Modeling the effect of copper availability on bacterial denitrification

When denitrifying bacteria such as Paracoccus denitrificans respire anaerobically they convert nitrate to dinitrogen gas via a pathway which includes the potent greenhouse gas, nitrous oxide (NO). The copper-dependent enzyme Nitrous Oxide reductase (Nos) catalyzes the reduction of NO to dinitrogen. In low-copper conditions, recent experiments in chemostats have demonstrated that Nos efficiency decreases resulting in significant NO emissions. For the first time, a chemostat-based mathematical model is developed that describes the anaerobic denitrification pathway based on Michaelis-Menten kinetics and published kinetic parameters. The model predicts steady-state enzyme levels from experimental data. For low copper concentrations, the predicted Nos level is significantly reduced, whereas the levels for the non copper-dependent reductases in the pathway remain relatively unaffected. The model provides time courses for the pathway metabolites that accurately reflect previously published experimental data. In the absence of experimental data purely predictive analyses can also be readily performed by calculating the relative Nos level directly from the copper concentration. Here, the model quantitatively estimates the increasing level of emitted NO as the copper level decreases. We have developed a mathematical model for the denitrification pathway based on existing experimental results, Michaelis-Menten kinetics and experimentally obtained kinetic constants. This is the first such model to incorporate the copper concentration in order to predict emissions of the potent greenhouse gas, nitrous oxide (NO), as well as the other nitrogenous compounds in the pathway. The model predicts increasing NO emissions as the copper level is lowered, in agreement with experimental observations in chemostats. © 2013 The Authors. MicrobiologyOpen published by John Wiley & Sons Ltd.

Inequity in developmental vulnerability, its determinants and the role of access to early identification and intervention

ABSTRACT BACKGROUND AND AIMS Children who are developmentally vulnerable are those that have significant problems in at least one area of their development. Limited information is available on the prevalence of developmental vulnerability prior to the start of school, whether it has an inequitable distribution and how children are identified and referred to early intervention. This thesis aimed to: 1. Explore challenges in investigating inequity in developmental vulnerability. 2. Assess inequities in the prevalence of developmental vulnerability, associated risk factors and their interactions. 3. Explore factors that influence access to early identification and intervention. METHODS Methods included: a literature review; a theoretical critique; a systematic review of the prevalence of parental concerns on the Parents’ Evaluation of Developmental Status (PEDS) indicating developmental vulnerability and associated risk factors; a prospective birth cohort investigating developmental vulnerability and its early identification; a qualitative study of access to early identification and intervention; and a survey of primary health practitioners. RESULTS Between a quarter to a third of children were developmentally vulnerable as indicated by parental concerns on the PEDS in the systematic review and the original research of this thesis. There was evidence of inequities in developmental vulnerability associated with socioeconomic disadvantage, and culturally and linguistically diverse background (CALD). Children with multiple risk factors at the child, parent, family and neighbourhood level were more likely to be developmentally vulnerable but were less likely to have the PEDS documented at well child checks. Parents from CALD backgrounds, health and early childhood practitioners described barriers to access and quality in early identification and intervention services. CONCLUSION To reduce inequities in developmental vulnerability, differential risk needs to be addressed through early childhood policy that ensures cumulative buffering through universal early interventions with enhanced support for vulnerable populations. Differential knowledge needs to be addressed by ensuring that early childhood development is “everyone’s business”. Differential quality needs to be addressed through training and monitoring of primary health care systems to ensure consistency of practice. Differential access needs to be addressed through integrating primary health and early childhood services

Partnerships for safe care: A meta-narrative of the experience for the parent of a child with Intellectual Disability in hospital

© 2019 The Authors. Health Expectations published by John Wiley & Sons Ltd. Objective: To systematically identify and synthesize peer-reviewed qualitative evidence of the parental experience of hospitalization with a child with Intellectual Disability. Search strategy: Key words, synonyms and MeSH subject headings that related to the three key concepts of parental experience, children with Intellectual Disability and hospital settings were applied to six electronic databases: Medline, CINAHL, Embase, PsycINFO, Scopus and Web of Science. Titles and abstracts of publications between January 2000 and February 2019 were screened for relevance. Inclusion criteria: Empirical qualitative research involved participants aged 0-18 years, involved children with Intellectual Disability, involved participants hospitalized as an in-patient and involved participants focused on parent perspective. Data extraction and synthesis: Data were extracted and synthesized using a meta-narrative approach. Results: Eleven publications met the inclusion criteria. Data synthesis revealed three research traditions contributing to this meta-narrative: Paediatric Nursing Practice, Intellectual Disability Healthcare and Patient Experience. A total of five themes were identified: (a) being more than a parent, (b) importance of role negotiation, (c) building trust and relationships, (d) the cumulative effect of previous experiences of hospitalization and (e) knowing the child as an individual. Discussion and conclusion: This review presents a working model for professional-parent partnership for the safe care of children with Intellectual Disability in hospital. Shifting paediatric healthcare to whole of hospital/multidisciplinary models of care that centre on the child will necessitate partnerships with the parent to identify and manage the needs of the child with Intellectual Disability, in order to achieve safe and equitable care for these children

