Differences in preschool-age children's dietary intake between meals consumed at childcare and at home.

Preschool children need optimal nutrition, including a variety of nutrient-dense foods, for growth and development. The purpose of this study was to determine differences in foods and nutrients consumed at childcare and home environments. Children ages 3-to-5 years (n = 90, 3.8 ± 0.7 years; 56% female) from 16 childcare centers participated in this cross-sectional study from 2011 to 2014. Lunches at childcare were observed for two days; three days of dinners at home were reported by caregivers. Nutrient-dense and energy-dense foods were counted and nutrient content of meals was determined using FoodWorks®. More servings of fruit (0.92 ± 0.82 vs. 0.15 ± 0.26; p ≤ 0.0001), vegetables (1.47 ± 1.43 vs. 0.62 ± 0.60; p ≤ 0.0001), and low-fat dairy (0.83 ± 0.32 vs. 0.07 ± 0.19; p ≤ 0.0001) were consumed at childcare than at home. More servings of high-fat, high-sugar foods (0.08 ± 0.18 vs. 0.43 ± 0.39, p ≤ 0.0001) and sugary drinks (0.22 ± 0.41 vs. 0.39 ± 0.35. p ≤ 0.001) were consumed at home than at childcare. There were no differences between environments in whole-grains, high-fat meats, or high-fat high-sugar condiments consumed. On average, children consumed 333.0 ± 180.3 kcal at childcare and 454.7 ± 175.3 at home (p ≤ 0.0001). There were no differences in macronutrient profiles or in iron, zinc, folate, or vitamin B6 intake. More calcium (86.2 ± 44.6 vs. 44.6 ± 22.2 mg/kcal, p ≤ 0.0001) and vitamin A/kcal (56.1 ± 36.9 vs. 26.5 ± 24.2 RAE/kcal, p ≤ 0.0001) were consumed at childcare than at home. Preschool children are consuming more nutrient-dense foods and a more servings of fruit and vegetables at childcare during lunch than at home during dinner. Childcare and parents should work together to provide early and consistent exposure to nutrient-rich foods to ensure optimal nutrition for developing children.

Pak3 inhibits local actin filament formation to regulate global cell polarity.

Lamellipodia are broad actin-based structures that define the protruding edge of many motile animal cells. Here we identify a Drosophila homolog of the p21-activated kinases (Paks) as a novel inhibitor of Rac-mediated lamellipodial formation: Pak3 overexpression mimics a loss of Rac activity, while Pak3 RNAi-mediated silencing enhances lamellipodial dynamics. Strikingly, the depletion of Pak3 also polarizes the cellular distribution of actin filaments, is sufficient to induce nonmotile cells to migrate, and, in cells firmly attached to the substrate, gives rise to a wave of high actin filament density that encircles the cell periphery at a steady pace. To better understand these systems level phenomena, we developed a model of the cortical actin network as an active gel whose behavior is dominated by the rate of actin filament bundling and polymer synthesis. In the presence of filament treadmilling, this system generates a propagating density wave of actin filaments like that seen in Pak3 RNAi cells. This analysis reveals an intimate relationship between local regulation of actin filament dynamics and global cytoskeletal polarity, and suggests a role for negative regulators of lamellipodial formation, like Pak3, in the maintenance of a poised state, in which regulated directional cell movement can occur.

"Choice" and place of delivery: a qualitative study of women in remote and rural Scotland.

OBJECTIVE: To explore women's perceptions of "choice" of place of delivery in remote and rural areas where different models of maternity services are available. SETTING AND METHODS: Remote and rural areas of the North of Scotland. A qualitative study design involved focus groups with women who had recent experience of maternity services. RESULTS: Women had varying experiences and perceptions of choice regarding place of delivery. Most women had, or perceived they had, no choice, though some felt they had a genuine choice. When comparing different places of birth, women based their decisions primarily on their perceptions of safety. Consultant-led care was associated with covering every eventuality, while midwife-led care was associated with greater quality in terms of psycho-social support. Women engaged differently in the choice process, ranging from "acceptors" to "active choosers." The presentation of choice by health professionals, pregnancy complications, geographical accessibility and the implications of alternative places of delivery in terms of demands on social networks were also influential in "choice." CONCLUSIONS: Provision of different models of maternity services may not be sufficient to convince women they have "choice." The paper raises fundamental questions about the meaning of "choice" within current policy developments and calls for a more critical approach to the use of choice as a service development and analytical concept.

An evaluation of a Mental Health Act educational resource.

