A meta-synthesis of how parents of children with autism describe their experience of accessing and using routine healthcare services for their children.

In order to present a greater understanding to parental experiences of supporting their child with autism to access healthcare services, a systematic review of qualitative research was undertaken, addressing the review question: 'How do parents of children with autism describe their experiences of utilising routine healthcare services?'. After a systematic search and selection process, 12 studies were identified and appraised independently by paired reviewers using an adapted version of the Critical Appraisal Skills Programme (CASP) tool. Data were synthesised by two reviewers in line with the Joanna Briggs Approach for meta-aggregation. The 12 studies included in this review (spanning 2012-2020), represented the voices of 240 parents. The synthesis resulted in the following synthesised finding (based on four categories that emerged from the original studies' themes): parents report challenges in accessing and use of mainstream health services, for their child with autism, due to not having a voice, inadequate communication and lack of understanding from health service providers. This review raises our awareness of parents' experiences of healthcare services and will assist healthcare practitioners to reconsider their own communication style, understanding and approach with children with autism and their families. From these findings, we recommend that healthcare practitioners more readily incorporate parents' contributory expertise into healthcare visits. These recommendations will help facilitate effective, supportive and positive healthcare experiences for all involved.

Ecological and physiological implications of nitrogen oxide reduction pathways on greenhouse gas emissions in agroecosystems.

Microbial reductive pathways of nitrogen (N) oxides are highly relevant to net emissions of greenhouse gases (GHG) from agroecosystems. Several biotic and abiotic N-oxide reductive pathways influence the N budget and net GHG production in soil. This review summarizes the recent findings of N-oxide reduction pathways and their implications to GHG emissions in agroecosystems and proposes several mitigation strategies. Denitrification is the primary N-oxide reductive pathway that results in direct N2O emissions and fixed N losses, which add to the net carbon footprint. We highlight how dissimilatory nitrate reduction to ammonium (DNRA), an alternative N-oxide reduction pathway, may be used to reduce N2O production and N losses via denitrification. Implications of nosZ abundance and diversity and expressed N2O reductase activity to soil N2O emissions are reviewed with focus on the role of the N2O-reducers as an important N2O sink. Non-prokaryotic N2O sources, e.g. fungal denitrification, codenitrification and chemodenitrification, are also summarized to emphasize their potential significance as modulators of soil N2O emissions. Through the extensive review of these recent scientific advancements, this study posits opportunities for GHG mitigation through manipulation of microbial N-oxide reductive pathways in soil.

A meta-synthesis of how parents of children with autism describe their experience of advocating for their children during the process of diagnosis.

The diagnostic process for children with autism can be complex for parents to navigate as they advocate for their child in order to obtain answers to their concerns, and receive the subsequent support they need. Gaining an understanding of parents' experiences during this process, will assist service providers in supporting families adequately. This systematic review was undertaken to consolidate in-depth qualitative data from parents of their experience of advocating for their child with autism, during the process of diagnosis. A qualitative meta-synthesis was conducted, whereby fifteen databases were systematically searched. Twenty-two studies were identified and appraised using an adapted version of the Critical Appraisal Skills Programme tool. Data were synthesised into themes through the steps of review, meta-aggregation, integration, and interpretation. The date range of the included studies spans 1999-2016. The voices of 1,178 parents are presented in this review describing their experiences in two overarching themes: "Pathway to diagnosis-Confusion and not feeling heard"; and "Pursuing diagnosis-Resilience and commitment." Each one of these main themes had sub-themes. Our findings highlight the intense emotional journey for parents during identification of their initial concerns and the formal process of diagnosis, and their perceptions of not being supported by others on this journey. This review illustrates the significant impact that positive experiences with first-line professionals have during the process of diagnosis, and how these experiences lay the foundation for all future relationships with other service providers. As a result, awareness of parents' experiences will assist service providers to reconsider their communication style, information sharing, provision of support and to incorporate parents' contributions in facilitating a more streamlined and more supportive process of diagnosis.

Antibiotic Effects on Microbial Communities Responsible for Denitrification and N2O Production in Grassland Soils.

