A Nurse Practitioner service designed to address the health needs of children living in housing instability: A non‐randomised, concurrent mixed methods study protocol

In 2019–2020 we conducted a pilot study of a Nurse Practitioner clinic working with housing insecure children (0–18 years) that found high levels of developmental delay, missed immunizations and dental caries. This present non-randomized, concurrent mixed-methods study protocol explains the next phase of the research designed proving proof of concept for a Nurse Practitioner model of care for these vulnerable children. Focusing on identifying and understanding clinic admission processes, tracking referral pathways and uptake, and how many vulnerable children miss potential care and why. This will help us to understand and address gaps in health service delivery for this cohort. Design The study uses a concurrent mixed- method design where both qualitative and quantitative data are collected during the same period (between January 2021 and March 2022 as per the funding timeline). Methods The concurrent mixed-method design will collect data from: • A comprehensive assessment tool used by the Nurse Practitioner to evaluate the child accessing specialist homeless services, which assess their mental, physical and social health needs. • Documentation about the child's referral needs and uptake by disadvantage families. • Interviews with housing insecure families, and staff/managers of the specialist homeless service. • A review of Nurse Practitioner case notes. • Surveys of families with children accessing the Nurse Practitioner service. Discussion Addressing the childhood impacts of family homelessness is of global importance. Structural equation modelling, from the surveys and in-depth health assessments along with the thematic analysis of the interviews with parents and staff/managers provide an understanding of the relationships between referral uptake and variables such as education, homelessness and transport accessibility. Investigating the enablers and barriers to the usual health access and our extended referral uptake impacted by family homelessness enables a better understanding of the current health gaps. Impact Just over one fifth of Australian children live with their families in some form of housing instability including homelessness. These children, aged from birth to 18 years, are often disconnected from health and similar social institutions, making them an underserviced population. Our research investigates a Nurse Practitioner services that helps reconnect children with services to help avoid poor long-term health outcomes

Controlling the supramolecular architecture of molecular gels with surfactants

Manipulating molecular assembly is significant for achieving materials with desirable performances. In this paper, two nonionic surfactants, Span 20 and Triton X-100, are used to tune the nucleation and fiber growth of a molecular gelator 2,3-di-n-decyloxyanthracene (DDOA). Confocal microscopic images show that Span 20 induces elongation of DDOA spherulites, and promotes fiber side branching. In contrast, Triton X-100 enhances the primary nucleation of DDOA leading to the formation of smaller DDOA spherulites, and promotes fiber tip branching. (1)H NMR investigation demonstrates strong interactions between the hydrophobic tails of the surfactants and the alkyl chains of DDOA molecules.The interactions significantly reduce the diffusion of DDOA molecules. The different effects of the two surfactants could be attributable to their different alkyl hydrophobic tails. The hydrophobic tail of Span 20 is similar to the alkyl chain of DDOA, which could promote the adsorption of Span 20 on the fiber side surface rich in alkyl chains of DDOA.While the benzene ring in the hydrophobic tail of Triton X-100 could facilitate the primary nucleation of DDOA and the adsorpion of Triton X-100 on the fiber tip surface rich in aromatic structure of DDOA. The observations of this work will help the development of a convenient approach to tune the fiber network structure of molecular gels

Investigation of IRGANOX® 1076 as a dosimeter for clinical X-ray, electron and proton beams and its EPR angular response

The suitability of IRGANOX ® 1076 in paraffin wax as a near-tissue equivalent radiation dosimeter was investigated for various radiotherapy beam types; kV and MV X-rays, electrons and protons over clinically-relevant doses (2 -20 Gy). The radical formed upon exposure to ionising radiations was measured by Electron Paramagnetic R esonance (EPR) spectroscopy, and the single peak signal obtained for solid solutions of IRGANOX ® 1076 in wax is attributed to the phenoxyl radical obtained by net loss of H • . Irradiation of solid IRGANOX ® 1076 gives a doublet consistent with the formation of the phenol cation radical, obtained by electron loss. Solid solutions of IRGANOX ® 1076 in paraffin wax give a linear dose response for all types of radiations examined, which was energy independent for MV, electron and proton beams, and energy-dependent for kV X-ray irradiation. Reliable dose measurements were obtained with exposures as low as 2 Gy, and comparisons with alanine wax-pellets containing the same amount of dosimeter material (w/w) gave similar responses for all beam types investigated. Post-irradiation measurements (up to 77 days for proton irradiation for samples stored in the dark and at room temperature) indicate good signal stability with minimal signal fading (between 1.6 to 3.8%). Relative to alanine dosimeters, solid solutions of IRGANOX ® 1076 in wax give EPR signals with better sensitivity at low dose and do not significantly change with the orientation of the sample. Solid solutions of IRGANOX ® 1076 are ideal for applications in radiotherapy dosimetry for X-rays and charged particles, as IRGANOX ® 1076 is relatively cheap, can easily and reproducibly prepared in wax and be moulded to different shapes

