Effectiveness of nurse home-visiting for disadvantaged families: results of a natural experiment

Extent: 9p.Objective: To evaluate the effects of a postnatal home-visiting programme delivered by community health nurses to socially disadvantaged mothers in South Australia. Design: The intervention group of 428 mothers lived in metropolitan Adelaide and the comparison group of 239 mothers lived in regional towns where the programme was not yet available. All participating mothers met health service eligibility criteria for enrolment in the home-visiting programme. Participants in both groups were assessed at baseline (mean child age=14.4 weeks SD=2.3), prior to programme enrolment, and again when the children were aged 9, 18 and 24 months. Setting: State-wide community child health service. Participants: 667 socially disadvantaged mothers enrolled consecutively. 487 mothers (73%) completed the 24-month assessment. Intervention: Two-year postnatal home-visiting programme based on the Family Partnership Model. Primary outcome measures: Parent Stress Index (PSI), Kessler Psychological Distress Scale and the Ages and Stages Questionnaire. Results: Mixed models adjusting for baseline differences were used to compare outcomes in the two groups. The mothers in the home-visiting group reported greater improvement on the PSI subscales assessing a mother's perceptions on the quality of their relationship with their child (1.10, 95% CI 0.06 to 2.14) and satisfaction with their role as parents (0.46, 95% CI −0.15 to 1.07) than mothers in the comparison group. With the exception of childhood sleeping problems, there were no other significant differences in the outcomes across the two groups. Conclusions: The findings suggest that home-visiting programmes delivered by community health nurses as part of routine clinical practice have the potential to improve maternal–child relationships and help mothers adjust to their role as parents.Michael Gifford Sawyer, Linda Frost, Kerrie Bowering, John Lync

Nurse perceptions of family home-visiting programs in Australia and England

Aims: Nurse home-visiting programs are employed to enhance the functioning of disadvantaged mothers and young children. Despite the key role played by nurses, there is little empirical evidence describing the views and experiences of nurses who deliver home-visiting programs. This study compared the views and experiences of nurses delivering home-visiting programs in England and South Australia. Methods: Participants were 108 nurses delivering the South Australian Family Home Visiting program (2008 – 2011), and 44 nurses delivering the Family Nurse Partnership program in England (2007 – 2009). Data were collected using a standard questionnaire that was completed by nurses in each country. The questionnaire asked nurses about their level of influence on program outcomes, approaches they used to retain maternal engagement with the home-visiting programs, barriers to effective program delivery and the effectiveness of supervision. Results: Both groups of nurses considered that their greatest influence was improving mothers’ confidence with parenting skills and increasing mothers’ knowledge about children's development. Each group identified quality of nurse-mother relationships as the factor most relevant to retaining maternal engagement. Other influential factors were flexibility of timing for visits and the capacity of the programs to meet specific needs of mothers

Mix design considerations of foamed bitumen mixtures with reclaimed asphalt pavement material

In the present work, a mix design parametric study was carried out with the aim of proposing a practical and consistent mix design procedure for foamed bitumen mixtures (FBMs). The mix design parameters that were adopted in the study are mixing and compaction water content (MWC), compaction effort using a gyratory compactor and aggregate temperature. This parametric study was initially carried out on FBMs with virgin limestone aggregate without reclaimed asphalt pavement (RAP) material and a mix design procedure was proposed. This proposed methodology was also found to apply to FBMs with RAP. A detailed consideration was also given to characterising the RAP material so as to understand its contribution to the mechanical properties of FBMs. Optimum MWC was achieved by optimising mechanical properties such as indirect tensile stiffness modulus and indirect tensile strength (ITS-dry and ITS-wet). A rational range of 75–85% of optimum water content obtained by the modified Proctor test was found to be the optimum range of MWC that gives optimum mechanical properties for FBMs. It was also found that the presence of RAP influenced the design foamed bitumen content, which means that treating RAP as black rock in FBM mix design is not appropriate. To study the influence of bitumen and water during compaction, modified Proctor compaction and gyratory compaction were employed on mixes with varying amounts of water and bitumen. By this, the work also evaluated the validity of the total fluid (water + bitumen) concept that is widely used in bitumen–emulsion-treated mixes, and found it not to be applicable

Usage, adherence and attrition: how new mothers engage with a nurse-moderated web-based intervention to support maternal and infant health. A 9-month observational study

