Steven Lucas

Exudation-reabsorption in a mycorrhizal fungus, the dynamic interface for interaction with soil and soil microorganisms

Abstract The mycelium of Suillus bovinus slowly absorbed [U-14C]glucose and other tracers from droplets placed on the cords, translocated them to the peripheral hyphae and exuded them into fluid drops on the hyphal tips. The exudate was characterized by 1H NMR spectroscopy and by sugar and amino acid analysis. The exuded compounds were mainly carbohydrates and peptides. Acetic acid and oxalic acid were also present in the exudate along with a number of unidentified compounds. Released ions (K, Na, Cl, P, Mg and Ca) were identified by X-ray microanalysis. The mycelium was shown to reabsorb up to 65% of the exuded 14C compounds in 2 days. Glucose, mannitol, glutamic acid (pH 3.2), and Rb+ (as well as other mineral ions) were all readily absorbed by the mycelium, while oxalic acid at pH 4.2 and glutamic acid at pH 6.5 were not. Exudation of fluid droplets on the surface of the hydrophobic mycorrhizal fungus S. bovinus may represent an ecophysiologically important function of the extramatrical hyphae, which provides an interface for interaction with the immediate hyphal environment and its other microorganisms where the peripheral hyphae exchange their photosynthetically derived products for nutrients to be used later by the pine host. We hypothesize that actively absorbed carbohydrates from the root are translocated to the peripheral hyphae along a concentration gradient of sugars and polyols by means of active translocation and diffusion in cell elements and by acropetal water transport in the cord vessels.

Improved Outcome in Neonatal Short Bowel Syndrome Using Parenteral Fish Oil in Combination With ω-6/9 Lipid Emulsions

BACKGROUND Newborn infants with short bowel syndrome (SBS) represent a high-risk group of developing intestinal failure-associated liver disease (IFALD), which may be fatal. However, infants have a great capacity for intestinal growth and adaptation if IFALD can be prevented or reversed. A major contributing factor to IFALD may be the soybean oil-based intravenous lipid emulsions used since the introduction of parenteral nutrition (PN) 40 years ago. METHODS This retrospective study compares the outcome in 20 neonates with SBS treated with parenteral fish oil (Omegaven) in combination with ω-6/9 lipid emulsions (ClinOleic) with the outcome in a historical cohort of 18 patients with SBS who received a soybean oil-based intravenous lipid emulsion (Intralipid). RESULTS Median gestational age was 26 weeks in the treatment group and 35.5 weeks in the historical group. All patients were started on PN containing Intralipid that was switched to ClinOleic/Omegaven in the treatment group at a median age of 39 gestational weeks. In the treatment group, direct bilirubin levels were reversed in all 14 survivors with cholestasis (direct bilirubin >50 umol/L). Median time to reversal was 2.9 months. Only 2 patients died of liver failure (10%). In the historical cohort, 6 patients (33%) died of liver failure, and only 2 patients showed normalization of bilirubin levels. CONCLUSIONS Parenteral fish oil in combination with ω-6/9 lipid emulsions was associated with improved outcome in premature neonates with SBS. When used instead of traditional soybean-based emulsions, this mixed lipid emulsion may facilitate intestinal adaptation by increasing the IFALD-free period.

The Children and Parents in Focus project: a population-based cluster-randomised controlled trial to prevent behavioural and emotional problems in children

BackgroundThere is large body of knowledge to support the importance of early interventions to improve child health and development. Nonetheless, it is important to identify cost-effective blends of preventive interventions with adequate coverage and feasible delivery modes. The aim of the Children and Parents in Focus trial is to compare two levels of parenting programme intensity and rate of exposure, with a control condition to address impact and cost-effectiveness of a universally offered evidence-based parenting programme in the Swedish context.Methods/DesignThe trial has a cluster randomised controlled design comprising three arms: Universal arm (with access to participation in Triple P - Positive Parenting Program, level 2); Universal Plus arm (with access to participation in Triple P - Positive Parenting Program, level 2 as well as level 3, and level 4 group); and Services as Usual arm. The sampling frame is Uppsala municipality in Sweden. Child health centres consecutively recruit parents of children aged 3 to 5 years before their yearly check-ups (during the years 2013–2017). Outcomes will be measured annually. The primary outcome will be children’s behavioural and emotional problems as rated by three informants: fathers, mothers and preschool teachers. The other outcomes will be parents’ behaviour and parents’ general health. Health economic evaluations will analyse cost-effectiveness of the interventions versus care as usual by comparing the costs and consequences in terms of impact on children’s mental health, parent’s mental health and health-related quality of life.DiscussionThis study addresses the need for comprehensive evaluation of the long-term effects, costs and benefits of early parenting interventions embedded within existing systems. In addition, the study will generate population-based data on the mental health and well-being of preschool aged children in Sweden.Trial registrationISRCTN: ISRCTN16513449.

Quality of life among Swedish school children who experienced multitype child maltreatment.

The aim of this study was to examine the overlap between child maltreatment types and their association with quality of life among school children.

