Two Novel Variants in PI4KA in a Family Presenting With Hereditary Spastic Paraparesis: A Case Report

Objectives

To report novel biallelic PI4KA variants in a family presenting with pure hereditary spastic paraparesis.

Methods

Two affected sisters presented with unsolved hereditary spastic paraparesis and underwent clinical and imaging assessments. This was followed by short-read next-generation sequencing.

Results

Analysis of next-generation sequencing data uncovered compound heterozygous variants in PI4KA (NM_058004.4: c.[3883C>A];[5785A>C]; p.[(His1295Asn);(Thr1929Pro)]. Using ACMG guidelines, both variants were classified as likely pathogenic.

Discussion

Here, next-generation sequencing revealed 2 novel compound heterozygous variants in the phosphatidylinositol 4-kinase alpha gene (PI4KA) in 2 sisters presenting with progressive pure hereditary spastic paraparesis. Pathogenic variants in PI4KA have previously been associated with a spectrum of disorders including autosomal recessive perisylvian polymicrogyria, with cerebellar hypoplasia, arthrogryposis, and pure spastic paraplegia. The cases presented in this study expand the phenotypic spectrum associated with PI4KA variants and contribute new likely pathogenic variants for testing in patients with otherwise unsolved hereditary spastic paraparesis.

Germline potential should not be overlooked for cancer variants identified in tumour-only somatic mutation testing

DNA sequencing of tumour tissue has become the standard care for many solid cancers because of the option to detect somatic variants that have significant therapeutic, diagnostic and prognostic implications. Variants found within the tumour may be either somatic or germline in origin. Somatic cancer gene panels are developed to detect acquired (somatic) variants that are relevant for therapeutic or molecular characterisation of the tumour, expanding gene panels now include genes which may also inform patient management such as cancer predisposition syndromes (CPS) genes. Identifying germline cancer predisposition variants can alter cancer management, the risk of developing new primary cancers and risk for cancer in at-risk family members. This paper discusses the clinical, technical and ethical challenges related to identifying and reporting potential germline pathogenic variants that are detected on tumour sequencing. It also highlights the existence of the eviQ national guidelines for CPS with advice on germline confirmation of somatic findings to pathology laboratories in Australia.

The Effect of an Online Health Literacy Promotion Program for Filipino Domestic Workers: A Mixed Method Study

Introduction

Health literacy refers to acquiring and utilizing health information to make health-related actions and decisions. Filipino domestic workers with low health literacy are often vulnerable to health problems due to poor living and working conditions.

Objective

This study examined the effect of an online health literacy promotion program on health literacy and health knowledge of Filipino domestic workers in Macao.

Methods

The mixed method combined quantitative findings of a quasi-experimental study with qualitative results applied. The quasi-experiment included three parallel groups: a synchronous online education group (videoconference group), an asynchronous online education group (video group), and a control group. A total of 88 Filipino domestic workers were assigned to one of these groups, and eight respondents participated in two focus-group interviews respectively after the intervention.

Results

For quantitative data, both synchronous and asynchronous online education interventions had positive effects. While comparing with the control group, participants in the videoconference group were more likely to have better health promotion health literacy after the intervention (β = 5.36, p = .02), and participants in the video group were more likely to have better general health literacy (β = 5.17, p = .01), disease prevention health literacy (β = 5.31, p = .04), health promotion health literacy (β = 5.97, p = .01). For qualitative data, three themes and eight subthemes were extracted after the online health literacy promotion program. After integrating the findings of this study, the study found that this program was essential and beneficial for Filipino domestic workers' health knowledge and health literacy.

Conclusion

Overall, online health literacy promotion programe had positive impacts on participants revealed in this study. Asynchronous online education has made significant progress in overall health literacy, which may be more suitable as a widely promoted education method because of the characteristics and working conditions of this population.

Gender similarities and differences in the perception of caring among nurses during the COVID-19 pandemic: a mixed-methods study

BACKGROUND

Caring is the essence and core of nursing. Current studies on the effect of gender on nurses' perception of caring have been inconsistent. Most of these studies were quantitative and conducted before the COVID-19 pandemic. The study aimed to explore the gender similarities and differences in nurses' perception of caring during the COVID-19 pandemic.

METHODS

In 2020, a cross-sectional mixed-method study was conducted in 11 cities in China using structured online questionnaire (n = 8030) and face-to-face individual interview (n = 42). Data collection tools included the Caring Dimensions Inventory and semi-structured interview.

