Joint Attention Impairment in Autism: Clinical Picture, Rationale and Functional MRI Findings

Joint attention is a keystone in social cognitive development and a skill acquired early in life. It is the triadic coordination of attention between two people and an object or event in which they are commonly interested. Language development follows in its tracks and is dependent on this early acquired skill. Its deviation from typical development is considered one of the earliest signs of autism. Consequently, its remediation has gained intensive focus in therapy. In this review, the development of joint attention skill in initiating (IJA) and responding (RJA), and its atypical development in autism and related spectrum disorders would be discussed. This would include existing problems in pointing, sharing attention with the participant, and facial recognition; and the rationale behind these deviations as covert attention. Related fMRI findings would also be reviewed, outlining the integration between the posterior involuntary parietal and superior temporal cortices (RJA) and the anterior volitional prefrontal and orbital frontal areas (IJA) in typical development, and the long‐distance underconnectivity and local overconnectivity in autism. Several cortical regions are implicated in autism, revealing the heterogeneity of the findings, but general conclusions could be drawn

Autism: A Neurodevelopmental Disorder and a Stratum for Comorbidities

Autism is a neurodevelopmental disorder which is more common in males than females. It is characterized by social communication disorders and restricted repetitive behaviors. There is wide heterogeneity in its etiology, clinical presentations, management and consequently prognosis. Although the etiology of autism remains unclear, the most currently proven theory is that it is a complex neurodevelopmental disorder that displays “brain network abnormalities”. fMRI studies have shown decreased brain connectivity or functional synchronization between frontal and more posterior cortical regions. Dynamic brain activity through high resolution electroencephalograghy (EEG) has revealed local overconnectivity and long-range underconnectivity. This disrupted connectivity pattern would involve connectivity between hemispheres (corpus callosum), together with axonal and synaptic connectivity within each hemisphere. Inconsistent morphometric changes involving both gray and white matter structure also exist. Clinically, autism is associated with multiple comorbidities (somatic, neurologic and psychiatric); some of which are attention deficit hyperactivity disorder, dyspraxia, and sensory processing disorders

Military Service in Eritrea

openThis study aims to analyse the human rights violations in the military service in Eritrea in details and to investigate how the international community as major power countries and international organisations as the United Nations react in response to these violations committed by the Eritrean government. The thesis starts with providing a country overview about Eritrea and the history of the country and its demographic distribution, then it is followed with a brief history of military service laws in different countries during the world wars and afterwards. After the brief introduction about Eritrea and military service, the thesis examines in details military service in Eritrea by discussing the history of the military service in Eritrea, and the laws that regulate the military service. Afterwards, a detailed description of the reality of the military service in Eritrea is found, and a description of the experiences of those conscripted, the draft evaders and the draft deserters and also their families. In addition, the experiences of vulnerable people as women and children is also assessed Further in the thesis, the journey of Eritreans to flee their country and seek asylum elsewhere due to the military service is also analysed. After an analysis of the current situation of the military service in Eritrea is done, the thesis investigates how the current reality in Eritrea is far from being inline with the country’s international obligations and how the international community has reacted in the face of these ongoing violations. The study eventually suggests international tools and laws that could be used by the international community in order to hold the Eritrean government responsible for these violations and sanction the decision-makers responsible

Phonological Deficit Traits in Verbal Language of Dyslexics

Developmental dyslexia is a common learning disorder which is defined as a specific deficit in reading acquisition that cannot be accounted for by low IQ , lack of typical educational opportunities, or an obvious sensory or neurological damage. Dyslexic children commonly present with delayed language development first, which selectively affects phonological processing more than other aspects of language. The problem at the level of phonological representations causes a range of typical symptoms which include problems of verbal short-term memory, non-word repetitions, phonological learning of new verbal information, word retrieval, and rapid naming. This chapter will address the picture of early oral language difficulties especially phonological deficits in dyslexia, and how reading problems are related to them

Numerical-Experimental characterization of honeycomb sandwich panel and numerical modal analysis of implemented delamination