Dynamic analysis of stochastic transcription cycles

In individual mammalian cells the expression of some genes such as prolactin is highly variable over time and has been suggested to occur in stochastic pulses. To investigate the origins of this behavior and to understand its functional relevance, we quantitatively analyzed this variability using new mathematical tools that allowed us to reconstruct dynamic transcription rates of different reporter genes controlled by identical promoters in the same living cell. Quantitative microscopic analysis of two reporter genes, firefly luciferase and destabilized EGFP, was used to analyze the dynamics of prolactin promoter-directed gene expression in living individual clonal and primary pituitary cells over periods of up to 25 h. We quantified the time-dependence and cyclicity of the transcription pulses and estimated the length and variation of active and inactive transcription phases. We showed an average cycle period of approximately 11 h and demonstrated that while the measured time distribution of active phases agreed with commonly accepted models of transcription, the inactive phases were differently distributed and showed strong memory, with a refractory period of transcriptional inactivation close to 3 h. Cycles in transcription occurred at two distinct prolactin-promoter controlled reporter genes in the same individual clonal or primary cells. However, the timing of the cycles was independent and out-of-phase. For the first time, we have analyzed transcription dynamics from two equivalent loci in real-time in single cells. In unstimulated conditions, cells showed independent transcription dynamics at each locus. A key result from these analyses was the evidence for a minimum refractory period in the inactive-phase of transcription. The response to acute signals and the result of manipulation of histone acetylation was consistent with the hypothesis that this refractory period corresponded to a phase of chromatin remodeling which significantly increased the cyclicity. Stochastically timed bursts of transcription in an apparently random subset of cells in a tissue may thus produce an overall coordinated but heterogeneous phenotype capable of acute responses to stimuli

Risk of Preeclampsia and Pregnancy Complications in Women With a History of Acute Kidney Injury

An episode of clinically recovered acute kidney injury (r-AKI) has been identified as a risk factor for future hypertension and cardiovascular disease. Our objective was to assess whether r-AKI was associated with future preeclampsia and other adverse pregnancy outcomes and to identify whether severity of AKI or time interval between AKI and pregnancy was associated with pregnancy complications. We conducted a retrospective cohort study of women who delivered infants between 1998 and 2016 at Massachusetts General Hospital. AKI was defined using the 2012 Kidney Disease Improving Global Outcomes laboratory criteria with subsequent clinical recovery (estimate glomerular filtration rate, >90 mL/min per 1.73 m2 before conception). AKI was further classified by severity (Kidney Disease Improving Global Outcomes stages 1-3) and time interval between AKI episode and the start of pregnancy. Women with r-AKI had an increased rate of preeclampsia compared with women without previous r-AKI (22% versus 9%; P<0.001). Infants of women with r-AKI were born earlier (gestational age, 38.2±3.0 versus 39.0±2.2 weeks; P<0.001) and were more likely to be small for gestational age (9% versus 5%; P=0.002). Increasing severity of r-AKI was associated with increased risk of preeclampsia for stages 2 and 3 AKI (adjusted odds ratio, 3.5; 95% confidence interval, 2.1-5.7 and adjusted odds ratio, 6.5; 95% confidence interval, 3.5-12.0, respectively), but not for stage 1 (adjusted odds ratio, 1.7; 95% confidence interval, 0.9-3.2). A history of AKI before pregnancy, despite apparent full recovery, was associated with increased risk of pregnancy complications. Severity and timing of the AKI episode modified the risk