The Benefits and Challenges of Kinship Care

The outcomes for children in kinship care are generally seen as positive in terms of identity formation, stability of placement, behavioural and mental health outcomes, enabling siblings to live together and child protection. However, there is some disquiet about the length of time children stay with relatives; agencies are not sure about how best to position themselves in relation to the families, or how best to conduct home studies and license relative carers. There is evidence that relatives receive both less support and supervision from agencies than do traditional foster parents. This paper examines the benefits and challenges of relative care, whilst identifying current research limitations, and focuses on the gaps in respect to the intersection between research policy and practice. Through this examination, considerations are given to such issues as: What service delivery models are needed to optimise potential benefits through aligning law, policy and practice guidance? How, and to what extent, should relative care be financed? Where does relative care fit with the intersection of permanency adoption and guardianship? The ambiguity that exists towards this care option needs exploration, as does the question of how a worker's own “family experiences and values” may influence, or be influenced in, the course of the relative-care work.     

Sibling involvement in childhood chronic heart disease through a bead program

In interviews with parents for the evaluation of a cardiac ward programme in a children's hospital, a number of parents mentioned the role of the Heart Beads Program in including siblings in the hospitalisation of the child with congenital heart condition (CHD). Inclusion of siblings in the events surrounding the child with the cardiac condition was of two kinds: (a) touching and explaining about the beads and the child's condition and (b) involvement in collecting and threading the beads. Discussion of the needs of siblings suggests that inclusion of siblings in activities related to the care and understanding of the CHD child as well as the creation and shaping of the family narrative is important. These cases illustrate the different ways in which siblings are involved and acknowledged and how involvement can be facilitated by a programme like Heart Beads.     

Antimicrobial resistance and resistance genes in Escherichia coli isolated from retail meat purchased in Alberta, Canada

This study analyzed antimicrobial resistance (AMR) and resistance genes in generic Escherichia coli isolated from retail meat samples purchased (2007-2008) in Alberta, Canada, and determined potential associations between resistance phenotypes and resistance genes with relation to the meat types. A total of 422 E. coli isolates from retail chicken, turkey, beef, and pork meats were tested for antimicrobial susceptibility. Multiplex PCRs were used to detect major resistance genes for tetracyclines [tet(A), tet(B), tet(C)], sulfonamides (sul1, sul2, sul3), aminoglycosides (strA/B, aadA, aadB, aac(3)IV, aphA1, aphA2), and β-lactamase (bla(CMY-2), bla(TEM), bla(SHV), bla(PSE-1)). Resistance to ciprofloxacin was not found in any isolate. Overall resistances to clinically important antimicrobials amoxicillin-clavulanic acid (16.8% of isolates) and ceftriaxone (12.6% isolates) were observed. These resistances were observed more frequently (p<0.0001) in chicken-derived E. coli than those from the other meat types. Resistance to multiple antimicrobials (≥ 5) was found in more chicken derived E. coli (32%) than E. coli from other meat types. The β-lactamase genes of clinical importance, including bla(CMY-2) and bla(TEM), were found in about 18% of poultry-derived E. coli and in only 5% of ground beef. The bla(CMY-2) gene was more likely to be found in E. coli from chicken than turkey, beef, or pork meats. The tet(A) gene was associated with bla(CMY-2), whereas bla(CMY-2) and bla(TEM) genes were associated with strA/B genes. Resistance genes for tetracycline, sulfonamides, and aminoglycosides were associated with the phenotypic expression of resistance to unrelated classes of antimicrobials. These data suggest the prevalence of AMR and select resistance genes were higher in poultry-derived E. coli. The multiple associations found between AMR phenotypes and resistance genes suggest a complex nature of resistance in E. coli from retail meat, and hence the use of a single antimicrobial could result in the selection of resistant E. coli not only to the drug being used but to other unrelated classes of antimicrobials as well.     

