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A book review of the Indonesian short story collection by Norman Erikson Pasaribu titled, Happy Stories, Mostly (Tilted Axis Press, 2021). Translated into English by Tiffany Tsao, it was longlisted for the 2022 International Booker Prize.

Objective: To compare the refractive outcomes of laser-treated and non-laser-treated retinopathy of prematurity (ROP) infant, at 2 years of age in Hospital Selayang.Methods: Retrospective review involving patients born between 2016 and 2018. They were divided into those who were treated with laser photocoagulation, and those who were observed. Laser treatment was given to infants with threshold and high-risk, pre-threshold disease. Refractive error was identified by cycloplegic refraction at 2 years of age.Results: There were 22 eyes from 11 infants in the laser-treated group, all of which had zone II ROP with plus disease; of these, four had stage 2 ROP and 18 had stage 3 ROP. There were 53 eyes from 28 patients in the non-laser-treated group. The mean birth weight for the laser-treated and non-laser-treated groups was 966.9 ± 92.6 g and 1019.3 ± 282.0 g, respectively (P = 0.398). Mean gestational age for the laser-treated and non-laser-treated groups was 28.2 ± 2.2 weeks and 27.7 ± 2.2 weeks, respectively (P = 0.390). At 2 years, the mean spherical equivalence for the laser-treated and non-laser treated groups was -0.55 ± 2.49 D and +0.17 ± 1.43 D, respectively, although the difference was not statistically significant (P = 0.120). Myopia was commoner in the laser-treated group (six eyes [27%] vs five eyes [9%], P = 0.047), and two eyes from two different infants (10%) from this group also developed high myopia (> -6.00 D). For hypermetropia and astigmatism, there were no statistically significant differences between the groups (all P > 0.05). High myopia was strongly related to the post-conceptual age when receiving laser therapy (P = 0.025). In the laser-treated group, two infants (9%) had amblyopia and one (5%) had exotropia at 2 years of age. None of the eyes developed structural retinal sequelae.Conclusion: Despite successful treatment of ROP, a significant number of laser-treated eyes developed myopia. This highlights the need for long-term refractive screening in these patients.

We live in a time of disappearing professions, pandemic-related upheaval, and growing social inequality. While recognizing that good opportunities are unequally distributed in society (an injustice that requires rectification), can

In today’s global world, it has become increasingly important for individuals moving to a different country for work, study, or permanent relocation to successfully adapt to this new culture. Responding to recent calls in the literature for more ecological approaches to the study of cultural adaptation, we examine the effect of host country historical heterogeneity—or, the extent to which a country’s current inhabitants descended from a diverse pool of ancestors—on newcomers’ cultural adaptation to that country. Across two studies, we find that higher levels of host country historical heterogeneity predict higher rates of cultural adaptation among newcomers. This relationship persists even when accounting for individual characteristics of the newcomers and sociocultural/economic characteristics of the home and host countries. These results suggest that a country’s historical levels of diversity may contribute to the successful adaptation of newcomers above and beyond their personal characteristics, their home country environment, or current conditions in the host country, including current levels of diversity. These results have practical implications for facilitating newcomers’ successful cultural adaptation.

Extracellular vesicles (EVs) can be functionalized to display specific protein receptors on their surface. However, surface-display technology typically labels only a small fraction of the EV population. Here, we show that the joint display of two different therapeutically relevant protein receptors on EVs can be optimized by systematically screening EV-loading protein moieties. We used cytokine-binding domains derived from tumour necrosis factor receptor 1 (TNFR1) and interleukin-6 signal transducer (IL-6ST), which can act as decoy receptors for the pro-inflammatory cytokines tumour necrosis factor alpha (TNF-α) and IL-6, respectively. We found that the genetic engineering of EV-producing cells to express oligomerized exosomal sorting domains and the N-terminal fragment of syntenin (a cytosolic adaptor of the single transmembrane domain protein syndecan) increased the display efficiency and inhibitory activity of TNFR1 and IL-6ST and facilitated their joint display on EVs. In mouse models of systemic inflammation, neuroinflammation and intestinal inflammation, EVs displaying the cytokine decoys ameliorated the disease phenotypes with higher efficacy as compared with clinically approved biopharmaceutical agents targeting the TNF-α and IL-6 pathways.

We examine resettled refugees’ construction of wellbeing using semi-structured interviews of Somali, Hmong, and Middle Eastern refugees in the United States and Canada. Resettled refugees’ descript...

The writings of Han Suyin during her sojourn in British Malaya from the 1950s to 1960s are a rich archive for understanding how the Cold War’s impact on postcolonial nation-building contributed to ...

How do biculturals, or individuals who identify with more than one culture, manage their loyalties between two cultural ingroups? We argue that this process is moderated by Bicultural Identity Integration (BII), or individual differences in perceived conflict between two cultural identities. Two quasi-experiments examined biculturals’ preferences for two competing groups, each representing one of their cultural identities, in response to cultural primes. In Study 1, we found that Flemish-Belgian biculturals with low BII, or those who perceive their cultural identities as conflicting, favored the primed cultural group less than the unprimed cultural group. In Study 2, we found the same effect among Asian-American biculturals, but only when the cultural primes were positive. These findings show that low BIIs exhibit psychological reactance to cultural primes that are seen as threatening to the self, which in turn affect their loyalties to competing cultural ingroups.

