Psychological Needs and Resources of the Staff in a Pediatric Neurosurgery Ward: A Phenomenological-Hermeneutic Study

Brain tumors are a common form of solid tumors in children and, unfortunately, they are characterized by a very uncertain prognosis. The treatment of this pathology often includes one or more very invasive surgical procedures, quite often in the very first steps of the treatment. Cases of brain tumors in children represent one of the greatest challenges for health care professionals in the domain of pediatric neurosurgery. This is clearly due to the complexity of the therapeutic plan, but also to the nature of the bond that is established between the child, the parents, and the members of the staff during the often-dramatic initial phase of the illness. In this phenomenological-hermeneutic study, we explore both the emotional and organizational needs, as well as the available professional and personal resources of the staff in the Neurosurgery ward of the Meyer Children’s Hospital in Florence (Italy). The ward staff, composed of 7 surgeons, a pediatric neuro-oncologist, 12 nurses, and 4 auxiliary health care professionals, underwent in-depth interviews that were recorded (with the consensus of the participants). The recordings were then transcribed and submitted to content analysis according to COREQ standards. A complex picture of emotional as well as organizational demands emerged from the data. Shared experiences were pointed out, together with more specific and idiosyncratic contents characteristic of different professional roles. The focus of the present paper was twofold, first, we considered the needs that are overtly expressed by the staff, and then we discussed the main sources of their motivational drives. We found that the latter is mainly found in the quality of the therapeutic bond that is established with the children and the family members, together with the deep interest in one’s own professional activity and the effective complementarity and integration of the personal and professional qualities of the staff members within the multidisciplinary caring group

Limiting the reliance on navigation assistance with navigation instructions containing emotionally salient narratives for confident wayfinding

We live in a world that is increasingly dependent on technology, including for orientation in both familiar and unfamiliar space, which contributes to a long-term erosion of innate spatial navigation skills. In this study, we examined whether modified navigation instructions can make pedestrians less reliant on navigation aids to solve wayfinding tasks. In contrast to standard instructions, the modified instructions make decision-relevant landmarks at intersections emotionally salient and connected through narrative, and thus more memorable. The results of our online VR study with seventy adults revealed that, after navigating an unfamiliar route using modified navigation instructions, people made significantly fewer references to the navigation aid without compromising the accuracy of navigation compared to standard instructions. Narrative-based navigation instructions improved memory for the order in which relevant features in the environment were encountered along the traversed route, but not landmark recognition memory or memory for landmark-direction associations. Our findings highlight the benefits of using human-centred technologies that – as opposed to current navigation systems – promote the encoding and memorability of spatial information during navigation, and have the potential to train human spatial navigation abilities in the long term as a countermeasure toward GPS cognitive deskilling of population

The positive effect of blue luminescent pathways on urban park visitor’s affective states: A virtual reality online study measuring facial expressions and self-reports

The colour blue often elicits feelings of calmness and contentment, for which evidence has largely been provided in daytime settings. It is unclear whether pathways illuminated in blue, for example, in urban recreational park areas at night confers the same positive impact on night time park visitors. To tackle this open empirical question, we investigated how adding blue self-luminous pavement to park lighting at night time affects park visitors’ emotions compared to conventional white street light illumination. Our goal is to inform design decisions aimed at enhancing the emotional well-being of people outdoors at night in urban environments. Participants’ emotional response was captured at four different time points while watching a video of a walk in a virtual urban park at night, which was lit with white street lights only or with the addition of blue luminescent pavement on the walked paths (between-subject design). To capture visitor’s emotions, we used a simplified version of the Geneva Emotion Wheel (GEW) instrument and online facial expression recognition technology as subjective (self-reports) and objective (physiological) measures of emotion, respectively. The results of the GEW self-reports showed that the addition of a blue self-luminous pavement in a park during night time yielded more positive affect than standard white lighting in park visitors for the first half of the walk. In the second half of the walk through the park, participants’ affective states seemed to equalize between the two lighting conditions. In contrast, sensory data on facial expressions indicated no difference between participants’ emotional states over the whole walk in the two experimental conditions. Consistent with the positive emotional state perceived in the second half of the walk, the state of relaxation experienced after the walk also did not differ between the two lighting conditions. Furthermore, participants’ relaxation judgements after the park walk were more negative overall for females than the more neutral ratings of males. Our results highlight the importance of lighting colour at night for the design of future affect-smart cities that may consider individual and group characteristics with the ultimate intent of promoting public well-being

How does the design of landmarks on a mobile map influence wayfinding experts’ spatial learning during a real-world navigation task?