Antibiotics in soils may affect the structure and function of microbial communities. In this study, we investigated the acute effects of tetracycline on soil microbial community composition and production of nitrous oxide (N2O) and dinitrogen (N2) as the end-products of denitrification. Grassland soils were pre-incubated with and without tetracycline for 1-week prior to measurements of N2O and N2 production in soil slurries along with the analysis of prokaryotic and fungal communities by quantitative polymerase chain reaction (qPCR) and next-generation sequencing. Abundance and taxonomic composition of bacteria carrying two genotypes of N2O reductase genes (nosZ-I and nosZ-II) were evaluated through qPCR and metabolic inference. Soil samples treated with tetracycline generated 12 times more N2O, but N2 production was reduced by 84% compared to the control. In parallel with greater N2O production, we observed an increase in the fungi:bacteria ratio and a significant decrease in the abundance of nosZ-II carrying bacteria; nosZ-I abundance was not affected. NosZ-II-carrying Bacillus spp. (Firmicutes) and Anaeromyxobacter spp. (Deltaproteobacteria) were particularly susceptible to tetracycline and may serve as a crucial N2O sink in grassland soils. Our study indicates that the introduction of antibiotics to agroecosystems may promote higher N2O production due to the inhibitory effects on nosZ-II-carrying communities.

Corrigendum: Chemical formation of hybrid di-nitrogen calls fungal codenitrification into question.

This corrects the article DOI: 10.1038/srep39077.

Social inclusion for children with hearing loss in listening and spoken Language early intervention: an exploratory study.

BACKGROUND: Social inclusion is a common focus of listening and spoken language (LSL) early intervention for children with hearing loss. This exploratory study compared the social inclusion of young children with hearing loss educated using a listening and spoken language approach with population data. METHODS: A framework for understanding the scope of social inclusion is presented in the Background. This framework guided the use of a shortened, modified version of the Longitudinal Study of Australian Children (LSAC) to measure two of the five facets of social inclusion ('education' and 'interacting with society and fulfilling social goals'). The survey was completed by parents of children with hearing loss aged 4-5 years who were educated using a LSL approach (n = 78; 37% who responded). These responses were compared to those obtained for typical hearing children in the LSAC dataset (n = 3265). RESULTS: Analyses revealed that most children with hearing loss had comparable outcomes to those with typical hearing on the 'education' and 'interacting with society and fulfilling social roles' facets of social inclusion. CONCLUSIONS: These exploratory findings are positive and warrant further investigation across all five facets of the framework to identify which factors influence social inclusion.

Chemical formation of hybrid di-nitrogen calls fungal codenitrification into question.

Removal of excess nitrogen (N) can best be achieved through denitrification processes that transform N in water and terrestrial ecosystems to di-nitrogen (N2) gas. The greenhouse gas nitrous oxide (N2O) is considered an intermediate or end-product in denitrification pathways. Both abiotic and biotic denitrification processes use a single N source to form N2O. However, N2 can be formed from two distinct N sources (known as hybrid N2) through biologically mediated processes of anammox and codenitrification. We questioned if hybrid N2 produced during fungal incubation at neutral pH could be attributed to abiotic nitrosation and if N2O was consumed during N2 formation. Experiments with gas chromatography indicated N2 was formed in the presence of live and dead fungi and in the absence of fungi, while N2O steadily increased. We used isotope pairing techniques and confirmed abiotic production of hybrid N2 under both anoxic and 20% O2 atmosphere conditions. Our findings question the assumptions that (1) N2O is an intermediate required for N2 formation, (2) production of N2 and N2O requires anaerobiosis, and (3) hybrid N2 is evidence of codenitrification and/or anammox. The N cycle framework should include abiotic production of N2.

Nitrous Oxide Fluxes, Soil Oxygen, and Denitrification Potential of Urine- and Non-Urine-Treated Soil under Different Irrigation Frequencies.