RESULTS

In stepwise multivariable linear regression analysis, female nurses scored 1.93 points higher on caring than male nurses, after completely controlling for the other factors. The interview results showed that both male and female nurses agreed that caring was to deal with three kinds of relationships, namely nurses and people, nurses and themselves, nurses and society. There were gender differences in the connotation of caring between nurses and themselves, but not in the connotations of caring between other relationships. The ranking of the importance of caring connotations among these relationships showed no gender difference except between nurses and themselves.

CONCLUSION

The quantitative findings suggest that gender influences nurses' perception of caring. The qualitative findings demonstrate that nurses regard themselves as both recipients and implementers of caring. The qualitative results indicate nurses of different genders have similarities and differences in their perception of caring, and the biggest difference lies in the relationship between nurses and themselves.

The impact of caring for COVID-19 patients on nurse professional identity: A cross-sectional study using propensity score analysis

Objective

To examine the impact of caring for COVID-19 patients on the professional identity of nurses.

Methods

An online survey was conducted between 19 May and 7 August 2020 in 11 Chinese cities, including Dongguan, Foshan, Guangzhou, Hong Kong, Huizhou, Jiangmen, Macao, Shenzhen, Zhaoqing, Zhongshan, and Zhuhai. Propensity score matching was used to adjust for confounding variables between nurses with and without experience caring for COVID-19 patients. To analyze the impact of caring for COVID-19 patients on nurses' professional identity, a nominal logistic regression model was used rather than an ordinal regression model because the parallel regression assumption was violated.

Results

After propensity score matching, the final sample contained 1,268 participants, including 634 nurses who cared for COVID-19 patients. During the COVID-19 outbreak, 88.6% of nurses had high levels of professional identity. Nurses who cared for COVID-19 patients had the lowest percentage of high score level on the professional identity subscale for "sense of organizational influence," as did nurses who did not care for COVID-19 patients. The findings indicated that nurses who cared for COVID-19 patients were 17.95 times more likely to have a high professional identity than a low professional identity (95% CI 2.38-135.39, p = 0.005), after completely controlling for the other factors. There were significant differences between nurses who cared for COVID-19 patients and those who did not in scores on the subscales of professional identity, except for the subscales "sense of self-decision-making" (χ² = 4.85, p = 0.089) and "sense of organizational influence" (χ² = 4.71, p = 0.095).

Conclusion

Nurses' professional identity is positively impacted by their experience caring for COVID-19 patients. Caring for COVID-19 patients should be highlighted as an opportunity to enhance nurses' professional identity. To further enhance the professional identity of nurses, we call for visible nursing leadership during the COVID-19 pandemic and improve their working environment.

Shariant platform: Enabling evidence sharing across Australian clinical genetic-testing laboratories to support variant interpretation

Sharing genomic variant interpretations across laboratories promotes consistency in variant assertions. A landscape analysis of Australian clinical genetic-testing laboratories in 2017 identified that, despite the national-accreditation-body recommendations encouraging laboratories to submit genotypic data to clinical databases, fewer than 300 variants had been shared to the ClinVar public database. Consultations with Australian laboratories identified resource constraints limiting routine application of manual processes, consent issues, and differences in interpretation systems as barriers to sharing. This information was used to define key needs and solutions required to enable national sharing of variant interpretations. The Shariant platform, using both the GRCh37 and GRCh38 genome builds, was developed to enable ongoing sharing of variant interpretations and associated evidence between Australian clinical genetic-testing laboratories. Where possible, two-way automated sharing was implemented so that disruption to laboratory workflows would be minimized. Terms of use were developed through consultation and currently restrict access to Australian clinical genetic-testing laboratories. Shariant was designed to store and compare structured evidence, to promote and record resolution of inter-laboratory classification discrepancies, and to streamline the submission of variant assertions to ClinVar. As of December 2021, more than 14,000 largely prospectively curated variant records from 11 participating laboratories have been shared. Discrepant classifications have been identified for 11% (28/260) of variants submitted by more than one laboratory. We have demonstrated that co-design with clinical laboratories is vital to developing and implementing a national variant-interpretation sharing effort. This approach has improved inter-laboratory concordance and enabled opportunities to standardize interpretation practices.

