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Exclusive breastfeeding is essential for infant health, yet its practice varies across generations and cultures. Although the health benefits of breastfeeding have been well known for decades, the utilization of infant formula feeding worldwide and in Oman, in particular, continues to rise, most likely as a result of a lack of social support and the time limit faced by working mothers. Little is known about the factors affecting Omani mothers' breastfeeding experiences and practices. Therefore, this study aims to gain an in-depth understanding of the experiences of breastfeeding practices among three generations of Omani mothers. This qualitative study investigated exclusive breastfeeding practices among three generations of Omani mothers. Participants were recruited using a selective approach followed by a snowball technique, resulting in a total of 50 women, which included 17 first-generation mothers, 18 grandmothers, and 15 great-grandmothers. Participants were characterized by varying ages and socio-demographic backgrounds. Semi-structured face-to-face interviews were conducted in Arabic, and data collection continued until data saturation was reached. Data were analyzed using qualitative content analysis methodology, ensuring robustness and credibility. The analysis yielded two main categories reflecting the mothers' experiences, three representing the grandmothers' experiences, and two concerning the great-grandmothers' experiences. While overarching themes like the significance of breastfeeding emerged across all generations, disparities were seen concerning challenges, beliefs, and support systems. Mothers highlighted contemporary hurdles such as work-life balance and societal pressures, whereas grandmothers emphasized inherited practices and cultural norms. Great-grandmothers reflected on the evolution of societal and familial dynamics impacting breastfeeding traditions. Despite these differences, a shared commitment to breastfeeding and recognition of its importance for maternal and child well-being was evident across generations. The findings underscore the importance of societal support, healthcare provider education, and workplace policies in promoting exclusive breastfeeding. Targeted interventions are needed to address barriers to breastfeeding and empower women to make informed feeding choices. By addressing these challenges, societal institutions can contribute to achieving higher rates of exclusive breastfeeding and improve maternal and child health outcomes in Oman.

PurposeVenoarterial extracorporeal membrane oxygenation (V-A ECMO) can be used to support severely ill patients with cardiogenic shock. While age is commonly used in patient selection, little is known regarding its association with outcomes in this population. We sought to evaluate the association between increasing age and outcomes following V-A ECMO.MethodsWe used individual-level patient data from 440 centers in the international Extracorporeal Life Support Organization registry. We included all adult patients receiving V-A ECMO from 2017 to 2019. The primary outcome was hospital mortality. Secondary outcomes included a composite of complications following initiation of V-A ECMO. We conducted Bayesian analyses of the relationship between increasing age and outcomes of interest.ResultsWe included 15,172 patients receiving V-A ECMO. Of these, 8172 (53.9%) died in hospital. For the analysis conducted using weakly informed priors, and as compared to the reference category of age 18–29, the age bracket of 30–39 (odds ratio [OR] 0.94, 95% credible interval [CrI] 0.79–1.10) was not associated with hospital mortality, but age brackets 40–49 (odds ratio [OR] 1.26, 95% CrI: 1.08–1.47), 50–59 (OR 1.78, 95% CrI: 1.55–2.06), 60–69 (OR 2.24, 95% CrI: 1.94–2.59), 70–79 (OR 2.90, 95% CrI: 2.49–3.39) and ≥ 80 (OR 4.02, 95% CrI: 3.13–5.20) were independently associated with increasing hospital mortality. Similar results were found in the analysis conducted with an informative prior, as well as between increasing age and post-ECMO complications.ConclusionsAmong patients receiving V-A ECMO for cardiogenic shock, increasing age is strongly associated with increasing odds of death and complications, and this association emerges as early as 40 years of age.

PurposeTargeted temperature management (TTM) may improve survival and functional outcome in comatose survivors of out-of-hospital cardiac arrest (OHCA), though the optimal target temperature remains unknown. We conducted a systematic review and network meta-analysis to investigate the efficacy and safety of deep hypothermia (31–32 °C), moderate hypothermia (33–34 °C), mild hypothermia (35–36 °C), and normothermia (37–37.8 °C) during TTM.MethodsWe searched six databases from inception to June 2021 for randomized controlled trials (RCTs) evaluating TTM in comatose OHCA survivors. Two reviewers performed screening, full text review, and extraction independently. The primary outcome of interest was survival with good functional outcome. We used GRADE to rate our certainty in estimates.ResultsWe included 10 RCTs (4218 patients). Compared with normothermia, deep hypothermia (odds ratio [OR] 1.30, 95% confidence interval [CI] 0.73–2.30), moderate hypothermia (OR 1.34, 95% CI 0.92–1.94) and mild hypothermia (OR 1.44, 95% CI 0.74–2.80) may have no effect on survival with good functional outcome (all low certainty). Deep hypothermia may not improve survival with good functional outcome, as compared to moderate hypothermia (OR 0.97, 95% CI 0.61–1.54, low certainty). Moderate hypothermia (OR 1.23, 95% CI 0.86–1.77) and deep hypothermia (OR 1.27, 95% CI 0.70–2.32) may have no effect on survival, as compared to normothermia. Finally, incidence of arrhythmia was higher with moderate hypothermia (OR 1.45, 95% CI 1.08–1.94) and deep hypothermia (OR 3.58, 95% CI 1.77–7.26), compared to normothermia (both high certainty).ConclusionsMild, moderate, or deep hypothermia may not improve survival or functional outcome after OHCA, as compared to normothermia. Moderate and deep hypothermia were associated with higher incidence of arrhythmia. Routine use of moderate or deep hypothermia in comatose survivors of OHCA may potentially be associated with more harm than benefit.

