Families' experiences of raising concerns in health care services: an interpretative phenomenological analysis

Background This exploratory study aimed to increase understanding of the experiences of families of people with intellectual disabilities when noticing and raising concerns in services. A qualitative design was employed. Methods Seven participants (all female) were recruited through local and national voluntary agencies; five were mothers of people with intellectual disabilities, one was the aunt and one the sister. Participants took part in semi structured interviews centred on their experiences of noticing and raising concerns, these were recorded and transcribed. The data was analyzed using Interpretative Phenomenological Analysis (IPA; Smith, 1996). Results The data was grouped into three superordinate themes: the nature and importance of concerns, relationships between families and staff and the process of raising concerns. A key and surprising finding was the importance of ‘the little things’. Conclusions This research highlights important implications for services such as the need to simplify the process of raising concerns, attend to the relationship with families and ensure advocacy services are identified for those without family

Rediscovery of Anacampsis lupinella Busck (Lepidoptera: Gelechiidae) in Ontario

We rediscovered populations of Anacampsis lupinella Busck (Lepidoptera: Gelechiidae) in three remnant populations of sundial lupines (Lupinus perennis L. (Fabaceae)) in southern Ontario. Here we provide a detailed description of the species and illustrate it with figures of adult moths and both male and female genitalia. Photographs of the moths taken recently in High Park, Toronto, match photos of the type specimen that was collected at High Park in 1901. The male genitalia of contemporary males match those of a male from the original series of specimens collected in Toronto. CO1DNA barcodes of eight contemporary specimens were very similar to the CO1barcode recovered from a specimen from the original series. The CO1sequences demonstrated slight genetic differentiation of the three Ontario populations, but collectively were clearly delimited from the seven congeneric species known from Ontario

Enzymatically-stable oxetane-based dipeptide hydrogels

Low molecular weight gelators that are not easily degraded by enzymes have a range of potential applications. Here, we report new Fmoc-protected dipeptides in which the amide carbonyl group has been replaced by an oxetane ring. Remarkably one of these peptidomimetics, but not the corresponding dipeptide, is an effective gelator, forming hydrogels at a concentration of 3 mg/mL. On assembly, there is a lack of beta-sheet structure, implying that there is no requirement for this motif in such a gel. Furthermore, the modified dipeptide is also stable to proteolysis compared to the parent dipeptide

Nuclear lamin stiffness is a barrier to 3D migration, but softness can limit survival

Lamin-A provides stiff resistance to cell migration Harada et al. describe how nuclear lamins affect the ability of migrating cells to squeeze through tissues and survive the resulting stress. Migrating cells must maneuver their large and chromatin-packed nuclei through tiny gaps in the surrounding tissue. A- and B-type lamins assemble in the nuclear periphery and help determine the organelle’s mechanical properties, but whether these proteins affect cell migration is unclear. Harada et al. tested the role of lamin-A in several different cell types. Partially reducing lamin-A levels enhanced the ability of cells to move through extracellular matrix containing small, 3-μm pores, whereas overexpressing the protein inhibited cell migration. Cells that expressed stoichiometrically high amounts of lamin-B were particularly sensitive to changes in lamin-A levels. The researchers found that nuclei containing low amounts of lamin-A were softer, allowing them to squeeze through tiny pores and—due to the spring-like properties of lamin-B—return to their normal shape on the other side. In contrast, high lamin-A levels made nuclei stiff and harder to maneuver, a property that could help keep mesenchymal stem cells, which express large amounts of lamin-A, anchored in their niche. Nuclei can be too soft for their own good, however. Cells experience stress as they migrate through tissues, occasionally resulting in apoptosis. Cells lacking lamin-A were less resistant to stress and more prone to death, possibly because the

Effect of self-monitoring of blood pressure on blood pressure control in pregnant individuals with chronic or gestational hypertension: the BUMP 2 randomized clinical trial

Importance: inadequate management of elevated blood pressure is a significant contributing factor to maternal deaths. The role of blood pressure self-monitoring in pregnancy in improving clinical outcomes for the pregnant individual and infant is unclear. Objective: To evaluate the effect of blood pressure self-monitoring, compared with usual care alone, on blood pressure control and other related maternal and infant outcomes, in individuals with pregnancy hypertension. Design, setting, and participants: unblinded, randomized clinical trial that recruited between November 2018 and September 2019 in 15 hospital maternity units in England. Individuals with chronic hypertension (enrolled up to 37 weeks' gestation) or with gestational hypertension (enrolled between 20 and 37 weeks' gestation). Final follow-up was in May 2020. Interventions: Participants were randomized to either blood pressure self-monitoring using a validated monitor and a secure telemonitoring system in addition to usual care (n = 430) or to usual care alone (n = 420). Usual care comprised blood pressure measured by health care professionals at regular antenatal clinics. Main outcomes and measures: the primary maternal outcome was the difference in mean systolic blood pressure recorded by health care professionals between randomization and birth. Results: Among 454 participants with chronic hypertension (mean age, 36 years; mean gestation at entry, 20 weeks) and 396 with gestational hypertension (mean age, 34 years; mean gestation at entry, 33 weeks) who were randomized, primary outcome data were available from 444 (97.8%) and 377 (95.2%), respectively. In the chronic hypertension cohort, there was no statistically significant difference in mean systolic blood pressure for the self-monitoring groups vs the usual care group (133.8 mm Hg vs 133.6 mm Hg, respectively; adjusted mean difference, 0.03 mm Hg [95% CI, -1.73 to 1.79]). In the gestational hypertension cohort, there was also no significant difference in mean systolic blood pressure (137.6 mm Hg compared with 137.2 mm Hg; adjusted mean difference, -0.03 mm Hg [95% CI, -2.29 to 2.24]). There were 8 serious adverse events in the self-monitoring group (4 in each cohort) and 3 in the usual care group (2 in the chronic hypertension cohort and 1 in the gestational hypertension cohort). Conclusions andrelevance: among pregnant individuals with chronic or gestational hypertension, blood pressure self-monitoring with telemonitoring, compared with usual care, did not lead to significantly improved clinic-based blood pressure control. Trial Registration: ClinicalTrials.gov Identifier: NCT03334149.</p