthel Index (MBI) and The Social Support Questionnaire, short form (SSQ6).

RESULTS

Length of stay, previous stroke, functional ability and social support were found to be significantly correlated with quality of life. Stepwise multiple regression analysis indicated that functional ability, psychological and physical SIP dimensions, social support satisfaction at two weeks and previous stroke explained 47% of the variance in sickness impact at three months following stroke. The factors predicting 53% of the variance in sickness impact at two weeks were baseline functional ability, psychological and physical SIP.

CONCLUSIONS

The findings indicate that both psychosocial and physical factors are important in predicting quality of life in stroke rehabilitation. Determining such predictors at an early stage will help to guide clinical decisions throughout rehabilitation.

Needs of Chinese families of critically ill patients

Critical illness and subsequent hospitalization are stressful for patients and their family members. The purpose of this descriptive study was to identify the family members' perceptions of their immediate needs within 48 to 96 hours following admission of a relative to a critical care unit in Hong Kong and to compare their perceptions with the critical care nurses' perceptions of the family needs. A convenience sample of 37 Chinese family members and 45 registered nurses completed a self-report Chinese version of the Critical Care Family Need Inventory. The 10 most important and 10 least important family needs were identified by family members and by nurses and the results were compared. Conclusions were drawn about the implications for nurses in planning and implementing quality family-centered care for critically ill patients.

State self-esteem following stroke

BACKGROUND AND PURPOSE

Physical rehabilitation after stroke is often highlighted in the absence of consideration of psychosocial factors. This study sought to determine the relationship between state self-esteem and functional independence in patients recovering from stroke.

METHODS

In a longitudinal study, data were collected from 152 stroke patients within 48 hours of admission to a rehabilitation hospital and at 2 weeks and 3 months after admission. The Modified Barthel Index was used to assess functional ability. Patients' current feelings of self-worth were assessed with use of the State Self-Esteem Scale. Additional variables included perceived social support, trait self-esteem, age, previous stroke, side of stroke, comorbidity, marital status, and gender.

RESULTS

State self-esteem was significantly correlated to functional independence. The results of linear stepwise regression analysis indicated that functional ability and state self-esteem at 2 weeks, as well as the presence of heart disease, were significant predictors (55%) of functional ability at 3 months. For those with a functional ability score of >/=81 on admission to the rehabilitation unit, state self-esteem and functional ability at 2 weeks as well as previous stroke explained 53% of the variance in functional ability at 3 months. When functional ability was </=80, baseline and 2-week functional ability, state self-esteem at 2 weeks, and age predicted 53% of the variance in functional ability at 3 months.

CONCLUSIONS

Functional ability at 2 weeks was a stronger predictor than baseline functional ability in this study. The level of state self-esteem was also a consistent factor in the prediction of functional outcome of patients after stroke.

Caring for relatives with serious mental illness at home: the experiences of family carers in Hong Kong

This article describes a study recently carried out in Hong Kong. The aim of the study was to gain an understanding of the experiences of Chinese family carers in giving care to a relative with serious mental illness at home. Eight primary carers were selected, and data were collected through audiotaped, semistructured interviews in Cantonese. Five main categories emerged from the data: emotional impact, coping and adaptation, psychosocial effect, social support needs, and perceptions of mental illness and mental health services. Conclusions highlight the need for family-oriented mental health services to be developed and for further research to identify the specific nursing interventions that are effective in helping to sustain family caregiving in Chinese families.

Community nurses' assessment of the needs of Hong Kong family carers who are looking after stroke patients

This research aimed to identify the current practice of community nurses in Hong Kong in assessing stroke patients and their carers, and to pilot a scale for inclusion in the routine assessment of Chinese carers and their families. Qualitative and quantitative methods were used. In Phase 1, information was gained about the current practice of Community Nurses in assessing the needs of carers, and appropriate areas for inclusion in a scale for assessing those needs were identified. In Phase 2, the Carer Assessment Scale was completed by 14 Community Nurses and subsequently administered by a research assistant independently to the carers themselves. The perceptions of the two groups of respondents were compared, agreements and differences noted, and conclusions drawn, as to the real needs of carers.