Building on intersectional awareness literature, this paper examines how another individual difference regarding one’s perception of identity intersections — bicultural identity conflict (BII-C)— predicts immigrants’ interpretations of their social environment and general orientation to take action to support immigrants from one’s heritage group (GOA-I). While previous research has shown that BII-C, or perceived conflict (vs. harmony) between multiple cultural identities, is related to negative intergroup outcomes, we extend this research to examine how BII-C relates to social change actions that promote a more equitable society. An experimental study with 165 first- and second-generation immigrants living in the United States found support for a moderated mediation model. BII-C moderated the relationship between discrimination and the degree to which participants attributed discrimination to societal factors. These attributions were associated with GOA-I. Future research should consider additional individual differences, beyond intersectional awareness and BII-C, to see how these orientations may also act as a lens through which people interpret their social environment and are willing to take action to change it.

To examine new graduate nurses' perceptions of competency on coping with dying and death and the relationship with death self-efficacy and death anxiety.A multicentre, cross-sectional study.Three hundred and forty new graduate nurses from five metropolitan hospitals were recruited between August-November 2018. Participants completed the Coping with Death Scale, Death Self-efficacy Scale, and Death Anxiety Scale.Two hundred and ninety-eight new graduate nurses responded to the survey. The mean score of coping with death and death self-efficacy was 120.11 (SD 24.59), 259.11 (SD 57.70) respectively. 88.9% feared a painful death, 81.5% were particularly afraid of getting cancer, and 80.2% were afraid of death. There was a positive relationship between coping with death and death self-efficacy, a negative relationship between coping with death and death anxiety and a negative correlation between death self-efficacy and death anxiety. Five variables, including death self-efficacy, three dimensions of death anxiety including emotion, cognition with life and death and stress and distress and religion in total accounted for 46.9% of the variance of coping with death.New graduate nurses are at a disadvantage in terms of death self-efficacy, less well prepared in coping with death and are more anxious about death.It is imperative for educational institutions to support new graduate nurses with pre-licensure learning related to patient death issues and care. Organizations are also strongly advised to support new graduate nurses to cope with patient death through development of culturally sensitive interventions and guidelines, which may in turn assist with decreasing new graduate nurses' risk of burnout and increasing their longevity in the profession.目的: 检验新毕业的护士在应对即将死亡和死亡以及死亡自我效能和死亡焦虑之间的关系时的认知能力。 设计: 多中心横向研究。 方法: 从2018年8月到11月,共招募了五个大城市医院的340名新毕业护士。参与者完成应对死亡量表、死亡自我效能量表以及死亡焦虑量表。 结果: 298名新毕业护士参与了此调查。应对死亡和死亡自我效能的平均分数分别为120.11 (SD 24.59)和259.11(SD 57.70)。88.9%的人害怕痛苦死亡,81.5%的人害怕患上癌症,80.2%的人害怕死亡。死亡应对与死亡自我效能呈正相关,死亡应对与死亡焦虑呈负相关,死亡自我效能与死亡焦虑呈负相关。死亡自我效能、情感、生死认知、压力与痛苦、宗教信仰等死亡焦虑三个维度共五个变量,占死亡应对变量的46.9%。 结论: 新毕业的护士在死亡自我效能方面处于劣势,在应对死亡时准备不足,且对死亡非常焦虑。 影响: 教育机构应支持新毕业的护士特许提前学习患者死亡问题和护理。强烈建议各组织也应支持新毕业的护士通过制定文化敏感的干预措施和指导方针来应对患者死亡,这反之可能有助于降低新毕业护士的职业倦怠风险,延长他们的从业期限。.

Background/AimsAcanthamoeba keratitis (AK) is a rare but sight-threatening infection. Molecular diagnosis of corneal scraping has improved the diagnosis of AK. Different molecular targets and conditions have been used in diagnosis thus far. In this study, we prospectively compared the performance of five PCR assays on corneal samples for the diagnosis of AK.Methods1217 corneal scraping samples were obtained from patients, for whom an AK was suspected. Sample processing involved both molecular diagnostics and culture. Acanthamoeba PCR assays detected different regions of the Acanthamoeba nuclear small-subunit rRNA gene: three final point PCR assays using Nelson, ACARNA and JDP1–JDP2 pairs of primers, and two real-time PCR assays using Acant primer-probe. Human DNA and internal control were co-amplified in the real-time PCR assay to ensure scraping quality and the absence of inhibitors. In the absence of a gold standard, the performance of each test was evaluated using latent class analysis. Genotypes of Acanthamoeba isolates were also characterised.ResultsEstimated prevalence of AK was 1.32%. The sensitivity of Acanthamoeba diagnostic PCRs (73.3% to 86.7%) did not differ significantly from that of culture (66.7%), or according to the target sequence or the technology. Sensitivity could be increased to 93.8% or 100% by combining two or three assays, respectively. PCR specificity (99.3% to 100%) differed between the assays. T4 was the predominant Acanthamoeba genotype (84.6%).ConclusionsCulture and a single PCR assay could lead to misdiagnosing AK. A combination of different PCR assays and improved sample quality could increase diagnosis sensitivity.

