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The extent of complexity was determined by multifaceted patient problems and resources as well as extensive knowledge, experience, attention and caring skills of registered nurses interacting with each other. LIMITATIONS The study did not include organisation-related complexity of nursing care. CONCLUSIONS The redefinition of the concept may support a common understanding of patient-related demands on nursing care among practitioners, managers and politicians which is important regarding patient safety and health nursing staff. © 2020 Nordic College of Caring Science.PREMISE Few studies have addressed the evolutionary history of tree species from African savannahs. Afzelia contains economically important timber species, including two species widely distributed in African savannahs A. africana in the Sudanian region and A. quanzensis in the Zambezian region. click here We aimed to infer whether these species underwent range fragmentation and/or demographic changes, possibly reflecting how savannahs responded to Quaternary climate changes. METHODS We characterized the genetic diversity and structure of these species across their distribution ranges using nuclear microsatellites (SSRs) and genotyping-by-sequencing (GBS) markers. Six SSR loci were genotyped in 241 A. africana and 113 A. quanzensis individuals, while 2800 high-quality single nucleotide polymorphisms (SNPs) were identified in 30 A. africana individuals. RESULTS Both species appeared to be mainly outcrossing. The kinship between individuals decayed with the logarithm of the distance at similar rates across species and markc oscillations of the Pleistocene, in contrast to patterns commonly found in African rainforest trees. © 2020 Botanical Society of America.Atrial fibrillation (AF) has become a global epidemic and puts affected patients at high risk of adverse events. In this review we summarise the current evidence on risk factors and complications of AF, describe current treatment strategies, and outline new fields of research. Current evidence shows that hypertension and obesity are the two most important modifiable risk factors for the development of AF. Patients with AF face an increased stroke risk. Oral anticoagulation reduces this risk substantially. Mainly for reasons of safety and ease of use, non-vitamin K antagonist oral anticoagulants are preferred for stroke prevention. Rate and rhythm control interventions remain important and are mainly used for symptom control in AF patients. Rate control is recommended as an initial treatment and in patients with a low or absent symptom burden. Following the advent of AF ablation 20 years ago, the chances of successful sustained rhythm control have increased. Nevertheless, the procedural risks, although low, must be discussed with the patient in the context of the potential benefits. Heart failure and AF often coexist, which creates a further challenge for optimal AF management. Recent studies have shown that AF patients have a high burden of silent brain lesions, and that these lesions are associated with cognitive dysfunction. A better understanding of these interrelationships may eventually help the development of new prevention and treatment strategies to decrease the burden and complications associated with AF.Adolescence is a period of life during which many people experiment with different kinds of legal and illegal substances. However, young people practising physical activities at a high level should avoid taking such substances. On the basis of a large sample of Swiss male recruits (C-SURF baseline data), we explore the consumption of substances among three subgroups of young adults, defined according to level of physical activity high, medium, and low. Our results show that respondents classified into the high level of physical activity group went through the same experimentation processes with substances as respondents in the other groups, but that they reduced their overall consumption level, as indicated by measures regarding the last 12 months only. However, substantial differences are observed when we look at each substance separately. In particular, smokeless tobacco products are consumed more in the high group, and alcohol consumption is high in all groups. Physical activity, even at a high level, is not a protective factor against substance consumption. Therefore, physicians should not forget to investigate substance use among people with high levels of physical activity, especially since their consumption can (1) differ from the general population; and (2) have important consequences on their physical performance.BACKGROUND Chloroplasts are a common character in plants. The chloroplasts in each plant lineage have shaped their own genomes, plastomes, by structural changes and transferring many genes to nuclear genomes during plant evolution. Some plastid genes have introns that are mostly group II introns. OBJECTIVE This study aimed to get genomic and evolutionary insights on the plastomes from green algae to flowering plants. METHODS Plastomes of 115 species from green algae, bryophytes, pteridophytes (spore bearing vascular plants), gymnosperms, and angiosperms were mined from NCBI organelle genome database. Plastome structure, gene contents and GC contents were analyzed by the in-house developed Phyton code. Intronic features including presence/absence, length, intron phases were analyzed by manually in the annotated information in NCBI. RESULTS The canonical quadripartite structures were retained in most plastomes except of a few plastomes that had lost an invert repeat (IR). Expansion or reduction or deletion of Ig and tRNA genes in the genome database, which might be confirmed by the chloroplast transcriptome analysis in the future.BACKGROUND Non-small cell lung cancer (NSCLC) poses a great threat to human health. DNA methylation abnormalities play a central role in the development and outcome of most human malignancies, providing potential biomarkers for diagnosis and prognosis. Iroquois homeobox 1 (IRX1) can act as a tumor suppressor or promoter depending on the tumor microenvironment, and its role in lung cancer is still controversial. OBJECTIVE The purpose of this study was to investigate the biological role and prognostic value of IRX1 in NSCLC. METHODS We examined the methylation status of IRX1 promoter in 146 tumors from patients with NSCLC using pyrosequencing and analyzed the association between methylation status and overall patient survival. RESULTS A total of 37 cases (25.3%) showed IRX1 methylation-positive tumors when compared with matched normal tissues. No association between IRX1 expression level and methylation status was found in lung cancer cell lines. IRX1 methylation significantly correlated with smoking status and TP53 mutation.