Feasibility and acceptability of a motivational interviewing breastfeeding peer support intervention

An uncontrolled study with process evaluation was conducted in three U.K. community maternity sites to establish the feasibility and acceptability of delivering a novel breastfeeding peer‐support intervention informed by motivational interviewing (MI; Mam‐Kind). Peer‐supporters were trained to deliver the Mam‐Kind intervention that provided intensive one‐to‐one peer‐support, including (a) antenatal contact, (b) face‐to‐face contact within 48 hr of birth, (c) proactive (peer‐supporter led) alternate day contact for 2 weeks after birth, and (d) mother‐led contact for a further 6 weeks. Peer‐supporters completed structured diaries and audio‐recorded face‐to‐face sessions with mothers. Semistructured interviews were conducted with a purposive sample of mothers, health professionals, and all peer‐supporters. Interview data were analysed thematically to assess intervention acceptability. Audio‐recorded peer‐support sessions were assessed for intervention fidelity and the use of MI techniques, using the MITI 4.2 tool. Eight peer‐supporters delivered the Mam‐Kind intervention to 70 mothers in three National Health Service maternity services. Qualitative interviews with mothers (n = 28), peer‐supporters (n = 8), and health professionals (n = 12) indicated that the intervention was acceptable, and health professionals felt it could be integrated with existing services. There was high fidelity to intervention content; 93% of intervention objectives were met during sessions. However, peer‐supporters reported difficulties in adapting from an expert‐by‐experience role to a collaborative role. We have established the feasibility and acceptability of providing breastfeeding peer‐support using a MI‐informed approach. Refinement of the intervention is needed to further develop peer‐supporters' skills in providing mother‐centred support. The refined intervention should be tested for effectiveness in a randomised controlled trial.     

Objectively characterizing Huntington’s disease using a novel upper limb dexterity test

Journal of Neurology - The Clinch Token Transfer Test (C3t) is a bi-manual coin transfer task that incorporates cognitive tasks to add complexity. This study explored the concurrent and convergent...     

Abrogation of the radiation-induced G2 checkpoint by the staurosporine derivative UCN-01 is associated with radiosensitisation in a subset of colorectal tumour cell lines

Ionising radiation is commonly used in the treatment of colorectal cancer. Tumour cells with mutant p53 undergo cell cycle arrest at G2/M after ionising radiation and evidence suggests that abrogation of this G2 arrest can lead to a premature, aberrant mitosis, thus enhancing ionising radiation-induced cell killing. The G2 checkpoint inhibitor UCN-01 was thus investigated to determine whether it would abrogate the G2 checkpoint induced by 5 Gy ionising radiation in a range of colorectal tumour cell lines. Data presented show that, at doses that are alone non-toxic to the cells, UCN-01 inhibits the ionising radiation-induced G2 checkpoint in five colorectal tumour cell lines with mutant p53. The ability of UCN-01 to sensitise cells to ionising radiation-induced growth inhibition and apoptosis was also investigated and UCN-01 was found to radiosensitise two out of five cell lines. These results were confirmed by long-term colony forming efficiency studies. These results demonstrate that abrogation of the ionising radiation-induced G2 checkpoint is not necessarily associated with sensitisation to ionising radiation, however, some colorectal tumour cell lines can be radiosensitised by UCN-01. Although the mechanism of radiosensitisation is not clear, this may still be an important treatment strategy.     

Physiological action of dissolved organic matter in rainbow trout in the presence and absence of copper: sodium uptake kinetics and unidirectional flux rates in hard and softwater