Objectives: To identify factors predicting use, adherence and attrition with a nurse-moderated webbased group intervention designed to support mothers of infants aged 0–6 months. Design: 9-Month observational study. Setting: Community maternal and child health service. Participants: 240 mothers attending initial postnatal health checks at community clinics who were randomly assigned to the intervention arm of a pragmatic preference randomised trial (total randomised controlled trial, n=819; response rate=45%). Intervention: In the first week (phase I), mothers were assisted with their first website login by a research assistant. In weeks 2–7 (phase II), mothers participated in the web-based intervention with an expectation of weekly logins. The web-based intervention was comparable to traditional face-to-face new mothers’ groups. During weeks 8–26 (phase III), mothers participated in an extended programme at a frequency of their choosing. Primary outcome measures: Number of logins and posted messages. Standard self-report measures assessed maternal demographic and psychosocial characteristics. Results: In phase II, the median number of logins was 9 logins (IQR=1–25), and in phase III, it was 10 logins (IQR=0–39). Incident risk ratios from multivariable analyses indicated that compared to mothers with the lowest third of logins in phase I, those with the highest third had 6.43 times as many logins in phase II and 7.14 times in phase III. Fifty per cent of mothers logged-in at least once every 30 days for 147 days after phase I and 44% logged-in at least once in the last 30 days of the intervention. Frequency of logins during phase I was a stronger predictor of mothers’ level of engagement with the intervention than their demographic and psychosocial characteristics. Conclusions: Mothers’ early use of web-based interventions could be employed to customise engagement protocols to the circumstances of individual mothers with the aim of improving adherence and reducing attrition with web-based interventions.Michael G Sawyer, Christy E Reece, Kerrie Bowering, Debra Jeffs, Alyssa C P Sawyer, Jacqueline D Peters, Christine Mpundu-Kaambwa, Jennifer J Clark, Denise McDonald, Murthy N Mittinty, John W Lync

Nurse-moderated internet-based support for new mothers: non-inferiority, randomized controlled trial

Background: Internet-based interventions moderated by community nurses have the potential to improve support offered to new mothers, many of whom now make extensive use of the Internet to obtain information about infant care. However, evidence from population-based randomized controlled trials is lacking. Objective: The aim of this study was to test the non-inferiority of outcomes for mothers and infants who received a clinic-based postnatal health check plus nurse-moderated, Internet-based group support when infants were aged 1-7 months as compared with outcomes for those who received standard care consisting of postnatal home-based support provided by a community nurse. Methods: The design of the study was a pragmatic, preference, non-inferiority randomized control trial. Participants were recruited from mothers contacted for their postnatal health check, which is offered to all mothers in South Australia. Mothers were assigned either (1) on the basis of their preference to clinic+Internet or home-based support groups (n=328), or (2) randomly assigned to clinic+Internet or home-based groups if they declared no strong preference (n=491). The overall response rate was 44.8% (819/1827). The primary outcome was parenting self-competence, as measured by the Parenting Stress Index (PSI) Competence subscale, and the Karitane Parenting Confidence Scale scores. Secondary outcome measures included PSI Isolation, Interpersonal Support Evaluation List-Short Form, Maternal Support Scale, Ages and Stages Questionnaire-Social-Emotional and MacArthur Communicative Development Inventory (MCDI) scores. Assessments were completed offline via self-assessment questionnaires at enrolment (mean child age=4.1 weeks, SD 1.3) and again when infants were aged 9, 15, and 21 months. Results: Generalized estimating equations adjusting for post-randomization baseline imbalances showed that differences in outcomes between mothers in the clinic+Internet and home-based support groups did not exceed the pre-specified margin of inferiority (0.25 of a SD) on any outcome measure at any follow-up assessment, with the exception of MCDI scores assessing children's language development at 21 months for randomized mothers, and PSI Isolation scores at 9 months for preference mothers. Conclusion: Maternal and child outcomes from a clinic-based postnatal health check plus nurse-moderated Internet-based support were not inferior to those achieved by a universal home-based postnatal support program. Postnatal maternal and infant support using the Internet is a promising alternative to home-based universal support programs.Michael G Sawyer, Christy E Reece, Kerrie Bowering, Debra Jeffs, Alyssa CP Sawyer, Murthy Mittinty, John W Lync

Accelerated stem cell labeling with ferucarbotran and protamine

To develop and characterize a clinically applicable, fast and efficient method for stem cell labeling with ferucarbotran and protamine for depiction with clinical MRI. The hydrodynamic diameter, zeta potential and relaxivities of ferucarbotran and varying concentrations of protamine were measured. Once the optimized ratio was found, human mesenchymal stem cells (MSCs) were labeled at varying incubation times (1–24 h). Viability was assessed via Trypan blue exclusion testing. 150,000 labeled cells in Ficoll solution were imaged with T1-, T2- and T2*-weighted sequences at 3 T, and relaxation rates were calculated. Varying the concentrations of protamine allows for easy modification of the physicochemical properties. Simple incubation with ferucarbotran alone resulted in efficient labeling after 24 h of incubation while assisted labeling with protamine resulted in similar results after only 1 h. Cell viability remained unaffected. R2 and R2* relaxation rates were drastically increased. Electron microscopy confirmed intracellular iron oxide uptake in lysosomes. Relaxation times correlated with results from ICP-AES. Our results show internalization of ferucarbotran can be accelerated in MSCs with protamine, an approved heparin antagonist and potentially clinically applicable uptake-enhancing agent

The Effect of Enzymatically Polymerised Polyphenols on CD4 Binding and Cytokine Production in Murine Splenocytes

