An exploration into the stressors and coping strategies of parents caring for children living with Autism spectrum disorder

This study sought to understand the experiences and challenges of parents caring for a child living with autism spectrum disorder (ASD). A qualitative research design was used to explore the stressors faced, coping strategies used, and support mechanisms needed by parents caring for a child living with ASD within South Africa. Non-probability sampling was used to select 20 respondents, initially using purposive and then snowball sampling techniques, until the target sample size was reached and data saturation had occurred. Respondents consisted of South African mothers who care for a child living with ASD, and who live in Cape Town, Johannesburg, or Durban. Data was collected with the use of semi-structured one-on-one interviews, and was analyzed according to Tesch's (1990) eight steps of analysis. The study found that there were various practical stressors for respondents regarding caring for a child living with ASD. This included the stressors of managing their child's difficult behaviours, respondents' high levels of anxiety as a result of these behaviours, and difficulties communicating with their child. Stressors also included the high cost of care and interventions, difficulty finding appropriate schooling, and the need to consult multiple professionals before receiving the diagnosis. The respondents' psychological stressors included experiencing grief and loss once their child was diagnosed, hurt from other's lack of understanding of ASD, and their concerns about their child's future. Various coping mechanisms were found to be used by respondents, including accepting the child with their diagnosis, increasing in patience and empathy, and attempting to manage and prevent their child's difficult behaviours. Another coping mechanism was to utilize a blend of interventions, for example Occupational and Speech Therapy, which catered to their child's unique ASD-presentation. Support mechanisms that were found to be beneficial to respondents were informal and consisted of support from family and from other parents caring for a child with ASD. This study concluded that caring for a child with ASD has many challenges, especially when one is the child's parent and primary caregiver. It also concluded that respondents displayed resilience towards these challenges by utilizing various coping and support mechanisms available to them. Numerous recommendations arose from this study, the most salient of which was for health care professionals (HCPs), which included social workers, as well as parents caring for a child living with ASD to educate themselves and others with regards to ASD. Another recommendation was for HCPs to link these parents with affordable and appropriate education and intervention options for their children

A COMPARATIVE STUDY OF SALICYLALDOXIME, CYSTEINE AND BENZOTRIAZOLE AS INHIBITORS FOR THE ACTIVE CHLORIDE-BASED CORROSION OF COPPER AND BRONZE ARTIFACTS

This study aimed to investigate the effectiveness of salicylaldoxime and cysteine as potential replacements to benzotriazole, the widely used but environmentally unfriendly and not always effective copper corrosion inhibitor. Coupons of modern copper, 5% tin bronze, and 12% tin bronze samples were corroded using an accelerated electrochemical procedure, which involved anodically polarizing the coupons in a solution of 0.5M NaCl + 0.1M CuCl2.2H2O. X-ray diffraction analysis of the corrosion products showed the presence of copper (I) chloride (CuCl) on the surfaces of the three reference materials. Tin (IV) oxide (SnO2) was also detected on the surface of the 12% tin bronze.The interaction of the corrosion inhibitors with the corrosion products was investigated by visual examination and scanning electron microscopy. Benzotriazole and salicylaldoxime formed a surface adherent and aesthetically acceptable green complexes for the corroded copper and bronze, while cysteine formed grey patches that cover the green corrosion on copper and bronze. Accelerated corrosion in an environmental chamber of high relative humidity and temperature (84% RH and 38oC) showed that salicylaldoxime was the most effective inhibitor for the three reference materials against corrosion in these severe environmental conditions. However, electrochemical impedance spectroscopy's results showed that the benzotriazole was the most effective inhibitor in chloride solutions, and that the effective of cysteine increases with the increase of tin content in the alloy. It was concluded that salicylaldoxime presented a relevant and effective corrosion inhibitor for most conservation applications on corroded copper and bronze, while cysteine presented an environmentally friendly replacement for benzotriazole to protect uncorroded or previously treated by reduction back to metal artifacts

Combined analysis of microbial metagenomic and metatranscriptomic sequencing data to assess in situ physiological conditions in the premature infant gut.