Case management: a review of the definitions and practices

Case management has been suggested as an innovative strategy which facilitates the linking of quality and cost-effective care. However, there is little consensus about what is actually being introduced under the name of case management. It is suggested that this absence of a clear understanding of case management has been an obstacle in moving forward case management practice and research. This paper presents a critical review of the confusion surrounding case management with an attempt to unravel issues relevant to the implementation of case management into community nursing practice in Hong Kong. It is concluded that there is a need for different definitions of case management as a result of the differences in the cultural and health care context in which it is being practised. Also, if case management programmes are to be advanced, there needs to be more co-ordinated effort in researching not only the expected outcomes but also the structures and processes of these programmes so that findings of similar case management programmes can be compared for ways of future improvement.

Expression of inhibitor of apoptosis proteins (IAPs) in rat granulosa cells during ovarian follicular development and atresia

The inhibitor of apoptosis proteins (IAPs) constitute a family of highly conserved apoptosis suppressor proteins that was originally identified in baculoviruses. Although IAP homologs have been recently identified and demonstrated to suppress apoptosis in mammalian cells, their expression and role during follicular development and atresia are unknown. The present study was conducted to address these questions. Using established in vivo models for the induction of follicular development and atresia in immature rats, it was possible to compare the immunolocalization of X-link inhibitor of apoptosis protein (Xiap) and human inhibitor of apoptosis protein-2 (Hiap-2), two members of the IAP family, at defined stages of follicular maturation and to relate the differences observed with those of follicular cell proliferation and apoptosis [as determined by proliferating cell nuclear antigen (PCNA) immunohistochemistry and in situ terminal deoxynucleotidyl transferase-mediated dUTP-biotin end labeling (TUNEL), respectively]. In addition, granulosa cell DNA and proteins were assessed for apoptotic fragmentation by 3'-end labeling/agarose gel electrophoresis (DNA ladder) and Hiap-2 and Xiap protein content by Western blot analysis, respectively. Hiap-2 and Xiap expression in both granulosa and theca cells increased with follicular maturation, reaching maximal levels at the antral stage of development. The immunoreactivity for PCNA, Xiap, and Hiap-2 decreased markedly in atretic (TUNEL-positive) follicles at the small to medium sized antral stage of development, suggesting follicular atresia may be associated with decreased granulosa cell IAP protein content and decreased proliferation. Atresia was also associated with a change in the intracellular distribution of IAPs in granulosa cells. Biochemical analysis of DNA fragmentation (DNA ladder) in granulosa cells from preantral and early antral follicles indicates extensive apoptosis that was associated with minimal IAP protein content. Gonadotropin treatment increased Hiap-2 and Xiap protein content and suppressed apoptosis in granulosa cells, resulting in the development of follicles to the antral and preovulatory stages. In addition, gonadotropin withdrawal induced apoptotic DNA fragmentation in granulosa cells in early antral and antral follicles, which is accompanied by a marked decrease in Hiap-2 and Xiap expression. These data suggest that IAPs may be involved in the suppression of granulosa cell apoptosis by gonadotropin in small to medium-sized antral follicles and play an important role in determining the fate of the cells, and thus also the eventual follicular destiny (atresia vs. ovulation).

An exploration of the carers' perceptions of caregiving and caring responsibilities in Chinese families

This qualitative study carried out with 10 Chinese families in Hong Kong describes caregiving and caring from the perceptions of the primary carers. Semi-structured interviews were carried out to gain personal accounts of experiences of primary carers caring for dependent family members. The analysis resulted in categories identifying and explaining the needs of primary carers. Suggestions for practice are made.

