Evaluating the role of Cardiac Genetics Nurses in inherited cardiac conditions services using a Maturity Matrix

Background: Cardiovascular disease is a leading cause of death worldwide and genetic risk factors play a role in nearly all such cases. In the UK, health service capacity to meet either current or future estimated needs of people affected by inherited cardiac conditions (ICC) is inadequate. In 2008 the British Heart Foundation funded nine three-year Cardiac Genetic Nurses (CGN) posts across England and Wales to enhance ICC services. The CGNs were experienced cardiac nurses who had additional training in genetics and acted to coordinate cardiac and genetics service activities. Aim: To create and apply a framework against which progress in ICC service improvement could be measured over time following the CGN appointments. Methods: A performance grid (Maturity Matrix) articulating standards in 5 domains against stages of ICC service development was created by stakeholders through a consensus approach. The Maturity Matrix (MM) was used to guide staged self-assessments by the CGNs between 2009-2011. A 6-point scale was used to locate progress from ‘emerging’ to ‘established’, represented graphically by spider diagrams. Results: Progress in all domains was significant for new, emerging and established services. It was most notable for effective utilisation of care pathways and efficient running of clinics. Commitment to family-centred care was evident. Conclusion: The ICC-MM provided a comprehensive framework for assessing ICC services and has merit in providing guidance on development. Cardiac genetics nurses can help integrate care across specialisms, facilitating the development of effective and sustainable ICC services at new, developing, and more established ICC service locations.Full text available via open access at journal website.British Heart Foundatio

Reciprocal associations between parental feeding practices and child eating behaviours from toddlerhood to early childhood: bivariate latent change analysis in the Gemini cohort

BACKGROUND: Parental feeding practices (PFPs) are a key component of a child's food environment. Parent-child feeding relationships are hypothesised to be bidirectional; however, to date, few large prospective studies have examined this, instead focussing on unidirectional relationships. As such, the direction of relationships between PFPs and children's eating behaviours remains unclear. METHODS: Data were from Gemini, a population-based sample of children born in England and Wales in 2007. Children's eating behaviours and PFPs were measured at 15/16 months and 5 years using validated psychometric measures (n = 1,858 children). Bivariate Latent Change Score Modelling was used to examine the nature of relationships between PFPs and children's eating behaviours at 15/16 months and 5 years. Models were adjusted to account for clustering of twins within families and for sex of the child, socioeconomic status, gestational age and age of the child at measurement time points. RESULTS: A reciprocal relationship was observed between instrumental feeding and emotional overeating, with greater instrumental feeding predicting greater increases in emotional overeating (β = .09; 0.03-0.15; p = .004) and vice versa (β = .09; 0.03-0.15; p = .005). Reciprocity was also observed between encouragement to eat nutritious foods and children's enjoyment of food, with greater encouragement predicting greater increases in enjoyment of food (β = .08; 0.02-0.13; p = .006) and vice versa (β = .07; 0.02-0.11; p = .003). Parent-child associations and child-parent associations were also observed. CONCLUSION: These findings are consistent with the hypothesis that certain feeding practices are used as a 'natural' response to a child expressing a greater interest in and enthusiasm for food, but at the same time, such practices impact the development of eating behaviours by nurturing and encouraging the expression of higher emotional overeating and greater enjoyment of food in preschool years. The findings provide important insights into the PFPs and eating behaviour traits that could be targeted as part of a tailored feeding intervention to support parents of children during the preschool formative years

Competitive outreach in the 21st century: Why we need conservation marketing

AbstractAddressing impacts from human activities requires the change of current practices. However, reaching a target audience about conservation issues and influencing their behaviour is not easy in a world where people are continually bombarded with information, and distractions are permanently available. Although not typically considered to be part of the conservation science toolbox, marketing techniques were designed in the commercial sector to identify and influence human preferences and behaviour by placing target audiences at the core of the marketing process. It thus seems reasonable that the same marketing principles and tools could and should be used to address pressing conservation issues. In this manuscript, we provide an introduction to the main objectives of marketing and illustrate how these can be applied to conservation and animal welfare issues. To that end we offer two examples: Project Ocean, where a major UK retailer joined forces with the Zoological Society of London to influence consumer behaviour around seafood; and Blackfish, which coupled social media with an award-winning documentary to create a discussion around the welfare of large cetaceans in captivity. Without the ability to influence human behaviour, a conservationists' role will likely be limited to that of describing the loss of biodiversity and the decline of the environment. We thus hope that conservation practitioners can embrace marketing as a fundamental component of the conservation toolbox

