From 'Parent' to 'Expert': How Parents of Children with Autism Spectrum Disorder Make Decisions About Which Intervention Approaches to Access.

Parents of children with Autism Spectrum Disorder are responsible for deciding which interventions to implement with their child. There is limited research examining parental decision-making with regards to intervention approaches. A constructivist grounded theory methodology was implemented in this study. Semi-structured interviews were undertaken with 14 participants from 12 family units. Data collection and analysis occurred concurrently, allowing a grounded theory to be constructed. Parental decision-making was influenced by many factors, arranged into seven core categories (values, experience, information, motivation, understanding, needs and logistics). Decision-making evolved over time, as parents transformed from 'parent' to 'expert'. The results of this study provide an insight into parental decision-making, which has implications for the support provided to parents by health professionals.

Oil binding capacities of triacylglycerol crystalline nanoplatelets: nanoscale models of tristearin solids in liquid triolein.

Polycrystalline particles composed of triacylglycerol (TAG) molecules, and their networks, in anhydrous TAG oils find extensive use as edible oils in the food industry. Although modelling studies of TAG systems, have been carried out, none have attempted to address a problem of central concern to food science and technology: the "oil binding capacity" of a system of such edible oils. Crystalline nanoparticles (CNPs) have recently been identified as the fundamental components of solid fats in oils. Oil binding capacity is an important concept regarding the ability of fats particles to retain oil, and the ability of these CNPs to bind oil is important in designing healthy foods. We have carried out atomic scale molecular dynamics computer simulations to understand the behavior of a triacylglycerol oil (triolein) in nanoscale confinements between tristearin CNPs. We define a nanoscale oil binding capacity function by utilizing the average oil number density, 〈Φ(d)〉, between two CNPs as a function of their separation, d. We modelled pure tristearin CNPs as well as tristearin CNPs in which the surfaces are covered with an interface comprising soft permanent coatings. Their surfaces are "hard" and "soft" respectively. We found that for a pair of hard-surface tristearin CNPs a distance d apart, (i) triolein exhibits number density, and therefore density, oscillations as a function of d, and (ii) the average number density between two such CNPs decreases as d decreases, viz. the oil binding capacity is lowered. When a soft layer of oil covers the CNP surfaces, we found that the oscillations are smeared out and that the average number density between the two CNPs remained approximately constant as d decreased indicating a high oil binding capacity. Our results might have identified important nanoscale aspects to aid in healthy food design.

Nanoscale characteristics of triacylglycerol oils: phase separation and binding energies of two-component oils to crystalline nanoplatelets.

Fats are elastoplastic materials with a defined yield stress and flow behavior and the plasticity of a fat is central to its functionality. This plasticity is given by a complex tribological interplay between a crystalline phase structured as crystalline nanoplatelets (CNPs) and nanoplatelet aggregates and the liquid oil phase. Oil can be trapped within microscopic pores within the fat crystal network by capillary action, but it is believed that a significant amount of oil can be trapped by adsorption onto crystalline surfaces. This, however, remains to be proven. Further, the structural basis for the solid-liquid interaction remains a mystery. In this work, we demonstrate that the triglyceride liquid structure plays a key role in oil binding and that this binding could potentially be modulated by judicious engineering of liquid triglyceride structure. The enhancement of oil binding is central to many current developments in this area since an improvement in the health characteristics of fat and fat-structured food products entails a reduction in the amount of crystalline triacylglycerols (TAGs) and a relative increase in the amount of liquid TAGs. Excessive amounts of unbound, free oil, will lead to losses in functionality of this important food component. Engineering fats for enhanced oil binding capacity is thus central to the design of more healthy food products. To begin to address this, we modelled the interaction of triacylglycerol oils, triolein (OOO), 1,2-olein elaidin (OOE) and 1,2-elaidin olein (EEO) with a model crystalline nanoplatelet composed of tristearin in an undefined polymorphic form. The surface of the CNP in contact with the oil was assumed to be planar. We considered pure OOO and mixtures of OOO + OOE and OOO + EEO with 80% OOO. The last two cases were taken as approximations to high oleic sunflower oil (HOSO). The intent was to investigate whether phase separation on a nanoscale took place. We defined an "oil binding capacity" parameter, B(Q,Q'), relating a state Q to a reference state Q'. We used atomic scale molecular dynamics in the NVT ensemble and computed averages over 1-5 ns. We found that the probability of the OOE phase separating into a layer on the surface of the CNP compared to being retained randomly in an OOO + OOE mix were approximately equal. However, we found that it was probable that the EEO component of an OOO + EEO mix would phase separate and coat the surface of the CNP. These results suggest a mechanism whereby many-component oils undergo phase separation on a nanoscale so as to create a transition oil region between the surface of the CNP and the bulk major oil component (OOO in the case considered here) so as to create the appropriate oil binding capacity for the use to which it is put.

Lost in translation: health resource variability in the achievement of optimal performance and clinical outcome.

BACKGROUND- An evidence-practice gap in acute coronary syndromes (ACS) is commonly recognized. System, provider, and patient factors can influence guideline adherence. Through using guideline facilitators in the clinical setting, the uptake of evidence-based recommendations may be increased. We hypothesized that facilitators of guideline recommendations (systems, tools, and workforce) in acute cardiac care were associated with increased guideline adherence and decreased adverse outcome. METHODS AND RESULTS- A cross-sectional evaluation of guideline facilitators was conducted in Australian hospitals. The population was derived from the Acute Coronary Syndrome Prospective Audit (ACACIA) and assessed performance, death, and recurrent myocardial infarction (death/re-MI) at 30 days and 12 months. Thirty-five hospitals and 2392 patients participated. Significant associations with decreased death/re-MI were observed with hospital strategies to facilitate primary percutaneous coronary intervention for ST-elevation MI patients (38/428 [8.9%] versus 30/154 [19.5%], P<0.001) and after adjustment (odds ratio [OR], 0.47 [95% confidence interval (CI), 0.24 to 0.90], P<0.023), electronic discharge checklists (none: 233/1956 [11.9%], integrated; 43/251[17.1%], P=0.069, electronic; 6/124 [4.8%], P<0.001) and after adjustment (integrated versus none: OR, 1.66 [95% CI, 0.98 to 2.80], P=0.057 and electronic versus none: OR, 0.49 [95% CI, 0.35 to 0.68], P<0.001), and intensive cardiac care unit (ICCU) staff-to-patient ratios (neither: 200/1257 (15.9%), CCU: 135/1051 (12.8%), ICCU: 8/84 (9.5%), P=0.049 and after adjustment (CCU versus neither: OR, 0.74 [95% CI, 0.47 to 1.14], P=0.172 and ICCU versus neither: OR, 0.55; [95% CI, 0.38 to 0.81] P=0.003). CONCLUSIONS- Facilitating uptake of evidence in clinical practice may need to consider quality improvement systems, tools and workforce to achieve optimal ACS outcomes.