Inequities in quality and safety outcomes for hospitalized children with intellectual disability.

AimTo investigate if there are inequities in quality and safety outcomes for children with intellectual disability admitted to two tertiary paediatric hospitals.MethodA cross-sectional study of 1367 admissions for 1018 randomly selected patients admitted for more than 23 hours to one of two tertiary children's hospitals in Sydney, Australia (1st January-31st December 2017). Electronic medical records were manually interrogated to identify children with intellectual disability (including developmental delay). Data extracted included patient demographics, length of stay, number of admissions, and reported clinical incidents.ResultsIn total, 12.3% (n=125) of children admitted during the study period had intellectual disability, which represented 13.9% (n=190) of admissions. Sex and age at admission in children with and without intellectual disability were similar: 83 (43.7%) vs 507 (43.1%) females and 107 (56.3%) vs 670 (56.9%) males, p=0.875; median age 3 years (0-18y) vs 4 years (0-18y), p=0.122. Children with intellectual disability had significantly greater median length of stay (100.5h vs 79h, pInterpretationChildren with intellectual disability experience inequitable quality and safety outcomes in hospital. Engaging children and families in clinical incident reporting may enhance understanding of safety risks for children with intellectual disability in hospital

Supplement Use In Professional Rugby League

The purpose of this research was to gain a better understanding of sports supplement use in elite Rugby League (RL) though identifying the prevalence of supplement use within elite RL; assessing the knowledge, beliefs and attitudes towards supplements amongst elite RL players; and by examining the knowledge, beliefs and attitudes towards supplements of support staff who have a direct influence on the sports nutrition practices within the elite RL. A questionnaire was distributed to identify the prevalence of supplement use and assess the knowledge, beliefs and attitudes of supplements amongst 166 elite RL players, across eight English teams competing in the European Super League (ESL). The questionnaire asked each player to report supplement use and type, the input they had, levels of knowledge and source of information, and reasons for use. Frequency analysis and comparison between frequency counts was performed using cross tabulation matrices and Chi2 analysis to identify any statistical significance. The questionnaire data revealed that 95 percent of elite RL players report the use of supplements. The main reasons for supplement use related to recovery (90%) and building muscle (86%) with the main ingredients reported as protein (100%); creatine (64%); vitamins and minerals (60%); carbohydrate (56%). Other than the players themselves, strength and conditioning coaches (85%) and dieticians or nutritionists (29%) were identified as the most influential individuals when deciding supplements practices. Many respondents (25%) reported having no input into the supplements they consumed with 92 percent acknowledged an awareness of potential risks associated with supplements. However only 56 percent of respondents were aware of the risk minimisation scheme in the UK. This was despite 97 percent of respondent reporting receiving advice relating to safe supplement use with strength and conditioning coaches (87%), dietician or nutritionist (73%) and sport scientist (39%) being identified as the main sources for such advice. Additionally, semi-structured one-to-one interviews, which were deductively developed to assess the knowledge of and attitudes towards supplements amongst player support staff, were conducted with one member of support staff from eight English teams competing in the ESL. The interviews were transcribed and a systematic, line-by-line process of coding took place to identify different themes and common trends, which later developed into general dimensions. Triangulation was also used to review the findings, provide a check on the selective perception, and illuminate any blind spots or misinterpretations during the initial analysis. The interview data highlighted the lack of qualified nutritionists within RL as only 2 respondents identified themselves as nutritionists. The additional six respondents were strength and conditioning staff. The majority of the respondents agreed that supplements do play a part in sport and identified that the benefits of supplements relate to convenience and the addition of certain dietary demands that were difficult to meet through food alone. However, the majority of participants also stresses the importance of a good diet. All respondents identified sponsorship and the related financial benefits as driving influential factors in supplement brand choice and there are similarities in the way that clubs decide and deliver supplement practices which highlight a possible dependency culture. However, it is reported that the head of strength of conditioning has the ultimate responsibility with respect to supplement use even where clubs have access to a nutritionist. Respondents also stress that there was a lack of educational resources available to both themselves and players and suggest that this could be a factor leading to the perceived lack of knowledge amongst players and support staff in RL. In conclusion, the current research reports the high prevalence of supplement use in elite RL whilst highlighting the issues concerning a potential lack of nutritional and anti-doping knowledge amongst both players and athlete support staff. These findings suggest that both players and athlete support staff would benefit from further education in relation to the safe use of supplements from an anti-doping perspective and further analysis is needed to assess the levels of dependency within elite RL

