Caring for at-risk infants : the experiences of parents with infants on home apnoea monitors : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Nursing Studies at Massey University

Home apnoea monitoring for infants considered to be at risk for sudden infant death syndrome (SIDS) has been available in New Zealand since 1978. In light of the fact that the efficacy of home monitoring is unproven (Krongrad and O'Neill. 1986; Phipps and Drotar, 1990) an understanding of the impact of monitoring on families is essential. In the present study, descriptive case studies (as described by Yin, 1984) are presented of six New Zealand families undertaking the home apnoea monitoring of their infants. Indepth interviews, conducted over a three month period, prospectively explored the experiences of one or more caregivers. Analysis of the data confirmed many of the reported findings from previous (mainly American) studies. In particular, parents perceived their infants to be "at risk" whilst monitored, and tended to become socially isolated because of their reluctance to leave their infants with other caregivers. The false alarms were a serious problem, causing negative arousal in the parents. When the alarms sounded parents found it very difficult to determine whether or not the infant was, or had been apnoeic. The monitor itself became the best indicator of the child's risk status and parents sometimes relied on the monitor to the detriment of other treatment regimes and of surveillance of the infant's condition for problems other than the risk of apnoea. The present study used a systemic family nursing perspective to frame the participants' experiences. It was thus considered essential to take into account the family context in which monitoring was undertaken. Parents in the present study who, for example, had previously lost infants to SIDS, spoke of the ongoing grieving processes underpinning their monitoring experiences of subsequent infants. When the youngest child was no longer monitored, the focus of attention shifted from the risk status of the infant to the prospect of a normal childhood. Parents increasingly made their own decisions about how and when to use the monitor, based on their perceptions of their own ability to cope without it, rather than on the medical indications for its use or discontinuance. Mothers, especially, expressed strong needs for support from knowledgeable health professionals who could provide an integrated, holistic approach to the care of their infants, for monitoring supervision and for general parenting advice and support. The concept of a community-based nurse case manager is suggested as an appropriate means to meet their needs for a co-ordinated professional support service

Using Realist Synthesis to Develop an Evidence Base from an Identified Data Set on Enablers and Barriers for Alcohol and Drug Program Implementation

The purpose of this paper is to show how “realist synthesis” methodology (Pawson, 2002) was adapted to review a large sample of community based projects addressing alcohol and drug use problems. Our study drew on a highly varied sample of 127 projects receiving funding from a national non-government organisation in Australia between 2002 and 2008. Open and pattern coding led to the identification of 10 barrier and nine enabler mechanisms influencing project implementation across the sample. Eight case studies (four demonstrating successful implementation; four demonstrating less than successful implementation) were used for depth exploration of these mechanisms. High level theories were developed, from these findings, on implementation effectiveness in projects addressing alcohol and other drug use problems

Central Nervous System Parasitosis and Neuroinflammation Ameliorated by Systemic IL-10 Administration in Trypanosoma brucei-Infected Mice

Peer reviewedPublisher PD

The Orthologue of Sjögren's Syndrome Nuclear Autoantigen 1 (SSNA1) in Trypanosoma brucei Is an Immunogenic Self-Assembling Molecule

Primary Sjögren's Syndrome (PSS) is a highly prevalent autoimmune disease, typically manifesting as lymphocytic infiltration of the exocrine glands leading to chronically impaired lacrimal and salivary secretion. Sjögren's Syndrome nuclear autoantigen 1 (SSNA1 or NA14) is a major specific target for autoantibodies in PSS but the precise function and clinical relevance of this protein are largely unknown. Orthologues of the gene are absent from many of the commonly used model organisms but are present in Chlamyodomonas reinhardtii (in which it has been termed DIP13) and most protozoa. We report the functional characterisation of the orthologue of SSNA1 in the kinetoplastid parasite, Trypanosoma brucei. Both TbDIP13 and human SSNA1 are small coiled-coil proteins which are predicted to be remote homologues of the actin-binding protein tropomyosin. We use comparative proteomic methods to identify potential interacting partners of TbDIP13. We also show evidence that TbDIP13 is able to self-assemble into fibril-like structures both in vitro and in vivo, a property which may contribute to its immunogenicity. Endogenous TbDIP13 partially co-localises with acetylated α-tubulin in the insect procyclic stage of the parasite. However, deletion of the DIP13 gene in cultured bloodstream and procyclic stages of T. brucei has little effect on parasite growth or morphology, indicating either a degree of functional redundancy or a function in an alternative stage of the parasite life cycle

Centerscope

Centerscope, formerly Scope, was published by the Boston University Medical Center "to communicate the concern of the Medical Center for the development and maintenance of improved health care in contemporary society.

Expression of nicotinic acetylcholine receptor subunits from parasitic nematodes in Caenorhabditis elegans

The levamisole-sensitive nicotinic acetylcholine receptor present at nematode neuromuscular junctions is composed of multiple different subunits, with the exact composition varying between species. We tested the ability of two well-conserved nicotinic receptor subunits, UNC-38 and UNC-29, from Haemonchus contortus and Ascaris suum to rescue the levamisole-resistance and locomotion defects of Caenorhabditis elegans strains with null deletion mutations in the unc-38 and unc-29 genes. The parasite cDNAs were cloned downstream of the relevant C. elegans promoters and introduced into the mutant strains via biolistic transformation. The UNC-38 subunit of H. contortus was able to completely rescue both the locomotion defects and levamisole resistance of the null deletion mutant VC2937 (ok2896), but no C. elegans expressing the A. suum UNC-38 could be detected. The H. contortus UNC-29.1 subunit partially rescued the levamisole resistance of a C. elegans null mutation in unc-29 VC1944 (ok2450), but did cause increased motility in a thrashing assay. In contrast, only a single line of worms containing the A. suum UNC-29 subunit showed a partial rescue of levamisole resistance, with no effect on thrashing

Magnetic Resonance Imaging to Assess Blood–Brain Barrier Damage in Murine Trypanosomiasis

The ability of trypanosomes to invade the brain and induce an inflammatory reaction is well-recognized. This study uses magnetic resonance imaging (MRI) in conjunction with a murine model of central nervous system (CNS) stage trypanosomiasis to investigate this phenomenon at the level of the blood–brain barrier (BBB). Mice were scanned before and after administration of the contrast agent. Signal enhancement maps were generated, and the percentage signal change was calculated. The severity of the neuroinflammation was also assessed. Statistical analysis of the signal change data revealed a significantly (P = 0.028) higher signal enhancement in mice at 28 days post-infection (least squares mean = 26.709) compared with uninfected animals (6.298), indicating the presence of BBB impairment. Leukocytes were found in the meninges and perivascular space of some blood vessels in the infected mice. This study shows that the integrity of the BBB is compromised during CNS stage trypanosomiasis and that the impairment does not correlate with inflammatory cell infiltration