Divergent roles for antigenic drive in the aetiology of primary versus dasatinib-associated CD8(+) TCR-Vβ(+) expansions

CD8(+) T-cell expansions are the primary manifestation of T-cell large granular lymphocytic leukemia (T-LGLL), which is frequently accompanied by neutropenia and rheumatoid arthritis, and also occur as a secondary phenomenon in leukemia patients treated with dasatinib, notably in association with various drug-induced side-effects. However, the mechanisms that underlie the genesis and maintenance of expanded CD8(+) T-cell receptor (TCR)-V beta(+) populations in these patient groups have yet to be fully defined. In this study, we performed a comprehensive phenotypic and clonotypic assessment of expanded (TCR-V beta(+)) and residual (TCR-V beta(-)) CD8(+) T-cell populations in T-LGLL and dasatinib-treated chronic myelogenous leukemia (CML) patients. The dominant CD8(+) TCR-V beta(+) expansions in T-LGLL patients were largely monoclonal and highly differentiated, whereas the dominant CD8(+) TCR-V beta(+) expansions in dasatinib-treated CML patients were oligoclonal or polyclonal, and displayed a broad range of memory phenotypes. These contrasting features suggest divergent roles for antigenic drive in the immunopathogenesis of primary versus dasatinib-associated CD8(+) TCR-V beta(+) expansions.Peer reviewe

Implementing Voluntary Medical Male Circumcision for HIV Prevention in Nyanza Province, Kenya: Lessons Learned during the First Year

In 2007, the World Health Organization endorsed male circumcision as an effective HIV prevention strategy. In 2008, the Government of Kenya (GoK) launched the national voluntary medical male circumcision (VMMC) program in Nyanza Province, the geographic home to the Luo, the largest non-circumcising ethnic group in Kenya. Currently, several other African countries are in the early stages of implementing this intervention.This paper uses data from a health facility needs assessment (n = 81 facilities) and a study to evaluate the implementation of VMMC services in 16 GoK facilities (n = 2,675 VMMC clients) to describe Kenya's experience in implementing the national program. The needs assessment revealed that no health facility was prepared to offer the minimum package of services as outlined by the national guidelines, and partner organizations were called upon to fill this gap. The findings concerning human resource shortages facilitated the GoK's decision to endorse trained nurses to provide VMMCs, enabling more facilities to offer the service. Findings from the evaluation study resulted in replacing voluntary counseling and testing (VCT) with provider-initiated testing and counseling (PITC) and subsequently doubling the proportion of VMMC clients tested for HIV.This paper outlines how certain challenges, like human resource shortages and low HIV test rates, were addressed through national policy changes, while other challenges, like large fluctuations in demand, were addressed locally. Currently, the program requires significant support from partner organizations, but a strategic plan is under development to continue to build capacity in GoK staff and facilities. Coordination between all parties was essential and was facilitated through the formation of national, provincial, and district VMMC task forces. The lessons learned from Kenya's VMMC implementation experience are likely generalizable to other African countries

Examining parent mood, feeding context, and feeding goals as predictors of feeding practices used by parents of preschool children with avid eating behavior: Protocol for an ecological momentary assessment study

