Nutrient optimization in bioleaching: are we overdosing?

The general trend in biomining (i.e., bioleaching and biooxidation) is the use of media with high concentrations of the nutrients (nitrogen as ammonium, phosphorous as phosphate, and K), which are considered to be essential for microbial growth. The depletion of any of the nutrients would affect negatively the bioleaching (and biooxidation) capacity of the microorganisms, so the formulation of the different media ensures that there is a surplus of nutrients. However, some of these nutrients (e.g., phosphate, K) may be already present in the ore and are made available to the microorganisms when the ore is exposed to the low-pH media used during bioleaching. The effect of phosphate addition (109 mg/L) and depletion on the bioleaching of low-grade sulfidic ore alongside the determination of ammonium (i.e., 25 mg/L, 50 mg/L, 109 mg/L, 409 mg/L, and 874 g/L) requirements were studied. The results of the experiments presented showed that the addition of phosphate did not have any effect on the bioleaching of the low-grade sulfidic ore while the addition of ammonium was necessary to obtain higher redox potentials (>650 mV vs. Ag/AgCl) and higher metal (Co, Cu, Ni, and Zn) dissolutions. Temperature was the factor that shaped the microbial communities, at 30°C, the microbial community at the end of all the experiments was dominated by Acidithiobacillus sp. as well as at 42°C, except when nutrients were not added and Sulfobacillus sp. was the dominant microorganism. At 55°C, DNA recovery was unsuccessful, and at 60°C, the microbial communities were dominated by Sulfolobus sp. In conclusion, the amount of nutrients in bioleaching could be reduced significantly to achieve the redox potentials and metal dissolution desired in bioleaching without affecting the microbial communities and bioleaching efficiencies.

Increased risk of attention-deficit/hyperactivity disorder in adolescents with high salivary levels of copper, manganese, and zinc.

Exposure to toxic heavy metals has been associated with the development of attention-deficit/hyperactivity disorder (ADHD). However, fewer studies have examined the associations between abnormal levels of essential trace metals and ADHD, and none have done so using saliva. We investigated whether salivary metals were associated with ADHD in adolescents aged 12 from the Family Life Project (FLP) using a nested case-control study design that included 110 adolescents who met diagnostic criteria for inattentive (ADHD-I), hyperactive-impulsive (ADHD-H), or combined type ADHD (ADHD-C) (cases) and 173 children who did not (controls). We used inductively coupled plasma optical emission spectrophotometry to measure chromium, copper, manganese, and zinc in saliva samples. We employed logistic regression models to examine associations between quartile levels of individual metals and ADHD outcomes by subtype. Salivary copper levels were significantly associated with increased odds of any ADHD diagnosis (OR = 3.31, 95% CI: 1.08-10.12; p = 0.04) and with increased odds of ADHD-C diagnosis (OR = 8.44, 95% CI: 1.58-45.12; p = 0.01). Salivary zinc levels were significantly associated with increased odds of ADHD-C diagnosis (OR = 4.06, 95% CI: 1.21-13.69; p = 0.02). Salivary manganese levels were also significantly associated with increased odds of ADHD-C diagnosis (OR = 5.43, 95% CI: 1.08-27.27, p = 0.04). This is the first study using saliva to assess metal exposure and provide a potential link between salivary levels of copper, manganese, and zinc and ADHD diagnoses in adolescents. Public health interventions focused on metal exposures might reduce ADHD incidence in low-income, minority communities.

Supporting families with complex early parenting needs through a virtual residential parenting service: An investigation of outcomes, facilitators and barriers.