Despite increased use of irrigation to improve forage quality and quantity for grazing cattle ( Linnaeus), there is a lack of data that assess how irrigation practices influence nitrous oxide (NO) emissions from urine-affected soils. Irrigation effects on soil oxygen (O) availability, a primary controller of NO fluxes, is poorly understood. It was hypothesized that increased irrigation frequency would result in lower NO emissions by increasing soil moisture and decreasing soil O concentrations. This would favor more NO reduction to dinitrogen (N). We examined effects of high (3-d) versus low (6-d) irrigation frequency with and without bovine urine addition to pasture. Nitrous oxide fluxes were measured daily for 35 d. Soil O, temperature, and water content were continuously measured at multiple depths. Inorganic nitrogen, organic carbon, and soil pH were measured at 6-d intervals. Measurements of denitrification enzyme activity with and without acetylene inhibition were used to infer the NO/(NO + N) ratio. The NO/(NO + N) ratio was lower under high- compared with low-frequency irrigation, suggesting greater potential for NO reduction to N with more frequent irrigation. Although NO fluxes were increased by urine addition, they were not affected by irrigation frequency. Soil O decreased temporarily after urine deposition, but O dynamics did not explain NO dynamics. Relative soil gas diffusivity (/) was a better predictor of NO fluxes than O concentration. On a free-draining soil, increasing irrigation frequency while providing the same total water volume did not enhance NO emissions under ruminant urine patches in a grazed pasture.

Wetland Soil Carbon in a Watershed Context for the Prairie Pothole Region.

Wetland restoration in the Prairie Pothole Region (PPR) often involves soil removal to enhance water storage volume and/or remove seedbanks of invasive species. Consequences of soil removal could include loss of soil organic carbon (SOC), which is important to ecosystem functions such as water-holding capacity and nutrient retention needed for plant re-establishment. We used watershed position and surface flow pathways to classify wetlands into headwater or network systems to address two questions relevant to carbon (C) cycling and wetland restoration practices: (i) Do SOC stocks and C mineralization rates vary with landscape position in the watershed (headwater vs. network systems) and land use (restored vs. native prairie grasslands)? (ii) How might soil removal affect plant emergence? We addressed these questions using wetlands at three large (?200 ha) study areas in the central North Dakota PPR. We found the cumulative amount of C mineralization over 90 d was 100% greater for network than headwater systems, but SOC stocks were similar, suggesting greater C inputs beneath wetlands connected by higher-order drainage lines are balanced by greater rates of C turnover. Land use significantly affected SOC, with greater stocks beneath native prairie than restored grasslands for both watershed positions. Removal of mineral soil negatively affected plant emergence. This watershed-based framework can be applied to guide restoration designs by (i) weighting wetlands based on surface flow connectivity and contributing area and (ii) mapping the effects of soil removal on plant and soil properties for network and headwater wetland systems in the PPR.

Soil organic carbon beneath croplands and re-established grasslands in the North Dakota Prairie Pothole Region.

Grassland ecosystems established under the conservation reserve program (CRP) in the Prairie Pothole Region (PPR) currently provide soil conservation and wildlife habitat services. We aimed to determine if these lands also sequester soil organic carbon (SOC), as compared with neighboring croplands across multiple farms in the North Dakota PPR. We sampled soil from small plots at 17 private farms in the central North Dakota PPR, where long-term (≥15 years) grasslands managed under the CRP were paired with neighboring annual croplands. Cores were collected to 100 cm and split into 0-10, 10-20, 20-30, 30-40, 40-70, and 70-100 cm soil depth layers. We hypothesized the effect of land use on soil organic carbon (SOC), root carbon (C), and bulk density would be greatest near the surface. For 0-10 and 10-20 cm layers, grasslands managed under the CRP were lower in bulk density and higher in SOC. From 0 to 70 cm, grasslands managed under the CRP were higher in root C. Average (±standard error) SOC for re-established grasslands and croplands was 25.39 (0.91) and 21.90 (1.02), respectively, for the 0-10 cm soil layer and 19.88 (0.86) and 18.31 (0.82), respectively, for the 10-20 soil layer. Compared to croplands, re-established grasslands sampled in the North Dakota PPR were 3-13 % lower in bulk density and 9-16 % higher in SOC from 0 to 20 cm, while root C was 2-6 times greater from 0 to 70 cm.

Higher social distress and lower psycho-social wellbeing: examining the coping capacity and health of people with hearing impairment.