Microbes alter their transcriptomic profiles in response to the environment. The physiological conditions experienced by a microbial community can thus be inferred using meta-transcriptomic sequencing by comparing transcription levels of specifically chosen genes. However, this analysis requires accurate reference genomes to identify the specific genes from which RNA reads originate. In addition, such an analysis should avoid biases in transcript counts related to differences in organism abundance. In this study we describe an approach to address these difficulties. Sample-specific meta-genomic assembled genomes (MAGs) were used as reference genomes to accurately identify the origin of RNA reads, and transcript ratios of genes with opposite transcription responses were compared to eliminate biases related to differences in organismal abundance, an approach hereafter named the "diametric ratio" method. We used this approach to probe the environmental conditions experienced by Escherichia spp. in the gut of 4 premature infants, 2 of whom developed necrotizing enterocolitis (NEC), a severe inflammatory intestinal disease. We analyzed twenty fecal samples taken from four premature infants (4-6 time points from each infant), and found significantly higher diametric ratios of genes associated with low oxygen levels in samples of infants later diagnosed with NEC than in samples without NEC. We also show this method can be used for examining other physiological conditions, such as exposure to nitric oxide and osmotic pressure. These study results should be treated with caution, due to the presence of confounding factors that might also distinguish between NEC and control infants. Nevertheless, together with benchmarking analyses, we show here that the diametric ratio approach can be applied for evaluating the physiological conditions experienced by microbes in situ. Results from similar studies can be further applied for designing diagnostic methods to detect NEC in its early developmental stages

Translating Research Into Practice: Speeding the Adoption of Innovative Health Care Programs

Looks at case studies of four innovative clinical programs to determine key factors influencing the diffusion and adoption of innovations in health care

Medication Management for People Living with Dementia: Development and Evaluation of a Multilingual Information Resource for Family Caregivers of People Living with Dementia

The aim of this chapter is to describe the development and evaluation of an online multilingual information resource focused on medication management, targeting people living with dementia and their family caregivers. Maintaining effective medication management is important to allow ongoing quality of life within the community setting and avoiding medication-related preventable hospitalisations for the person living with dementia. Family caregivers are likely to assume the role of medication management on behalf of the person in their care as dementia progresses. Little training or information is available to family caregivers to assist them with this role. A pilot online information resource was developed and evaluated. Responding to the evaluation, this resource was improved, and a more extensive evaluation process was undertaken. The development and evaluation process are outlined with a view to guiding the development of similar resources, especially those targeting linguistically diverse family caregivers and those with dementia. This is especially important given that many older adults will migrate during their lifetime, often to a country where they are not familiar with the language or health services. Extra support is needed to assist older immigrants who are themselves at risk or are caring for someone with dementia

Innovating urban governance: a research agenda

Urban governance innovation is being framed as an imperative to address complex urban and global challenges, triggering the adoption of novel institutional forms, approaches and techniques. Urban political geographers are still some way off fully apprehending the dynamics of these innovations and their potential to reconfigure the composition and politics of urban governance. This paper suggests dialogue between urban political geography and public sector innovation literatures as a productive way forward. We build from this engagement to suggest a critical research agenda to drive systematic analysis of innovatory urban governance, its heterogeneous formation, politics and possibilities

A Prospective Cohort Study Investigating Associations between Hyperemesis Gravidarum and Cognitive, Behavioural and Emotional Well-Being in Pregnancy

Objectives: To investigate the association between hyperemesis gravidarum and altered cognitive, behavioural and emotional well-being in pregnancy. Methods: The study cohort consisted of 3423 nulliparous women recruited in the Screening for Pregnancy Endpoints (SCOPE) study performed in Auckland, New Zealand; Adelaide, Australia; Cork, Ireland; Manchester and London, United Kingdom between November 2004 and August 2008. Women were interviewed at 15±1 weeks' gestation and at 20±1weeks' gestation. Women with a diagnosis of hyperemesis gravidarum (HG) were compared with women who did not have a diagnosis of HG. Main outcome measures included the Short form State- Trait Anxiety Inventory (STAI) score (range 6–24), Perceived Stress Scale score (PSS, range 0–30), Edinburgh Postnatal Depression Scale (EPDS) score (range 0–30 or categories a–c) and behavioural responses to pregnancy score (limiting/resting [range 0–20] and all-or-nothing [range 0–28]). Results: During the study period 164 women suffered from HG prior to their 15 week interview. Women with HG had significantly higher mean STAI, PSS, EPDS and limiting response to pregnancy scores compared to women without HG. These differences were observed at both 15±1 and 20±1 weeks' of gestation. The magnitude of these differences was greater in women with severe HG compared to all women with HG. Women with severe HG had an increased risk of having a spontaneous preterm birth compared with women without HG (adjusted OR 2.6 [95% C.I. 1.2, 5.7]). Conclusion: This is the first large prospective study on women with HG. Women with HG, particularly severe HG, are at increased risk of cognitive, behavioural and emotional dysfunction in pregnancy. Women with severe HG had a higher rate of spontaneous preterm birth compared to women without HG. Further research is required to determine whether the provision of emotional support for women with HG is beneficial.Fergus P. McCarthy, Ali S. Khashan, Robyn A. North, Rona Moss-Morris, Philip N. Baker, Gus Dekker, Lucilla Poston, Louise C. Kenny on behalf of the SCOPE consortiu