The transcription factor PLZF [promyelocytic leukemia zinc finger, encoded by zinc finger BTB domain containing 16 (Zbtb16)] is induced during the development of innate and innate-like lymphocytes to direct their acquisition of a T-helper effector program, but the molecular mechanisms involved are poorly understood. Using biotinylation-based ChIP-seq and microarray analysis of both natural killer T (NKT) cells and PLZF-transgenic thymocytes, we identified several layers of regulation of the innate-like NKT effector program. First, PLZF bound and regulated genes encoding cytokine receptors as well as homing and adhesion receptors; second, PLZF bound and activated T-helper–specific transcription factor genes that in turn control T-helper–specific programs; finally, PLZF bound and suppressed the transcription of Bach2, a potent general repressor of effector differentiation in naive T cells. These findings reveal the multilayered architecture of the transcriptional program recruited by PLZF and elucidate how a single transcription factor can drive the developmental acquisition of a broad effector program.

DNA is thought to behave as a stiff elastic rod with respect to the ubiquitous mechanical deformations inherent to its biology. To test this model at short DNA lengths, we measured the mean and variance of end-to-end length for a series of DNA double helices in solution, using small-angle x-ray scattering interference between gold nanocrystal labels. In the absence of applied tension, DNA is at least one order of magnitude softer than measured by single-molecule stretching experiments. Further, the data rule out the conventional elastic rod model. The variance in end-to-end length follows a quadratic dependence on the number of base pairs rather than the expected linear dependence, indicating that DNA stretching is cooperative over more than two turns of the DNA double helix. Our observations support the idea of long-range allosteric communication through DNA structure.

Background Post-cardiac arrest, outcomes for most patients are poor, regardless of setting. Many patients who do achieve spontaneous return of circulation require vasopressor therapy to maintain organ perfusion. There is some evidence to support the use of corticosteroids in cardiac arrest. Research question Assess the efficacy and safety of corticosteroids in patients following in- and out-of-hospital cardiac arrest. Study design and methods We searched databases CINAHL, EMBASE, LILACS, MEDLINE, Web of Science, CENTRAL, ClinicalTrails.gov, and ICTRP. We included randomized controlled trials (RCTs) that examined the efficacy and safety of corticosteroids, as compared to placebo or usual care in patients post-cardiac arrest. We pooled estimates of effect size using random effects meta-analysis and report relative risk (RR) with 95% confidence intervals (CIs). We assessed risk of bias (ROB) for the included trials using the modified Cochrane ROB tool and rated the certainty of evidence using Grading of Recommendations Assessment, Development and Evaluation methodology. Results We included 8 RCTs ( n  = 2213 patients). Corticosteroids administered post-cardiac arrest had an uncertain effect on mortality measured at the longest point of follow-up (RR 0.96, 95% CI 0.90–1.02, very low certainty, required information size not met using trial sequential analysis). Corticosteroids probably increase return of spontaneous circulation (ROSC) (RR 1.32, 95% CI 1.18–1.47, moderate certainty) and may increase the likelihood of survival with good functional outcome (RR 1.49, 95% CI 0.87–2.54, low certainty). Corticosteroids may decrease the risk of ventilator associated pneumonia (RR 0.76, 95% CI 0.46–1.09, low certainty), may increase renal failure (RR 1.29, 95% CI 0.84–1.99, low certainty), and have an uncertain effect on bleeding (RR 2.04, 95% CI 0.53–7.84, very low certainty) and peritonitis (RR 10.54, 95% CI 2.99–37.19, very low certainty). Conclusions In patients during or after cardiac arrest, corticosteroids have an uncertain effect on mortality but probably increase ROSC and may increase the likelihood of survival with good functional outcome at hospital discharge. Corticosteroids may decrease ventilator associated pneumonia, may increase renal failure, and have an uncertain effect on bleeding and peritonitis. However, the pooled evidence examining these outcomes was sparse and imprecision contributed to low or very low certainty of evidence.