People are guided by the roles they assume in their everyday lives. Roles are cognitive schemas that are associated with specific goals and expectations that organize and guide individuals' perception and preferences. The social roles individuals assume affect their goals, which in turn affect their point of view and preferences. We propose and show that role schemas are malleable, allowing individuals to shift from one schema to another depending on the role they assume at the moment of judgment. Drawing on role theory and theories of espoused organizational values, we show that matching between the goals derived from a specific role and espoused organizational values influence the preferences of individuals toward an organization. An experiment with 476 working adults and students in three countries, found that individual assumed role (as a potential employee or an investor) and espoused organizational values (embeddedness-autonomy, egalitarianism-hierarchy, and mastery-harmony) affected individuals' preferences to invest or work in organizations. Our findings suggest that role-specific goals are important drivers of how individuals perceive organizations, and that individuals seek "fit" between organizational values and their role-specific goals. Finally, we discuss supplementary analyses testing the classical notion of value-based person-organization fit. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

We explore the process of posttraumatic growth for multicultural individuals after experiences of cumulative multicultural identity-relevant adversity.We conducted an exploratory sequential mixed methods study with two parts. Study 1 utilized Photovoice methodology and individual interviews (Findings from Study 1 indicate that participants appreciated environments that valued diversity, and this helped participants positively frame their cumulative adversities. Participants also described how the struggle with these adversities fostered psychological wellbeing outcomes of personal growth and positive relations with others. Results from Study 2 indicate that appreciation of diversity mediates and positive framing moderates the relationship between discrimination and personal growth, thus supporting and building on the findings in Study 1.Together, these studies highlight the significance of including cumulative adversity in the posttraumatic growth process for multicultural individuals, while identifying appreciation of diversity and positive framing as potential postadversarial growth mechanisms. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Infectious disease forecasting for ongoing epidemics has been traditionally performed, communicated, and evaluated as numerical targets - 1, 2, 3, and 4 week ahead cases, deaths, and hospitalizations. While there is great value in predicting these numerical targets to assess the burden of the disease, we argue that there is also value in communicating the future trend (description of the shape) of the epidemic -- for instance, if the cases will remain flat or a surge is expected. To ensure what is being communicated is useful we need to be able to evaluate how well the predicted shape matches with the ground truth shape. Instead of treating this as a classification problem (one out of $n$ shapes), we define a transformation of the numerical forecasts into a ``shapelet''-space representation. In this representation, each dimension corresponds to the similarity of the shape with one of the shapes of interest (a shapelet). We prove that this representation satisfies the property that two shapes that one would consider similar are mapped close to each other, and vice versa. We demonstrate that our representation is able to reasonably capture the trends in COVID-19 cases and deaths time-series. With this representation, we define an evaluation measure and a measure of agreement among multiple models. We also define the shapelet-space ensemble of multiple models as the mean of their shapelet-space representations. We show that this ensemble is able to accurately predict the shape of the future trend for COVID-19 cases and trends. We also show that the agreement between models can provide a good indicator of the reliability of the forecast., Comment: Accepted at the IEEE International Conference on Big Data (IEEE BigData 2022)

Passion for work has become increasingly valued, as reflected by its ubiquity in popular and empirical discourse. Yet we lack scientific consensus on the definition of work passion, and a reliable,...

Our research explores the experience of holding a Hybrid Multicultural Identity (a superordinate cultural identity; HMI) and the social contextual experiences hybrid multiculturals describe as influential to the development of an HMI. We conducted a Photovoice study with 10 hybrid multiculturals (age 18-32; 6 women and 4 men) living in a college town in the Midwestern US. The participants valued HMI for the psychological advantages they attributed to this identity. We also found the participants described three broad categories of their social environment that were key to the development of HMI: cultural composition in living environments, perceptions of macro-level marginalization, and culturally related interpersonal experiences. Our research documents (1) the lived experience of being a hybrid multicultural (2) the importance of cultural mixing for HMI development, and (3) how people with HMI describe primarily negative perceptions of the social environment as instrumental to the development of HMI.