We investigated the physiological effects of dissolved organic matter (DOM) on sodium (Na+) transport in juvenile Oncorhynchus mykiss (approximately 2.5 g) in the presence and absence of simultaneous acute exposure to copper (Cu2+; 0, 70, and 300 microg l(-1)). Trout were acclimated in either hardwater (approximately 1000 microM Ca2+) or softwater (approximately 100 microM Ca2+), and DOM was tested at approximately 8 mg C l(-1) using a natural (NOM) and a commercial (AHA) source. Ion transport was evaluated based on kinetics estimates (maximum Na+ uptake rates, Jmax; substrate affinity, Km) and unidirectional flux measurements (Jin, Jout, Jnet). Jmax was higher and unidirectional flux rates were greater in softwater-acclimated trout. Fish exposed to DOM alone in hardwater exhibited an increased Na+ transport capacity indicated by both the kinetics (67% higher Jmax for AHA) and Jin measurements (153% higher for AHA and 125% higher for NOM). In softwater, the effects of DOM alone on kinetic parameters and unidirectional flux rates were negligible. Cu2+ affected Na+ uptake by a mixed-type inhibition (both non-competitive and competitive). In hardwater, only Km was increased (i.e., affinity decreased), whereas in softwater, Km was increased and Jmax was decreased, with more marked effects at the higher Cu2+ level. In hardwater, the stimulatory effect of AHA on Jmax persisted even in the presence of 300 microg l(-1) Cu2+, whereas both AHA and NOM prevented the increase in Km caused by Cu2+; these effects were reflected in Jin measurements. In softwater, AHA helped to protect against the increased Km caused by high Cu2+, but there was no protection against the inhibition of Jmax. Unidirectional flux measurements indicated that in softwater, Cu2+ inhibited Jin at 70 microg l(-1), whereas at 300 microg l(-1) Cu2+, Jout was also stimulated. Fish were more affected by Cu2+ in softwater, as indicated by the inability to control diffusive losses of Na+ and a reduced ability to take up Na+, but in the presence of DOM, losses were better controlled at the end of 6 h exposure. We conclude that DOM has direct effects on the gills, as well as protecting fish against acute Cu2+ toxicity. This occurs because DOM complexes Cu2+, and because it acts on the transport and permeability properties of the gills. These effects differ depending on both water hardness and the nature of the DOM source.     

Influence of natural organic matter source on acute copper, lead, and cadmium toxicity to rainbow trout (Oncorhynchus mykiss)

Natural organic matter (NOM) was concentrated from various sites across Canada using a portable reverse-osmosis unit to obtain a range of NOM types, from mainly allochthonous (terrestrially derived) to mainly autochthonous (aquatically derived) NOM. The addition of NOM to Cu exposures in ion-poor water always decreased Cu toxicity to rainbow trout (Oncorhynchus mykiss, approximately 1 g) over a 96-h period, and the degree of protection varied with respect to NOM source. A good correlation was found between the specific absorbance coefficient (SAC) and time to reach 50% mortality (LT50; p < 0.001), indicating that more optically dark, allochthonous-like NOM decreases Cu toxicity better than does optically light, more autochthonous-like NOM. A similar, good relationship between NOM source and Pb toxicity was seen (p < 0.001), once confounding effects of Ca binding to NOM were accounted for. No significant relationship between Cd toxicity and NOM optical quality was seen (p = 0.082), and in toxicity tests with Cd the presence of some of the NOM sources increased Cd toxicity compared to Cd-only controls. Specific absorbance coefficients were used as a proxy measurement of NOM aromaticity in our study, and fluorescence indices were run on some NOM samples to obtain percent aromaticity for each sample. A good correlation was found between SAC and percent aromaticity, indicating that the simple SAC measurement is a reasonable indication of NOM aromaticity and of metal binding by NOM.     

Interaction of cadmium toxicity in embryos and larvae of zebrafish (Danio rerio) with calcium and humic substances

The influence of humic substances (HS) and calcium (Ca) on cadmium (Cd) toxicity was determined using zebrafish (Danio rerio). Embryo and larvae of the zebrafish were exposed to various Cd concentrations (1.8; 2.8; 4.2; 6.2; 9.3 mg/l Cd) for 144 h. Combinations of low (0.2 mmol/l) and high (2 mmol/l) Ca, +HS (5 mg/l C) or -HS were used during Cd exposure. The toxicity of Cd was affected by (1) exposure concentration; (2) exposure time; (3) presence of HS; and (4) the Ca concentration. The results show that Ca and HS protect against Cd toxicity in zebrafish embryos. The best protection was in the high Ca-HS group, followed by high Ca+HS group and low Ca+HS group. The survival in the low Ca-HS group was the worse. Survival in the high Ca-HS group and the high Ca+HS group was similar with the exception of the highest Cd concentration (9.3 mg/l) where the survival of the high Ca+HS group was less than in the high Ca-HS group. The exposure system was modelled using a chemical equilibrium program (MINEQL+) to determine if the likely mechanism causing the anomalous result in the highest Cd concentration. The equilibrium model cannot explain these results, which suggests that this effect has a kinetic basis, such as time needed for Cd to displace Ca already bound by HS.     