Bully, bullied and abused. Associations between violence at home and bullying in childhood

Aims: The aim was to examine experiences of bullying among Swedish adolescents and whether victims and perpetrators were also exposed to violence in the home, with particular focus on how abuse severity affected the risk of exposure to bullying. Methods: A nationally representative sample of pupils aged 14–15 responded to a questionnaire exploring exposure to corporal punishment and other types of violence. Results were analysed using Pearson’s chi-square and multiple logistic regression, adjusting for factors regarding the child, the parents and the families’ socioeconomic status. Results: Among the 3197 respondents, a significant proportion reported at least one incident of either bullying victimisation (girls 36%, boys 26%) or bullying perpetration (girls 24%, boys 36%). Physical and emotional violence in the home, including witnessed intimate partner violence, were significantly associated with both bullying victimisation and bullying perpetration. Odds ratios for exposure to bullying rose with increasing frequency and severity of abuse. Adjusted odds ratios ranged from 1.6 for any event of abuse vs. single episodes of bullying to 20.3 for multiple types of abuse vs. many episodes of bullying. The child’s gender and the presence of a chronic health condition were consistently associated with nearly all levels of abuse and bullying. Conclusions: Bullying experiences are common among youth and are clearly associated with abuse. Frequent bullying, whether as victim or perpetrator, warrants particular vigilance, as it appears to be an indicator of severe violence in the home.

In My Shoes - Validation of a computer assisted approach for interviewing children

Interviewing young children presents a challenge because they tend to provide incomplete accounts and are easily misled. Therefore there is a need for techniques to improve young childrens recall, while maintaining accuracy and increasing completeness. The computer-assisted interview In My Shoes (IMS) is an aid that potentially offers a way for young children to provide accounts of their experiences. This study examined the validity of IMS, by comparing it with a forensic best practice interview approach using a real-life clinical situation to ensure high ecological validity. Children were randomly assigned to either method and both accuracy and completeness of statements made by 4- and 5-year-olds (N=54) regarding a video-documented health check-up were assessed. The In My Shoes interviews were as good as best practice interviews on all accuracy measures for both age groups, except for object accuracy that was better in the forensic interview condition. Events description completeness was similar in both interview conditions; however, IMS interviews generated more complete statements about people present at the visit. The findings suggest that the IMS approach yields comparable results to a best practice interview, and it can be used as an alternative aid in child interviews.

'Now I use words like asymmetry and unstable': nurses' experiences in using a standardized assessment for motor performance within routine child health care.

RATIONALE, AIMS AND OBJECTIVES There is an increasing recognition that early intervention is important for children with motor disorders. The use of standardized assessment methods within the Swedish Child Health Services (CHS) may improve early identification of these children and thereby their development and quality of care. Given the key role of nurses within the CHS, we explored their experiences of using a structured assessment of motor performance (SOMP-I) in a clinical setting, and investigated possible barriers and facilitators for implementation of the method within the CHS. METHODS The study was conducted in 2013 in Uppsala County, Sweden. Ten child health nurses participated in two focus group interviews, which were analysed using systematic text condensation. RESULTS The analysis yielded three themes: (1) increased knowledge and professional pride - nurses described their desire to provide high-quality care for which SOMP-I was a useful tool; (2) improved parent-provider relationship - nurses felt that using SOMP-I involved both the parents and their infant to a greater extent than routine care; and (3) conditions for further implementation - nurses described that the time and effort needed to master new skills must be considered and practical barriers, such as lack of examination space, resource constraints and difficulties in documenting the assessment must be addressed before implementing the SOMP-I method in routine care. CONCLUSION Child health nurses felt that the SOMP-I method fitted well with their professional role and increased the quality of care provided. However, significant barriers to implementing SOMP-I into routine child health care were described.

Childhood death rates declined in Sweden from 2000 to 2014 but deaths from external causes were not always investigated

Countries that conduct systematic child death reviews report a high proportion of modifiable characteristics among deaths from external causes, and this study examined the trends in Sweden.

Disclosure of Child Physical Abuse and Perceived Adult Support among Swedish Adolescents

Child abuse is a major public health problem which is largely hidden in the society.The main aim of the thesis was to study child maltreatment from children’s and young people’s perspectives focusing on prevalence, health, disclosure and support.The thesis is based on four studies. Quantitative and qualitative data from three national surveys of child maltreatment, including children in different age groups and young adults, have been analysed.The results showed that child maltreatment is prevalent and there is a large degree of overlap between maltreatment types. Neglect and witnessing intimate partner violence were the types that overlapped most with other types of maltreatment. Child maltreatment was strongly associated to psychosomatic symptoms and impaired quality of life. Young people who have been victims of child maltreatment described the psychological consequences, such as painful memories, low self-esteem and depression. The psychological abuse was described as particularly detrimental. Victims of sexual abuse expressed feelings of shame and guilt. About half of the severely abused children did not disclose the abuse, mainly because of lack of trust in adults. Many children felt that they did not receive adequate support when they disclosed the maltreatment, particularly because they experienced a lack of child perspective among professionals. Children and young people experienced positive support from the school health services which they considered to have a particularly important role in the detection and support of maltreated children. The results emphasize an increased awareness among professionals to recognise and respond to child maltreatment.

Nurses’ experiences of screening for communication difficulties at 18 months of age

Early identification of communication disorders is important and may be possible through screening in the child health services. The aim of the study was to investigate nurses’ experiences and sense of competence when using the Infant‐Toddler Checklist (ITC) communication screening at the 18‐month health visit.