AIM: To investigate clients' perspectives about outcomes of a telehealth residential unit (RU) program for families experiencing complex early parenting issues, and to explore facilitators and barriers to positive client outcomes. DESIGN: Qualitative study using semi-structured interviews. METHODS: Semi-structured interviews were conducted with mothers (n = 18) admitted to a telehealth RU program. Interview transcripts were analysed using thematic analysis. RESULTS: Mothers reported short-term improvements in their child's presenting issues (e.g. feeding to sleep, night-time waking, co-sleeping), increased confidence and increased partner involvement. According to participants, program outcomes were facilitated by a positive parent-clinician relationship, the accessibility of clinicians and being able to take part in the program from their own home. Barriers included difficulties with technical equipment and connecting with the clinician overnight, and challenges with implementing strategies in the longer term. CONCLUSION: This nurse-led telehealth program was viewed positively by parents and the study identified a number of areas for improvement. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Telehealth early parenting programs provide an important way for parents to receive support with early child sleep, settling and feeding issues. Clinicians working in this area should focus on the development of positive parent-nurse relationships, enhancing communication and availability for parents during overnight periods and supporting parents to develop early parenting skills that will be applicable across the early childhood period. IMPACT: The study is the first to address client experiences of a telehealth RU program. Facilitators and barriers identified will inform service improvements to the program going forward, and similar telehealth programs for families; to ensure benefits and service outcomes are maximised for parents for such a crucial service. REPORTING METHOD: The Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines for qualitative research were followed.

Heterogeneity in familial clustering of metabolic syndrome components in the multiethnic GENNID study.

OBJECTIVE: Metabolic syndrome (MetS) is defined by clustering of cardiometabolic components, which may be present in different combinations. The authors evaluated clustering in individuals and extended families within and across ancestry groups. METHODS: The prevalence of different combinations of MetS components (high fasting glucose, low high-density lipoprotein cholesterol, high triglycerides, high blood pressure, and abdominal obesity) was estimated in 1651 individuals (340 families) self-reporting as European American (EA), Hispanic/Mexican American (MA), African American (AA), and Japanese American (JA). Odds ratios were estimated using logistic regression with generalized estimating equations comparing individual MetS components, number, and combinations of components for each ancestry group versus EA. RESULTS: Clustering of all five components (Combination #16) was more prevalent in EA (29.9%) and MA (25.2%) individuals than in AA (18.7%) and JA (15.5%) individuals. Compared with EA individuals, AA individuals were 64% and 66% less likely to have high triglycerides and low high-density lipoprotein cholesterol, whereas JA individuals were 85% and 56% less likely to have abdominal obesity and high blood pressure, respectively. Compared with EA individuals, the odds of having two, four, or five components were at least 77% lower in JA individuals, whereas the odds of having three, four, or five components were at least 3.79 times greater in MA individuals. CONCLUSIONS: Understanding heterogeneity in MetS clustering may identify factors important in reducing health disparities.

Gait and balance in apolipoprotein Ɛ4 allele carriers in older adults and Parkinson's disease.

Background: Gait and balance impairments are among the most troublesome and heterogeneous in Parkinson's disease (PD). This heterogeneity may, in part, reflect genetic variation. The apolipoprotein E (APOE) gene has three major allelic variants (ε2, ε3 and ε4). Previous work has demonstrated that older adult (OA) APOE ε4 carriers demonstrate gait deficits. This study compared gait and balance measures between APOE ε4 carriers and non-carriers in both OA and PD. Methods: 334 people with PD (81 APOE ε4 carriers and 253 non-carriers) and 144 OA (41 carriers and 103 non-carriers) were recruited. Gait and balance were assessed using body-worn inertial sensors. Two-way analyses of covariance (ANCOVA) compared gait and balance characteristics between APOE ε4 carriers and non-carriers in people with PD and OA, controlling for age, gender, and testing site. Results: Gait and balance were worse in people with PD compared to OA. However, there were no differences between APOE ε4 carriers and non-carriers in either the OA or PD group. In addition, there were no significant group (OA/PD) by APOE ε4 status (carrier/non-carrier) interaction effects for any measures of gait or balance. Conclusions: Although we found expected impairments in gait and balance in PD compared to OA, gait and balance characteristics did not differ between APOE ε4 carriers and non-carriers in either group. While APOE status did not impact gait and balance in this cross-sectional study, future work is needed to determine whether progression of gait and balance deficits is faster in PD APOE Ɛ4 carriers.

Natural carbon mineralization and its control on the geochemical evolution of coal-based aquifers in the Salt Range, Punjab, Pakistan.