Superficial siderosis: a potential diagnostic marker of cerebral amyloid angiopathy in Alzheimer disease

Abstract BACKGROUND AND PURPOSE: Superficial siderosis of the central nervous system results from chronic bleeding in the superficial layers of the cortex and spinal cord. In cerebral amyloid angiopathy (CAA), there is amyloid deposition in meningeal and meningo-cortical arteries and capillaries, predisposing them to rupture. CAA is frequently associated with Alzheimer disease (AD). METHODS: We report a series of 3 AD patients with MRI evidence of superficial siderosis. Two had neuropathological examination confirming superficial siderosis, AD, and CAA. CONCLUSIONS: Superficial siderosis should be recognized within the spectrum of AD with CAA and considered as a possible antemortem diagnostic feature

A systematic review of the prevalence of parental concerns measured by the Parents' Evaluation of Developmental Status (PEDS) indicating developmental risk

© 2014 Woolfenden et al.; licensee BioMed Central Ltd. Background: Parental concerns about their children's development can be used as an indicator of developmental risk. We undertook a systematic review of the prevalence of parents' concerns as an indicator of developmental risk, measured by the Parents' Evaluation of Developmental Status (PEDS) and associated risk factors. Methods: Electronic databases, bibliographies and websites were searched and experts contacted. Studies were screened for eligibility and study characteristics were extracted independently by two authors. A summary estimate for prevalence was derived. Meta-regression examined the impact of study characteristics and quality. Meta-analysis was used to derive pooled estimates of the impact of biological and psychosocial risk factors on the odds of parental concerns indicating high developmental risk. Results: Thirty seven studies were identified with a total of 210,242 subjects. Overall 13.8% (95% CI 10.9 -16.8%) of parents had concerns indicating their child was at high developmental risk and 19.8% (95% CI 16.7-22.9%) had concerns indicating their child was at moderate developmental risk. Male gender, low birth weight, poor/fair child health rating, poor maternal mental health, lower socioeconomic status (SES), minority ethnicity, not being read to, a lack of access to health care and not having health insurance were significantly associated with parental concerns indicating a high developmental risk. Conclusions: The prevalence of parental concerns measured with the PEDS indicating developmental risk is substantial. There is increased prevalence associated with biological and psychosocial adversity. Trial Registration: PROSPERO Registration: CRD42012003215

'Smiles and laughter and all those really great things': Nurses' perceptions of good experiences of care for inpatient children and young people with intellectual disability.

AIM: To understand what constitutes a good experience of care for inpatient children and young people with intellectual disability as perceived by nursing staff. DESIGN: Interpretive qualitative study. METHODS: Focus groups with clinical nursing staff from speciality neurological/neurosurgical and adolescent medicine wards across two specialist tertiary children's hospitals in Australia were conducted between March and May 2021. Data analysis followed interpretative analysis methods to develop themes and codes which were mapped to a conceptual model of safe care. RESULTS: Six focus groups with 29 nurses of varying experience levels were conducted over 3 months. Themes and codes were mapped to the six themes of the conceptual model: use rapport, know the child, negotiate roles, shared learning, build trust and relationships, and past experiences. The analysis revealed two new themes that extended the conceptual model to include; the unique role of a paediatric nurse, and joy and job satisfaction, with a third contextual theme, impacts of COVID-19 pandemic restrictions. With the perspectives of paediatric nurses incorporated into the model we have enhanced our model of safe care specifically for inpatient paediatric nursing care of children and young people with intellectual disability. CONCLUSION: Including perceptions of paediatric nurses confirmed the position of the child with intellectual disability being at the centre of safe care, where care is delivered as a partnership between nursing staff, child or young person and their parents/family and the hospital systems and processes. IMPACT: The enhanced model offers a specialized framework for clinical staff and health managers to optimize the delivery of safe care for children and young people with intellectual disability in hospital