Barriers to correct child restraint use: A qualitative study of child restraint users and their needs

© 2018 Motor vehicle crashes are a major cause of death and injury to children worldwide. Although risk of injury to child passengers can be reduced by using a child restraint, most restraints are incorrectly used. This greatly reduces the restraints’ protective potential; however there is limited research on drivers of correct child restraint use. The aim of this study was to explore perceived barriers and motivators of correct child restraint use in experienced child restraint users, to inform interventions to promote correct use. Motivations and risk perceptions concerning incorrect child restraint use among high and low socioeconomic populations and culturally and linguistically diverse (CALD) child restraint users in Sydney, Australia were qualitatively examined. Six focus groups (N = 44 participants) were facilitated using a semi-structured discussion guide. Transcriptions were deductively analysed using QSR NVivo11 software and the COM-B model of behaviour. Common perceived barriers to correct restraint use were: (a) difficulty interpreting instructions and labels, particularly among CALD participants; (b) remembering and attending to correct use information; (c) lack of information and behavioural feedback on how to correctly install and use a child restraint; and (d) low confidence in ability to install and use a child restraint correctly. The results indicate current child restraint product information is poorly understood, particularly among those whose first language is not English. Interventions to increase correct child restraint use should address access to correct use information, capability to understand and use these, and the influence of motivation, memory and attention in the process

Effect of upper airway fat on tongue dilation during inspiration in awake people with obstructive sleep apnea

Study Objectives: To investigate the effect of upper airway fat composition on tongue inspiratory movement and obstructive sleep apnea (OSA). Methods: Participants without or with untreated OSA underwent a 3T magnetic resonance imaging (MRI) scan. Anatomical measurements were obtained from T2-weighted images. Mid-sagittal inspiratory tongue movements were imaged using tagged MRI during wakefulness. Tissue volumes and percentages of fat were quantified using an mDIXON scan. Results: Forty predominantly overweight participants with OSA were compared to 10 predominantly normal weight controls. After adjusting for age, BMI, and gender, the percentage of fat in the tongue was not different between groups (analysis of covariance [ANCOVA], p = 0.45), but apnoeic patients had a greater tongue volume (ANCOVA, p = 0.025). After adjusting for age, BMI, and gender, higher OSA severity was associated with larger whole tongue volume (r = 0.51, p < 0.001), and greater dilatory motion of the anterior horizontal tongue compartment (r = -0.33, p = 0.023), but not with upper airway fat percentage. Higher tongue fat percentage was associated with higher BMI and older age (Spearman r = 0.43, p = 0.002, and r =0.44, p = 0.001, respectively), but not with inspiratory tongue movements. Greater inspiratory tongue movement was associated with larger tongue volume (e.g. horizontal posterior compartment, r = -0.44, p = 0.002) and smaller nasopharyngeal airway (e.g. oblique compartment, r = 0.29, p = 0.040). Conclusions: Larger tongue volume and a smaller nasopharynx are associated with increased inspiratory tongue dilation during wakefulness in people with and without OSA. This compensatory response was not influenced by higher tongue fat content. Whether this is also true in more obese patient populations requires further investigation

The relationship between mandibular advancement, tongue movement, and treatment outcome in obstructive sleep apnea

Study Objectives: To characterize how mandibular advancement enlarges the upper airway via posterior tongue advancement in people with obstructive sleep apnea (OSA) and whether this is associated with mandibular advancement splint (MAS) treatment outcome. Methods: One-hundred and one untreated people with OSA underwent a 3T magnetic resonance (MRI) scan. Dynamic mid-sagittal posterior tongue and mandible movements during passive jaw advancement were measured with tagged MRI. Upper airway cross-sectional areas were measured with the mandible in a neutral position and advanced to 70% of maximum advancement. Treatment outcome was determined after a minimum of 9 weeks of therapy. Results: Seventy-one participants completed the study: 33 were responders (AHI50% AHI reduction), 11 were partial responders (>50% AHI reduction but AHI>10 events/hr), and 27 nonresponders (AHI reduction 4 mm). In comparison, a model using only baseline AHI correctly classified 50.0% of patients (5-fold cross-validated 52.5%, n = 40). Conclusions: Tongue advancement and upper airway enlargement with mandibular advancement in conjunction with baseline AHI improve treatment response categorization to a satisfactory level (69.2%, 5-fold cross-validated 62.5%)

