Qualitative evaluation of Australian Caregiver's experiences of parent–child interaction therapy delivered in a community-based clinic setting

Background: Parent–child interaction therapy (PCIT) is a short-term, evidence-based parent training program for parents of children aged 2–7 years with disruptive behaviour disorders (DBDs). The evidence-base for the effectiveness of PCIT is extensive but to date most studies have been quantitative in nature and conducted in university research clinics within the United States. Thus, understanding of the effectiveness and acceptability of PCIT in community-based settings in other countries, including Australia, is limited. Objective: This study used a qualitative methodology to explore Australian caregiver's perceptions of a standard PCIT program delivered at a community-based PCIT clinic. Method: Participants were nine mothers and one father who completed the PCIT program at the clinic for treatment of child DBD. Results: Thematic analysis yielded four major themes, namely “Parenting challenges before PCIT”; “Positive treatment outcomes” (sub-themes: improved child behaviour, increased parental confidence, increased insight into the child needs, and improved relationships with partner); “Program strengths” (sub-themes: child-directed interaction, parent-directed interaction, home practice, therapeutic relationship); and “Challenges experienced.”. Conclusions: These findings highlight the benefits of the PCIT program for families who are struggling with DBD in early childhood, and point to the potential positive impacts of disseminating PCIT within clinical settings more widely across Australia

(Re)considering equity, inclusion and belonging in the updating of the early years learning framework for Australia: The potential and pitfalls of book sharing

Few would dispute the importance of equity, inclusion and belonging in early childhood education and care, yet translation into meaningful practice rarely centres the priorities of historically divested communities. The national learning framework for early childhood in Australia is the Early Years Learning Framework, positioning the child as a capable agent and describing inclusive, culturally competent practice. This article presents part of a larger study investigating educators’ beliefs and practices when using culturally diverse literature to address the Early Years Learning Framework’s diversity principles. A critical theoretical framework enables a robust examination of how the Early Years Learning Framework constructs, maintains, legitimises and/or disaffirms social inequities, implicitly probing how literacy education mediate/s messages children receive about their identity, cultures and roles in society. The findings suggest that instead of pursuing anti-racism and transformative justice, educators’ pedagogical practices were likely to legitimise existing racist structures. The findings are discussed in relation to 20 recommendations published by a consortium of experts in the updating of the Early Years Learning Framework. The implementation of the updated Early Years Learning Framework must act on questions of justice for whom and according to whom. To move to ideologies, methodologies and pedagogies of potentiality, it is necessary to interrogate and reject oppressive and harmful practices, inaccurate and insensitive portrayals, and pedagogies damaging to Black, Indigenous, and other communities of Color which this study shows have beenevident in the EYLF to date

Brain Differently Changes Its Algorithms in Parallel Processing of Visual Information

Feedback from the visual cortex (Vl) to the Lateral Geniculate Nucleus (LGN) in macaque monkey increase contrast gain of LGN neurons for black and white (B&W) and for color (C) stimuli. LGN parvocellular cells responses to B&W gratings are enhanced by feedback multiplicatively and in contrast independent manner. However, in magnocellular neurons corticofugal pathways enhance cells responses in a contrast~dependent non-linear manner. For C stimuli cortical feedback enhances parvocellular neurons responses in a very strong contrast-dependent manner. Based on these results [13] we propose a model which includes excitatory and inhibitory effects on cells activity (shunting equations) in retina and LGN while taking into account the anatomy of cortical feedback connections. The main mechanisms related to different algorithms of the data processing in the visual brain are differences in feedback properties from Vl to parvocellular (PC) and to magnocellular (MC) neurons. Descending pathways from Vl change differently receptive field (RF) structure of PC and MC cells. For B&W stimuli, in PC cells feedback changes gain similarly in the RF center and in the RF surround, leaving PC RF structure invariant. However, feedback influence MC cells in two ways: directly and through LGN interneurons, which together changes gain and sizes of their RF center differently than gain and size of the RF surround. For C stimuli PC cells operate like MC cells for B&W. The first mechanism extracts from the stimulus an important features in a independent way from other stimulus parameters, whereas the second channel changes its tuning properties as a function of other stimulus attributes like contrast and/or spatial extension. The model suggests novel idea about the possible functional role of PC and MC pathways

Event-Free Survival in Adults With Heart Failure who Engage in Self-Care Management

Background Self-care management in heart failure (HF) involves decision-making to evaluate, and actions to ameliorate symptoms when they occur. This study sought to compare the risks of all-cause mortality, hospitalization, or emergency-room admission among HF patients who practice above-average self-care management, those who practice below-average self-care management, and those who are symptom-free. Methods A secondary analysis was conducted of data collected on 195 HF patients. A Cox proportional hazards model was used to examine the association between self-care management and event risk. Results The sample consisted of older (mean ± standard deviation = 61.3 ± 11 years), predominantly male (64.6%) adults, with an ejection fraction of 34.7% ± 15.3%; 60.1% fell within New York Heart Association class III or IV HF. During an average follow-up of 364 ± 288 days, 4 deaths, 82 hospitalizations, and 5 emergency-room visits occurred as first events. Controlling for 15 common confounders, those who engaged in above-average self-care management (hazard ratio, .44; 95% confidence interval, .22 to .88; P \u3c .05) and those who were symptom-free (hazard ratio, 0.48; 95% confidence interval, .24 to .97; P \u3c .05) ran a lower risk of an event during follow-up than those engaged in below-average self-care management. Conclusion Symptomatic HF patients who practice above-average self-care management have an event-free survival benefit similar to that of symptom-free HF patients

