Parents' Experience during the Diagnostic Process of Autism Spectrum Disorder in the West Bank. A Descriptive Phenomenological Study

ASD (Autism Spectrum Disorder) is one of the crucial subjects in the mental health sector, and it is a universal, rapidly-growing disorder. The aim of my study is to investigate and describe the experiences of the parents going through the process of diagnosing autism spectrum disorder in the West Bank. Briefly, my specific objectives are to describe: how an autism diagnosis affects families; the psychological impacts on parents; and the physical burden associated with it. I also investigated the consequences of diagnosis of autism spectrum disorder on couples' lives, family dynamics and the effects of community stigma. In order to explore the aim, the Giorgi methodology was adopted, and the design that I used was a qualitative phenomenological descriptive design. I conducted the study on 12 parents of children with autism in the West Bank. Semi-structured face-to-face interviews were conducted to elicit parents’ experiences. A thematic analysis of the data identified 4 core themes and 14 sub-themes representing the vital challenging elements of the parents' experiences: diagnosis, stigma, grief, and family challenges. This study is unique in being a pioneer in the field of ASD in the West Bank. It highlights the needs of children and their families throughout the process of diagnosis and afterwards. This study fills a gap in current research on ASD. Keywords: Autism spectrum disorder (ASD), diagnosis, parents' experience

Prevalence and Severity of Depression among Mothers of Disabled Children in Palestine. A Descriptive, Aanalytical, Cross Sectional Study

Introduction: Mothers of children with disabilities often experience greater stress and emotional demands than other mothers do. Mothers of children with disabilities showed also more psychological distress than other member in their families, as they are the primary caregivers for their children. Childhood disability often imposes a social and emotional burden for children and their families. Aim: The aim of the study is to assess the prevalence and severity of depression among mothers of disabled children in the north of the West Bank in order to establish baseline data and suggest recommendations to policy makers and professional workers. Subjects and Methods: A descriptive, analytical kind (cross sectional) study. Two hundred mothers were included in the study divided in two groups, including 100 mothers of children with disabilities (age range, 2-16years) as a study group, and 100 mothers of normally developing children (age range, 2-16 years) as a control group. There were 47%  girls and 53% boys of  the children in the control group and there were 38%  girls and 62% boys of the children in the study group. These children have different diagnoses with a 10% down syndrome, 18% hearing disabilities, 7 % physical disability, 11% speech disorders, 18% autism, 14% mental retardation, 12% cerebral palsy and 10 % other disorders.  The mothers’ average ages in the study group and control group were 32.6 (SD±6.3) and 31(SD± 5.7) years, respectively. A demographic information form and Beck Depression Inventory were administered to mothers of these children who met the inclusion criteria. The assessments were performed during children´s treatment in rehabilitation centers. Results: The prevalence of depression was higher among mothers caring for disabled children than mothers of non-disabled children in the control group. Fifty four percent of mothers of disabled children had a mild to severe level of depression and 18% of them suffered from moderate to severe depression as derived from Beck Inventory score. When we compare between the study and control groups, the study reveals that there are many factors that increase the prevalence of depression among mothers in the study group compared to control group which include: child’s age <10 years, mother’s age <40 years, middle and low income, and un-employment. On the other hand there was no association in the study group between mothers´ depression score and mothers´ age, child age, educational level of the mothers, family style and family income. For the control group (mothers of normally developing children) 15% of them had a mild to severe level of depression and 2% had moderate to severe depression and there was a significant correlation between mothers´ depression score and mother´s age (p=0.010). There was a relation between mothers depression score and family income, but it was not statically significant (p=0.07).The result of this study indicates that there was a significant difference between mothers’ depression score with respect to having or not having disabled children (u=1911, p<0.01).The mothers of children with physical disabilities (mean rank was 60.36) and cerebral palsy (mean rank was 58.67) have a higher depression score than mothers with children of other kinds of disabilities, and the lowest level of depression score was for mothers whose children have down syndrome, which had a mean rank of 38.45. Conclusion: The results of this study indicate that 54% of the mothers of disabled children had various degrees of depression, with 18 % suffering from severe depression. For the mothers with non-disabled children, 18% had various degrees of depression, which is within the normal statistics (12-25%) (WHO, 1990). In study group the study reveals that the disability itself tend to be consider as a strong factor in the same group to increase the prevalence of depression, in contrary in control group the study reveals that there are many factors to increase the prevalence of depression among mothers which include: mothers age>40, child age >10, low family income and low educational level. When we compare between the study and control groups, the study reveals that there are many factors to increase the prevalence of depression among mothers in the study group compared to control group which include: child’s age <10 years, mother’s age <40 years, middle and low income, and un-employment. Recommendations: Early recognition of depression symptoms in mothers of disabled children should be of great concern for health care providers. The effective rehabilitation programs should provide ample opportunity for repeated follow-up interviews that not only offer information about children's disabilities but also psychological support for mothers. Shifting the rehabilitation services from child-centered to family-centered services through providing supportive services is recommended. Keywords: disabled children, depression, Beck depression inventory, extended family, nuclear family

