Autism- towards comprehensive assessment and management

Autism is a pervasive, neurodevelopmental disorder characterized by stereotyped movements and impairment in social skills and communication patterns. Prevalence patterns show an increasing burden of about 1 in 150 children affected by the disorder. Most affected individuals have symptoms that interfere greatly with quality of life. Although a burgeoning concern, research on the prevalence, etiological factors and presentation patterns is limited in LAMI countries, leading to a minimal understanding of the disorder at individual, professional and societal level. There is an urgent need to enhance awareness and education to decrease stigma that maybe associated with autism

Disrupting the Hegemony of Choice: Community Service Learning in Activist Placements

In this paper, we share insights from a research project that investigated the effects of a service learning experience in a graduate adult education seminar with an explicitly critical pedagogical focus and activist placements. We analyze a subset of the findings related to the lack of “choice” through a critique of CSL as a market commodity and argue that disrupting the hegemony of choice had implications for reconstructing student identities

Synergistic effects of a copper–cobalt–nitroisophthalic acid/neodymium oxide composite on the electrochemical performance of hybrid supercapacitors

Hybrid supercapacitors can produce extraordinary advances in specific power and energy to display better electrochemical performance and better cyclic stability. Amalgamating metal oxides with metal–organic frameworks endows the prepared composites with unique properties and advantageous possibilities for enhancing the electrochemical capabilities. The present study focused on the synergistic effects of the CuCo(5-NIPA)–Nd2O3 composite. Employing a half-cell configuration, we conducted a comprehensive electrochemical analysis of CuCo(5-NIPA), Nd2O3, and their composite. Owing to the best performance of the composite, the hybrid device prepared from CuCo(5-NIPA)–Nd2O3 and activated carbon demonstrated a specific capacity of 467.5 C g−1 at a scan rate of 3 mV s−1, as well as a phenomenal energy and power density of 109.68 W h kg−1 and 4507 W kg−1, respectively. Afterwards, semi-empirical techniques and models were used to investigate the capacitive and diffusive mechanisms, providing important insights into the unique properties of battery–supercapacitor hybrids. These findings highlight the enhanced performance of the CuCo(5-NIPA)–Nd2O3 composite, establishing it as a unique and intriguing candidate for applications requiring the merging of battery and supercapacitor technologies

Assessing physical activity in people with mental illness: 23-country reliability and validity of the simple physical activity questionnaire (SIMPAQ)

Background: Physical inactivity is a key contributor to the global burden of disease and disproportionately impacts the wellbeing of people experiencing mental illness. Increases in physical activity are associated with improvements in symptoms of mental illness and reduction in cardiometabolic risk. Reliable and valid clinical tools that assess physical activity would improve evaluation of intervention studies that aim to increase physical activity and reduce sedentary behaviour in people living with mental illness.Methods: The five-item Simple Physical Activity Questionnaire (SIMPAQ) was developed by a multidisciplinary, international working group as a clinical tool to assess physical activity and sedentary behaviour in people living with mental illness. Patients with a DSM or ICD mental illness diagnoses were recruited and completed the SIMPAQ on two occasions, one week apart. Participants wore an Actigraph accelerometer and completed brief cognitive and clinical assessments.Results: Evidence of SIMPAQ validity was assessed against accelerometer-derived measures of physical activity. Data were obtained from 1010 participants. The SIMPAQ had good test-retest reliability. Correlations for moderate-vigorous physical activity was comparable to studies conducted in general population samples. Evidence of validity for the sedentary behaviour item was poor. An alternative method to calculate sedentary behaviour had stronger evidence of validity. This alternative method is recommended for use in future studies employing the SIMPAQ.Conclusions: The SIMPAQ is a brief measure of physical activity and sedentary behaviour that can be reliably and validly administered by health professionals

Effects of antibiotic resistance, drug target attainment, bacterial pathogenicity and virulence, and antibiotic access and affordability on outcomes in neonatal sepsis: an international microbiology and drug evaluation prospective substudy (BARNARDS)