PURPOSE: The objectives of this paper are as follows: (1) propose an explanatory model as to how hearing disability may impact on health and (2) examine the model's utility. METHODS: Data were collected on the psycho-social wellbeing, disability and physical health of farmers (n = 56) participating in an intervention to manage the social impacts of hearing disability. Two models were proposed and examined using multiple hierarchical linear regression. Model 1 used self-rated quality of life and model 2 used capacity to manage hearing and listening impairments, as dependent variables. RESULTS: The analyses found that physical measures of hearing impairment (audiograms) were not correlated with physical or mental health outcomes. However, in model 1, self-confidence and self-rated ability to manage hearing impairment were most closely associated with reduced quality of life (anxiety and diastolic blood pressure were positively associated with quality of life). In model 2, higher anxiety and reduced self-confidence were associated with decreasing ability to successfully manage one's hearing impairment. CONCLUSIONS: The findings support the explanatory model that stress is higher and wellbeing lower when the fit between the person's coping capacity and environmental demands is poor. IMPLICATIONS FOR REHABILITATION: This paper demonstrates that anxiety is associated with coping with the psycho-social aspects of hearing disability. This finding has important implications for the many hearing services, which only provide assessment and devices. To negate anxiety and its long-term impacts, rehabilitation providers need to ensure people with hearing disability have the capacity to manage the psycho-social aspects of communication breakdown.

Achieving patient-centred care: the potential and challenge of the patient-as-professional role.

BACKGROUND: The patient-as-professional concept acknowledges the expert participation of patients in interprofessional teams, including their contributions to managing and coordinating their care. However, little is known about experiences and perspectives of these teams. OBJECTIVE: To investigate (i) patients' and carers' experiences of actively engaging in interprofessional care by enacting the patient-as-professional role and (ii) clinicians' perspectives of this involvement. DESIGN, SETTING AND PARTICIPANTS: A two-phased qualitative study. In Phase 1, people with chronic disease (n = 50) and their carers (n = 5) participated in interviews and focus groups. Phase 2 involved interviews with clinicians (n = 14). Data were analysed thematically. FINDINGS: Patients and carers described the characteristics of the role (knowing about the condition, questioning clinicians, coordinating care, using a support network, engaging an advocate and being proactive), as well as factors that influence its performance (the patient-clinician partnership, benefits, barriers and applicability). However, both patients and carers, and clinicians cautioned that not all patients might desire this level of involvement. Clinicians were also concerned that not all patients have the required knowledge for this role, and those who do are time-consuming. When describing the inclusion of the patient-as-professional, clinicians highlighted the patient and clinician's roles, the importance of the clinician-patient relationship and ramifications of the role. CONCLUSION: Support exists for the patient-as-professional role. The characteristics and influencing factors identified in this study could guide patient engagement with the interprofessional team and support clinicians to provide patient-centred care. Recognition of the role has the potential to improve health-care delivery by promoting patient-centred care.

Psychosocial outcomes of children with ear infections and hearing problems: a longitudinal study.

BACKGROUND: There is some evidence of a relationship between psychosocial health and the incidence of ear infections and hearing problems in young children. There is however little longitudinal evidence investigating this relationship. This paper used 6-year prospective longitudinal data to examine the impact of ear infection and hearing problems on psychosocial outcomes in two cohorts of children (one cohort recruited at 0/1 years and the other at 4/5 years). METHODS: Data from the Longitudinal Study of Australian Children (LSAC) were analysed to address the research aim. The LSAC follows two cohorts of children (infants aged 0/1 years - B cohort, n = 4242; and children aged 4/5 years - K cohort, n = 4169) collecting data in 2004, 2006, 2008 and 2010. In B cohort at baseline 3.7% (n = 189) of the sample were reported by their parent to have had an ear infection (excluding hearing problems) and 0.5% (n = 26) were reported by their parent to have hearing problems (excluding ear infections). 6.7% (n = 323) of the K cohort were identified as having had an ear infection and 2.0% (n = 93) to have hearing problems. Psychosocial outcomes were measured using the Strengths and Difficulties Questionnaire. Data were analysed using multivariate analysis of variance and logistic regression, reporting adjusted odds ratio and 95% confidence intervals of the association between reported ear infections (excluding hearing problems)/or hearing problems (excluding ear infections) and psychosocial outcomes. RESULTS: Children were more likely to have abnormal/borderline psychosocial outcomes at 10/11 years of age if they had been reported to have ongoing ear infections or hearing problems when they were 4/5 years old. When looking at the younger cohort however, poorer psychosocial outcomes were only documented at 6/7 years for children reported to have hearing problems at 0/1 years, not for those who were reported to have ongoing ear infections. CONCLUSION: This study adds further evidence that a relationship may exist between repeated ear infections or hearing problems and the long-term psychosocial health of children and provides support for a more systematic investigation of these issues.