Hydrochemical analysis of the Salt Range was conducted to understand carbon weathering and its impact on groundwater evolution within the complex geological framework of Punjab. Our results showed that groundwater samples were alkaline with a pH range of 7.0-8.6 and 7.8-8.8 for the eastern Salt Range (ESR) and Trans-Indus Salt Range (TSR), respectively, while that of the Central Salt Range (CSR) was acidic to moderately alkaline ranging between 5.7 and 7.5. The water types of Ca-Mg-HCO3, Ca-Mg-Cl, and Ca-Cl2 were the dominant hydro-chemical facies in ESR and CSR sites. However, groundwater of the TSR site falls under Ca-Mg-Cl, Ca-Cl2, and mixed types of Ca-Mg-SO4. Our new findings suggest that groundwater chemistry is primarily controlled by rock dominance and reverse ion exchange reaction, followed by evapotranspiration processes. The wells of ESR, CSR, and TSR were reported with higher levels of Fe and Zn. Regarding the suitability for irrigation, sodium adsorption ratio (SAR), magnesium adsorption ratio (MAR), sodium percentage (Na%), Kelley's ratio (KR), and potential salinity (PS) at all three sites (ESR, TSR, and CSR) had the potential to become a salinity hazard. The conceptual model of geochemical evolution shows that both local and regional salinization is driven by local geology and intensive coal mining activities. The neutralization capacity of the parent geological formation buffers the acidity and lowers the overall trace element enrichment. The potential of natural weathering could be further explored as a solution to coal mining's impact on the environment.

Reliability and Validity Evidence for an Academic Gender Equity Questionnaire.

Objective. The majority of practicing pharmacists and student pharmacists are women. However, instruments to assess perceptions of gender equity within pharmacy academia are not available. The objective of this research was to describe the psychometric analysis of a questionnaire developed to assess gender equity by a Gender Equity Task Force and to report reliability and validity evidence.Methods. A questionnaire with 21 items addressing the teaching, research, service, advancement, mentoring, recruitment, and gender of college leaders was created. The survey was distributed via email in December 2020 to all social and administrative science section members of two professional associations. Rasch analysis was performed to evaluate the reliability and validity evidence for the questionnaire.Results. After reverse coding, all items met parameters for unidimensionality necessary for Rasch analysis. Once adjacent categories were merged to create a 3-point scale, the scale and items met parameters for appropriate functionality. Items were ordered hierarchically in order of difficulty. The modified instrument and scale can be treated as interval level data for future use.Conclusion. This analysis provides reliability and validity evidence supporting use of the gender equity questionnaire in the social and administrative academic pharmacy population if recommended edits such as the 3-point scale are used. Future research on gender equity can benefit from use of a psychometrically sound questionnaire for data collection.

Gender equity perceptions among social and administrative science faculty: A qualitative evaluation.

BACKGROUND: Anecdotal evidence suggests that gender inequity persists in academic pharmacy. To date, there are limited published data about the perception of gender inequity in academic pharmacy. OBJECTIVE: The objective of this project was to determine themes associated with gender inequity perceptions in social and administrative science faculty from 2 national pharmacy organizations. METHODS: A gender equity task force comprising 13 members from Social and Administrative Sciences (SAS) sections of the American Pharmacists Association and the American Association of Colleges of Pharmacy was formed. The task force designed a semistructured interview guide comprising questions about demographics and core areas where inequities likely exist. When the survey invitation was sent to faculty members of the SAS sections via Qualtrics, faculty indicated whether they were willing to be interviewed. Interviews were conducted by 2 members of the task force via video conferencing application. The interviews were transcribed. Topic coding involving general categorization by theme followed by refinement to delineate subcategories was used. Coding was conducted independently by 3 coders followed by consensus when discrepancies were identified. RESULTS: A total of 21 faculty participated in the interviews. Respondents were primarily female (71%), were white (90%), had Doctor of Philosophy as their terminal degree (71%), and were in nontenure track positions (57%). Most respondents (90%) experienced gender inequity. A total of 52% reported experiencing gender inequity at all ranks from graduate student to full professor. Four major themes were identified: microaggression (57%), workload (86%), respect (76%), and opportunities (38%). Workload, respect, and opportunities included multiple subthemes. CONCLUSION: Faculty respondents perceive gender inequities in multiple areas of their work. Greater inequity perceptions were present in areas of workload and respect. The task force offers multiple recommendations to address these inequities.