Transcending Dichotomy: Functions of Ritual among the Pagans of Fife

Sabrina Russo examines belief, ritual, and social relations among Fife Pagans

Idrogeochimica di sorgenti carsiche dell’area transfrontaliera Italia – Slovenia (Monte Canin)

Scientific community considers the Karst aquifers as one of the most important global water resources but also one of the most vulnerable landscape, linked to environmental impacts and global climate fluctuation and for their particular hydrogeological - hydrogeochemical characterization. Therefore, global environmental change studies have increasingly become important for environmental researches allowing to define the relation between ground water and climate in order to ground water hydrologists and hydrogeochemistry. The main topic of this thesis is geochemical characterization of spring waters of Kanin Mountain karst aquifer, by means of water – rock interactions study, geochemical mobility of important chemical elements, in order to identify the possible geochemical markers by meteo – climatic analysis, that could influence the climatic variability, especially seasonal changes. The researches were focused on geochemical study of springs, which are located in the trans boundary area Italy – Slovenia (Kanin Montain) of the Isonzo river basin. Major and trace elements in water samples were detected by Ion chromatography (anions) and ICP – MS (Inductively Coupled Plasma Mass Spectrometry) (cations and trace elements) and stable isotopes δ18O e δD analysis were carried out in water, snow and rain samples. Moreover, the software GWB (Geochemist’s Workbench) were used to obtain the model of water – rock interaction and arsenic – iron speciation. The analysis results are helpful to identify the links between climatic changes (especially seasonal changes) and the related geochemical variability of springs water of Kanin Mountain. Furthermore, seasonal changes showed the presence of particular environmental geochemical markers to estimate higher vulnerability of karst water resources

Women and Suicide in Palestine: Victimization, Loss, Socio-Psychological Factors and Lack of Support - A Phenomenological Study

Background: Despite the protective factors of Islam suicide, female suicide attempts exists in Palestine.  However there is little information about the causes, risks or protective factors regarding suicide for women in Palestine. Aims: This study investigates the history and experiences of Palestinian women who have attempted suicide in order to better inform policy makers, service providers and the international community about steps need to reduce this disturbing trend. Methods: Guided interviews were completed with 20 female suicide attempt survivors in Palestine using a qualitative phenomenological method to analyze the data. Results: Five themes emerged: victimization related to violence; Loss (family members, cultural identity, relationships, and security); psychological factors ;  socio-cultural factors;  and lack of support systems. Conclusion and Recommendation: The findings of the study demonstrate the importance of understanding the experience of suicide in the female population in Palestine, looking at risks related to victimization, loss, and lack of personal control.  The findings reflect the need for a holistic national strategy for prevention including support for mental health and advocacy programs for women, demanding basic human rights, prohibiting cultural practices such as child marriage, providing economic and social support and promoting Islamic values rather than traditional customs. Keywords: Suicide, Women’s Issues, Palestine, Victimization, Socio-cultural factor

Nurses’ Attitudes and Practices towards Inpatient Aggression in a Palestinian Mental Health Hospital

