Defense against attaching and effacing (A/E) bacteria requires the sequential generation of interleukin 23 (IL-23) and IL-22 to induce protective mucosal responses. While CD4+ and NKp46+ innate lymphoid cells (ILCs) are the critical source of IL-22 during infection, the precise source of IL-23 is unclear. We used genetic techniques to deplete specific subsets of classical dendritic cells (cDCs) and analyzed immunity to the A/E pathogen Citrobacter rodentium. We found that Notch2 controlled the terminal stage of cDC differentiation. Notch2-dependent intestinal CD11b+ cDCs, but not Batf3-dependent CD103+ cDCs, were an obligate source of IL-23 required to survive C. rodentium infection. These results provide the first demonstration of a non-redundant function of CD11b+ cDCs in response to pathogens in vivo.

An automated SMS-based reminder system can potentially enhance medication adherence in ACS patients during the early post-discharge period.

No abstract

No abstract

The Mre11–Rad50–Nbs1 (MRN) complex functions in the repair of DNA double-strand breaks (DSBs) by homologous recombination (HR) at postreplicative stages of the cell cycle. During HR, the MRN complex functions directly in the repair of DNA DSBs and in the initiation of DSB responses through activation of the ataxia telangiectasia-mutated (ATM) serine-threonine kinase. Whether MRN functions in DNA damage responses before DNA replication in G0/G1 phase cells has been less clear. In developing G1-phase lymphocytes, DNA DSBs are generated by the Rag endonuclease and repaired during the assembly of antigen receptor genes by the process of V(D)J recombination. Mice and humans deficient in MRN function exhibit lymphoid phenotypes that are suggestive of defects in V(D)J recombination. We show that during V(D)J recombination, MRN deficiency leads to the aberrant joining of Rag DSBs and to the accumulation of unrepaired coding ends, thus establishing a functional role for MRN in the repair of Rag-mediated DNA DSBs. Moreover, these defects in V(D)J recombination are remarkably similar to those observed in ATM-deficient lymphocytes, suggesting that ATM and MRN function in the same DNA DSB response pathways during lymphocyte antigen receptor gene assembly.

Aim To determine the occurrence, factors and outcome of missed nursing care from the perspective of Malaysian nurses. Background Missed nursing care is an important issue in the global health care sector. However, little is known on the extent of missed nursing care in the Malaysian context and its contributing factors. Methods A cross‐sectional design was adopted for data collection using the MISSCARE Survey instrument. Participants comprised 364 nurses from medical and surgical wards of a large teaching hospital. Data were analysed using descriptive, binomial logistic and hierarchical regression analyses. Results The overall occurrence of missed nursing care was 1.88 (on a scale of 1.00–5.00), which differed across 24 nursing care elements. Basic nursing care and communication‐related care were the most frequently missed elements. Types of ward and labour resources were identified as contributing factors to missed nursing care (p < .001). No significant association was found between missed nursing care and nurses' intention to leave (p > .05). Conclusion The occurrence of missed nursing care was noted to be low. Implications for Nursing Management Practical strategies such as an acuity‐based staffing system, close monitoring of rendered care and strengthening of teamwork are recommended to minimize missed nursing care.

Background: Retaining experienced critical care nurses (CCNs) remains a challenge for health care organizations. Nursing practice environment and resilience are both seen as modifiable factors in ameliorating the impact on CCNs' intention to leave andhave not yet been explored in Malaysia.Aims and objectives: To assess the association between perceived nursing practice environment, resilience, and intention to leave among CCNs and to determine the effect of resilience on intention to leave after controlling for other independent variables.Design: This was a cross-sectional survey.Methods: The universal sampling method was used to recruit nurses from adult and paediatric (including neonatal) critical care units of a large public university hospital in Malaysia. Descriptive analysis and χ 2 and hierarchical logistic regression tests were used to analyse the data.Results: A total of 229 CCNs completed the self-administrated questionnaire. Of the nurses, 76.4% perceived their practice environment as being favourable, 54.1% were moderately resilient, and only 20% were intending to leave. The logistic regression model explained 13.1% of variance in intention to leave and suggested that being single, an unfavourable practice environment, and increasing resilience were significant predictors of nurses' intention to leave. Conclusion:This study found that an unfavourable practice environment is a strong predictor of intention to leave; however, further exploration is needed to explain the

Aim To investigate semantic equivalence between two translated versions of the heart quality of life (HeartQoL) questionnaire produced by the forward‐backward and dual‐panel methods. Methods The forward‐backward and dual‐panel versions of HeartQoL were self‐administered among 60 participants who met the inclusion criteria of being a native Bahasa Malaysia‐speaking Malay, aged 18 and older, having an indexed diagnosis of ischaemic heart disease and being cognitively fit. The administration sequence of the two versions was randomized. Additionally, three sociolinguists, who were blinded to translation processes and survey findings, rated the translated versions against the source version on three aspects of semantic equivalence. Results Textual content in both translated versions was considerably similar (n = 9/14 items, ≈64%). The overall results from weighted kappa, raw agreement, intraclass correlations, and Wilcoxon signed‐rank as well as experts' ratings were confirmative of semantic equivalence between the forward‐backward and dual‐panel versions of the HeartQoL. However, some mixed findings were indicative of potential gaps in both translated versions against the source version. Conclusion Both the forward‐backward and dual‐panel methods produced semantically equivalent versions of HeartQoL; but translation alone is insufficient to narrow the subtle gaps caused by differences in culture and linguistic style.