Cognition as a mediator for gait and balance impairments in GBA-related Parkinson's disease.

The extent to which the heterogeneity of gait and balance problems in PD may be explained by genetic variation is unknown. Variants in the glucocerebrosidase (GBA) gene are the strongest known genetic risk factor for PD and are associated with greater motor and cognitive severity. However, the impact of GBA variants on comprehensive measures of gait and balance and their relationship to cognition remains unknown. We aimed to determine differences in gait and balance impairments in those with and without GBA variants (mutation carriers and E326K polymorphism) and explore direct and indirect effects of GBA status on gait, balance, and cognition. 332 participants, 43 of whom had GBA variants, were recruited. Participants completed a comprehensive, objective assessment of gait and standing balance using body-worn inertial sensors. Group differences in gait and balance between PD with and without GBA variants were assessed with linear regression, adjusting for age, gender, clinical testing site, disease duration, and apolipoprotein E (APOE) ɛ4 status. Structural equation modeling (SEM) explored direct relationships between GBA status and gait and balance and indirect relationships between GBA status and gait and balance via cognition. The GBA variant group had more impaired gait (pace and variability) and balance (sway area/jerk and sway velocity), than the non-GBA variant group. SEM demonstrated cognition as a mediator of GBA status on gait and balance. The close relationships among GBA, gait/balance, and cognition suggest potential for novel therapeutics to target the GBA pathway and/or cognition to improve mobility in PD GBA variants.

Advances in the use of recycled non-ferrous slag as a resource for non-ferrous metal mine site remediation.

The growing global demand for non-ferrous metals has led to serious environmental issues involving uncovered mine site slag dumps that threaten the surrounding soils, surface waters, groundwater, and the atmosphere. Remediation of these slags using substitute cement materials for ordinary Portland cement (OPC) and precursors for alkali-activated materials (AAMs) can convert hazardous solid wastes into valuable construction materials, as well as to attain the desired solidification and stabilization (S/S) of heavy metal(loid)s (HM). This review discusses the current research on the effect of non-ferrous slags on the reaction mechanisms of the OPC and AAM. The S/S of HM from the non-ferrous slags in AAM and OPC is also reviewed. HM can be stabilized in these materials based on the complex salt effect and isomorphic effects. The major challenges faced in AAMs and OPC for HM stabilization include the long-term durability of the matrix (e.g., sulfate attack, stability of volume). The existing knowledge gaps and future trends for the sustainable application of non-ferrous slags are also discussed.

Groundwater nitrate and fluoride profiles, sources and health risk assessment in the coal mining areas of Salt Range, Punjab Pakistan.

To assess the loading profiles of groundwater nitrate (NO3-) and fluoride (F-), their spatial distributions, geochemistry and associated health risks were determined for 131 groundwater samples from eastern (ESR), central (CSR) and Trans-Indus Salt Ranges (TSR) in Pakistan. Groundwater NO3- concentrations were 0.2-308 mg/L (mean 59 mg/L) in ESR, 2.7-203 mg/L (mean 73 mg/L) in CSR and 1.1-259 mg/L (mean 69 mg/L) in the TSR. Forty-one %, 57% and 36% of the ESR, CSR and TSR samples, respectively, exceeded the WHO and Pak-NEQs permissible limit of 50 mg/L NO3-. Likewise, groundwater F- concentrations ranged from 0.1-1.8 mg/L (mean 0.6 mg/L), 0.1-2.7 mg/L (mean 0.9 mg/L) and 0.3-2.5 mg/L (mean 1.6 mg/L) mg/L in the ESR, CSR and TSR sites, respectively. In this case, 3%, 17% and 27% of the ESR, CSR and TSR samples, respectively, exceeded the WHO and Pak-NEQs permissible limit of 1.5 mg/L F. Oxidation of coal and coal waste resulted in the release of NO3- to groundwater. By contrast, enrichment of F- in groundwater was due to dissolution and cation exchange processes. Elevated values of the Higher Pollution Index (PI) and Health Risk Index (HRI) reflect a non-acceptable carcinogenic risk for drinking water NO3- and F- which should be addressed on a priority basis to protect human health.