Evaluating individual performance in higher education: a new challenge for nurse educators

In response to the demands for more accountability and efficiency in higher education, of which nurse education is now a part, this paper explores the evaluation of individual performance. It considers the purposes of staff appraisal and draws upon a study of criteria for self-appraisal of teachers and upon experience gained in introducing teacher appraisal into schools. Different teaching environments are discussed and the additional demands upon academic staff in universities in terms of research are considered in the light of the recent Research Assessment Exercises. Particular consideration is given to the performance of nursing departments in the 1992 exercise and to the implications for staff appraisal. Successful procedures for evaluating individual performance in schools that might transfer to higher education are identified and strategies that might be adopted by nursing departments are suggested. This paper argues that evaluation of individual performance is a worthwhile departmental function which, when successful, may help to create an atmosphere more conductive to the eventual successful introduction of total quality management to the institution as a whole. It concludes that the extra substantial demands upon staff time and energy, at a time when nursing departments are trying to establish themselves in the higher education sector, might be alleviated if the groundwork already undertaken in schools is put to good use.

A review of the historical and social processes contributing to care and caregiving in Chinese families

The purpose of this paper is to review the literature on caring and caregiving in Chinese families in relation to the contribution made by historical and social processes. The beliefs and traditions of care appearing in the professional and popular literature are explored to enable comparison with recent research from Hong Kong, China and the United Kingdom. Caring emerges as profoundly complicated and ambivalent, drawing on notions of morality, obligation, love, kinship and gender responsibility. Furthermore, caring in contemporary Chinese families in Hong Kong appears to have more similarities than differences with western families, possibly due to changing kinship networks. Such conclusions have particular relevance for nursing in the light of recent policy directives in Hong Kong promoting the role of the families in caring for their dependent members based on the assumption that families can and will care.

Evaluating ethnography: considerations for analysis

The informed evaluation of ethnographic reports is essential to the practitioner who is working towards research-based practice. It is also part of the process of developing and refining nursing knowledge. While there are features common to the critical examination of all research, an understanding of ethnographic design and, in particular, of issues of validity and reliability, is a prerequisite for evaluation of ethnographic research reports.

Learning from experience in the community: an ethnographic study of district nurse students

This study seeks to gain an understanding of the learning experiences of district nurse students in the learning environment of the community, and to examine learning in the practice setting from the perspective of the student. Since the research depends upon the changing and differing interpretations of the individuals involved in the natural setting of the community, an ethnographic approach has been adopted. The experiences of students are monitored throughout the taught practice element of the district nurse course in both inner city and rural/urban locations. Data, collected through interview and observations, are analysed in the context of theory relating to adult learning and learning from experience. Three major categories are identified. Examples from these categories are identified and discussed. The categories are sequential and represent the learning process experienced by the students in the practice setting as they learn to fit into a new environment, test out their own ideas and compare the unreality of college with the reality of practice. Attention is drawn to the difficulties for students of fitting into new settings and trying out change, to the detrimental effect on learning of rigid practice routines and to the powerlessness of community practice teachers to exert a major influence on the learning environment. These issues are discussed in the context of changes in nurse education and evaluation of the community learning environment.

Simpson-Golabi-Behmel syndrome associated with renal dysplasia and embryonal tumor: localization of the gene to Xqcen-q21

We report 6 affected males in a 5-generation family with x-linked Simpson-Golabi-Behmel (SGB) syndrome. All had pre- and postnatal overgrowth with 2 adult males attaining heights over 195 cm. Other features included "coarse" face with hypertelorism, broad nasal root, cleft palate, full lips with a midline groove of the lower lip, grooved tongue with tongue tie, prominent mandible, congenital heart defects, arrhythmias, supernumerary nipples, splenomegaly, large dysplastic kidneys, cryptorchidism, hypospadias, skeletal abnormalities and postaxial hexadactyly. All affected individuals were of normal intelligence. One boy died at age 19 months of a neuroblastoma. The putative origin of the gene in this family was the maternal great grandmother of the propositus. Eight carrier females, who showed varying manifestations of the gene, have been identified. Anthropometric analysis has identified preliminary characteristic craniofacial dimensions in this syndrome. Molecular studies have shown a maximal lod score of 2.81 with no recombinants observed for the SGB-DXYS68 pairing, mapping the disorder to Xqcen-Xq21.3.