"You Need to Get Over the Difficulties and Stand Up Again"-A Qualitative Inquiry into Young Nurses' Coping with Lateral Violence from the Feminist Perspective

Previous studies have reported lateral violence (LV) styles among nurses and the adverse impacts of LV on nurses and nursing. Young nurses, including nursing students and novice nurses, are often victims of LV. A large qualitative research study that contained three sub-studies exploring professional identity development in different professional stages was conducted by a research team in Macau, Special Administrative Region of China. Semi-structured interviews with nursing students and clinical nurses were carried out; among the 58 participants in the three sub-studies, 20 described some forms of LV and their ways of dealing with them. Framed by the feminist perspective, the researchers explored young nurses’ coping strategies in dealing with LV perpetrated by senior colleagues. Two themes were developed reflecting the coping strategies for LV: “making extra efforts” and “soothing emotional distress”. Three sub-themes were under the theme of “making extra efforts”: “catching up knowledge”, “making the most use of learning resources”, “adjusting communication manner”; another batch of sub-themes was under the theme of “soothing emotional distress”: “seeking support from schoolmates”, “living with family but crying alone”, and “adjusting lifestyle”. The study implied that young nurses exerted their agency in coping with LV in clinical practices. Nursing managers and educators should support young nurses’ efforts in overcoming power-based LV and incivility.

Health Literacy Regarding Infectious Disease Predicts COVID-19 Preventive Behaviors: A Pathway Analysis

Health literacy has been identified as one vital determinant of public health and healthy behaviors, but very few studies regarding infectious disease prevention have been found. This descriptive cross-sectional study aimed to validate the pathway of infectious disease-specific health literacy (IDSHL), COVID-19 (coronavirus disease 2019) preventive behaviors, and their determinants. A sample of 1459 casino workers in Macao was eligible for analysis. The concept model was verified with a comparative fit index of 0.937 and goodness-of-fit index of 0.971. Government responses was a significant determinant of situational factors (helpfulness of health information, resource accessibility, and organizational training adequacy), while situational factors showed a direct effect on COVID-19 preventive behaviors. Education and organization training adequacy was the strongest influencing factor of IDSHL, which should be a key target of intervention programs for COVID-19.

"I am called girl, but that doesn't matter" -perspectives of male nurses regarding gender-related advantages and disadvantages in professional development

Background

Exploration of professional development experiences of male nurses can help develop evidence-based strategies to attract males into nursing. The study aims to investigate the advantages and disadvantages of being a male in nursing profession that male nurses and male nursing students experience in their professional development.

Methods

A descriptive qualitative research was designed. Purposive sampling was applied and 24 males (12 nursing students and 12 clinical nurses) participated. Semi-structured individual interviews were used in data collection. Thematic analysis was used in data analysis.

Results

Professional development of male nurses was related to three interplayed identities: a man, a nurse, and a minority. Three themes emerged relating to the professional development of the males: “feeling role strains” “taking perceived advantage of masculine traits” and “taking an egalitarian viewpoint”. There was no clear line between the gender-related advantages and disadvantages as factors influencing professional development can be turned by the males from barriers to facilitators.

Conclusions

Male nurses perceive nursing as equally suitable for males and females and make use of masculine traits to thrive in their professional development.

Factors influencing recruitment and retention of male nurses in Macau and mainland China: a collaborative, qualitative study

BACKGROUND

Macau and the Mainland China have different political and socio-economic policies but are both influenced by Chinese culture. By comparing the professional development experiences of male nurses from Macau and the Mainland, this study aims to explore factors influencing the recruitment and retention of male nurses.

METHODS

A collaborative, qualitative approach was adopted in which researchers from Macau and the Mainland were jointly involved in carrying out interviews and analyzing data. A total of 24 clinical male nurses were invited, with 12 each from Macau the Mainland. Recruitment was based on purposive sampling from various health institutions in the two regions. Semi-structured interviews were conducted in 2017-2018 with similar interview guidelines for both Macau and the Mainland sites. Thematic analysis was used for data analysis, and Nvivo11 Plus software was used to facilitate the analysis.

RESULTS

Key facilitators/barriers to recruitment and retention of male nurses were clustered under the two research questions: 1) What are the factors influencing the recruitment of male nurses? 2) What are the factors influencing the retention of male nurses? Males in Macau and the Mainland experienced pressure while entering nursing because of the stereotype that nursing is a feminine occupation. However, males in Macau chose nursing as a college major under their own volition while males in the Mainland were mostly forced into nursing. The males in Macau hardly thought of leaving nursing while their Mainland counterparts constantly felt uncertain about their professional future. The males on both sides hoped to thrive in career development. While the Macanese tended to pursue advanced programs in specialty nursing for better health care in the frontline, the Mainlanders wanted to get promoted to leave the frontline.

CONCLUSION

Male nurses in Macau and Mainland share some common experiences in professional development but have different views and values regarding nursing.