Multimodal imaging of dry age‐related macular degeneration

Purpose: The purpose of this study was to understand clinical significance of near‐infrared reflectance (NIR), blue fundus autofluorescence (FAF) and near‐infrared autofluorescence (NIA) in dry age‐related macular degeneration (AMD), by correlation with fluorescein angiography (FA) and cross‐sectional spectral domain optical coherence tomography (SD OCT). Methods: We evaluated 110 eyes (62 patients, mean age: 64 ± 8 years) diagnosed with dry AMD between January 2010 and December 2010, which underwent NIR (λ = 830 nm), FAF and FA (excitation λ = 488 nm; emission λ > 500 nm), NIA (excitation λ = 787 nm; emission λ > 800 nm), and simultaneous SD OCT scanning using a combined confocal scanning laser ophthalmoscope/SD OCT device (Spectralis HRA + OCT; Heidelberg Engineering, Heidelberg, Germany). Results: Drusen showed variable increased/decreased NIR, FAF, NIA and FA, which corresponded to variable increased/decreased thickness of the retinal pigment epithelium (RPE) and possible presence of subretinal deposits on SD OCT. Geographic atrophy (GA) was present in 43/110 eyes (39.0%) and showed increased NIR and fluorescence (FA), absent FAF and NIA, and loss of RPE on SD OCT. The hyperautofluorescence of the GA margin was never larger in FAF than that in NIA, while in 16.2% of cases, it was larger in NIA than that in FAF and corresponded to mild choroidal hyperreflectivity on SD OCT. Conclusions: Simultaneous recording of SD OCT scans provided ultrastructural data for the evaluation of NIR, FAF, NIA and FA in dry AMD. Near‐infrared autofluorescence might detect earlier than FAF areas of RPE cell loss at the GA margin.     

Systematic review of physical activity and health in the early years (aged 0-4 years)

The early years represent a critical period for promoting physical activity. However, the amount of physical activity needed for healthy growth and development is not clear. Using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework, we aimed to present the best available evidence to determine the relationship between physical activity and measures of adiposity, bone and skeletal health, motor skill development, psychosocial health, cognitive development, and cardiometabolic health indicators in infants (1 month - 1 year), toddlers (1.1-3.0 years), and preschoolers (3.1-4.9 years). Online databases, personal libraries, and government documents were searched for relevant studies. Twenty-two articles, representing 18 unique studies and 12?742 enrolled participants, met inclusion criteria. The health indicators of interest were adiposity (n = 11), bone and skeletal health (n = 2), motor development (n = 4), psychosocial health (n = 3), cognitive development (n = 1), and cardiometabolic health indicators (n = 3); these indicators were pre-specified by an expert panel. Five unique studies involved infants, 2 involved toddlers, and 11 involved preschoolers. In infants, there was low- to moderate-quality evidence to suggest that increased or higher physical activity was positively associated with improved measures of adiposity, motor skill development, and cognitive development. In toddlers, there was moderate-quality evidence to suggest that increased or higher physical activity was positively associated with bone and skeletal health. In preschoolers, there was low- to high-quality evidence on the relationship between increased or higher physical activity and improved measures of adiposity, motor skill development, psychosocial health, and cardiometabolic health indicators. There was no serious inconsistency in any of the studies reviewed. This evidence can help to inform public health guidelines. (PROSPERO registration: CRD42011001243).     

Identification and evaluation of a thinning agent compatible with MegaCell DCS, an animal product-free corneal storage medium

Purpose

MegaCell DCS, an animal product-free culture medium formulated for storing corneas, is superior to the traditionally used MEM (Eagle’s) with Earles salts, Hepes, and supplemented with foetal calf serum (2?%), glutamine and an antibiotic cocktail (EB MEM). Because this medium does not prevent corneal swelling, and Dextran T500, which is traditionally used for reversing this process before transplant may have adverse effects on corneas, the purpose of the current investigation was to identify an alternative polymer that is compatible with MegaCell DCS.

Methods

Corneas maintained in MegaCell DCS or EB MEM were transferred to either EB MEM 5?% Dextran T500 or MegaCell DCS containing 5?% Dextran T500, 4?% polyethylene glycol (PEG) 10,000, PEG 35,000 (2?%, 3?%, 4?%) or Poloxamer 188 (4?%). Endothelial cell losses were determined and corneal hydration levels measured. Stromal cell cultures were generated and immunostained with anti α-SMA antibody. Janus Green was used to compare the viability of endothelial cells of corneas maintained in MegaCell DCS and EB MEM and respectively thinned with PEG 35,000 and Dextran T500.

Results

The rates of endothelial cell loss from corneas held in MegaCell DCS and thinned in MegaCell DCS containing 5?% Dextran T500, 4?% PEG 10,000 and 4?% Poloxamer 188 for 6?days were similar. When explants of these corneas were cultured myofibroblasts were generated. Although at concentrations of 4?% (w/v) both PEG 10,000 and Poloxamer 188 caused excessive dehydration, the hydration levels of corneas held in MegaCell DCS containing 3?% PEG 35,000 were similar to those of corneas held in EB MEM 5?% Dextran T500. Endothelial cell losses after 6?days were negligible, explants of the corneas generated uniform fibroblastic stromal cell cultures and the extents of Janus Green staining were similar. Over 20?days the inclusion of 5?% Dextran T500 in EB MEM but not 3?% PEG 35,000 in MegaCell DCS, increased the rate of endothelial cell loss.

Conclusion

PEG 35,000 at a concentration of 3?%?w/v does not induce endothelial cell loss and is compatible with MegaCell DCS for thinning corneas prior to transplantation.     

