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An accurate diagnosis of early-onset sepsis (EOS) is challenging because of subtle symptoms and the lack of a good diagnostic tool, resulting in considerable antibiotic overtreatment. A biomarker, discriminating between infected and non-infected newborns at an early stage of the disease, could improve EOS prediction. Numerous biomarkers have been tested, but have never been compared directly. We aimed to provide a comprehensive overview of early biomarkers and their diagnostic value in maternal samples, umbilical cord blood, and neonatal serum. PubMed-Medline, EMBASE, The Cochrane Library, and Web of Science were searched up to 1 March 2023, without restrictions on publication date, population, or language. Articles describing the diagnostic value of at least one biomarker in the detection of EOS in neonates, independent of gestational age, were included. The QUADAS-2 tool was used to assess study quality. Three independent researchers assessed the articles using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Meta-analysis was performed with all manuscripts describing diagnostic accuracy using a random-effects model. Of 2296 identified articles, 171 reports were included in the systematic review and 69 in the meta-analysis. Literature showed mixed and inconsistent evidence for most biomarkers and sample types, because of a lack of a uniform EOS case definition, small sample sizes, and large heterogeneity between studies. Interesting markers were procalcitonin (pooled sensitivity 79%, 95% CI 71–84%; specificity 91%, 95% CI 83–96%, n = 11) and interleukin (IL)-6 (pooled sensitivity 83%, 95% CI 71–90%; specificity 87%, 95% CI 78–93%, n = 8) in umbilical cord blood and presepsin (pooled sensitivity 82%, 95% CI 62–93%; specificity 86%, 95% CI 73–93%, n = 3) and serum amyloid A (pooled sensitivity 92%, 95% CI 75–98%; specificity 96%, 95% CI 78–99%, n = 4) in neonatal serum. Studies on the combination of biomarkers were scarce. A biomarker stand-alone test is currently not reliable for direct antibiotic stewardship in newborns, although several biomarkers show promising initial results. Further research into biomarker combinations could lead to an improved EOS diagnosis, reduce antibiotic overtreatment, and prevent associated health-related problems. [ABSTRACT FROM AUTHOR]

To undertake a comprehensive investigation into both the process of information acquisition and the clinical decision-making process utilized by primary care nurses in the course of treating chronic wounds. Scenario-based think-aloud method, enriched by the integration of information processing theory. The study was conducted within the framework of home care nursing organizations situated in Flanders, the Flemish speaking part of Belgium. A cohort of primary care nurses (n = 10), each possessing a minimum of one year of nursing experience, was recruited through the collaboration of three home care nursing organizations. Two real-life clinical practice scenarios were employed for the interviews, with the researcher adopting the roles of either the patient or another clinician to enhance the realism of the think-aloud process. Each think-aloud session was promptly succeeded by a subsequent follow-up interview. The Consolidated criteria for Reporting Qualitative research checklist was followed to guarantee a consistent and complete report of the study. Amidst noticeable variations, a discernible pattern surfaced, delineating three sequential concepts: 1. gathering overarching information, 2. collecting and documenting wound-specific data, and 3. interpreting information to formulate wound treatment strategies. These concepts encompassed collaborative discussions with stakeholders, while the refinement of wound treatment strategies was interwoven within both concepts 2 and 3. Evident variations were identified in chronic wound care clinical decision-making, regardless of educational background or experience. These insights hold the potential to inform the development of clinical decision support systems for chronic wound management and provide guidance to clinicians in their decision-making endeavours. • An analysis of chronic wound care clinical decision-making identified noticeable variations. • A scenario-based think-aloud study enabled a visual depiction of chronic wound care decision-making. • An analysis of chronic wound care decision-making can contribute to the future development of decision support systems. • An analysis of chronic wound care decision-making offers guidance to clinicians in their future decision-making endeavours. [ABSTRACT FROM AUTHOR]

The incidence of pressure ulcers remains high in patients with moderate to severe acute respiratory distress syndrome, ventilated in the prone position. A digital platform, dedicated to prone positioning and skin/tissue damage education was developed. To evaluate the impact of the PRONEtect Education Hub versus a traditional lecture on final-year nursing students' confidence levels and knowledge in a non-inferiority study. A multicenter, non-blinded, parallel-group, non-inferiority study with equal randomization (1:1 allocation) was conducted at two nursing schools in Belgium. Clinicaltrials.gov (NCT05575869). Following baseline assessments, the control group received a 1-h classroom lecture, and the experimental group gained access to the PRONEtect website. Three weeks later, participants completed the knowledge, confidence, and visual knowledge assessment. At baseline, 67 of the 80 participants completed the assessments and post-intervention, 28 and 27 participants respectively completed the confidence, knowledge, and visual knowledge assessments (dropout rate of 66.25%). Confidence levels: a mean ratio of relative change from baseline = 0.96 (Control (C)/Experimental (E)); 97.5% confidence interval (CI): 0.74 to 1.26; p = 0.74. Knowledge assessment: a mean difference in change from baseline = 1.58 (C-E); 97.5% CI: −0.58 to 3.75; p = 0.1. Although confidence and knowledge scores increased in both groups, the study cannot conclude non-inferiority. The trade-off between the inability to conclude efficacy of the impact of the website and the benefit of having an accessible educational platform on prone positioning and skin damage prevention makes the PRONEtect Education Hub an acceptable adjunct to traditional lecturing. • Education on prone positioning and skin/tissue damage was developed and evaluated. • The simulation videos and prone protocol were validated by international experts. • Knowledge scores and confidence levels increased in both groups. • The study could not conclude non-inferiority due to high attrition rates. • The PRONEtect Education Hub is an acceptable adjunct to traditional lecturing. [ABSTRACT FROM AUTHOR]