Non-compliance and professional power

The non-compliance of patients with prescribed treatments is considered as a barrier to effective health care. Non-compliance has implications for the health of patients, effective use of resources and assessments of the clinical efficacy of treatments. Research into non-compliance has increased over the last 30 years. This seems to indicate that it is seen as an important area of concern for all health care professionals. Definitions of non-compliance are problematic, as are methods of assessment of its nature and frequency. Many factors which may account for non-compliance have been proposed, as well as methods to improve compliance. Research into these factors however, mainly based on a positivist epistemology, has failed to provide any conclusive answers to the problem. Sound clinical reasons are suggested as the basis for the increase in interest in non-compliance. It is contended, however, that it is not only these reasons that account for the identification of non-compliance as a problem. Non-compliant behaviour is seen as problematic, because it contravenes professional beliefs, norms and expectations regarding the ‘proper’ roles of patients and professionals. These have formed the basis of an ideology that views patients as passive recipients of health care. It has led to an inherent tendency to ‘blame’ the patient and view non-compliance as irrational and deviant. The professional view of non-compliance as irrational, is exemplified in the case of individuals with mental illness, where there are inherent assumptions that non-compliance can be seen primarily as a symptom of illness. This denies the legitimacy of patient choice, and has led to attempts to control compliance via suggested legislative measures. Serious moral and ethical problems arise from such measures, and can be seen as the ultimate legitimization of an ideology of non-compliance. The maintenance of professional power and control is suggested as central to the debates surrounding non-compliance. The ideological assumptions underpinning the concept of non-compliance need questioning, and a re-conceptualization of the roles of patients and professionals is required. This must involve a view of patients as active participators in their own health care. Research based on an interpretative epistemology, aimed at understanding individual action, rather than control, would seem a more appropriate model to pursue.     

Three-dimensional motion analysis - an exploratory study. Part 1: assessment of facial movement

Authors – Popat H, Richmond S, Playle R, Marshall D, Rosin PL, Cosker D Objectives – To objectively quantify facial movement in response to facial expression and spoken word. Design – Experimental study. Setting – Department of Dental Health and Biological Sciences, University Dental Hospital, Cardiff, UK. Experimental Variable – Facial movement was assessed in response to a standardized smile expression and the utterance ‘puppy’. The sequences were recorded using a non‐invasive, three‐dimensional motion analysis image capture system (3dMDface? Dynamic System) at 48 frames per second. Outcome Variable – To quantify the facial movement, sequential frames of a sequence were aligned to the baseline/reference frame three‐dimensionally using best fit on non‐moveable points in the upper half of the face. Accuracy of the alignment process for each sequence was tested using the percentage of stable points (i.e. within ±0.5 mm) within the upper half of the face. Results – Quantifiable changes in facial topology were seen during both the standardized smile expression and the utterance ‘puppy’. The mean percentage of points (SD) that remained stable within the upper half of the face during the utterance ‘puppy’ was 88.8% (4.7). During the standardized smile expression, there were a much lower percentage of stable points in the upper half of the face with a mean (SD) of 60.9% (3.2). Conclusion – The 3dMDface? Dynamic System allows objective, three‐dimensional, non‐invasive assessment of facial movement. The utterance ‘puppy’ is a more appropriate measure of facial movement when compared with the standardized smile expression.     

Facial attractiveness: A longitudinal study

BACKGROUND: The aim of the study was to investigate various factors that might affect facial attractiveness from ages 11 to 31 years. METHODS: Sixty subjects were selected from a sample participating in the longitudinal Cardiff Survey. Three-quarter-view facial photographs were taken of the subjects smiling and not smiling. Photos were taken in 1981, when the subjects were aged 11 years, and in 2001, when they were aged 31. Twelve judges used a 9-point Likert scale to evaluate overall facial attractiveness and the attractiveness of various facial features. The judges were also asked to estimate the adults' ages. Univariate and multivariate statistical tests and the generalizability theory were used. RESULTS AND CONCLUSIONS: Overall facial attractiveness does not depend on any single feature; smiling and youthful facial appearance make women look more attractive; facial attractiveness tends to decrease over time from ages 11 to 31; people tend to retain their relative levels of attractiveness throughout their life spans; orthodontic treatment improves dental appearance, but it does not necessarily make a person more attractive in the long term. Nevertheless, the positive effect of orthodontic treatment could still be observed, especially in men with lower levels of facial attractiveness in childhood.