Genetic variants on 15q25.1, smoking, and lung cancer: an assessment of mediation and interaction

Genome-wide association studies have identified variants on chromosome 15q25.1 that increase the risks of both lung cancer and nicotine dependence and associated smoking behavior. However, there remains debate as to whether the association with lung cancer is direct or is mediated by pathways related to smoking behavior. Here, the authors apply a novel method for mediation analysis, allowing for gene-environment interaction, to a lung cancer case-control study (1992-2004) conducted at Massachusetts General Hospital using 2 single nucleotide polymorphisms, rs8034191 and rs1051730, on 15q25.1. The results are validated using data from 3 other lung cancer studies. Tests for additive interaction (P = 2 × 10(-10) and P = 1 × 10(-9)) and multiplicative interaction (P = 0.01 and P = 0.01) were significant. Pooled analyses yielded a direct-effect odds ratio of 1.26 (95% confidence interval (CI): 1.19, 1.33; P = 2 × 10(-15)) for rs8034191 and an indirect-effect odds ratio of 1.01 (95% CI: 1.00, 1.01; P = 0.09); the proportion of increased risk mediated by smoking was 3.2%. For rs1051730, direct- and indirect-effect odds ratios were 1.26 (95% CI: 1.19, 1.33; P = 1 × 10(-15)) and 1.00 (95% CI: 0.99, 1.01; P = 0.22), respectively, with a proportion mediated of 2.3%. Adjustment for measurement error in smoking behavior allowing up to 75% measurement error increased the proportions mediated to 12.5% and 9.2%, respectively. These analyses indicate that the association of the variants with lung cancer operates primarily through other pathways.     

Use of lipid-based nutrient supplements by HIV-infected Malawian women during lactation has no effect on infant growth from 0 to 24 weeks

The Breastfeeding, Antiretrovirals, and Nutrition Study evaluated the effect of daily consumption of lipid-based nutrient supplements (LNS) by 2121 lactating, HIV-infected mothers on the growth of their exclusively breast-fed, HIV-uninfected infants from 0 to 24 wk. The study had a 2 × 3 factorial design. Malawian mothers with CD4(+) ≥250 cells/mm(3), hemoglobin ≥70 g/L, and BMI ≥17 kg/m(2) were randomized within 36 h of delivery to receive either no LNS or 140 g/d of LNS to meet lactation energy and protein needs, and mother-infant pairs were assigned to maternal antiretroviral drugs (ARV), infant ARV, or no ARV. Sex-stratified, longitudinal, random effects models were used to estimate the effect of the 6 study arms on infant weight, length, and BMI. Logistic regression models were used to calculate the odds of growth faltering [decline in weight-for-age Z-score (WAZ) or length-for-age Z-score (LAZ) >0.67] using the control arm as the reference. Although some differences between study arms emerged with increasing infant age in boys, there were no consistent effects of the maternal supplement across the 3 growth outcomes in longitudinal models. At the ages where differences were observed, the effects on weight and BMI were quite small (≤200 g and ≤0.4 kg/m(2)) and unlikely to be of clinical importance. Overall, 21 and 34% of infants faltered in WAZ and LAZ, respectively. Maternal supplementation did not reduce the odds of infant weight or length faltering from 0 to 24 wk in any arm. These results indicate that blanket supplementation of HIV-infected lactating women may have little impact on infant growth.     

Induction of colonic aberrant crypts in mice by feeding apparent N-nitroso compounds derived from hot dogs

Nitrite-preserved meats (e.g., hot dogs) may help cause colon cancer because they contain N-nitroso compounds. We tested whether purified hot-dog-derived total apparent N-nitroso compounds (ANC) could induce colonic aberrant crypts, which are putative precursors of colon cancer. We purified ANC precursors in hot dogs and nitrosated them to produce ANC. In preliminary tests, CF1 mice received 1 or 3 i.p. injections of 5 mg azoxymethane (AOM)/kg. In Experiments 1 and 2, female A/J mice received ANC in diet. In Experiment 1, ANC dose initially dropped sharply because the ANC precursors had mostly decomposed but, later in Experiment 1 and throughout Experiment 2, ANC remained at 85 nmol/g diet. Mice were killed after 8 (AOM tests) or 17-34 (ANC tests) wk. Median numbers of aberrant crypts in the distal 2 cm of the colon for 1 and 3 AOM injections, CF1 controls, ANC (Experiment 1), ANC (Experiment 2),and untreated A/J mice were 31, 74, 12, 20, 12, and 5-6, with P < 0.01 for both ANC tests. Experiment 2 showed somewhat increased numbers of colonic mucin-depleted foci in the ANC-treated group. We conclude that hot-dog-derived ANC induced significant numbers of aberrant crypts in the mouse colon.