The objective of this paper is to investigate the influence of the delamination on the vibration behavior of honeycomb sandwich panel, firstly, numerical characterization to provide the constant properties of the core only are performed using initial finite element model of Representative Volume Element (RVE) which does not take into account the double thickness wall existing in aluminum core structure. According to these initial parameters, finite element model of sandwich composite plate is constructed to extract its elasto-dynamic parameters. In order to validate the numerical results, Experimental Modal Analysis of sandwich plate specimens was performed. Secondly, the double thickness wall is selected to be introduced in the RVE because of important error between numerical and experimental achievements. Comparative study validates the improved mechanical characteristics. The knowledge of these constants is not sufficient and additional information about the delamination effects on the dynamical parameters of honeycomb composite panel is required. In present investigation this defect was implemented on the validated 3-D finite element model. The frequencies and associated modes shapes are obtained and analyzed

A developed IoT technique and P&O-MPPT to enhance the output power of solar cell systems

Abstract- Given the urgent need for continuous development in solar cell systems to increase their efficiency, in this study, a developed IoT technique was built to monitor the solar irradiance fluctuation around the solar cell systems, and a Perturbation and observation algorithm (P&O) was developed to increase the output power from the PV systems. In order to save energy, the IoT technique has been supported with a light-dependent resistor to operate and shut down with sunlight. The whole IoT technique was fed from the PV system to save energy and avoid a power outage. The measured solar irradiance profile was displayed online on the ubidots. Then, the measured solar power irradiance through IoT was introduced to the MATLAB simulation program to study the performance of the proposed P&O maximum power point tracking (P&O-MPPT) algorithm. The P&O-MPPT algorithm was used to control the voltage and current by continuous adjustments in the duty cycle to improve the output power of the studied solar system. The obtained results showed the efficiency of the monitoring system based on IoT in recording changes in solar radiation and the improvement in the output power as a result of the developed P&O-MPPT system

A developed IoT technique and P&O-MPPT to enhance the output power of solar cell systems

Abstract- Given the urgent need for continuous development in solar cell systems to increase their efficiency, in this study, a developed IoT technique was built to monitor the solar irradiance fluctuation around the solar cell systems, and a Perturbation and observation algorithm (P&O) was developed to increase the output power from the PV systems. In order to save energy, the IoT technique has been supported with a light-dependent resistor to operate and shut down with sunlight. The whole IoT technique was fed from the PV system to save energy and avoid a power outage. The measured solar irradiance profile was displayed online on the ubidots. Then, the measured solar power irradiance through IoT was introduced to the MATLAB simulation program to study the performance of the proposed P&O maximum power point tracking (P&O-MPPT) algorithm. The P&O-MPPT algorithm was used to control the voltage and current by continuous adjustments in the duty cycle to improve the output power of the studied solar system. The obtained results showed the efficiency of the monitoring system based on IoT in recording changes in solar radiation and the improvement in the output power as a result of the developed P&O-MPPT system

Body Composition Changes after Weight-Loss Interventions among Obese Females: A Comparison of Three Protocols

AIM: To evaluate body composition changes after use of three different types of obesity management protocols: dietary measures and physical activity; acupuncture or laser acupuncture with healthy diet; aiming at achieving stable weight loss among obese Egyptian females.METHODS:  A randomized longitudinal prospective study included 76 obese adult females; aged 26 up to 55 years. Anthropometric, body composition, ultrasonographic and biochemical assessments were done.RESULTS: The three types of obesity management protocols showed significant improvement in body composition (decrease in fat% and increases in FFM and TBW) and visceral fat by US. However, nutritional intervention showed highly significant improvement in the skin fold thickness at triceps and biceps sites and peripheral adiposity index.  Acupuncture intervention showed highly significant improvement in fasting blood glucose (decreased) and lipid profile (decreased triglycerides, total cholesterol and LDL, and increased HDL). Laser intervention showed highly significant improvement in all the skin fold thickness and some parameters of lipid profile (decreased total cholesterol and LDL). CONCLUSIONS: The three obesity management protocols have significant effect on body composition, but acupuncture has the best effect in improving the lipid profile and fasting blood sugar. In addition, Laser intervention was recommended to improve skin fold thickness and subcutaneous fat

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication