The experiences of new mothers accessing feeding support for infants with down syndrome during the COVID-19 pandemic

Infants with Down syndrome are more likely to experience feeding problems and mothers are likely to require more feeding support than mothers of typically developing infants. During the COVID-19 pandemic, many feeding support services changed from face-to-face to online, which impacted some maternal feeding experiences negatively, but no studies to date have explored the impact for mothers of infants with Down syndrome. Thematic analysis was conducted on semi-structured interviews from thirteen new mothers of infants (aged 8-17 months) with Down syndrome in the UK. Three superordinate themes were generated: (1) Every baby with Down syndrome has a unique journey, (2) There's no point asking, they won't know, (3) Lack of in-person support. Many mothers expressed frustrations over health professionals' lack of Down syndrome specific knowledge resulting in unmet needs, further magnified due to the nature of the virtual support being offered. Moreover, mothers struggled with reduced social support from other mothers when encountering feeding problems. These results hold real-world implications for health professionals who could provide more specialised face-to-face feeding support to mothers of infants with Down syndrome. This should be prioritised for children's overall development and mothers' wellbeing.

Using Human-Centred Design to Develop Innovative Approaches to Improve Delivery of Brief Interventions in Primary Care: The HealthEir Project

Introduction

A priority action of the Healthy Ireland implementation plan is the Making Every Contact Count initiative (MECC) that aims to leverage the 30 million annual contacts with the healthcare system by asking every health worker to deliver brief interventions [1]. Benefits of brief interventions are well established, but GPs and pharmacists report challenges implementing them in practice including limited training, time, and poor fit with existing practices [2].

Aim

This government-funded Sláintecare project aimed to develop a novel method for brief interventions in pharmacy/GP settings using human-centred design.

Methods

User research was carried out with twelve users, including patients (3), GPs (4), and pharmacists (5) to identify their needs and priorities. Participants were recruited via email using a purposive sampling approach and completed semi-structured interviews with a design researcher. All participants invited agreed to participate. Next, a series of design sprints were completed with the research team. Design sprints allowed the team to integrate insights from user research with findings from a literature review/secondary research to understand pain points, identify stakeholder and user goals, and develop a list of initial design specifications. This list was used to develop and iterate a series of prototype solutions. Prototype service blueprints and wireframes (simple, two-dimensional schematic illustrations of the digital interface) were developed and tested with users before final versions were agreed.

Results

Findings from the interviews and literature review indicated (1) the main barrier to adoption was time, (2) patients and pharmacists were very positive about brief interventions with GPs more hesitant, (3) an approach blending technology with a consultation was preferred, and (4) having a specific list of local supports was important. Prototyping and evaluation processes identified that a simple interface with a clear indication of progress were preferred.

A blended intervention combining a tablet-based digital tool and structured interaction was developed. The interface was designed to maximise use of patient and healthcare professional time, and mapped to the 5As approach (which is underpinned by principles of motivational interviewing, shared-decision making, and readiness to change frameworks). The HealthEir digital tool enables patients to self-complete the Ask, Advise, and Assess phases of a brief intervention using a tablet device while waiting to see their pharmacist/GP. The pharmacist or GP then review the patient’s responses, risk level, and importance confidence and readiness scores. They complete the Assist and Arrange elements during the consultation, supported by a directory of local/national patient support services before printing information tickets for the patient to keep. The HealthEir intervention has been successfully rolled out at eight pilot pharmacy sites nationally, with a mix of urban/rural sites, and independent/chain pharmacies.

Conclusions

Adopting an interdisciplinary approach based on human-centred design principles led to the development of a blended brief intervention that has been successfully introduced in pilot sites across Ireland. While the implementation has been smooth despite COVID-19 challenges, and initial feedback has been very positive, the impact cannot yet be fully evaluated as research is ongoing. Future work will involve extending the intervention to include other healthcare professionals.

References

1. Making Every Contact Count Framework https://www.hse.ie/eng/about/who/healthwellbeing/making-every-contact-count/framework/framework.html (accessed Oct 10, 2020)

2. Keyworth C, Epton T, Goldthorpe J, Calam R, Armitage CJ. ‘It's difficult, I think it's complicated’: Health care professionals’ barriers and enablers to providing opportunistic behaviour change interventions during routine medical consultations. British journal of health psychology. 2019 Sep;24(3):571–92.

New bounds on dark matter coupling from a global network of optical atomic clocks

We report on the first Earth-scale quantum sensor network based on optical atomic clocks aimed at dark matter (DM) detection. Exploiting differences in the susceptibilities to the fine-structure constant of essential parts of an optical atomic clock, i.e., the cold atoms and the optical reference cavity, we can perform sensitive searches for DM signatures without the need for real-time comparisons of the clocks. We report a two orders of magnitude improvement in constraints on transient variations of the fine-structure constant, which considerably improves the detection limit for the standard model (SM)-DM coupling. We use Yb and Sr optical atomic clocks at four laboratories on three continents to search for both topological defect and massive scalar field candidates. No signal consistent with a DM coupling is identified, leading to considerably improved constraints on the DM-SM couplings.

Activation of platelet-transforming growth factor beta-1 in the absence of thrombospondin-1

Thrombospondin-1 (TSP-1) has been shown to bind and activate transforming growth factor-beta1 (TGF-beta1). This observation raises the possibility that TSP-1 helps to sequester TGF-beta1 in platelet alpha granules and activates TGF-beta1 once both proteins are secreted. Herein, we evaluated the level of active and latent TGF-beta1 in the plasma and in the supernatant of thrombin-treated platelets from TSP-1 null and wild-type mice on two genetic backgrounds (C57BL/6 and 129Sv). The plasminogen activator inhibitor-1/luciferase bioassay and an immunological assay were used to determine active and latent TGF-beta1. No significant differences were observed in the levels of active and latent TGF-beta1 in the supernatant of thrombin-treated platelets from TSP-1 null and wild-type mice. Active and latent TGF-beta1 were significantly increased in the plasma and platelets of C57BL/6 mice as compared with 129Sv mice. In addition, there was an increase of plasma level of latent TGF-beta1 in TSP-1 null mice as compared with wild-type mice on the C57BL/6 background but not on the 129Sv background. No active TGF-beta1 was observed in the plasma of either TSP-1 null and wild-type mice. These data indicate that TSP-1 does not function as a chaperon for TGF-beta1 during platelet production and does not activate significant quantities of secreted TGF-beta1 despite a vast excess in the number of TSP-1 molecules as compared with TGF-beta1 molecules. Because platelet releasates from TSP-1 null mice contain active TGF-beta1, we suggest that other important mechanisms of physiological activation of TGF-beta1 probably exist in platelets.

Active transforming growth factor-beta in wound repair: determination using a new assay

Transforming growth factor (TGF)-beta regulates wound repair and scarring in an isoform-specific fashion. TGF-beta is produced in a latent form, and its activation is a critical regulatory step controlling the bioactivity of this growth factor. To date, it has been impossible to determine latent TGF-beta activation in vivo due to a lack of quantitative assays. We describe here a semiquantitative modification of the plasminogen activator inhibitor-1/luciferase bioassay (PAI/L assay) for TGF-beta, which we used to determine active and latent TGF-beta isoforms in frozen sections of rat wound tissue. We found that significant amounts of latent TGF-beta were rapidly activated upon wounding (38% of the total TGF-beta at 1 hour after wounding). A second peak of active TGF-beta (17% of total) occurred at 5 days after wounding. The predominant isoforms were TGF-beta1 and -2 with only minor amounts of TGF-beta3 present. This is the first TGF-beta bioassay allowing semiquantitative determination of active and latent isoforms present in vivo, and our results document the significance and temporal regulation of latent TGF-beta isoform activation in wound repair.