The consensus molecular subtype (CMS) classification of colorectal cancer is based on bulk transcriptomics. The underlying epithelial cell diversity remains unclear. We analyzed 373,058 single-cell transcriptomes from 63 patients, focusing on 49,155 epithelial cells. We identified a pervasive genetic and transcriptomic dichotomy of malignant cells, based on distinct gene expression, DNA copy number and gene regulatory network. We recapitulated these subtypes in bulk transcriptomes from 3,614 patients. The two intrinsic subtypes, iCMS2 and iCMS3, refine CMS. iCMS3 comprises microsatellite unstable (MSI-H) cancers and one-third of microsatellite-stable (MSS) tumors. iCMS3 MSS cancers are transcriptomically more similar to MSI-H cancers than to other MSS cancers. CMS4 cancers had either iCMS2 or iCMS3 epithelium; the latter had the worst prognosis. We defined the intrinsic epithelial axis of colorectal cancer and propose a refined 'IMF' classification with five subtypes, combining intrinsic epithelial subtype (I), microsatellite instability status (M) and fibrosis (F). ispartof: NATURE GENETICS vol:54 issue:7 pages:963-+ ispartof: location:United States status: published

This essay explores what it means to theorize Han racism in Malaysian contexts, where ethnic Chinese constitute a minority. Given the history of Malay political dominance and recent intensi...

The extracellular environment consists of a plethora of molecules, including extracellular miRNA that can be secreted in association with extracellular vesicles (EVs) or soluble protein complexes (non-EVs). Yet, interest in therapeutic short RNA carriers lies mainly in EVs, the vehicles conveying the great majority of the biological activity. Here, by overexpressing miRNA and shRNA sequences in parent cells and using size exclusion liquid chromatography (SEC) to separate the secretome into EV and non-EV fractions, we saw that &gt, 98% of overexpressed miRNA was secreted within the non-EV fraction. Furthermore, small RNA sequencing studies of native miRNA transcripts revealed that although the abundance of miRNAs in EVs, non-EVs and parent cells correlated well (R2 = 0.69–0.87), quantitatively an outstanding 96.2–99.9% of total miRNA was secreted in the non-EV fraction. Nevertheless, though EVs contained only a fraction of secreted miRNAs, these molecules were stable at 37 °C in a serum-containing environment, indicating that if sufficient miRNA loading is achieved, EVs can remain delivery-competent for a prolonged period of time. This study suggests that the passive endogenous EV loading strategy might be a relatively wasteful way of loading miRNA to EVs, and active miRNA loading approaches are needed for developing advanced EV miRNA therapies in the future.

In this chapter, the authors examine the social-personality processes underlying multiculturalism and multicultural identity and the cultural and societal factors that influence these phenomena. They focus the discussion on bicultural identity integration (BII), an individual difference construct describing the extent to which a bicultural individual experiences her two cultural identities as compatible and integrated versus oppositional and compartmentalized. Drawing from the literatures of acculturation, social-personality and cultural psychologies, and interculturalism studies, the authors review research on the antecedents and outcomes associated with BII. While there is extensive evidence showing that BII is psychologically consequential, and also an important moderator of how multicultural individuals respond to different kinds of cultural information and demands, there remains pressing needs to understand the developmental trajectories that influence BII, the role of macro societal and historical factors in how BII changes, and how BII can be used to understand multiculturalism in social collectives.

Multiple myeloma (MM) is a fatal hematological malignancy, where the majority of patients are diagnosed with, or develop, destructive and debilitating osteolytic bone lesions. Current treatments for MM bone disease such as the bisphosphonate zoledronic acid can result in deleterious side effects at high doses. In this study, eliglustat, an FDA approved glycosphingolipid inhibitor, was shown to reduce MM bone disease in preclinical models of MM. Mechanistically, eliglustat alters the lipid composition and plasma membrane fluidity and acts as an autophagy flux inhibitor in bone-resorbing osteoclasts (OC). Autophagic degradation of the signaling molecule TRAF3 is key step in OC differentiation; this was prevented by eliglustat in OC precursors. In addition, eliglustat works depend on TRAF3 in vivo. Furthermore, the combination of eliglustat and zoledronic acid was found to have an additive effect to reduce MM bone disease, suggesting the potential for combination therapies that would allow for drug dose reductions. Taken together, this project identifies a novel mechanism in which glycosphingolipid inhibition reduces osteoclastogenesis via autophagy and highlights the translational potential of eliglustat for the treatment of bone loss disorders such as MM.One Sentence SummaryTranslational use of eliglustat as an autophagy inhibitor to limit bone lesions in multiple myeloma.

Aim To describe and discuss clinical strategies for nurses working in partnership with substitute decision-makers for people living with advanced dementia. Background By providing person-centred care to patients living with advanced dementia, nurses are positioned to work in partnership with substitute decision-makers who make healthcare decisions related to advanced care. Because the experience of being substitute decision-makers is complex and stressful, nurses need skillsets for working in partnership with substitute decision-makers. Design In this discursive paper, an innovative framework for working in partnership with substitute decision-makers is proposed. Method Evidence-based findings from a systematic review provided five domain foci for the partnership framework. In each domain, two clinical strategies were discursively proposed. Clinical strategies were hypothesised from research findings and insights from the authors' nursing experiences. Then, topical literature was searched, and findings were used to support the discursively argued strategies. Discussion To deal with complexities and reduce stress for substitute decision-makers, an innovative Nurse-Substitute Decision-Maker Partnership Framework for use in the context of advanced dementia is proposed and discussed. The partnership framework consists of five domains: Building trust, Exploring emotions, Translating quality of life, Encouraging proactivity and Negotiating families. Within these domains, ten strategies to support the practices of clinical nurses to work in partnership with substitute decision-makers are discussed. Relevance to clinical practice In the framework, the ten clinical nursing strategies are designed to provide targeted care to substitute decision-makers in areas that are known to cause complexity and stress to them. The Nurse-Substitute Decision-Maker Partnership Framework has been designed to improve nurse-substitute decision-maker partnerships and reduce the stress experienced by substitute decision-makers as they work through the complexities associated with advanced dementia.