Male Nurses' Dealing with Tensions and Conflicts with Patients and Physicians: A Theoretically Framed Analysis

Proposes

Delivery of healthcare involves engagements of patients, nurses and other health professionals. The Social Identity Theory (SIT) can provide a lens to investigate intergroup interactions. This study explores how male nurses deal with intergroup tensions and conflicts with patients and physicians when delivering healthcare.

Methods

A collaborative qualitative research study was conducted by two research teams, with one from Mainland China and the other from Macau. Twenty-four male nurses were recruited, with 12 from each of the two regions. A similar guide was used by the two teams to conduct in-depth interviews with the participants. Thematic analysis was used, and SIT guided the data analysis and interpretation of the results.

Results

Four themes identified are related to nurse/patient relationships: respecting patients’ decisions, neglecting minor offenses, defending dignity, taking a dominant position; two themes are related to nurse/physician relationships: rationalizing physicians’ superiority over nurses, establishing relationships with physicians by interpersonal interactions.

Conclusion

Male nurses avoid confrontation with patients in case of disagreements but take on gender- and profession-based dominance in dealing with intense conflicts to maintain healthcare order. They do not challenge the status hierarchy between nurses and physicians but manage to maintain harmonious relationships with physicians by engaging in interpersonal activities with physicians in leisure times.

Implication

Male nurses can take the lead to create inclusive groups to engage patients and physicians in delivering healthcare. The masculine traits of male nurses do not subvert the nurse/physician hierarchy stereotype but strengthen it.

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"My Friends are at the Bottom of My Schedule": A Qualitative Study on Social Health among Nursing Students during Clinical Placement

Clinical placement is an essential component for nursing students, allowing them to transfer professional knowledge into practice. The quality of life among nursing students and nurses was reviewed to examine its impact on the quality of provided care. However, it is unclear how social health among nursing students is affected during clinical placement. Final-year students who had finished clinical placement were invited to participate in this qualitative study. Twenty-one in-depth interviews were conducted and transcribed verbatim for thematic analysis. Two main themes, i.e., contributors to lack of social health, and manifestations of lack of social health, emerged from seven sub-themes. Students experienced different challenges during the clinical placement, but some of these did contribute to effects on their social health. Lack of social health might further influence career development after graduation. Supportive strategies from colleagues, nursing colleges and hospitals might potentially improve students' social health during the clinical placement.

Robust CRISPR/Cas9 Genome Editing of the HUDEP-2 Erythroid Precursor Line Using Plasmids and Single-Stranded Oligonucleotide Donors

The study of cellular processes and gene regulation in terminal erythroid development has been greatly facilitated by the generation of an immortalised erythroid cell line derived from Human Umbilical Derived Erythroid Precursors, termed HUDEP-2 cells. The ability to efficiently genome edit HUDEP-2 cells and make clonal lines hugely expands their utility as the insertion of clinically relevant mutations allows study of potentially every genetic disease affecting red blood cell development. Additionally, insertion of sequences encoding short protein tags such as Strep, FLAG and Myc permits study of protein behaviour in the normal and disease state. This approach is useful to augment the analysis of patient cells as large cell numbers are obtainable with the additional benefit that the need for specific antibodies may be circumvented. This approach is likely to lead to insights into disease mechanisms and provide reagents to allow drug discovery. HUDEP-2 cells provide a favourable alternative to the existing immortalised erythroleukemia lines as their karyotype is much less abnormal. These cells also provide sufficient material for a broad range of analyses as it is possible to generate in vitro-differentiated erythroblasts in numbers 4-7 fold higher than starting cell numbers within 9-12 days of culture. Here we describe an efficient, robust and reproducible plasmid-based methodology to introduce short (<20 bp) DNA sequences into the genome of HUDEP-2 cells using the clustered regularly interspaced short palindromic repeats (CRISPR)/CRISPR associated protein 9 Cas9 system combined with single-stranded oligodeoxynucleotide (ssODN) donors. This protocol produces genetically modified lines in ~30 days and could also be used to generate knock-out and knock-in mutations.