The Mental Health (Care and Treatment) (Scotland) Act 2003 was developed with the participation of patients and carers. This Act is fundamentally different from all previous versions of the Mental Health Acts in the UK because it is based on Millan's 10 principles. Its objective is to ensure that people with mental disorder receive effective care and treatment. It is crucial that all staff who deal with persons with mental disorder are familiar with the Act and incorporate it into practice. This depends on the effectiveness of educational resources in supporting staff to develop their practice. The project presented here was commissioned by the National Health Service Education for Scotland (NES) to evaluate the accessibility and use of the educational resources produced for all frontline staff in Scotland. The aim was to evaluate the educational resources produced by NES to prepare the frontline staff in relation to the Mental Health (Care and Treatment) (Scotland) Act 2003. Evaluation was conducted through a questionnaire survey, focus groups and individual interviews. The NES educational resource was effective in assisting professionals in implementing the complex and progressive requirements of the new Mental Health Act. The three formats reached a wide audience, and are an effective model for future initiatives.

Models of intrapartum care and women's trade-offs in remote and rural Scotland: a mixed-methods study.

OBJECTIVE: To explore women's preferences for, and trade-offs between, key attributes of intrapartum care models. DESIGN: Mixed-methods study using discrete choice experiments (DCEs) and focus groups. SETTING: The North of Scotland. POPULATION: Women from the catchment areas of eight rural maternity units in the North of Scotland. METHODS: Based on current policy, 'model of care' and 'time travelled' were selected as key attributes of intrapartum care in remote and rural settings. A DCE questionnaire explored women's preferences for and trade-offs between these attributes. Focus groups validated the DCE attributes and provided valuable information about the drivers of women's preferences for place of delivery. MAIN OUTCOME MEASURES: Preferences for attributes of intrapartum care. RESULTS: Eight focus groups were conducted, and 877 eligible women completed the questionnaire. Overall, the DCE results found women preferred delivery in a unit to home birth and consultant-led care (CLC) to midwife-managed care (MMC). Women preferring CLC associated it with covering every eventuality and increased safety. Although women preferred shorter travel times, trade-offs indicated a willingness to travel for approximately 2 hours to get one's preferred choice. Focus group findings and subgroup DCE analysis showed heterogeneity of preferences related to experience, risk status, geographic location, perception of care and family circumstances. CONCLUSIONS: In contrast to service redesign offering local midwife-managed intrapartum care, most rural women in our study expressed a preference to give birth in hospital and have CLC because they felt safer. Women were willing to travel for this but within limits. Qualitative results showed that women's preferences were influenced by their home and family context, beliefs and previous pregnancy experiences. Challenges for service redesign are to provide comprehensive obstetric services within acceptable travel time, while responding to the heterogeneity of women's preferences.

Slovenian midwives' and nurses' views on post-natal depression: an exploratory study.

BACKGROUND: Post-natal depression affects approximately 10-15% of women. The literature suggests that midwives and nurses are key professionals in dealing with post-natal mood disorders. However, this would be a new role in Slovenia for which it is not clear whether midwives and nurses are prepared. AIM: This study explored Slovenian midwives' and nurses' knowledge of, and attitudes towards, post-natal mood disorders. METHODS: Two focus groups were conducted, each with five participants, working in the maternity hospital and in the community centre in Postojna. FINDINGS: Data were grouped into three main themes--knowledge of post-natal mental health disorders, role in the management of these issues, and perceived problems and possible solutions in the health care of post-natally depressed women. Participants lacked knowledge on post-natal mental health and did not consider its management to be their role. They saw the main obstacle to caring for these women as being a lack of continuity of carer. CONCLUSION: Slovenian midwives and nurses should be appropriately educated regarding this subject in order to become more capable of managing post-natal mental health. Continuous relationships with women should be encouraged. LIMITATIONS: Further investigation is required and a questionnaire survey involving a larger sample of midwives and community nurses is planned on the basis of the findings of this study.

Professional competence: factors described by nurses as influencing their development.

AIM: To discuss the results of a study that explored factors that may influence competence development. BACKGROUND: Competence, a controversial issue in health care settings, affects many aspects of the nursing profession, including education, practice and management. Although a number of research and discussion papers have explored the issue, in particular the meaning and assessment of nursing competence, to date little research has explored factors identified by nurses themselves as influencing their development of professional competence. METHODS: A purposive sample of 27 registered nurses was recruited from two university-affiliated hospitals. Data collection was by tape-recorded semi-structured interviews. Interviews were transcribed verbatim and analysed according to the qualitative methodology of content analysis. FINDINGS: Six descriptive categories were identified from the data: experience, opportunities, environment, personal characteristics, motivation and theoretical knowledge. CONCLUSIONS: The findings suggest that the factors influencing the process of developing professional competence in nursing extend across personal and extra-personal domains. An understanding of these factors may enhance the ability of nursing managers and educators to enable student and qualified nurses to pursue effective competency development pathways to prepare them to provide a high standard of care. These findings, which may have important implications for nursing practice, management and education, are being further tested in a larger study.