Using Growth Mixture Modeling to Identify Classes of Sodium Adherence in Adults with Heart Failure

BACKGROUND: The prevention of fluid retention is important to reduce hospitalizations in patients with heart failure (HF). Following a low-sodium diet helps to reduce fluid retention. OBJECTIVE: The primary objective of this study was to use growth mixture modeling to identify distinct classes of sodium adherence-characterized by shared growth trajectories of objectively measured dietary sodium. The secondary objective was to identify patient-level determinants of the nonadherent trajectory. METHODS: This was a secondary analysis of data collected from a prospective longitudinal study of 279 community-dwelling adults with previously or currently symptomatic HF. Growth mixture modeling was used to identify distinct trajectories of change in 24-hour urinary sodium excretion measured at 3 time points over 6 months. Logistic modeling was used to predict membership in observed trajectories. RESULTS: The sample was predominantly male (64%), had a mean age of 62 years, was functionally compromised (59% New York Heart Association class III), and had nonischemic HF etiology. Two distinct trajectories of sodium intake were identified and labeled adherent (66%) and nonadherent (34%) to low-sodium diet recommendations. Three predictors of the nonadherent trajectory were identified, confirming our previous mixed-effect analysis. Compared with being normal weight (body mass index/m2), being overweight and obese was associated with a 4-fold incremental increase in the likelihood of being in the nonadherent trajectory (odds ratio [OR], 4.63; 95% confidence interval [CI], 1.66-12.91; P \u3c .002). Being younger than 65 years (OR, 4.66; 95% CI, 1.04-20.81; P = .044) or having diabetes (OR, 4.15; 95% CI, 1.29-13.40; P = .016) were both associated with more than 4 times the odds of being in the nonadherent urine sodium trajectory compared with being older than 65 years or not having diabetes, respectively. CONCLUSIONS: Two distinct trajectories of sodium intake were identified in patients with HF. The nonadherent trajectory was characterized by an elevated pattern of dietary sodium intake shown by others to be associated with adverse outcomes in HF. Predictors of the nonadherent trajectory included higher body mass index, younger age, and diabetes

Multimodal phantoms for clinical PET/MRI

Phantoms are commonly used throughout medical imaging and medical physics for a multitude of applications, the designs of which vary between modalities and clinical or research requirements. Within positron emission tomography (PET) and nuclear medicine, phantoms have a well-established role in the validation of imaging protocols so as to reduce the administration of radioisotope to volunteers. Similarly, phantoms are used within magnetic resonance imaging (MRI) to perform quality assurance on clinical scanners, and gel-based phantoms have a longstanding use within the MRI research community as tissue equivalent phantoms. In recent years, combined PET/MRI scanners for simultaneous acquisition have entered both research and clinical use. This review explores the designs and applications of phantom work within the field of simultaneous acquisition PET/MRI as published over the period of a decade. Common themes in the design, manufacture and materials used within phantoms are identified and the solutions they provided to research in PET/MRI are summarised. Finally, the challenges remaining in creating multimodal phantoms for use with simultaneous acquisition PET/MRI are discussed. No phantoms currently exist commercially that have been designed and optimised for simultaneous PET/MRI acquisition. Subsequently, commercially available PET and nuclear medicine phantoms are often utilised, with CT-based attenuation maps substituted for MR-based attenuation maps due to the lack of MR visibility in phantom housing. Tissue equivalent and anthropomorphic phantoms are often developed by research groups in-house and provide customisable alternatives to overcome barriers such as MR-based attenuation correction, or to address specific areas of study such as motion correction. Further work to characterise materials and manufacture methods used in phantom design would facilitate the ability to reproduce phantoms across sites

Identifying Predictors of High Sodium Excretion in Patients with Heart Failure: A Mixed Effect Analysis of Longitudinal Data

BACKGROUND: A low-sodium diet is a core component of heart failure self-care but patients have difficulty following the diet. AIM: The aim of this study was to identify predictors of higher than recommended sodium excretion among patients with heart failure. METHODS: The World Health Organization Five Dimensions of Adherence model was used to guide analysis of existing data collected from a prospective, longitudinal study of 280 community-dwelling adults with previously or currently symptomatic heart failure. Sodium excretion was measured objectively using 24-hour urine sodium measured at three time points over six months. A mixed effect logistic model identified predictors of higher than recommended sodium excretion. RESULTS: The adjusted odds of higher sodium excretion were 2.90, (95% confidence interval (CI): 1.15-4.25, pp=0.007) for patients with diabetes; and 2.22 (95% CI: 1.09-4.53, p=0.028) for patients who were cognitively intact. CONCLUSION: Three factors were associated with excess sodium excretion and two factors, obesity and diabetes, are modifiable by changing dietary food patterns