Humans increasingly rely on GPS-enabled mobile maps to navigate novel environments. However, this reliance can negatively affect spatial learning, which can be detrimental even for expert navigators such as search and rescue personnel. Landmark visualization has been shown to improve spatial learning in general populations by facilitating object identification between the map and the environment. How landmark visualization supports expert users’ spatial learning during map-assisted navigation is still an open research question. We thus conducted a real-world study with wayfinding experts in an unknown residential neighborhood. We aimed to assess how two different landmark visualization styles (abstract 2D vs. realistic 3D buildings) would affect experts’ spatial learning in a map-assisted navigation task during an emergency scenario. Using a between-subjects design, we asked Swiss military personnel to follow a given route using a mobile map, and to identify five task-relevant landmarks along the route. We recorded experts’ gaze behavior while navigating and examined their spatial learning after the navigation task. We found that experts’ spatial learning improved when they focused their visual attention on the environment, but the direction of attention between the map and the environment was not affected by the landmark visualization style. Further, there was no difference in spatial learning between the 2D and 3D groups. Contrary to previous research with general populations, this study suggests that the landmark visualization style does not enhance expert navigators’ navigation or spatial learning abilities, thus highlighting the need for population-specific mobile map design solutions

Effectiveness and Tolerability of DOR/3TC/TDF in Experienced People with HIV Switching from RPV/FTC/TDF: A Retrospective, Single Center Cohort Study

Background: With advances in antiretroviral therapy for HIV treatment, newer drug combinations provide improved efficacy, safety, and compliance. This study evaluates switching to a regimen of doravirine (DOR), tenofovir disoproxil fumarate (TDF), and lamivudine (3TC) in a cohort of people living with HIV (PLWH). Methods: this Italian retrospective study included 426 PLWH who switched from rilpivirine (RPV)/TDF/emtricitabine (FTC) to DOR/3TC/TDF. The analysis focused on treatment effectiveness, safety, and metabolic and renal markers. Results: this study reports a treatment failure (defined as virological failure or discontinuation of the regimen) rate of 2.34% (95% confidence interval, 1.28–4.50%), with significant improvement in CD4 counts (+49.93 cells/μL, p < 0.001). Notably, the switch to DOR/3TC/TDF did not result in adverse metabolic effects or significant changes in renal function. Analysis of lipid profiles showed stabilization in the majority of PLWH. Conclusions: this study indicates that switching to a DOR/3TC/TDF from RPV/TDF/FTC is an effective and well-tolerated option for PLWH, with benefits in terms of maintaining viral suppression, CD4 count recovery, and metabolic health, without evidence of renal impairment. These results support the continued use of DOR/3TC/TDF as part of HIV treatment strategies and highlight the need for ongoing research to refine ART regimens for different populations

Switching to bictegravir/emtricitabine/tenofovir alafenamide from efavirenz/emtricitabine/tenofovir disoproxil in virologically suppressed people with HIV: findings from a non-randomized clinical trial (EBONY study)

Objectives: No previous studies specifically explored the switch from efavirenz to bictegravir (BIC)-containing three-drug antiretroviral regimens. This study aimed to evaluate the efficacy and safety outcomes of a treatment switch from efavirenz/emtricitabine/tenofovir disoproxil fumarate (EFV/FTC/TDF) given once daily (OD) or on alternate days (ATAD) to BIC/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) in virologically suppressed people with HIV (PWH). Methods: A pilot, single-arm, prospective study was conducted. Results: Overall, 234 PWH were enrolled. 217 of 234 (92.7%, 95% confidence interval [CI], 88.6-95.7%) participants had HIV-RNA <40 cp/ml at 48 weeks. Virological failure occurred in three participants, none with documented resistance, and all resuppressed without antiretroviral therapy change. After 48 weeks, a slight increase in cluster of differentiation (CD)4 cell count was observed from the baseline (+ 59 cells/mmc, 95% CI, 31; 86, P <0.001), but not in CD4/CD8 ratio. A slight increase in creatinine (mean change +0.11 mg/dl, 95% CI 0.10; 0.13, P <0.001) and a decrease in total cholesterol (mean change −8 mg/dl, 95% CI −14; −3, P = 0.001) were also observed. Conclusions: Our data showed that BIC/FTC/TAF demonstrated high virologic and immunologic efficacy and an excellent safety profile