Background: An avid eating behavior profile is characterized by a greater interest in food and a tendency to overeat in response to negative emotions. Parents use specific strategies to manage feeding interactions with children with avid eating behavior. While momentary and contextual factors, such as parental mood, have been found to influence parental feeding practices, there is a lack of research examining parents’ daily experiences of feeding children with avid eating behavior. Examining this is important because parental feeding practices are key levers in tailored interventions to support children’s healthy eating behavior. Objective: We aim to describe the ecological momentary assessment methods and procedures used in the APPETItE (Appetite in Preschoolers: Producing Evidence for Tailoring Interventions Effectively) project, which aims to examine how variation in parental mood, feeding goals, and the context of eating occasions affect the parental feeding practices used to manage feeding interactions with children with an avid eating behavior profile. Methods: Participants are primary caregivers from the APPETItE cohort who have a preschool-age child (aged 3-5 years) with an avid eating behavior profile. Caregivers complete a 10-day ecological momentary assessment period using signal- and event-contingent surveys to examine (1) mood and stress, (2) parental feeding goals, and (3) contextual factors as predictors of parental feeding practices. Results: Recruitment and data collection began in October 2023 and is expected to be completed by spring 2024. The data have a 3-level structure: repeated measurements (level 1) nested within days (level 2) nested within an individual (level 3). Thus, lag-dependent models will be conducted to test the main hypotheses. Conclusions: The findings from this study will provide an understanding of caregivers’ daily experiences of feeding preschool children with avid eating behavior, who are at greater risk for the development of obesity. Understanding the predictors of feeding practices at the moment they occur, and across various contexts, will inform the development of tailored resources to support caregivers in managing children’s avid eating behavior. International Registered Report Identifier (IRRID): DERR1-10.2196/5519

Associations between Parent and Child Latent Eating Profiles and the Role of Parental Feeding Practices

Previous research employing the person-centred approach of Latent Profile Analysis (LPA) with parent-reported data of their child’s eating behaviour identified four distinct eating profiles in 3-6-year-old children: typical, avid, happy, and avoidant eating (Pickard et al., 2023). In this follow-up study, the same parents were asked to self-report their own eating behaviour (N=785) and LPA was conducted to determine the latent eating profiles of the parents/caregivers. The LPA showed that a four-profile solution best represented the sample of parents, termed: typical eating (n = 325, 41.4%), avid eating (n = 293, 37.3%), emotional eating (n = 123, 15.7%) and avoidant eating (n = 44, 5.6%). Multiple mediation analysis was then conducted to examine both the direct associations between parents’ eating profiles and the child’s probability of eating profile membership, as well as the indirect associations through the mediatory role of specific parental feeding practices. The results suggested direct links between parent and child eating profiles, with the 'avid eating' and 'avoidant eating' profiles in parents predicting similar profiles in their children. Feeding practices, such as using food for emotional regulation, providing balanced and varied food, and promoting a healthy home food environment, mediated associations between parent and child eating profiles. This research provides novel evidence to reinforce the need for interventions to be specifically tailored to both the parent's and child’s eating profiles. The work also provides an interesting avenue for future longitudinal examination of whether the parents' provision of a healthy home food environment could protect against intergenerational transmission of less favourable eating behaviours

Prospective associations between parental feeding practices used in toddlerhood and preschool children's appetite vary according to appetite avidity in toddlerhood

Parental feeding practices are a key modifiable component of children's food environments. Evidence suggests that certain feeding practices may differentially influence children's eating behaviour or weight, depending on the child's temperament (e.g. emotionality). Building on this work, we tested the hypothesis that feeding practices during toddlerhood influence children's developing eating behaviours differently, depending on their appetite avidity (which is characterised by a larger appetite and greater interest in food). Data were from Gemini, a population-based cohort of British twin children born in 2007. Parental feeding practices were assessed at 15-months, and child appetite at 15-months and 5-years, using validated psychometric measures (n = 1858 children). Complex samples general linear models examined prospective associations between PFPs at 15-months and child appetitive traits at 5-years, adjusting for clustering of twins within families and for the corresponding child appetitive trait at 15-months, difference in age between timepoints, child sex, gestational age, and socioeconomic status. Moderation analyses revealed that pressuring a child to eat led to greater increases in emotional overeating from 15-months to 5-years, only for children with high (1 SD above the mean: B = 0.13; SE± = 0.03,