• Professional moulage is not widely researched; however, it enhances the fidelity of simulation activities, when applying it in simulations. • Students can perceive moulage differently and their senses and emotions are triggered by moulage when the fidelity is high. • Simulation is an effective tool for training nursing students and even more so when moulage is used to increase fidelity. The simulation community knows immersive clinical simulation works, especially high-fidelity simulations that portray situations close to real-life. The question remains: what is the role of moulage in the effectiveness of this strategy? This article describes students' perceived fidelity of moulage used during a burns simulation activity. In a mixed method study, 85 nursing students completed the Moulage Authenticity Rating Scale (MARS) and responded to two open-ended questions that explored emotional fidelity. Most respondents rated the moulage burns high in fidelity. Respondents' senses of sight, touch, hearing, and smell were triggered giving way to intense emotions. However, sensory overload may have led to the students missing clinical cues. The moulage met the criteria for physical, conceptual, and emotional fidelity, contributing to students' engagement during the simulation activity. Educators could improve student engagement by enhancing the fidelity of simulation activities through moulage whilst considering the cognitive load. [ABSTRACT FROM AUTHOR]

Caves present unique and interesting habitats, captivating scientists in discovering new species and disentangling unfamiliar food webs. However, cave-dwelling nematodes remain poorly studied with minimal evidence supporting their ecological relevance. Therefore, the present study was aimed at investigating the role of selected environmental filters over temporal (seasonal) and spatial (site location) scales on the community dynamics and functional diversity of cave-dwelling nematodes in Dripkelder Cave (South Africa). Multiple sampling sites, with varying levels of exposure to surface material, were investigated over four consecutive seasons. Selected microhabitat characteristics were also measured including sediment respiration, organic and active carbon, moisture content, pH, electrical conductivity, texture, and temperature. The results indicated significant effects on nematode community dynamics from exposure to surface material and environmental filters (including a physical restriction between the entrance area and deeper cave sites). Furthermore, clear temporal trends evidenced the effect of seasonality. An example of this was the rapid response of nematode colonisers (Rhabditis sp.) to the introduction of food and later transitioning to dauer larvae. Finally, multiple trophic groups associated with more isolated cave habitats indicated the potential role of nematode functional diversity in food web dynamics. This study showed that nematode dynamics in caves are likely more complex than originally believed. [ABSTRACT FROM AUTHOR]

The incidence of breast cancer is often associated with geographic variation which indicates that a person's surrounding environment can be an important etiological factor in cancer development. Environmental risk factors can include exposure to sewage- or wastewater, which consist of a complex mixture of pathogens, mutagens and carcinogens. Wastewater contains primarily carbonaceous, nitrogenous and phosphorus compounds, however it can also contain trace amounts of chemical pollutants including toxic metal cations, hydrocarbons and pesticides. More importantly, the contamination of drinking water by wastewater is a potential source of exposure to mammary carcinogens and endocrine disrupting compounds. Organic solvents and other pollutants often found in wastewater have been detected in various tissues, including breast and adipose tissues. Furthermore, these pollutants such as phenolic compounds in some detergents and plastics, as well as parabens and pesticides can mimic estrogen. High estrogen levels are a well-established risk factor for estrogen-receptor (ER) positive breast cancer. Therefore, exposure to wastewater is a risk factor for the initiation, progression and metastasis of breast cancer. Carcinogens present in wastewater can promote tumourigenesis through various mechanisms, including the formation of DNA adducts, gene mutations and oxidative stress. Lastly, the presence of endocrine disrupting compounds in wastewater can have negative implications for ER-positive breast cancers, where these molecules can activate ERα to promote cell proliferation, survival and metastasis. As such, strategies should be implemented to limit exposure, such as providing funding into treatment technologies and implementation of regulations that limit the production and use of these potentially harmful chemicals. [Display omitted] • Exposure to wastewater is a risk factor for the initiation, progression and metastasis of breast cancer. • Carcinogens present in wastewater can promote tumourigenesis through pro-tumourigenic mechanisms. • Endocrine disrupting compounds in wastewater has negative implications for ER-positive breast cancer. [ABSTRACT FROM AUTHOR]