Background: Inpatient aggression can occur for many reasons and there are many factors that contribute to this occurrence such as patient factors, staff factors and environmental factors. There are strategies to prevent and manage aggression. Aims: The aims of this study are to explore nurse's practices and attitudes of inpatient psychiatric aggression to identify the way the nurses handle aggression by patients and exploring the effects of patients, staff and environmental factors on the occurrence of aggression. Participants and methods: The study was conducted at a Mental Health Hospital in Palestine. All nursing staff in the mental health hospital who had worked for at least one year at the time of the study was recruited (67 nurses). The participants ranged in age from 20-50 years with a mean age of (35.1) (±SD = ±7.8) and included 30 females and 37 males. A questionnaire was used which has three scales: Attitude Toward Aggression Scale (ATAS), Management Of Aggression and Violence Scale (MAVAS) and Demographic Scale.Results: Nurses were inclined to perceive patient aggression as destructive, violent, intrusive and functional reactions. They were less inclined to view aggression as protective, communicative or acceptable normal reactions. Female nurses in this study were more likely to view aggression as having an intrusive role whereas, on the contrary, male nurses were more likely to view aggression as having a communicative role and they believed that the aggression could be managed in general. Longer professional experience was significantly associated with a higher frequency of the management of aggression in general. Nurses from the admission ward (male and female) were in less agreement with the Protective and Communicative Attitudes scales than the nurses from the other inpatient wards. On the other hand, nurses from admission ward (particularly female) and recovery ward (male and female) had a higher rate of violent and offensive reaction to aggression than nurses from the other wards. The nurses from the chronic female ward had a higher intrusive scale than nurses from the other wards. The highest level of the scientific grade group is a Master of Mental Health with a high level mean regarding the attitudes to the acceptable normal reaction scale, violent reaction scale, functional reaction scale, offensive scale, communicative scale, destructive scale, external causative factors scale, situational/interactional causative factors scale, Management: general, and Management: use of medication. The nurses agree that there are internal, external and interactional factors to inpatient aggression. Nurses believe that patients may be aggressive because of the environment of the psychiatric hospital. Nurses believe that aggression develops because staff does not listen to the patients, there is poor interaction between staff and patients and other people make patients aggressive. Nurses believe in the use of medications, restraint and seclusion widely, on the contrary, they believe in the use of non-physical methods like negotiation and expression of anger. Conclusion: This study demonstrates that there are different attitudes of nurses toward patient aggression in psychiatric inpatient settings. This study found that aggression is negatively viewed by Palestinian psychiatric nurses. These attitudes are reflective of the opinions of lay persons in our society. There is a need for training programs to reorient the opinions of nurses in relation to inpatient aggression. These programs should contribute to improved patient care and reduction in the frequency of aggressive acts within inpatient units. Keywords: Aggression; mental health, nurses; ATAS; MAVAS

Docking Manoeuvre Control for CubeSats

Rendezvous and Docking missions of small satellites are opening new scenarios to accomplish unprecedented in-obit operations. These missions impose to win the new technical challenges that enable the possibility to successfully perform complex and safety-critical manoeuvres. The disturbance forces and torques due to the hostile space environment, the uncertainties introduced by the onboard technologies and the safety constraints and reliability requirements lead to select advanced control systems. The paper proposes a control strategy based on Model Predictive Control for trajectory control and Sliding Mode Control for attitude control of the chaser in last meters before the docking. The control performances are verified in a dedicated simulation environment in which a non-linear six Degrees of Freedom and coupled dynamics, uncertainties on sensors and actuators responses are included. A set of 300 Monte Carlo Simulation with this Non-Linear system are carried out, demonstrating the capabilities of the proposed control system to achieve the final docking point with the required accuracy

Association between Autism Spectrum Disorder and Iron Deficiency in Children Diagnosed Autism Spectrum Disorder in the Northern West Bank

Iron has an important role in cognitive, behavioral, and motor development. A high prevalence of iron deficiency (ID) has been reported in people with autism. Children with autism are at risk for ID and this condition may increase the severity of psychomotor and behavioral problems, some of which already inherently exist in these children. Aim of the study: The aim of this study is to investigate the association between autism and iron deficiency in autistic children in the Northern West Bank and to identify food selectivity and compare indices of food selectivity among children with autism, children with mental disorders and typically developing children (normal children).Background: Autism is a developmental disorder characterized by qualitative abnormalities of social interaction, impairments in communication, and unusual forms of repetitive behavior . Research shows that a high prevalence of iron deficiency has been reported in children with autism spectrum disorders. Inadequate dietary iron intake was considered as a cause of iron deficiency, and low iron intake was thought to be associated with food selectivity which is commonly seen in children with autistic disorders. Method: 90 children with an age range of 3 to 13 years participated in a case control study distributed into study group and two control groups. Thirty children diagnosed with autism according to DSMIV and ICD-10 criteria served as a study group, 30 children with mental disorders other than autism served as a control group, and 30 typically developing children taken from the public functioned as a second control group. The three groups were matched for age, gender and geographical area. Serum ferritin, hemoglobin, hematocrit, mean corpuscular volume, and red cell distribution width values were measured and analyzed with food habit survey and demographic data. Results: ID was detected in 20% (N = 6/30) of autistic children based on Serum ferritin level (SF< 10μ/l), compared with 0% for the two control groups (p= 0.0001). Anemia was defined as hemoglobin <110g/l for children under the age of 6 years and hemoglobin <120g/l for children between 6 and 13 years of age .When analysis done for HGB to these six children (children who have low serum ferritin); it was found that 66.6% (4/6) of the children two were pre-school male children (HGB is less than 110g/1), and the other two were one male and one female of school children (HGB is less than 120g/l) have iron deficiency anemia, and the iron deficiency anemia was 13.3% (4\30) for all autistic group. The results indicated that these differences were for males. It was found also that the frequency of low iron intake in these children was associated with feeding difficulties and food selectivity; there was a significant difference between children in the autistic group who chose foods with a red color as a favorite 23% (7/30) compared to the other two control groups: 0%, respectively (p= 0.0001). The results demonstrated also a significant difference in the frequency of snacks per day (≥ 4) in autistic children 40% (12/30) compared to both mental disorder 16.7 % (n = 5/30) (p = 0.006) and typically developing children 6.7% (n = 2/30) groups (p = 0.001).Conclusions: Results of this study indicated that there is an association between autism, iron deficiency and anemia. Low levels of serum ferritin in autistic children might be a sign of iron deficiency and an early precursor of iron deficiency anemia. These findings suggest that food selectivity is more common in children with autism than in typically developing children. These findings suggest that ferritin levels should be measured in children with autism as a part of routine investigation. Keywords: Child, Autism, Mental disorder, typically developing children, Iron deficiency, Iron deficiency anemia, Ferritin