Innate-like natural killer T (NKT) cells critically enhance cell and humoral immunity against infections through recognition of conserved microbial lipid antigens presented by CD1d-expressing antigen-presenting cells, and provision of CD40L and cytokine signals. Whereas NKT cells efficiently licensed dendritic cells to prime potent effector and memory T cells, studies based on model antigens such as alphagalactosylceramide-nitrophenyl conjugates concluded that help to B cells was associated with NKT follicular helper differentiation, but limited to short-term responses without induction of memory. We revisited this surprising conclusion in the context of the extracellular encapsulated pathogen Streptococcus pneumoniae , where recognition of lipid and capsular polysaccharide antigens by NKT cells and B cells, respectively, provide critical host protection. Using liposomal nanoparticles displaying synthetic lipid and polysaccharide antigens to elicit pure and direct NKT–B-cell interactions in vivo, we observed intense and prolonged antibody responses with isotype switch, affinity maturation, and long-lasting B-cell memory, despite modest or absent NKT follicular helper differentiation. Furthermore, conditional ablation of Cd1d demonstrated a requirement for a two-step process involving first cognate interactions with dendritic cells, for NKT cell activation, and then with B cells, for induction of isotype switch and memory. Thus, NKT help to B cells represents both a major arm of antimicrobial defense and a promising target for B-cell vaccines.

The mechanisms by which TCR signaling 'instructs' thymic lineages remain unclear. Bendelac and colleagues show that the TCR-induced transcription factor Egr2 specifies the early and late stages of differentiation into the natural killer T cell lineage. Interactions driven by the T cell antigen receptor (TCR) determine the lineage fate of CD4 + CD8 + thymocytes, but the molecular mechanisms that induce the lineage-determining transcription factors are unknown. Here we found that TCR-induced transcription factors Egr2 and Egr1 had higher and more-prolonged expression in precursors of the natural killer T (NKT) than in cells of conventional lineages. Chromatin immunoprecipitation followed by deep sequencing showed that Egr2 directly bound and activated the promoter of Zbtb16 , which encodes the NKT lineage–specific transcription factor PLZF. Egr2 also bound the promoter of Il2rb , which encodes the interleukin 2 (IL-2) receptor β-chain, and controlled the responsiveness to IL-15, which signals the terminal differentiation of the NKT lineage. Thus, we propose that persistent higher expression of Egr2 specifies the early and late stages of NKT lineage differentiation, providing a discriminating mechanism that enables TCR signaling to 'instruct' a thymic lineage.

Background New-onset atrial fibrillation (NOAF) is commonly encountered in critically ill adults. Evidence evaluating the association between NOAF and patient-important outcomes in this population is conflicting. Furthermore, little is known regarding the association between NOAF and resource use or hospital costs. Methods Retrospective analysis (2011–2016) of a prospectively collected registry from two Canadian hospitals of consecutive ICU patients aged ≥ 18 years. We excluded patients with a known history of AF prior to hospital admission. Any occurrence of atrial fibrillation (AF) was prospectively recorded by bedside nurses. The primary outcome was hospital mortality, and we used multivariable logistic regression to adjust for confounders. We used a generalized linear model to evaluate contributors to total cost. Results We included 15,014 patients, and 1541 (10.3%) had NOAF during their ICU admission. While NOAF was not associated with increased odds of hospital death among the entire cohort (adjusted odds ratio [aOR] 1.02 [95% confidence interval [CI] 0.97–1.08]), an interaction was noted between NOAF and sepsis, and the presence of both was associated with higher odds of hospital mortality (aOR 1.28 [95% CI 1.09–1.36]) than either alone. Patients with NOAF had higher total costs (cost ratio [CR] 1.09 [95% CI 1.02–1.20]). Among patients with NOAF, treatment with a rhythm-control strategy was associated with higher costs (CR 1.24 [95% CI 1.07–1.40]). Conclusions While NOAF was not associated with death or requiring discharge to long-term care among critically ill patients, it was associated with increased length of stay in ICU and increased total costs.

Introduction: This study addresses the imperative in contemporary nursing education to prepare students for diverse healthcare settings by exploring nursing students’ expectations and perceptions of preceptorship programs, emphasizing the role of evidence-based educational strategies. The research aims to bridge the existing literature gap and contribute valuable insights into strategically designing preceptorship programs aligned with nursing students’ needs, preferences, and aspirations, ultimately enhancing precepting practices and relationships within nursing education. Methods: Employing a sequential explanatory mixed method, 140 nursing students, from various colleges in the United Arab Emirates (UAE) participated in the study. A structured questionnaire, encompassing demographic information, a need assessment survey, and a survey on expectations on preceptors was administered. A focus group discussion was conducted to identify perceived barriers to the utilization of preceptorship practices in nursing colleges. Data analysis involved descriptive statistics, the chi-square test, exploratory factor analysis, and content analysis of the focus group discussion. Results: The majority of participants expressed a high need for a preceptorship program, providing empirical evidence to support the development of a nurse educator preceptorship program in colleges and institutes. Preceptorship was identified as a significant contributor to career growth and achievement for nursing students, serving as a valuable tool to establish professional competency throughout their careers. Conclusion: There is a complex demand and high expectations for the core role of nurse educators as preceptors in the field of nursing education. This pioneering study sheds light on the need and perception of nursing students for a preceptorship program in the nursing curriculum.