Sustainable maternity services in remote and rural Scotland? A qualitative survey of staff views on required skills, competencies and training.

OBJECTIVES: To explore staff views on their roles, skills and training to deliver high quality and local intrapartum services in remote and rural settings against national recommendations. DESIGN: Interview and postal survey. SETTING: A stratified representative sample of remote and rural maternity units in Scotland (December 2002 to May 2003). PARTICIPANTS: Staff proportionally representative of professional groups involved in maternity care. RESULTS: Staff interviews took place at 11 units (response rate 93%). A subsequent postal survey included the interview sample and staff in a further 11 units (response rate 78%). Medical specialisation, workforce issues, and proposed regulatory evaluation of competencies linked to throughput raised concerns about the sustainability and safety of services, particularly for "generalists" in rural maternity care teams and for medical cover in small district general hospitals with large rural catchments. Risk assessment and decision making to transfer were seen as central for effective rural practice and these were influenced by rural context. Staff self-reported competence and confidence varied according to procedure, but noted service change appeared to be underway ahead of their preparedness. Self-reported competence in managing obstetric emergencies was surprisingly high, with the caveat that they were not independently assessed in this study. Staff with access to video conference technology reported low actual use although there was enthusiasm about its potential use. CONCLUSIONS: Considerable uncertainties remain around staffing models and training to maintain maternity care team skills and competencies. Further research is required to test how this will impact on safety, appropriateness, and access and acceptability to rural communities.

A functional genomic analysis of cell morphology using RNA interference.

BACKGROUND: The diversity of metazoan cell shapes is influenced by the dynamic cytoskeletal network. With the advent of RNA-interference (RNAi) technology, it is now possible to screen systematically for genes controlling specific cell-biological processes, including those required to generate distinct morphologies. RESULTS: We adapted existing RNAi technology in Drosophila cell culture for use in high-throughput screens to enable a comprehensive genetic dissection of cell morphogenesis. To identify genes responsible for the characteristic shape of two morphologically distinct cell lines, we performed RNAi screens in each line with a set of double-stranded RNAs (dsRNAs) targeting 994 predicted cell shape regulators. Using automated fluorescence microscopy to visualize actin filaments, microtubules and DNA, we detected morphological phenotypes for 160 genes, one-third of which have not been previously characterized in vivo. Genes with similar phenotypes corresponded to known components of pathways controlling cytoskeletal organization and cell shape, leading us to propose similar functions for previously uncharacterized genes. Furthermore, we were able to uncover genes acting within a specific pathway using a co-RNAi screen to identify dsRNA suppressors of a cell shape change induced by Pten dsRNA. CONCLUSIONS: Using RNAi, we identified genes that influence cytoskeletal organization and morphology in two distinct cell types. Some genes exhibited similar RNAi phenotypes in both cell types, while others appeared to have cell-type-specific functions, in part reflecting the different mechanisms used to generate a round or a flat cell morphology.

Stem cell self-renewal specified by JAK-STAT activation in response to a support cell cue.

Stem cells generate many differentiated, short-lived cell types, such as blood, skin, and sperm, throughout adult life. Stem cells maintain a long-term capacity to divide, producing daughter cells that either self-renew or initiate differentiation. Although the surrounding microenvironment or "niche" influences stem cell fate decisions, few signals that emanate from the niche to specify stem cell self-renewal have been identified. Here we demonstrate that the apical hub cells in the Drosophila testis act as a cellular niche that supports stem cell self-renewal. Hub cells express the ligand Unpaired (Upd), which activates the Janus kinase-signal transducer and activator of transcription (JAK-STAT) pathway in adjacent germ cells to specify self-renewal and continual maintenance of the germ line stem cell population.

Somatic support cells restrict germline stem cell self-renewal and promote differentiation.

Stem cells maintain populations of highly differentiated, short-lived cell-types, including blood, skin and sperm, throughout adult life. Understanding the mechanisms that regulate stem cell behaviour is crucial for realizing their potential in regenerative medicine. A fundamental characteristic of stem cells is their capacity for asymmetric division: daughter cells either retain stem cell identity or initiate differentiation. However, stem cells are also capable of symmetric division where both daughters remain stem cells, indicating that mechanisms must exist to balance self-renewal capacity with differentiation. Here we present evidence that support cells surrounding the stem cells restrict self-renewal and control stem cell number by ensuring asymmetric division. Loss of function of the Drosophila Epidermal growth factor receptor in somatic cells disrupted the balance of self-renewal versus differentiation in the male germline, increasing the number of germline stem cells. We propose that activation of this receptor specifies normal behaviour of somatic support cells; in turn, the somatic cells play a guardian role, providing information that prevents self-renewal of stem cell identity by the germ cell they enclose.

Developmental genetics of the essential Drosophila nucleoporin nup154: allelic differences due to an outward-directed promoter in the P-element 3' end.