Purpose: Enhanced Recovery After Surgery (ERAS) has become standard of care in colorectal surgery. However, there is not a universally accepted colorectal ERAS protocol and significant variations in care exist between institutions. The aim of this study was to examine the impact of variations in ERAS interventions and complications on length of stay (LOS).Methods: This study was a single-center review of the first 200 consecutive patients recruited into our prospectively collected ERAS database. The primary outcome of this study was to examine the rate of compliance to ERAS interventions and the impact of these interventions on LOS. The secondary outcome was to assess the impact of complications (anastomotic leak, ileus, and surgical site infections) on LOS. ERAS interventions, rate of adherence, LOS, readmissions, morbidity, and mortality were recorded, and statistical analysis was performed.Results: ERAS variations and complications significantly influenced patient LOS on both univariate and multivariate analysis. ERAS interventions identified as the most important strategies in reducing LOS included laparoscopic surgery, mobilization twice daily postoperative day (POD) 0 to 1, discontinuation of intravenous fluids on POD 0 to 1, upgrading to solid diet by POD 0 to 2, removal of indwelling catheter by POD 0 to 2, avoiding nasogastric tube reinsertion and removing drains early. Both major and minor complications increased LOS. Anastomotic leak and ileus were associated with the greatest increase in LOS.Conclusion: Seven high-yield ERAS interventions reduced LOS. Major and minor complications increased LOS. Reducing variations in care and complications can improve outcomes following colorectal surgery.

Extracellular vesicles (EVs) have recently emerged as a highly promising cell-free bio-therapeutics. While a range of engineering strategies have been developed to functionalize the EV surface, current approaches fail to address the limitations associated with endogenous surface display, pertaining to the heterogeneous display of commonly used EV-loading moieties among different EV subpopulations. Here we present a novel engineering platform to display multiple protein therapeutics simultaneously on the EV surface. As proof-of-concept, we screened multiple endogenous display strategies for decorating the EV surface with cytokine binding domains derived from tumor necrosis factor receptor 1 (TNFR1) and interleukin 6 signal transducer (IL6ST), which can act as decoys for the pro-inflammatory cytokines TNFα and IL6, respectively. Combining synthetic biology and systematic screening of loading moieties, resulted in a three-component system which increased the display and decoy activity of TNFR1 and IL6ST, respectively. Further, this system allowed for combinatorial functionalization of two different receptors on the same EV surface. These cytokine decoy EVs significantly ameliorated disease phenotypes in three different inflammatory mouse models for systemic inflammation, neuroinflammation, and intestinal inflammation. Importantly, significantly improvedin vitroandin vivoefficacy of these engineered EVs was observed when compared directly to clinically approved biologics targeting the IL6 and TNFα pathways.

1217 corneal scraping samples were obtained from patients, for whom an AK was suspected. Sample processing involved both molecular diagnostics and culture.Estimated prevalence of AK was 1.32%. The sensitivity ofCulture and a single PCR assay could lead to misdiagnosing AK. A combination of different PCR assays and improved sample quality could increase diagnosis sensitivity.

This paper reports on MexCo (Mexico-Coventry), an ongoing online intercultural learning project underpinned by action research. Its aim is to embed internationalisation into the curriculum of the institutions involved in order to promote citizenship competences, online intercultural communicative competence in particular, among both students and staff. The integration of telecollaboration into the curriculum has highlighted problematic aspects of the development of intercultural communicative competence (ICC), such as cyberpragmatics (Yus, 2011). Cyberpragmatics is intended here as the skill of understanding others' intended meanings in computer-mediated communication. It is suggested that cyberpragmatics in online intercultural learning exchanges is a ‘Threshold Concept' (TC) (Meyer & Land, 2005, p. 375), i.e. a key concept that is troublesome to understand as it is challenging to the identity of the learner, but which could open new learning horizons to the students who do manage to grasp it.