Semantic fluency and processing speed are reduced in non-cognitively impaired participants with Parkinson's disease.

Introduction: Parkinson's disease (PD) is associated with a range of cognitive deficits. Few studies have carefully examined the subtle impacts of PD on cognition among patients who do not meet formal criteria for MCI or dementia. The aim of the current study was thus to describe the impact of PD on cognition in those without cognitive impairment in a well-characterized cohort.Methods: Non-cognitively impaired participants (122 with PD, 122 age- and sex-matched healthy volunteers) underwent extensive cognitive testing. Linear regression analyses compared diagnostic group performance across cognitive measures. For cognitive tasks that were significantly different between groups, additional analyses examined group differences restricting the group inclusion to PD participants with mild motor symptoms or disease duration less than 10 years.Results: Processing speed and semantic verbal fluency were significantly lower in the PD group (B = -3.77, 95% CIs [-5.76 to -1.77], p < .001, and B = -2.02, 95% CIs [-3.12, -0.92], p < .001, respectively), even after excluding those with moderate to severe motor symptoms (B = -2.73, 95% CIs [-4.94 to -0.53], p = .015 and B = -2.11, 95% CIs [-3.32 to -0.91], p < .001, respectively) or longer disease duration (B = -3.89, 95% CIs [-6.14 to -1.63], p < .001 and B = -1.58, 95% CIs [-2.78 to -0.37], p = .010, respectively). Semantic verbal fluency remained significantly negatively associated with PD diagnosis after controlling for processing speed (B = -1.66, 95% CIs [-2.79 to -0.53], p = .004).Conclusions: Subtle decline in specific cognitive domains may be present among people diagnosed with PD but without evidence to support a formal cognitive diagnosis. These results suggest the importance of early awareness of the potential for diminishing aspects of cognition in PD even among those without mild cognitive impairment or dementia.

Potentially toxic elements contamination in surface sediment and indigenous aquatic macrophytes of the Bahmanshir River, Iran: Appraisal of phytoremediation capability.

To determine the status and sources of contamination and phytoremediation capability of Typha latifolia L. in the Bahmanshir River of Iran, the concentration of eight potentially toxic elements (As, Cd, Cr, Cu, Mn, Ni, Pb, and Zn) in sediment and plant tissues from ten sampling sites were measured. Mean concentrations of Cd, Cr, Cu, Pb, and Zn in the sediment exceeded those of local background. PCA-MLR receptor analysis suggested that the sediment contamination was due to municipal wastewater/vehicular pollution and weathering/industrial/agricultural activities, with contributions of 66% and 34%, respectively. Average enrichment factor (EF) and modified hazard quotient (mHQ) for Pb and Cu were categorized as moderate. Modified pollution index (MPI) and modified ecological risk index (MRI) values suggested moderate to heavy pollution and low ecological risk, respectively. The values of sediment quality guidelines (SQGs), ecological contamination index (ECI), contamination severity index (CSI), and toxic risk index (TRI) were all similar, reflecting low to moderate contamination and toxicity. Typha latifolia L. showed good phytostabilization capability for Cd, Cu, and Pb, and phytoextraction capacity for Zn. Using the metal accumulation index (MAI) and the comprehensive bioconcentration index (CBCI), Typha latifolia L. was shown to have acceptable performance in the accumulation of Cd, Cu, Pb, and Zn and thus, can be considered a good candidate for bioaccumulation of these elements in the study area. Overall, this study suggests that phytoremediation using Typha latifolia L. could be a practical method for uptake and remove of potentially toxic elements from aquatic environments.