Drosophila nup154 encodes a predicted nucleoporin homologous to yeast Nup170p, Nup157p, and vertebrate Nup155, all of which are major components of the nuclear pore complex (NPC). Unlike its yeast homologs, nup154 is essential for viability. Animals with strong loss-of-function nup154 mutations caused by P-element insertion in the 5'-UTR of the gene died as larvae with small discs, brains, and testes. nup154 mRNA expression appeared developmentally regulated in tissues of wild-type embryos, larvae, and adults, suggesting that new nup154 synthesis is required when assembly of new NPCs is required, as in proliferating or growing tissues. Two additional nup154 alleles also associated with different P-element inserts in the 5'-UTR were viable but had strong loss-of-function sterile phenotypes, including failure to maintain spermatogenic stem cells and failure to progress into vitellogenic stages of oogenesis. Lethality vs. viability correlated with orientation of the P-element inserts in the different alleles. Transcript analysis by 5'-RACE suggested a mechanism for allelic differences: an outward-directed promoter internal to the P-element 3' end able to drive sufficient expression of the nup154 transcript for viability but not for fertility.

Development through self-assessment: strategies used during clinical nursing placements.

The question asked for this small research project was 'how do senior students judge their progress towards being a "good nurse"?' A qualitative approach was taken and a convenience sample of 10 student midwives identified. Interviews were the main source of data collection. Since the method of analysis was that of grounded theory, the interviews became more focused as themes emerged. Results demonstrated that each student developed a range of self-assessment strategies which were used in any clinical placement. Some techniques were used only at a certain stage in a clinical placement while others were used throughout. Cyclical techniques were related to the achievement of short-term goals; strategies used for the duration of the placement had more long-term significance. Highlights of the findings were explored in the literature. These features included models of professional development, the need to feel part of a team, the necessity of identifying a role model, and the significance of the length of a clinical placement. Conclusions related to the duration of a clinical placement and the necessity for the student to have the opportunity to complete the cycle. The value of acquainting new students with self-assessment strategies is suggested.

Queen busting: a personality profile of hospital royalty.

Is there room for royalty in your unit? A queen/king profile thoroughly examines any personality traits that may indicate "regal" behaviors. Guidelines to behavior modifications follow the profile examination.

Clinical staff and the new student nurse: anticipating change.

This article focuses on the feelings and perceptions of clinical staff who are about to encounter Project 2000 students. It makes use of selected findings from a small exploratory study in which interviews were used to gather qualitative data from such staff. There is a brief consideration of the historical context of nurse education from which Project 2000 has arisen and the legislation that has been instrumental in its development. Embodied within this change is the expectation that clinical staff will continue to contribute to the education of student nurses on clinical placements. The target population for this study was identified as clinical staff who would be working with Project 2000 students within a large general teaching hospital. Through means of taped informal interviews, the study explored the world of the clinical staff in relation to their expectations of Project 2000 students. It identified feelings of threat, lack of communication and issues of change and its implementation. For successful implementation and wide acceptance of such a radical change in nurse education, consistency of knowledge and communication was shown to be essential.

Student nurses' involvement with death: the image and the experience.

A qualitative study of student nurses' images of nursing revealed that features related to death were prominent in both entry and experience-mediated images. These features appeared in entry images as part of 'the bad' of nursing and were affirmed in this respect through experience. However, mediated through students' encounters with reality, death-related experiences also acquired characteristics of 'the good'. The 'involvement' entailed in caring for the dying represented a poignant but emotionally draining aspect of students' clinical experiences. Regardless of the degree of accuracy of students' entry images, the 'knowing' that came through experience made adjusting to death-related encounters a particular challenge for students. A clear implication was the need for effective guidance and support to be provided by the system and by individual members of teaching and clinical staff.

Accord and discord in students' images of nursing.

This article discusses findings from a qualitative study of student nurses' images of nursing from entry to training through early clinical experiences. Three rounds of interviews were conducted with 24 Scottish students. Analysis revealed five major themes in students' initial images: pictures of nursing, the good nurse, what nursing entails, occupational labels for nursing, and being a student/becoming a nurse. These were pursued in later interviews and characteristics of students' experience-mediated images were identified. The picture of adult medical-surgical nursing as typical of real nursing persisted throughout. "Working with people" and "helping" appeared as central characteristics of nursing. Notions of good and bad underlay many features of the image. The paradoxical nature of "involvement" was noticeable. Staff attitudes figured prominently in determining the quality of students' experience and in development of image. Commitment and belonging were integral to students' images and made nursing more than just a job. Processes through which students' images developed included affirmation, accommodation, and nonaccommodation. Associated processes included identification, disillusionment, and extenuation. There was clear evidence of the importance of support to enable students to adapt to image disparities.