Microarray analysis of expression of cell death-associated genes in rat spinal cord cells exposed to cyclic tensile stresses in vitro

<p>Abstract</p> <p>Background</p> <p>The application of mechanical insults to the spinal cord results in profound cellular and molecular changes, including the induction of neuronal cell death and altered gene expression profiles. Previous studies have described alterations in gene expression following spinal cord injury, but the specificity of this response to mechanical stimuli is difficult to investigate in vivo. Therefore, we have investigated the effect of cyclic tensile stresses on cultured spinal cord cells from E15 Sprague-Dawley rats, using the FX3000^®Flexercell Strain Unit. We examined cell morphology and viability over a 72 hour time course. Microarray analysis of gene expression was performed using the Affymetrix GeneChip System^®, where categorization of identified genes was performed using the Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) systems. Changes in expression of 12 genes were validated with quantitative real-time reverse transcription polymerase chain reaction (RT-PCR).</p> <p>Results</p> <p>The application of cyclic tensile stress reduced the viability of cultured spinal cord cells significantly in a dose- and time-dependent manner. Increasing either the strain or the strain rate independently was associated with significant decreases in spinal cord cell survival. There was no clear evidence of additive effects of strain level with strain rate. GO analysis identified 44 candidate genes which were significantly related to "apoptosis" and 17 genes related to "response to stimulus". KEGG analysis identified changes in the expression levels of 12 genes of the mitogen-activated protein kinase (MAPK) signaling pathway, which were confirmed to be upregulated by RT-PCR analysis.</p> <p>Conclusions</p> <p>We have demonstrated that spinal cord cells undergo cell death in response to cyclic tensile stresses, which were dose- and time-dependent. In addition, we have identified the up regulation of various genes, in particular of the MAPK pathway, which may be involved in this cellular response. These data may prove useful, as the accurate knowledge of neuronal gene expression in response to cyclic tensile stress will help in the development of molecular-based therapies for spinal cord injury.</p

Ascending central canal dilation and progressive ependymal disruption in a contusion model of rodent chronic spinal cord injury

<p>Abstract</p> <p>Background</p> <p>Chronic spinal cord injury (SCI) can lead to an insidious decline in motor and sensory function in individuals even years after the initial injury and is accompanied by a slow and progressive cytoarchitectural destruction. At present, no pathological mechanisms satisfactorily explain the ongoing degeneration.</p> <p>Methods</p> <p>Adult female Sprague-Dawley rats were anesthetized laminectomized at T10 and received spinal cord contusion injuries with a force of 250 kilodynes using an Infinite Horizon Impactor. Animals were randomly distributed into 5 groups and killed 1 (n = 4), 28 (n = 4), 120 (n = 4), 450 (n = 5), or 540 (n = 5) days after injury. Morphometric and immunohistochemical studies were then performed on 1 mm block sections, 6 mm cranial and 6 mm caudal to the lesion epicenter. The SPSS 11.5 t test was used to determine differences between quantitative measures.</p> <p>Results</p> <p>Here, we document the first report of an ascending central canal dilation and progressive ependymal disruption cranial to the epicenter of injury in a contusion model of chronic SCI, which was characterized by extensive dural fibrosis and intraparenchymal cystic cavitation. Expansion of the central canal lumen beyond a critical diameter corresponded with ependymal cell ciliary loss, an empirically predictable thinning of the ependymal region, and a decrease in cell proliferation in the ependymal region. Large, aneurysmal dilations of the central canal were accompanied by disruptions in the ependymal layer, periependymal edema and gliosis, and destruction of the adjacent neuropil.</p> <p>Conclusion</p> <p>Cells of the ependymal region play an important role in CSF homeostasis, cellular signaling and wound repair in the spinal cord. The possible effects of this ascending pathology on ependymal function are discussed. Our studies suggest central canal dilation and ependymal region disruption as steps in the pathogenesis of chronic SCI, identify central canal dilation as a marker of chronic SCI and provide novel targets for therapeutic intervention.</p