Genome-wide association analysis of metabolic syndrome quantitative traits in the GENNID multiethnic family study.

BACKGROUND: To identify genetic associations of quantitative metabolic syndrome (MetS) traits and characterize heterogeneity across ethnic groups. METHODS: Data was collected from GENetics of Noninsulin dependent Diabetes Mellitus (GENNID), a multiethnic resource of Type 2 diabetic families and included 1520 subjects in 259 African-American, European-American, Japanese-Americans, and Mexican-American families. We focused on eight MetS traits: weight, waist circumference, systolic and diastolic blood pressure, high-density lipoprotein, triglycerides, fasting glucose, and insulin. Using genotyped and imputed data from Illumina's Multiethnic array, we conducted genome-wide association analyses with linear mixed models for all ethnicities, except for the smaller Japanese-American group, where we used additive genetic models with gene-dropping. RESULTS: Findings included ethnic-specific genetic associations and heterogeneity across ethnicities. Most significant associations were outside our candidate linkage regions and were coincident within a gene or intergenic region, with two exceptions in European-American families: (a) within previously identified linkage region on chromosome 2, two significant GLI2-TFCP2L1 associations with weight, and (b) one chromosome 11 variant near CADM1-LINC00900 with pleiotropic blood pressure effects. CONCLUSIONS: This multiethnic family study found genetic heterogeneity and coincident associations (with one case of pleiotropy), highlighting the importance of including diverse populations in genetic research and illustrating the complex genetic architecture underlying MetS.

Improving reporting standards for polygenic scores in risk prediction studies.

Polygenic risk scores (PRSs), which often aggregate results from genome-wide association studies, can bridge the gap between initial discovery efforts and clinical applications for the estimation of disease risk using genetics. However, there is notable heterogeneity in the application and reporting of these risk scores, which hinders the translation of PRSs into clinical care. Here, in a collaboration between the Clinical Genome Resource (ClinGen) Complex Disease Working Group and the Polygenic Score (PGS) Catalog, we present the Polygenic Risk Score Reporting Standards (PRS-RS), in which we update the Genetic Risk Prediction Studies (GRIPS) Statement to reflect the present state of the field. Drawing on the input of experts in epidemiology, statistics, disease-specific applications, implementation and policy, this comprehensive reporting framework defines the minimal information that is needed to interpret and evaluate PRSs, especially with respect to downstream clinical applications. Items span detailed descriptions of study populations, statistical methods for the development and validation of PRSs and considerations for the potential limitations of these scores. In addition, we emphasize the need for data availability and transparency, and we encourage researchers to deposit and share PRSs through the PGS Catalog to facilitate reproducibility and comparative benchmarking. By providing these criteria in a structured format that builds on existing standards and ontologies, the use of this framework in publishing PRSs will facilitate translation into clinical care and progress towards defining best practice.

Perioperative Nurse Educators: Rapid Response to the COVID-19 Pandemic.

During the initial response to the coronavirus disease 2019 (COVID-19) pandemic, hospital leaders limited or halted the scheduling of elective surgical procedures. Perioperative nurse educators participated in a rapid response to develop innovative strategies and use a variety of modalities to provide information and education activities for staff members who were reassigned to different hospital areas. Residency program educators used alternative teaching methods to accommodate the lack of clinical rotations and allow orienting nurses to progress in an OR nurse residency program. Limited access to ORs and social distancing rules prevented nursing students from completing clinical rotations in health care settings, and academic educators developed flexible solutions to meet the students' needs. Perioperative educators can use guidance from national and international organizations to assist leaders and staff members with managing patient care during the pandemic. This article presents specific information on perioperative nurse educator roles and responses during the pandemic.

Characteristics and mechanisms of Pb(II) sorption onto Fe-rich waste water treatment residue (WTR): A potential sustainable Pb immobilisation technology for soils.