Purpose Research on organizational diversity initiatives generally focus on either numerical diversity or racial climate. Both facets of diversity are critical, however, research has rarely examined their impact simultaneously. The paper aims to discuss these issues. Design/methodology/approach In the current study, the authors use the context of higher education, to examine how variations in the composite of numerical diversity and racial climate predict psychological disparities between faculty of color (FOC) and White faculty. The authors test how institutions that engage in authentic diversity (i.e. institutions that are both numerically diverse and have a positive racial climate) compare to other diversity composites. Findings Using a data set of n=37,406 faculty members in US colleges/universities, this study found that racial disparities between FOC and White faculty for various psychological outcomes are smaller in authentic diversity institutions compared to institutions with low numeric diversity/ poor racial climate. Further, the data demonstrate that authentic diversity institutions have reduced psychological disparities compared to institutions with high numeric diversity/poor racial climate, but have similar disparities to institutions with low numeric/positive racial climate. Originality/value These results suggest that diversity climate may be the primary driver of mitigating psychological disparities between FOC and White faculty. However, it is necessary for institutions to authentically engage in diversity – by promoting both entities – to become more effective in reducing disparities.

Background Substitute decision makers are important for people with advanced dementia, particularly at the end of life. Substitute decision makers report issues in providing support, and physical and psychological consequences from the role. However, there is no synthesised evidence about how substitute decision makers are affected by and experience making decisions for older persons diagnosed with dementia at end of life. Methodology: A protocol for a qualitative systematic review was developed. Seven articles met both inclusion and research quality criteria following a comprehensive search for published and unpublished studies (January 2007–2017, English language). Meta-synthesis was achieved through meta-aggregation of the results from included studies. Results Meta-aggregation of 20 themes into eight categories resulted in five synthesised findings. The findings were: ‘trust’; ‘guilt, mistrust and confusion’; ‘translating quality of life’; ‘negotiating families’; and ‘uncertainty and reactivity’. Trust in healthcare personnel positively affected substitute decision makers and supported their adaptability. Substitute decision makers experienced guilt, mistrust, and confusion as they encountered increased complexity in care and health interventions as social needs changed. Substitute decision makers experienced complexities and struggles as they interpreted quality of life and negotiated end of life treatment decisions. Substitute decision makers experienced practical needs to negotiate family as they fulfilled their support roles. Ambiguity in advance care plans, limited knowledge of dementia, end of life uncertainties, and communication issues reduced substitute decision makers’ proactivity. Implications: Being a substitute decision maker for people with advanced dementia at end of life is stressful. Health professionals need to be cognizant of substitute decision makers experiences and needs, and identify mechanisms to achieve support and education. The findings generate need for further investigation of interventions to meet the needs of substitute decision makers.

Loss of expression of ACTN3, due to homozygosity of the common null polymorphism (p.Arg577X), is underrepresented in elite sprint/power athletes and has been associated with reduced muscle mass and strength in humans and mice. To investigate ACTN3 gene dosage in performance and whether expression could enhance muscle force, we performed meta-analysis and expression studies. Our general meta-analysis using a Bayesian random effects model in elite sprint/power athlete cohorts demonstrated a consistent homozygous-group effect across studies (per allele OR = 1.4, 95% CI 1.3-1.6) but substantial heterogeneity in heterozygotes. In mouse muscle, rAAV-mediated gene transfer overexpressed and rescued α-actinin-3 expression. Contrary to expectation, in vivo "doping" of ACTN3 at low to moderate doses demonstrated an absence of any change in function. At high doses, ACTN3 is toxic and detrimental to force generation, to demonstrate gene doping with supposedly performance-enhancing isoforms of sarcomeric proteins can be detrimental for muscle function. Restoration of α-actinin-3 did not enhance muscle mass but highlighted the primary role of α-actinin-3 in modulating muscle metabolism with altered fatiguability. This is the first study to express a Z-disk protein in healthy skeletal muscle and measure the in vivo effect. The sensitive balance of the sarcomeric proteins and muscle function has relevant implications in areas of gene doping in performance and therapy for neuromuscular disease.

Aims and objectives To review literature on nurses’ coping strategies with patient death. Background dealing with the loss of a patient was viewed as one of the most demanding and challenging encounters in clinical practice. Those nurses who are not competent in coping with patient death may be inadequate in supporting dying patients and their family members, and minimize the quality of end-of-life care. To get a broader understanding of how nurses cope with patient death and to develop meaningful and effective interventions, a systematic review which would help underpin the multidimensional approaches is needed. Design A systematic review. Methods Exhaustive searching in ten databases: cinahl plus, embase, medline, amed, psycinfo, proquest health & medical complete, proquest dissertations & theses global, googlescholar, ethos and caresearch. Meta-aggregation was used to synthesise the findings of the included studies. Results This systematic review aggregated ten categories from the sixteen qualitative studies included, and then two synthesised findings were derived: intrinsic resources and extrinsic resources. The intrinsic resources consisted of setting boundaries, reflection, crying, death beliefs, life and work experience, and daily routines and activity. The extrinsic resources were comprised of talking and being heard, spiritual practices, education and programs, and debriefing. Conclusion This systematic review synthesised the findings about what resources nurses use when coping with patient death and made recommendations on future directions. Areas which could be developed to improve deficiencies that nurses had when faced with the losses of their patients were identified. Nurses need more support resources which better assist them in coping with patient death. Relevance to clinical practice The results of this systematic review could provide evidence for nurses’ coping strategies when dealing with patient death, and the recommendations could be employed by nurses to cope with the losses of patients. This article is protected by copyright. All rights reserved.