Lymphatic Clearance of the Brain: Perivascular, Paravascular and Significance for Neurodegenerative Diseases

The lymphatic clearance pathways of the brain are different compared to the other organs of the body and have been the subject of heated debates. Drainage of brain extracellular fluids, particularly interstitial fluid (ISF) and cerebrospinal fluid (CSF), is not only important for volume regulation, but also for removal of waste products such as amyloid beta (A?). CSF plays a special role in clinical medicine, as it is available for analysis of biomarkers for Alzheimer’s disease. Despite the lack of a complete anatomical and physiological picture of the communications between the subarachnoid space (SAS) and the brain parenchyma, it is often assumed that A? is cleared from the cerebral ISF into the CSF. Recent work suggests that clearance of the brain mainly occurs during sleep, with a specific role for peri- and para-vascular spaces as drainage pathways from the brain parenchyma. However, the direction of flow, the anatomical structures involved and the driving forces remain elusive, with partially conflicting data in literature. The presence of A? in the glia limitans in Alzheimer’s disease suggests a direct communication of ISF with CSF. Nonetheless, there is also the well-described pathology of cerebral amyloid angiopathy associated with the failure of perivascular drainage of A?. Herein, we review the role of the vasculature and the impact of vascular pathology on the peri- and para-vascular clearance pathways of the brain. The different views on the possible routes for ISF drainage of the brain are discussed in the context of pathological significance

Case Study: Imaging of Apnea Termination in a Patient with Obstructive Sleep Apnea during Natural Sleep

A 55-year-old woman who presented to the sleep clinic with severe sleep apnea (OSA) (apnea-hypopnea index [AHI] 62) and excessive somnolence (Epworth Sleepiness Scale score 18/24), was imaged with MRI using the Spatial Modulation of Magnetization tagging sequence awake and asleep to visualize upper airway tissue movement. Awake quiet breathing resulted in minimal movement of upper airway tissues. Asleep sequences taken during airway opening post-apnea demonstrated neck extension, mandibular advancement, and widespread tongue deformation accompanying contraction of genioglossus. At the end of the asleep image sequence, the nasopharyngeal airway had a cross-sectional area larger than during quiet breathing awake and there was antero-lateral movement in the lateral walls. In conclusion, the airway responds to apnea by widespread contraction of the genioglossus, followed by mandibular advancement and neck extension. All these maneuvers stabilize and open the airway

Sources of child restraint information utilized by parents in NSW

Abstract Suboptimal child restraint practices are widespread and parental knowledge about child restraint use influences child restraint practices. In this analysis we examine parent-reported sources of child restraint information and their influence on observed child restraint practices. Data collected during a crosssectional study of restraint use among 503 NSW children aged 0-12 years was used in this analysis. Few children were unrestrained (&lt;1%) but the prevalence of suboptimal restraint use was high (38% moderately or seriously incorrect, 52% inappropriate). Approximately one in five parents reported having obtained information about child restraints within the 6 months prior to observation. The primary information sources were the RTA (27%), health providers, e.g. child health clinics and ante-natal programs, (11%) and the media (17%). There were significant associations between information source and appropriateness of restraint, but no association with correctness of restraint use. Parents of the youngest children were more likely to get information from health providers and parents of older children more likely to use other sources. Of the 302 child restraint users, one third had parents who reported using a restraint fitting station. These children were significantly more likely to be appropriately restrained. However there was no association between fitting station use and correctness of restraint use. This information is useful for the development of targeted optimal restraint campaigns, and suggests a need for a broader review of how and what messages are being delivered by different information providers

Identification of insects, spiders and mites in vegetable crops: Trainer's handbook

The trainers manual provides workshop plans and sample slides for trainers wishing to conduct the 'Identification of insects, spiders and mites in vegetable crops' workshop