Pb contamination of soils is a global problem. This paper discusses the ability of an Fe-rich waste, water treatment residual (WTR), to adsorb Pb(II). This was investigated using batch sorption experiments, X-ray diffraction, electron microprobe microanalysis, PHREEQC modeling and Extended X-ray Absorption Fine Structure (EXAFS) analysis. The WTR is composed of approximately 23 wt. % natural organic matter (NOM), 70 wt. % ferrihydrite and <10 wt. % silicate material. Pb(II) sorption to WTR was dependent on initial Pb(II) load, particle size, time and pH, but not on ionic strength. EXAFS analysis at the Pb LIII-edge confirmed that Pb(II) sorbed to WTR by co-existing bidentate edge-sharing and monodentate or corner-sharing complexes, with 2 O at ∼2.31-2.34 Å, 1 Fe at ∼3.32-3.34 Å, 2 Fe at ∼3.97-3.99 Å and 1 Pb at ∼3.82-3.85 Å. Linear combination showed that the Pb(II)-sorbed spectra were best fit with a ∼0.9 ± 0.1 and 0.1 ± 0.1 contribution from Pb(II)-sorbed ferrihydrite and Pb(II)-sorbed humic acid end members, respectively. Overall, we show that Pb(II) sorbs via strong inner-sphere complexation of Pb(II) to the ferrihydrite component of the WTR, which itself is stable over a wide pH range. Therefore, we suggest that Fe-rich WTR wastes could be used as effective adsorbents in Pb(II)-contaminated soils to help ensure sustainable terrestrial ecosystems.

Improving outcomes for marginalised rural families through a care navigator program.

ISSUES ADDRESSED: Health promotion programs are based on the premise that health and well-being is impacted by a person's living circumstances, not just factors within the health arena. Chronic health issues require integrated services from health and social services. Navigator positions are effective in assisting chronic disease patients to access services. This family program in a small rural town in Western New South Wales targeted marginalised families with children under five years of age with a chronic health issue. The navigator developed a cross-sectoral care plan to provide services to address family issues. The study aimed to identify navigator factors supporting improved family outcomes. METHODS: Participants included parent/clients (n = 4) and the cross-sectoral professional team (n = 9) involved in the program. During the interview, participants were asked about their perspective of the program. Interview transcripts were thematically analysed informed by the Chronic Care Model underpinned by Health Promotion Theory. RESULTS: The program improved client family's lives in relation to children's health and other family health and social issues. Trust in the care navigator was the most important factor for parents to join and engage with the program. The care navigator role was essential to maintaining client engagement and supporting cooperation between services to support families. CONCLUSION: Essential care navigator skills were commitment, ability to persuade and empower parents and other professionals. SO WHAT?: This descriptive study demonstrated the positive influence of the care navigator and the program on high risk families in a small isolated community. It can be adopted by other communities to improve life for families at risk.

Relationships Between Sensorimotor Inhibition and Mobility in Older Adults With and Without Parkinson's Disease.

BACKGROUND: Reduced cortical sensorimotor inhibition is associated with mobility and cognitive impairments in people with Parkinson's disease (PD) and older adults (OAs). However, there is a lack of clarity regarding the relationships among sensorimotor, cognitive, and mobility impairments. The purpose of this study was to determine how cortical sensorimotor inhibition relates to impairments in mobility and cognition in people with PD and OAs. METHOD: Cortical sensorimotor inhibition was characterized with short-latency afferent inhibition (SAI) in 81 people with PD and 69 OAs. Six inertial sensors recorded single- and dual-task gait and postural sway characteristics during a 2-minute walk and a 1-minute quiet stance. Cognition was assessed across the memory, visuospatial, executive function, attention, and language domains. RESULTS: SAI was significantly impaired in the PD compared to the OA group. The PD group preformed significantly worse across all gait and postural sway tasks. In PD, SAI significantly correlated with single-task foot strike angle and stride length variability, sway area, and jerkiness of sway in the coronal and sagittal planes. In OAs, SAI significantly related to single-task gait speed and stride length, dual-task stride length, and immediate recall (memory domain). No relationship among mobility, cognition, and SAI was observed. CONCLUSIONS: Impaired SAI related to slower gait in OA and to increased gait variability and postural sway in people with PD, all of which have been shown to be related to increased fall risk.