Biomarkers of Myocardial Stress and Systemic Inflammation in Patients Who Engage in Heart Failure Self-Care Management

Background: Self-care is believed to improve heart failure (HF) outcomes, but the mechanisms by which such improvement occurs remain unclear. Methods: We completed a secondary analysis of cross-sectional data collected on adults with symptomatic HF to test our hypothesis that effective self-care is associated with less myocardial stress and systemic inflammation. Multivariate logistic regression modeling was used to determine if better HF self-care reduced the odds of having serum levels of amino-terminal pro-B-type natriuretic peptide and soluble tumor necrosis factor α receptor type 1 at or greater than the sample median. Heart failure self-care was measured using the Self-care of Heart Failure Index. Results: The sample (n = 168) was predominantly male (65.5%), and most (50.6%) had New York Heart Association III HF (mean left ventricular ejection fraction, 34.9% [SD, 14.0%]); mean age was 58.8 (SD, 11.5) years. Self-care management was an independent factor in the model (block χ2 = 14.74; P = .005) after controlling for pertinent confounders (model χ2 = 52.15; P \u3c .001). Each 1-point increase in self-care management score (range, 15-100) was associated with a 12.7% reduction in the odds of having levels of both biomarkers at or greater than the sample median (adjusted odds ratio, 0.873; 95% confidence interval, 0.77-0.99; P = .03). Conclusion: Better self-care management was associated with reduced odds of myocardial stress and systemic inflammation over and above pharmacological therapy and other common confounding factors. Teaching HF patients early symptom recognition and self-care of symptoms may decrease myocardial stress and systemic inflammation

Examination of the Potential Association of Stress with Morbidity and Mortality Outcomes in Patient with Heart Failure

OBJECTIVES: The high mortality and morbidity rates associated with heart failure are still not well explained. A few psychosocial factors have been studied and explain some of this risk, but other factors, like stress, remain largely unexplored in heart failure. This study aimed to (1) examine the association of stress with 6-month cardiac event-free survival, (2) examine the relationship of stress with salivary cortisol, and (3) examine the association of salivary cortisol level with 6-month cardiac event-free survival. METHOD: A total of 81 heart failure patients participated. Stress was measured using the brief Perceived Stress Scale. Cortisol was measured from unstimulated whole expectorated saliva. Cox regression analyses were used to determine whether stress predicted event-free survival, and if salivary cortisol predicted event-free survival. Linear and multiple regressions were used to determine the association of stress with salivary cortisol. RESULTS: Stress was not a significant predictor of event-free survival in heart failure (heart rate = 1.06; 95% confidence interval = 0.95-1.81; p = 0.32). Salivary cortisol was a significant predictor of event-free survival in the unadjusted model (heart rate = 2.30; 95% confidence interval = 0.99-5.927; p = 0.05), but not in the adjusted model. Stress (β 1.06; 95% confidence interval = 0.95-1.18; p = 0.32) was not a significant predictor of salivary cortisol level. CONCLUSION: Stress is a complex phenomenon, and our measure of stress may not have captured it well. Alternatively, the physical stressors acting in heart failure produce levels of neurohormonal activation that mask the effects of psychosocial stressors or an indirect association of stress with outcomes that is mediated through another construct. Future studies are needed to investigate stress in patients with heart failure to provide definitive answers

Improved prediction equations for estimating height in adults from ethnically diverse backgrounds

Background & aims When body height cannot be measured, it can be predicted from ulna length (UL). However, commonly used published prediction equations may not provide useful estimates in adults from all ethnicities. This study aimed to evaluate the relationship between UL and height in adults from diverse ethnic groups and to consider whether this can be used to provide useful prediction equations for height in practice. Methods Standing height and UL were measured in 542 adults at seven UK locations. Ethnicity was self-defined using UK Census 2011 categories. Data were modelled to give two groups of height prediction equations based on UL, sex and ethnicity and these were tested against an independent dataset (n = 180). Results UL and height were significantly associated overall and in all groups except one with few participants (P = 0.059). The new equations yielded predicted height (H p) that was closer to measured height in the Asian and Black subgroups of the independent population than the Malnutrition Universal Screening Tool (MUST) equations. For Asian men, (H p (cm) = 3.26 UL (cm) + 83.58), mean difference from measured (95% confidence intervals) was −0.6 (−2.4, +1.2); Asian women, (H p = 3.26 UL + 77.62), mean difference +0.5 (−1.4, 2.4) cm. For Black men, H p = 3.14 UL + 85.80, −0.4 (−2.4, 1.7); Black women, H p = 3.14 UL + 79.55, −0.8 (−2.8, 1.2). These differences were not statistically significant while predictions from MUST equations were significantly different from measured height. Conclusions The new prediction equations provide an alternative for estimating height in adults from Asian and Black groups and give mean predicted values that are closer to measured height than MUST equations