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BackgroundVaccines for SARS-CoV-2 have been considerably effective in reducing rates of infection and severe COVID-19. However, many patients, especially those who are immunocompromised due to cancer or other factors, as well as individuals who are unable to receive vaccines or are in resource-poor countries, will continue to be at risk for COVID-19. We describe clinical, therapeutic, and immunologic correlatives in two patients with cancer and severe COVID-19 who were treated with leflunomide after failing to respond to standard-of-care comprising remdesivir and dexamethasone. Both patients had breast cancer and were on therapy for the malignancy.MethodsThe protocol is designed with the primary objective to assess the safety and tolerability of leflunomide in treating severe COVID-19 in patients with cancer. Leflunomide dosing consisted of a loading dose of 100 mg daily for the first three days, followed by daily dosing, at the assigned dose level (Dose Level 1: 40 mg, Dose Level -1, 20 mg; Dose Level 2, 60 mg), for an additional 11 days. At defined intervals, serial monitoring of blood samples for toxicity, pharmacokinetics, and immunologic correlative studies were performed, as well as nasopharyngeal swabs for PCR analysis of SARS-CoV-2.ResultsPreclinically, leflunomide impaired viral RNA replication, and clinically, it led to a rapid improvement in the two patients discussed herein. Both patients completely recovered, with minimal toxicities; all adverse events experienced were considered unrelated to leflunomide. Single-cell mass-cytometry analysis showed that leflunomide increased levels of CD8+ cytotoxic and terminal effector T cells and decreased naïve and memory B cells.ConclusionsWith ongoing COVID-19 transmission and occurrence of breakthrough infections in vaccinated individuals, including patients with cancer, therapeutic agents that target both the virus and host inflammatory response would be helpful despite the availability of currently approved anti-viral agents. Furthermore, from an access to care perspective, especially in resource-limited areas, an inexpensive, readily available, effective drug with existing safety data in humans is relevant in the real-world setting.

Many contemporary researchers claim to use a phenomenological approach but seldom connect their methods to tenets from phenomenological philosophy. We describe a distinctive approach, grounded in the writings of French philosopher Maurice Merleau-Ponty, for conducting educational research. Procedures are outlined for bracketing pre-understandings of a phenomenon, interviewing, and thematizing data with assistance of an interdisciplinary interpretive group. Using our approach, researchers capture the figural aspects of a phenomenon that dominate perception as well as the contextual background that is less visible but integral to understanding it. This phenomenological approach offers educational researchers a radical empiricism, a flexible structure, and a dialogical community of support.

An introduction to articles in the issue is presented on topics including the transformational power of the therapeutic nurse-patient relationship, societal conditions that were prevalent in the history of mental health nursing, and barriers influencing the use of sensory approaches in acute psychiatric units.

Previous analyses of transformational learning (TL) focused on rational or nonrational processes such as critical reflection on an uncomfortable personal situation or emotional learning. In this phenomenological study, researchers examined existential dimensions of TL. Individual interviews were analyzed to identify the lived experiences of eight participants in a graduate seminar. Participants described their experience to be "different" from other courses and "relevant and applicable" to their lives. They found the "atmosphere" of the course to be "free" from institutional obligations and "open" to ideas. They were "collaborative" in exploring course content and "connected" with other students, "safe" to share perspectives and understandings, and "comfortable" to explore content in their own way. Study findings suggest that discomfort is not necessary for TL to occur when students build relationships and learn in a safe and open classroom climate and that such an environment supported spontaneous application of course content to student lives.

Rabbit calicivirus disease (RCD), also known as rabbit haemorrhagic disease, is being used to control wild rabbits in Australia. Deliberate release of RCD followed extensive non-target animal and human testing and consideration of some 472 submissions. A national monitoring and surveillance program is in place to quantify the impact of RCD on rabbits, rabbit damage, predators, competitors, and ecosystems. Preliminary data suggest wide spatial variation in RCD impact, from no observable effect to >90% mortality and marked response in competitors and vegetation. This paper provides an overview of rabbit impact in Australia, details of the considerations and testing that preceded a decision to release, and results of impact studies to date.