Supporting patients to self-manage chronic disease: clinicians' perspectives and current practices.

This study investigated: clinicians' perspectives of the scope of self-management, which self-management support initiatives are used, and the factors clinicians consider when deciding which initiative to use with individual patients. Three phases of data collection were used. First, clinicians were interviewed about their attitudes toward self-management (n=14). Second, clinicians and managers completed a survey about the support initiatives they use (n=38). Third, in interviews clinicians described the applications of initiatives (n=6). Data were descriptively and thematically analysed. Clinicians believed that supporting self-management involved a holistic approach. However, some also thought that not all patients had the capacity to self-manage. This idea may be at odds with the underlying notion of self-management and impact on the support provided. Clinicians reported using 54 initiatives to support self-management and identified a range of situations when each initiative may or may not be suitable. This suggests that clinicians need to be familiar with a range of support initiatives as one will not suit everyone. Deciding which initiative is most appropriate may be aided by the development of guidelines.

Measuring activity and participation in children and adolescents with disabilities: a literature review of available instruments.

BACKGROUND/AIM: This article aims to (1) identify instruments available to measure activity and participation in children with disabilities; (2) describe the reliability and validity of these instruments; and (3) consider whether the available instruments capture the extent of involvement, as well as the difficulty and satisfaction/enjoyment associated with performance in all life areas. METHOD: A literature review was completed by undertaking an electronic search to identify instruments that measure activity and participation in children with disabilities. A further electronic search was conducted to obtain an adequate description of the instruments, including psychometric properties. RESULTS: The search identified 20 instruments purporting to measure activity and participation, however, no single instrument measured extent of involvement, difficulty and satisfaction/enjoyment in all life areas. There were instances in which each of these aspects was captured, but not within the one instrument. Instruments assessed combinations of frequency, difficulty, assistance, environment and satisfaction across varying contexts, for example, school, domestic life, recreational tasks, leisure tasks or all life areas. CONCLUSIONS: Although a large number of instruments exist to measure varying aspects of activity and participation, there is currently no single instrument available to measure the extent of involvement, difficulty and satisfaction/enjoyment in all life areas. This finding indicates that there is the opportunity to develop a single instrument to measure activity and participation across all life areas.

Mixed-grass prairie canopy structure and spectral reflectance vary with topographic position.

Managers of the nearly 0.5 million ha of public lands in North and South Dakota, USA rely heavily on manual measurements of canopy height in autumn to ensure conservation of grassland structure for wildlife and forage for livestock. However, more comprehensive assessment of vegetation structure could be achieved for mixed-grass prairie by integrating field survey, topographic position (summit, mid and toeslope) and spectral reflectance data. Thus, we examined the variation of mixed-grass prairie structural attributes (canopy leaf area, standing crop mass, canopy height, nitrogen, and water content) and spectral vegetation indices (VIs) with variation in topographic position at the Grand River National Grassland (GRNG), South Dakota. We conducted the study on a 36,000-ha herbaceous area within the GRNG, where randomly selected plots (1 km(2) in size) were geolocated and included summit, mid and toeslope positions. We tested for effects of topographic position on measured vegetation attributes and VIs calculated from Landsat TM and Advanced Spaceborne Thermal Emission and Reflection Radiometer (ASTER) data collected in July 2010. Leaf area, standing crop mass, canopy height, nitrogen, and water content were lower at summits than at toeslopes. The simple ratio of Landsat Band 7/Band 1 (SR71) was the VI most highly correlated with canopy standing crop and height at plot and landscape scales. Results suggest field and remote sensing-based grassland assessment techniques could more comprehensively target low structure areas at minimal expense by layering modeled imagery over a landscape stratified into topographic position groups.

Fertilizer application timing influences greenhouse gas fluxes over a growing season.