High-molecular weight polymerised polyphenols have been shown to exhibit anti-influenza virus, anti-HIV, and anti-cancer activities. The purpose of this study was to evaluate the immunomodulating activities of enzymatically polymerised polyphenols, and to clarify the underlying mechanisms of their effects. The cytokine-inducing activity of the enzymatically polymerised polyphenols derived from caffeic acid (CA), ferulic acid (FA), and p-coumaric acid (CoA) was investigated using murine splenocytes. Polymerised polyphenols, but not non-polymerised polyphenols, induced cytokine synthesis in murine splenocytes. Polymerised polyphenols induced several cytokines in murine splenocytes, with interferon-γ (IFN-γ) and granulocyte-macrophage colony-stimulating factor (GM-CSF) being the most prominent. The underlying mechanisms of the effects of the polymerised polyphenols were then studied using neutralising antibodies and fluorescent-activated cell sorting (FACS) analysis. Our results show that polymerised polyphenols increased IFN-γ and GM-CSF production in splenocytes. In addition, the anti-CD4 neutralised monoclonal antibody (mAb) inhibited polymerised polyphenol-induced IFN-γ and GM-CSF secretion. Moreover, polymerised polyphenols bound directly to a recombinant CD4 protein, and FACS analysis confirmed that interaction occurs between polymerised polyphenols and CD4 molecules expressed on the cell surface. In this study, we clearly demonstrated that enzymatic polymerisation confers immunoactivating potential to phenylpropanoic acids, and CD4 plays a key role in their cytokine-inducing activity

Macrophage entry mediated by HIV Envs from brain and lymphoid tissues is determined by the capacity to use low CD4 levels and overall efficiency of fusion

AbstractHIV infects macrophages and microglia in the central nervous system (CNS), which express lower levels of CD4 than CD4+ T cells in peripheral blood. To investigate mechanisms of HIV neurotropism, full-length env genes were cloned from autopsy brain and lymphoid tissues from 4 AIDS patients with HIV-associated dementia (HAD). Characterization of 55 functional Env clones demonstrated that Envs with reduced dependence on CD4 for fusion and viral entry are more frequent in brain compared to lymphoid tissue. Envs that mediated efficient entry into macrophages were frequent in brain but were also present in lymphoid tissue. For most Envs, entry into macrophages correlated with overall fusion activity at all levels of CD4 and CCR5. gp160 nucleotide sequences were compartmentalized in brain versus lymphoid tissue within each patient. Proline at position 308 in the V3 loop of gp120 was associated with brain compartmentalization in 3 patients, but mutagenesis studies suggested that P308 alone does not contribute to reduced CD4 dependence or macrophage-tropism. These results suggest that HIV adaptation to replicate in the CNS selects for Envs with reduced CD4 dependence and increased fusion activity. Macrophage-tropic Envs are frequent in brain but are also present in lymphoid tissues of AIDS patients with HAD, and entry into macrophages in the CNS and other tissues is dependent on the ability to use low receptor levels and overall efficiency of fusion

Microscopic simulation of xenon-based optical TPCs in the presence of molecular additives

[EN] We introduce a simulation framework for the transport of high and low energy electrons in xenon-based optical time projection chambers (OTPCs). The simulation relies on elementary cross sections (electron-atom and electron-molecule) and incorporates, in order to compute the gas scintillation, the reaction/quenching rates (atom-atom and atom-molecule) of the first 41 excited states of xenon and the relevant associated excimers, together with their radiative cascade. The results compare positively with observations made in pure xenon and its mixtures with CO2 and CF4 in a range of pressures from 0.1 to 10 bar. This work sheds some light on the elementary processes responsible for the primary and secondary xenon-scintillation mechanisms in the presence of additives, that are of interest to the OTPC technology.DGD is supported by the Ramon y Cajal program (Spain) under contract number RYC-2015-18820. The authors want to acknowledge the RD51 collaboration for encouragement and support during the elaboration of this work, and in particular discussions with F. Resnati, A. Milov, V. Peskov, M. Suzuki and A. F. Borghesani. The NEXT Collaboration acknowledges support from the following agencies and institutions: the European Research Council (ERC) under the Advanced Grant 339787-NEXT; the Ministerio de Economia y Competitividad of Spain under grants FIS2014-53371-C04 and the Severo Ochoa Program SEV-2014-0398; the GVA of Spain under grant PROM-ETEO/2016/120; the Portuguese FCT and FEDER through the program COMPETE, project PTDC/FIS-NUC/2525/2014 and UID/FIS/04559/2013; the U.S. Department of Energy under contracts number DE-AC02-07CH11359 (Fermi National Accelerator Laboratory) and DE-FG02-13ER42020 (Texas A& and the University of Texas at Arlington.Azevedo, C.; Gonzalez-Diaz, D.; Biagi, SF.; Oliveira, CAB.; Henriques, CAO.; Escada, J.; Monrabal, F.... (2018). Microscopic simulation of xenon-based optical TPCs in the presence of molecular additives. Nuclear Instruments and Methods in Physics Research Section A Accelerators Spectrometers Detectors and Associated Equipment. 877:157-172. https://doi.org/10.1016/j.nima.2017.08.049S15717287