\u3ci\u3eCorrigendum\u3c/i\u3e (Russo et al. 2007): A Re-Analysis of Growth–Size Scaling Relationships of Woody Plant Species

Russo et al. (2007) tested two predictions of the Metabolic Ecology Model (Enquist et al. 1999, 2000) using a data set of 56 tree species in New Zealand: (i) the rate of growth in tree diameter (dD/dt) should be related to tree diameter (D) as dD/dt = βDα and (ii) tree height (H) should scale with tree diameter as H(D) = γDδ, where t is time, β and γ are scaling coefficients that may vary between species, and α and δ are invariant scaling exponents predicted to equal 1/3 and 2/3, respectively (Enquist et al. 1999, 2000). To this end, Russo et al. (2007) used maximum likelihood methods to estimate α and δ and their two-unit likelihood support intervals. As noted in our original manuscript, the growth–diameter scaling exponent and coefficient covary, complicating the estimation of confidence intervals. We now recognize that the method we used to estimate support intervals (using marginal support intervals with the nuisance parameters fixed) underestimates the breadth of the interval and that the support intervals, properly estimated, should account for the variability in all parameters (Hilborn & Mangel 1997). This can be done in several ways. For example, the Hessian matrix can be used to estimate the standard deviation for each parameter, assuming asymptotic normality. Alternatively, one can systematically vary the parameter for which the interval is being estimated, re-estimate the Maximum likelihood estimates (MLEs) for the other parameters, and take the support interval to be the values of the target parameter that result in log likelihoods that are two units away from the maximum (Edwards 1992; Hilborn & Mangel 1997). A third and more direct approach to comparing data with prediction is to use the likelihood ratio test (LRT), which explicitly tests if a model with a greater number of parameters provides a significantly better fit to the data than a simpler model in which some parameters are fixed at predicted values (Hilborn & Mangel 1997; Bolker in press). Here, we re-analyze our data using LRTs, present a table revising Tables 1 and 2 from Russo et al. (2007), and reevaluate whether there is statistical support for the predictions of the Metabolic Ecology Model that we tested in Russo et al. (2007). We used LRTs to test, respectively, whether a model in which a,or d, was estimated at its MLE had a significantly greater likelihood than did a model with α = 1/3, or δ = 2/3, for the growth–diameter and height–diameter scaling relationships

Interactions with soil fungi alter density dependence and neighborhood effects in a locally abundant dipterocarp species

Seedling recruitment can be strongly affected by the composition of nearby plant species. At the neighborhood scale (on the order of tens of meters), adult conspecifics can modify soil chemistry and the presence of host microbes (pathogens and mutualists) across their combined canopy area or rooting zones. At local or small spatial scales (on the order of one to few meters), conspecific seed or seedling density can influence the strength of intraspecific light and resource competition and also modify the density-dependent spread of natural enemies such as pathogens or invertebrate predators. Intrinsic correlation between proximity to adult conspecifics (i.e., recruitment neighborhood) and local seedling density, arising from dispersal, makes it difficult to separate the independent and interactive factors that contribute to recruitment success. Here, we present a field experiment in which we manipulated both the recruitment neighborhood and seedling density to explore how they interact to influence the growth and survival of Dryobalanops aromatica, a dominant ectomycorrhizal tree species in a Bornean tropical rainforest. First, we found that both local seedling density and recruitment neighborhood had effects on performance of D. aromaticaseedlings, though the nature of these impacts varied between growth and survival. Second, we did not find strong evidence that the effect of density on seedling survival is dependent on the presence of conspecific adult trees. However, accumulation of mutualistic fungi beneath conspecifics adults does facilitate establishment of D. aromatica seedlings. In total, our results suggest that recruitment near adult conspecifics was not associated with a performance cost and may have weakly benefitted recruiting seedlings. Positive effects of conspecifics may be a factor facilitating the regional hyperabundance of this species. Synthesis: Our results provide support for the idea that dominant species in diverse forests may escape the localized recruitment suppression that limits abundance in rarer species