Recombinant Human-C1 inhibitor is effective and safe for repeat hereditary angioedema attacks

BackgroundHereditary angioedema (HAE) caused by a deficiency in functional C1 esterase inhibitor (C1INH) is characterized by recurrent episodes of cutaneous and/or mucosal/submucosal tissue swelling affecting multiple anatomic locations. Previous studies demonstrated efficacy of recombinant human C1INH (rhC1INH) for acute HAE attacks.ObjectiveThis study evaluated the efficacy and safety of rhC1INH (50 IU/kg) for the treatment of multiple HAE attacks in an open-label extension study.MethodsTime to onset of symptom relief and time to minimal symptoms were assessed using a Treatment Effect Questionnaire (TEQ), a visual analog scale, and a 6-point ordinal scale Investigator Score.ResultsForty-four patients received rhC1INH, and a single dose was administered for 215 of 224 (96%) attacks. Median time to beginning of symptom relief based on TEQ for the first 5 attacks was 75.0 (95% CI, 69-89) minutes, ranging from 62.5 (95% CI, 48-90) to 134.0 (95% CI, 32-119) minutes. Median time to minimal symptoms using TEQ for the first 3 attacks was 303.0 (95% CI, 211-367) minutes. rhC1INH was well tolerated. There were no discontinuations due to adverse events. No thrombotic or anaphylactic events were reported, and repeat rhC1INH treatments were not associated with neutralizing anti-C1INH antibodies.ConclusionsA single 50-IU/kg dose rhC1INH was effective for improving symptoms of an HAE attack with sustained efficacy for treatment of subsequent attacks. rhC1INH had a positive safety profile throughout the study. This study supports repeated use of rhC1INH over time in patients with HAE attacks

Investigation of EMIC wave scattering as the cause for the BARREL 17 January 2013 relativistic electron precipitation event: A quantitative comparison of simulation with observations

Abstract Electromagnetic ion cyclotron (EMIC) waves were observed at multiple observatory locations for several hours on 17 January 2013. During the wave activity period, a duskside relativistic electron precipitation (REP) event was observed by one of the Balloon Array for Radiation belt Relativistic Electron Losses (BARREL) balloons and was magnetically mapped close to Geostationary Operational Environmental Satellite (GOES) 13. We simulate the relativistic electron pitch angle diffusion caused by gyroresonant interactions with EMIC waves using wave and particle data measured by multiple instruments on board GOES 13 and the Van Allen Probes. We show that the count rate, the energy distribution, and the time variation of the simulated precipitation all agree very well with the balloon observations, suggesting that EMIC wave scattering was likely the cause for the precipitation event. The event reported here is the first balloon REP event with closely conjugate EMIC wave observations, and our study employs the most detailed quantitative analysis on the link of EMIC waves with observed REP to date. Key PointsQuantitative analysis of the first balloon REP with closely conjugate EMIC wavesOur simulation suggests EMIC waves to be a viable cause for the REP eventThe adopted model is proved to be applicable to simulating the REP event

Association of Chartered Physiotherapists in Respiratory Care scoping review: Post-operative physiotherapy management in upper gastrointestinal (GI) surgery

Objective This scoping review will identify and synthesise the available evidence for post-operative physiotherapy following upper GI surgery, in order to identify gaps in the literature, inform evidence-based practice and contribute towards guidelines and/or policy development. Introduction Physiotherapy management following thoracic, cardiac and upper gastrointestinal surgery has been identified as one of the five key priorities for review by the Association of Chartered Physiotherapists in Respiratory Care (ACPRC) editorial board. Previously, systematic reviews have been published with a focus on one type of physiotherapy treatment. The aim of this scoping review was to identify all types of post-operative physiotherapy following upper GI surgery research to provide a comprehensive review of available evidence