Emulation of a Target Trial From Observational Data to Compare Effectiveness of Casirivimab/Imdevimab and Bamlanivimab/Etesevimab for Early Treatment of Non-Hospitalized Patients With COVID-19

OBJECTIVES: Comparative analysis between different monoclonal antibodies (mAbs) against SARS-CoV-2 are lacking. We present an emulation trial from observational data to compare effectiveness of Bamlanivimab/Etesevimab (BAM/ETE) and Casirivimab/Imdevimab (CAS/IMD) in outpatients with early mild-to-moderate COVID-19 in a real-world scenario of variants of concern (VoCs) from Alpha to Delta. METHODS: Allocation to treatment was subject to mAbs availability, and the measured factors were not used to determine which combination to use. Patients were followed through day 30. Viral load was measured by cycle threshold (CT) on D1 (baseline) and D7. Primary outcome was time to COVID-19-related hospitalization or death from any cause over days 0-30. Weighted pooled logistic regression and marginal structural Cox model by inverse probability weights were used to compare BAM/ETE vs. CAS/IMD. ANCOVA was used to compare mean D7 CT values by intervention. Models were adjusted for calendar month, MASS score and VoCs. We evaluated effect measure modification by VoCs, vaccination, D1 CT levels and enrolment period. RESULTS: COVID19-related hospitalization or death from any cause occurred in 15 of 237 patients in the BAM/ETE group (6.3%) and in 4 of 196 patients in the CAS/IMD group (2.0%) (relative risk reduction [1 minus the relative risk] 72%; p=0.024). Subset analysis carried no evidence that the effect of the intervention was different across stratification factors. There was no evidence in viral load reduction from baseline through day 7 across the two groups (+0.17, 95% -1.41;+1.74, p=0.83). Among patients who experienced primary outcome, none showed a negative RT-PCR test in nasopharyngeal swab (p=0.009) and 82.4% showed still high viral load (p<0.001) on D7. CONCLUSIONS: In a pre-Omicron epidemiologic scenario, CAS/IMD reduced risk of clinical progression of COVID-19 compared to BAM/ETE. This effect was not associated with a concomitant difference in virological response

Characteristics and Outcomes of COVID-19-Related Hospitalization among PLWH

Background: There is conflicting evidence for how HIV influences COVID-19 infection. The aim of this study was to compare characteristics at presentation and the clinical outcomes of people living with HIV (PLWH) versus HIV-negative patients (non-PLWH) hospitalized with COVID-19. Methods: Primary endpoint: Time until invasive ventilation/death. Secondary endpoints: Time until ventilation/death, time until symptoms resolution. Results: A total of 1647 hospitalized patients were included (43 (2.6%) PLWH, 1604 non-PLWH). PLWH were younger (55 vs. 61 years) and less likely to be with PaO2/FiO2 < 300 mmHg compared with non-PLWH. Among PLWH, nadir of CD4 was 185 (75–322) cells/μL; CD4 at COVID-19 diagnosis was 272 cells/μL (127–468) and 77% of these were virologically suppressed. The cumulative probability of invasive mechanical ventilation/death at day 15 was 4.7% (95%CI 1.2–17.3) in PLWH versus 18.9% (16.9–21.1) in non-PLWH (p = 0.023). The cumulative probability of non-invasive/invasive ventilation/death at day 15 was 20.9% (11.5–36.4) in PLWH versus 37.6% (35.1–40.2) in non-PLWH (p = 0.044). The adjusted hazard ratio (aHR) of invasive mechanical ventilation/death of PLWH was 0.49 (95% CI 0.12–1.96, p = 0.310) versus non-PLWH; similarly, aHR of non-invasive/invasive ventilation/death of PLWH was 1.03 (95% CI 0.53–2.00, p = 0.926). Conclusion: A less-severe presentation of COVID-19 at hospitalization was observed in PLWH compared to non-PLWH; no difference in clinical outcomes could be detected