The severity of hereditary porphyria is modulated by the porphyrin exporter and Lan antigen ABCB6

Hereditary porphyrias are caused by mutations in genes that encode haem biosynthetic enzymes with resultant buildup of cytotoxic metabolic porphyrin intermediates. A long-standing open question is why the same causal porphyria mutations exhibit widely variable penetrance and expressivity in different individuals. Here we show that severely affected porphyria patients harbour variant alleles in the ABCB6 gene, also known as Lan, which encodes an ATP-binding cassette (ABC) transporter. Plasma membrane ABCB6 exports a variety of disease-related porphyrins. Functional studies show that most of these ABCB6 variants are expressed poorly and/or have impaired function. Accordingly, homozygous disruption of the Abcb6 gene in mice exacerbates porphyria phenotypes in the Fech^m1Pas mouse model, as evidenced by increased porphyrin accumulation, and marked liver injury. Collectively, these studies support ABCB6 role as a genetic modifier of porphyria and suggest that porphyrin-inducing drugs may produce excessive toxicities in individuals with the rare Lan(−) blood type.

Accumulation of intermediates of haem biosynthesis, porphyrins, is harmful and usually inherited, but it is unclear how the same mutation may make some individuals more ill than others. Here, the authors show that a porphyrin transporter ABCB6 is a modulator of porphyria, and that patients with functionally defective ABCB6 show more severe symptoms.

Approaches for classifying DNA variants found by Sanger sequencing in a medical genetics laboratory

Diagnostic applications of DNA sequencing technologies present a powerful tool for the clinical management of patients. Applications range from better diagnostic classification to identification of therapeutic options, prediction of drug response and toxicity, and carrier testing. Although the advent of massively parallel sequencing technologies has increased the complexity of clinical interpretation of sequence variants by an order of magnitude, the annotation and interpretation of the clinical effects of identified genomic variants remain a challenge regardless of the sequencing technologies used to identify them. Here, we survey methodologies which assist in the diagnostic classification of DNA variants and propose a practical decision analytic protocol to assist in the classification of sequencing variants in a clinical setting. The methods include database queries, software tools for protein consequence, evolutionary conservation and pathogenicity prediction, familial segregation, case-control studies, and literature review. These methods are deliberately pragmatic as diagnostic constraints of clinically useful turnaround times generally preclude obtaining evidence from in vivo or in vitro functional experiments for variant assessment. Clinical considerations require that variant classification is stringent and rigorous, as misinterpretation may lead to inappropriate clinical consequences; thus, multiple parameters and lines of evidence are considered to determine potential biological significance.

Can ALS-associated C9orf72 repeat expansions be diagnosed on a blood DNA test alone?

Gene mutations that preferentially affect the CNS have been implicated in a number of neurological disorders. This leads to the possibility that a disease-causing mutation present only in CNS tissues could be missed if it were tested in a blood DNA sample only. The commonest mutation in amyotrophic lateral sclerosis (ALS) is an expansion of the hexanucleotide repeats of C9orf72. To find out if CNS-specific mutations of this gene could cause some cases of ALS we looked for differences in the size of C9orf72 repeats between DNA from the CNS and from white blood cells (WBCs) of 38 sporadic ALS patients, using a repeat-primed PCR screening test. We also looked for differences in C9orf72 repeats in WBC DNA from 6 ALS-discordant and 1 ALS-concordant monozygotic twins. Abnormally expanded C9orf72 repeats were found in 13% of the ALS CNS samples, as well as in their paired WBC DNA. The 87% of ALS CNS samples with normal-sized C9orf72 repeats had the same number of repeats in paired WBC samples. All ALS-discordant twins had the same normal numbers of WBC C9orf72 repeats. Although previous work suggests some tissue mosaicism in C9orf72 repeat size is probably present, this study indicates that this is not likely to be of sufficient magnitude to result in a normal C9orf72 repeat length in blood but an abnormally expanded repeat length in the CNS. This suggests that a blood DNA test alone will usually be sufficient to make a diagnosis of C9orf72 repeat-related ALS.

Carotid geometry reconstruction: a comparison between MRI and ultrasound

Image-based Computational Fluid Dynamics (CFD) has become a popular tool for the prediction of in vivo flow profiles and hemodynamic wall parameters. Currently, Magnetic Resonance Imaging (MRI) is most widely used for in vivo geometry acquisition. For superficial arteries such as the carotids and the femoral artery, three-dimensional (3-D) extravascular ultrasound (3-DUS) could be a cost-effective alternative to MRI. In this study, nine healthy subjects were scanned both with MRI and 3-DUS. The reconstructed carotid artery geometries for each subject were compared by evaluating cross-sectional areas, centerlines, and carotid nonplanarity. Lumen areas agreed very well between the two different acquisition techniques, whereas centerlines and nonplanarity parameters showed measurable disagreement, possibly due to the different neck and head positions adopted for 3-DUS versus MRI. With the current level of agreement achieved, 3-DUS has the potential to become an inexpensive and fast alternative to MRI for image-based CFD modeling of superficial arteries.