This article analyses the representation of the gig economy in three Australian newspapers from 2014 to 2019. ‘Gig work’ is defined as short term, contract or freelance employment and is seen by many social institutions as the future of work. Drawing on a corpus of 426 articles, Laclau and Mouffe’s discourse theory is used to examine the construction of the ‘gig economy’ in the cultural imaginary. Five key elements emerge, including: demographics of workers; working conditions; workers’ rights; resistance and regulation; and change and disruption. Despite multiple competing discourses evident across the newspapers, each constructs the gig economy as an inexorable phase in the evolution of the relationship between capital and the worker. The article critically analyses the construction of the discourse, including the difficulties of regulating gig economy platforms and the narrative of inevitability used to describe changes to work and life brought about by technology.

In this article, we test the hypothesis that individuals with higher levels of identity integration—or those who perceive their different social identities as more blended and harmonious—will exhibit greater interpersonal tolerance toward others holding dissimilar values and preferences. Three studies examined this hypothesis using bicultural identity integration (or perceived blendedness and harmony between multiple cultural identities) and generalized identity integration (or perceived blendedness and harmony between one’s social identities in general). We find that individuals who perceive higher levels of blendedness, but not harmony, between their social identities are more tolerant of dissimilar others, as demonstrated by making more positive trait inferences about them. We also find that experimentally increasing identity integration leads to more positive trait inferences. Our findings have theoretical and practical implications for managing conflict between individuals and groups.

This paper reports on MexCo (Mexico-Coventry), an ongoing online intercultural learning project underpinned by action research. Its aim is to embed internationalisation into the curriculum of the institutions involved in order to promote citizenship competences, online intercultural communicative competence in particular, among both students and staff. The integration of telecollaboration into the curriculum has highlighted problematic aspects of the development of intercultural communicative competence (ICC), such as cyberpragmatics (Yus, 2011). Cyberpragmatics is intended here as the skill of understanding others' intended meanings in computer-mediated communication. It is suggested that cyberpragmatics in online intercultural learning exchanges is a ‘Threshold Concept' (TC) (Meyer & Land, 2005, p. 375), i.e. a key concept that is troublesome to understand as it is challenging to the identity of the learner, but which could open new learning horizons to the students who do manage to grasp it.

Objectives To provide reference data for the Cumberland Ankle Instability Tool (CAIT) and to investigate the prevalence and correlates of perceived ankle instability in a large healthy population. Design Cross-sectional observational study. Setting University laboratory. Participants Self-reported healthy individuals (N=900; age range, 8–101y, stratified by age and sex) from the 1000 Norms Project. Interventions Not applicable. Main Outcome Measures Participants completed the CAIT (age range, 18–101y) or CAIT-Youth (age range, 8–17y). Sociodemographic factors, anthropometric measures, hypermobility, foot alignment, toes strength, lower limb alignment, and ankle strength and range of motion were analyzed. Results Of the 900 individuals aged 8 to 101 years, 203 (23%) had bilateral and 73 (8%) had unilateral perceived ankle instability. The odds of bilateral ankle instability were 2.6 (95% confidence interval [CI], 1.7–3.8; P P =.001) for each year of increasing age, increased by 3% (95% CI, 0%–6%; P =.041) for each degree of ankle dorsiflexion tightness, and increased by 4% (95% CI, 2%–6%, P Conclusions Perceived ankle instability was common, with almost a quarter of the sample reporting bilateral instability. Female sex, younger age, increased abdominal adiposity, and decreased ankle dorsiflexion range of motion were independently associated with perceived ankle instability.

Background: Studies have indicated that family members or health professionals may not know or predict their older relatives’ or patients’ health preferences. Although advance care planning is encouraged for older people to prepare end-of-life care, it is still challenging. Aim: To understand the experiences and perspectives of older people regarding advance care planning. Design: A systematic review of qualitative studies and meta-synthesis was conducted. Data sources: CINAHL, MEDLINE, EMBASE, and PsycINFO databases were searched. Results: A total of 50 articles were critically appraised and a thematic synthesis was undertaken. Four themes were identified: life versus death, internal versus external, benefits versus burdens, and controlling versus being controlled. The view of life and death influenced older people’s willingness to discuss their future. The characteristics, experiences, health status, family relationship, and available resources also affected their plans of advance care planning. Older people needed to balance the benefits and burdens of advance care planning, and then judge their own ability to make decisions about end-of-life care. Conclusion: Older people’s perspectives and experiences of advance care planning were varied and often conflicted; cultural differences amplified variances among older people. Truthful information, available resources, and family support are needed to enable older people to maintain dignity at the end of life. The views of life and death for older people from different cultures should be compared to assist health professionals to understand older people’s attitudes toward advance care planning, and thus to develop appropriate strategies to promote advance care planning in different cultures.