Microbial production and consumption of greenhouse gases (GHG) is influenced by temperature and nutrients, especially during the first few weeks after agricultural fertilization. The effect of fertilization on GHG fluxes should occur during and shortly after application, yet data indicating how application timing affects both GHG fluxes and crop yields during a growing season are lacking. We designed a replicated (n = 5) field experiment to test for the short-term effect of fertilizer application timing on fluxes of methane (CH(4)), carbon dioxide (CO(2)), and nitrous oxide (N(2)O) over a growing season in the northern Great Plains. Each 0.30-ha plot was planted to maize (Zea mays L.) and treated similarly with the exception of fertilizer timing: five plots were fertilized with urea in early spring (1 April) and five plots were fertilized with urea in late spring (13 May). We hypothesized time-integrated fluxes over a growing season would be greater for the late-spring treatment, resulting in a greater net GHG flux, as compared to the early-spring treatment. Data collected on 59 dates and integrated over a 5-mo time course indicated CO(2) fluxes were greater (P < 0.0001) and CH(4) fluxes were lower (P < 0.05) for soils fertilized in late spring. Net GHG flux was also significantly affected by treatment, with 0.84 +/- 0.11 kg CO(2) equivalents m(-2) for early spring and 1.04 +/- 0.13 kg CO(2) equivalents m(-2) for late spring. Nitrous oxide fluxes, however, were similar for both treatments. Results indicate fertilizer application timing influences net GHG emissions in dryland cropping systems.

Organic agriculture and nitrous oxide emissions at sub-zero soil temperatures.

In the Red River Valley of the upper midwestern United States, soil temperatures often remain below freezing during winter and N2O emissions from frozen cropland soils is assumed to be negligible. This study was conducted to determine the strength of N2O emissions and denitrification when soil temperatures were below zero for a manure-amended, certified organic field (T2O) compared with an unamended, conventionally managed field (T2C). Before manure application, both fields were similar with respect to autotrophic and heterotrophic N2O production and N2O flux at the soil surface (0.15+/-0.05 mg N2O-N m-2 d-1 for T2O and 0.12+/-0.06 mg N2O-N m-2 d-1 for T2C). After application of pelletized, dehydrated manure, average daily flux (based on time-integrated fluxes from 20 November to 8 April), was 1.19+/-0.34 mg N2O-N m-2 d-1 for T2O and 0.47+/-0.37 mg N2O-N m-2 d-1 for T2C. Denitrification for intact cores measured in the laboratory at -2.5 degrees C was greater for organically managed soils, although only marginally significant (p<0.1). Cumulative emissions for all winter measurements (from 16 November to 8 April) averaged 1.63 kg N2O-N ha-1 for T2O and 0.64 kg N2O-N ha-1 for T2C. Biological N2O production was evident at sub-zero soil temperatures, with winter emissions exceeding those measured in late summer. Late autumn manure application enhanced cumulative N2O-N emissions by 0.9 kg ha-1.

Microbial community composition and function beneath temperate trees exposed to elevated atmospheric carbon dioxide and ozone.

We hypothesized that changes in plant growth resulting from atmospheric CO2 and O3 enrichment would alter the flow of C through soil food webs and that this effect would vary with tree species. To test this idea, we traced the course of C through the soil microbial community using soils from the free-air CO2 and O3 enrichment site in Rhinelander, Wisconsin. We added either 13C-labeled cellobiose or 13C-labeled N-acetylglucosamine to soils collected beneath ecologically distinct temperate trees exposed for 3 years to factorial CO2 (ambient and 200 µl l-1 above ambient) and O3 (ambient and 20 µl l-1 above ambient) treatments. For both labeled substrates, recovery of 13C in microbial respiration increased beneath plants grown under elevated CO2 by 29% compared to ambient; elevated O3 eliminated this effect. Production of 13C-CO2 from soils beneath aspen (Populus tremuloides Michx.) and aspen-birch (Betula papyrifera Marsh.) was greater than that beneath aspen-maple (Acer saccharum Marsh.). Phospholipid fatty acid analyses (13C-PLFAs) indicated that the microbial community beneath plants exposed to elevated CO2 metabolized more 13C-cellobiose, compared to the microbial community beneath plants exposed to the ambient condition. Recovery of 13C in PLFAs was an order of magnitude greater for N-acetylglucosamine-amended soil compared to cellobiose-amended soil, indicating that substrate type influenced microbial metabolism and soil C cycling. We found that elevated CO2 increased fungal activity and microbial metabolism of cellobiose, and that microbial processes under early-successional aspen and birch species were more strongly affected by CO2 and O3 enrichment than those under late-successional maple.