Background: The number of patients admitted with infective endocarditis (IE) from intravenous drug use (IVDU) in Appalachia is increasing, a direct downstream effect of the opioid crisis. Extant literature highlights the pejorative attitudes health care workers have toward patients with substance use disorder, with nurses among the most punitive. Rather than describe attitudes, the purpose of this study was to describe the lived experiences of nurses caring for patients diagnosed with IE from IVDU in Appalachia. Aims: To describe an unexplored phenomenon in Appalachia to inform nursing practice, nursing education, and health policy. Method: Qualitative phenomenological study using the University of Tennessee method based on the tenets of Maurice Merleau-Ponty. Nine nurses (ages 29-53 years) recruited using purposive and snowball sampling participated in unstructured phenomenological interviews. Results: The essential meaning or central theme of the nurse experience working with these patients was a sense of hopelessness/hope, with four interrelated themes derived from the central theme: (1) guarding/escaping, (2) responsibility and revulsion, (3) apathy/empathy, and (4) grief and sorrow/cold and unemotional. Universally, nurses perceived caring for this population as futile, feeling a sense of powerlessness to change the outcome. Conclusions: These care experiences frustrated nurses, who described being physically and emotionally drained. To improve care delivery and improve patient outcomes, emphasis must be placed on nurse addiction education and standardizing nurse to patient with substance use disorder ratios to decrease work-related stress on nurses. [ABSTRACT FROM AUTHOR]

In an era where campus environments were often unwelcoming to women, and there were few women role models, an innovative program funded by the National Institute of Education produced 100% completion by female and minority doctoral students. At a 25-year reunion, the graduates reflected on their program experiences and careers. Reflections were audiotaped and subjected to thematic narrative analysis. Five themes were identified through the assistance of a large interdisciplinary interpretive group: Freedom to Widen Horizons, We Were Kindred Souls, Women Who Wanted Us to Succeed, It Was a Gift, and Paying it Forward. Findings of the study are highly relevant today, given the persistence of sexism in academia, the underrepresentation of women among holders of doctoral degrees, and the need to better prepare women for faculty and leadership roles.

The article discusses ongoing human violence and the persistence of hatred despite advances in technology. Topics discussed include the psychological theories of hate, methods for reducing and resolving hatred, and the effectiveness of interventions like Intergroup Dialogue and Peace and Power groups in fostering understanding and reconciliation.

Increasingly, nurses with a Doctor of Nursing Practice (DNP) degree are seeking a Doctor of Philosophy (PhD) degree. This subset of students may provide valuable insight for bolstering the PhD-prepared workforce, which is in decline. The purpose of this research was to understand the essence of the lived experience of DNP-prepared nurses choosing to pursue a PhD degree. An existential phenomenological study was undertaken, with 10 DNP-to-PhD students interviewed. The DNP-to-PhD experience is about being On a Mission. The Nursing Hierarchy was an implicit force influencing students' missions, and their experiences were characterized by five themes: (a) Having Needs the DNP Can't Meet : " I had to go back and do more ," (b) Considering Dreams and Circumstances : " Now's the time ," (c) Developing Confidence : " You can do this! " (d) " I've been very supported "/" I had no support ," and (e) " It had to be an internal drive for me." Study findings demonstrate profound effects of the nursing hierarchy on students' decisions as well as misperceptions that still surround DNP and PhD education and careers. Nursing academicians, organizational leaders, and researchers must address PhD program disinterest, intimidation, and imposter syndrome and improve messaging about both degrees. • Experiences of nurses seeking a Doctor of Philosophy (PhD) are underexplored. • The nursing hierarchy informs Doctor of Nursing Practice (DNP)-to-PhD experiences. • Nurses with a DNP pursue a PhD because they are on a mission. • DNP nurses are drawn to the PhD because of unmet needs, dreams, and circumstances. • Confidence, supportive others, and internal drive are vital to DNP-to-PhD pursuit. [ABSTRACT FROM AUTHOR]