Starting school is a major milestone in family life, and there is increasing awareness that a child who is ‘ready for school’ when they begin full-time education is more likely to reach their full potential. This is not only in terms of academic achievement, but also social and behavioural skills, which have an impact later in adulthood ( UNICEF, 2012 ). Health visitors' responsibilities include supporting parents to maximise their child's health and development from birth onwards—a complex and challenging remit for which they need to be continually developing engaging strategies and tools ( Department of Health, 2009 ). This article reviews the collaborative development of a school readiness mobile app for Bridgewater Community Foundation NHS Trust. The project won the prestigious 2016 Journal of Health Visiting Award for School Readiness, and the University of Chester was recognised as a key collaborator in this innovative development. The article seeks to inspire health visiting colleagues to search for collaborative partners to address school readiness in an engaging way with parents.

Background Patient death is an emotional and demanding experience for nurses, especially for new graduate nurses who are unprepared to deliver end-of-life care. Understanding new graduate nurses' experience of death and dying will inform the design of training programs and interventions for improvements in the quality of care and support of new graduates. Objective To summarize new graduate nurses' experience with patient death by examining the findings of existing qualitative studies. Design Systematic review methods incorporating meta-synthesis were used. Methods A comprehensive search was conducted in 12 databases from January 1990 to December 2014. All qualitative and mixed-method studies in English and Chinese that explored new graduate nurses' experience of patient death were included. Two independent reviewers selected the studies for inclusion and assessed each study quality. Meta-aggregation was performed to synthesize the findings of the included studies. Results Five primary qualitative studies and one mix-method study met inclusion and quality criteria. Six key themes were identified from the original findings: emotional experiences, facilitating a good death, support for family, inadequacy on end-of-life care issues, personal and professional growth and coping strategies. New graduate nurses expressed a variety of feelings when faced with patient death, but still they tried to facilitate a good death for dying patients and provide support for their families. The nurses benefited from this challenging encounter though they lacked of coping strategies.

Purpose To evaluate parents' performance in using the American Association for Pediatric Ophthalmology and Strabismus (AAPOS) Vision Screening App (application) as a vision screening tool among preschool children and to evaluate the reliability of this app. Methods A total of 195 5- and 6-year-old preschoolers were recruited from children attending Hospital Selayang, Selangor, Malaysia, to test the app. Uncooperative children and those with visual acuity of >logMAR 0.6 were excluded. Results from parents and the screening doctor using the app (Lea symbols) to test visual acuity were compared to each other and to gold standard vision testing by an optometrist using the Lea symbols chart. Results Children 5 years of age represented 46.7% of the study population. The mean age of parents was 37.27 ± 7.68 years. Bland-Altman scatterplot agreement between assessors mainly was within the 95% confidence interval for bilateral eyes screening. Parents obtained a sensitivity of 86.6% (right vision) and 79.5% (left vision) and specificity of 78.9% (right vision) and 71.8% (left vision). Parents took a mean of 191.2 ± 70.82 seconds for bilateral screening. The intraclass correlation coefficient between optometrist and parents in bilateral eyes screening was good (P 0.7, indicating high internal reliability of the app. Most parents (178/195 [91.3%]) strongly agreed on the app's acceptability and ease of use. Conclusions The AAPOS Vision Screening App used by parents is a promising tool for visual acuity screening among Malaysian preschool children and a reliable app for vision screening.

This chapter provides a description of the CoCo (Coventry Colmar) telecollaborative course. It illustrates the tasks designed and/or adopted for it, such as the Cultura Quizzes. It discusses how CoCo was fully integrated into the curriculum and assessment of both institutions involved and how students practised critical digital literacies for global citizenship though active learning with the creation of a group Intercultural Digital Learning Project (IDLP). It describes the materials and instruments used including more details about the politeness frameworks adopted and it illustrates how the analysis was performed. The chapter includes relevant figures and tables that help to illustrate the telecollaborative project structure, the politeness framework used to analyse the data and the breakdown of the relevant strategies.

This chapter discusses the research questions for this study at a deeper level and provides a rationale for some of the analysis decisions made on the asynchronous discussion forums linked to the tasks designed for the CoCo telecollaborative project. It investigates what the application of linguistic politeness theory frameworks reveals about how politeness is negotiated online by project participants. The asynchronous interactions in the CoCo forum are examined from a cyberpragmatic perspective and by applying Brown and Levinson’s (Politeness: Some universals in language usage, Cambridge University Press, 1987) and Leech’s (The pragmatics of politeness, Oxford University Press, 2014) linguistic politeness frameworks to the data to investigate politeness strategies and facework used by the CoCo interactants.

This chapter provides a systematic analysis of the results derived from the analysis of the exchanges on the asynchronous discussion forums linked to the tasks designed for the telecollaborative CoCo project. Brown and Levinson’s (Politeness: Some universals in language usage, Cambridge University Press, 1987) and Leech’s (The pragmatics of politeness, Oxford University Press, 2014) linguistic politeness frameworks were applied to the three online exchanges students engages with and were used to identify patterns of linguistic behaviour such as type and frequency of politeness strategy/maxim.