Background Sepsis is a major contributor to neonatal mortality, particularly in low-income and middle-income countries (LMICs). WHO advocates ampicillin–gentamicin as first-line therapy for the management of neonatal sepsis. In the BARNARDS observational cohort study of neonatal sepsis and antimicrobial resistance in LMICs, common sepsis pathogens were characterised via whole genome sequencing (WGS) and antimicrobial resistance profiles. In this substudy of BARNARDS, we aimed to assess the use and efficacy of empirical antibiotic therapies commonly used in LMICs for neonatal sepsis. Methods In BARNARDS, consenting mother–neonates aged 0–60 days dyads were enrolled on delivery or neonatal presentation with suspected sepsis at 12 BARNARDS clinical sites in Bangladesh, Ethiopia, India, Pakistan, Nigeria, Rwanda, and South Africa. Stillborn babies were excluded from the study. Blood samples were collected from neonates presenting with clinical signs of sepsis, and WGS and minimum inhibitory concentrations for antibiotic treatment were determined for bacterial isolates from culture-confirmed sepsis. Neonatal outcome data were collected following enrolment until 60 days of life. Antibiotic usage and neonatal outcome data were assessed. Survival analyses were adjusted to take into account potential clinical confounding variables related to the birth and pathogen. Additionally, resistance profiles, pharmacokinetic–pharmacodynamic probability of target attainment, and frequency of resistance (ie, resistance defined by in-vitro growth of isolates when challenged by antibiotics) were assessed. Questionnaires on health structures and antibiotic costs evaluated accessibility and affordability. Findings Between Nov 12, 2015, and Feb 1, 2018, 36 285 neonates were enrolled into the main BARNARDS study, of whom 9874 had clinically diagnosed sepsis and 5749 had available antibiotic data. The four most commonly prescribed antibiotic combinations given to 4451 neonates (77·42%) of 5749 were ampicillin–gentamicin, ceftazidime–amikacin, piperacillin–tazobactam–amikacin, and amoxicillin clavulanate–amikacin. This dataset assessed 476 prescriptions for 442 neonates treated with one of these antibiotic combinations with WGS data (all BARNARDS countries were represented in this subset except India). Multiple pathogens were isolated, totalling 457 isolates. Reported mortality was lower for neonates treated with ceftazidime–amikacin than for neonates treated with ampicillin–gentamicin (hazard ratio [adjusted for clinical variables considered potential confounders to outcomes] 0·32, 95% CI 0·14–0·72; p=0·0060). Of 390 Gram-negative isolates, 379 (97·2%) were resistant to ampicillin and 274 (70·3%) were resistant to gentamicin. Susceptibility of Gram-negative isolates to at least one antibiotic in a treatment combination was noted in 111 (28·5%) to ampicillin–gentamicin; 286 (73·3%) to amoxicillin clavulanate–amikacin; 301 (77·2%) to ceftazidime–amikacin; and 312 (80·0%) to piperacillin–tazobactam–amikacin. A probability of target attainment of 80% or more was noted in 26 neonates (33·7% [SD 0·59]) of 78 with ampicillin–gentamicin; 15 (68·0% [3·84]) of 27 with amoxicillin clavulanate–amikacin; 93 (92·7% [0·24]) of 109 with ceftazidime–amikacin; and 70 (85·3% [0·47]) of 76 with piperacillin–tazobactam–amikacin. However, antibiotic and country effects could not be distinguished. Frequency of resistance was recorded most frequently with fosfomycin (in 78 isolates [68·4%] of 114), followed by colistin (55 isolates [57·3%] of 96), and gentamicin (62 isolates [53·0%] of 117). Sites in six of the seven countries (excluding South Africa) stated that the cost of antibiotics would influence treatment of neonatal sepsis

Depression in pregnancy and the postpartum period: balancing adverse effects of untreated illness with treatment risks

The author reviews the risks and benefits of untreated maternal depression during pregnancy and the postnatal period and its effects on the well-being of the mother and infant. She then discusses the significant role psychiatrists can play in detecting and managing maternal depression as a primary measure for preventing future child psychopathology. A literature search was conducted on PubMed to identify both preclinical and clinical studies concerning deleterious effects of maternal depression on offspring. Additional searches focused on available safety data concerning the use of antidepressants during pregnancy and lactation. Key search items included depression during pregnancy, postpartum depression, lactation, and antidepressants. Burgeoning evidence was found concerning the adverse effects of maternal depression on the developing fetus and infant in the perinatal period. No controlled studies on the safety of antidepressant use in pregnancy and lactation were found; therefore, case reports, and some retrospective and prospective case series, must serve as guidelines for the treating clinician. Each case of maternal depression needs to be evaluated on an individual basis and decisions about treatment interventions should involve both the patient and family. Maternal depression during pregnancy and the postnatal period is associated with a significant disease burden in that it affects not only the mother but may also have both short- and long-term effects on offspring. Therefore, early detection and management of maternal depression, of which perinatal screening of mothers is an important component, are warranted

Terrorism in Pakistan and its impact on children\u27s mental health

At the end of the session, participants will be able to do the following: 1) discuss the context of the school killings in the Army Public School (APS) in Peshawar, Pakistan; 2) appreciate the psychological impact of school killings on children and the community at large; and 3) differentiate interventions designed for violence-based disasters versus natural ones