Adapting Attachment and Biobehavioral Catch-up for infants and young children with intellectual disabilities and developmental delays in South Africa: Reflections and recommendations from local stakeholders.

Attachment and Biobehavioral Catch-up (ABC) is an intervention targeted at enhancing the socioemotional and regulatory functioning of at-risk infants. However, to use the ABC for infants/toddlers with intellectual disabilities/developmental delays (ID/DD) and in novel cultural contexts, such as South Africa, adaptations may be required. This study aimed, therefore, to explore the opinions of clinical experts and perceptions of caregivers regarding the use of ABC for children with ID/DD in South Africa. It also sought to incorporate the experiences of families of children with ID/DD who received, and intervenors who delivered, ABC in its first implementation in South Africa. Semi-structured interviews were conducted with 18 participants. Thematic analysis explicated 12 main themes: Intervention Strengths, Points of Concern, and Recommendations (Experts); Focus on Caregiver-child Relationship, and Intervention Targets and Duration (Caregivers); Benefits of ABC, and Cultural Considerations (ABC Recipients); Focused and Targeted, Value of Feedback, Supportive Supervision, Working Alliance, and Challenges Experienced (ABC Intervenors). Practice and training recommendations include psychoeducation for parents and training for intervenors that is ID/DD-specific, expanding supervision capacity, building intervenors' cultural/linguistic sensitivity and competence, accessing referral networks, including local Community Health Workers as intervenors, and greater flexibility in how the sessions are organized.

La intervención de Afectividad y Alcance del Bio-comportamiento (ABC) está dirigida a mejorar el funcionamiento socioemocional y regulatorio de los infantes bajo riesgo. Sin embargo, para usar el ABC para infantes y niños pequeñitos con discapacidades intelectuales / retrasos en el desarrollo (ID/DD) y dentro de nuevos contextos culturales, tal como en Sudáfrica, se requieren adaptaciones. Este estudio se propuso, por tanto, explorar las opiniones de expertos clínicos y las percepciones de quienes prestan el cuidado acerca del uso del ABC con niños con ID/DD en Sudáfrica. También buscaba incorporar las experiencias de familias de niños con ID/DD que recibían, así como de practicantes de la intervención que ofrecían el servicio de ABC durante su primera implementación en Sudáfrica. Se llevaron a cabo entrevistas semiestructuradas con 18 participantes. Análisis temáticos explicaron los 12 principales temas: Puntos Fuertes de la Intervención, Puntos que Preocupan y Recomendaciones (Expertos); Enfoque en la Relación Cuidador-Niño y Metas de Enfoque y Duración de la Intervención (Cuidadores); Beneficios del ABC y Consideraciones Culturales (Quienes recibían el ABC); Lo Enfocado y Diseñado como Meta, Valor de Ideas Recibidas, Supervisión con Apoyo, Alianza de Trabajo y Retos Experimentados (Practicantes de la Intervención ABC). Las recomendaciones de práctica y entrenamiento incluyen la psico-educación de padres, entrenamiento a quienes practican la intervención específicamente orientada a ID/DD, expandir la capacidad de supervisión, formar la sensibilidad y competencia cultural/lingüística de quienes practican la intervención, acceso a los sistemas de referencias, incluir Trabajadores de Salud Comunitarios como practicantes de la intervención y mayor flexibilidad en cómo organizar las sesiones.

L'attachement et le rattrapage bio-comportemental (en anglais Attachment and Biobehavioral Catch-up, soit ABC) est une intervention ciblée sur l'amélioration du fonctionnement socio-émotionnel et régulatoire de bébés à risques. Cependant, pour utiliser l'ABC pour des bébés/jeunes enfants avec des retards intellectuels et des retards du comportement (ID/DD) et dans des contextes culturels nouveaux, comme l'Afrique du Sud, des adaptations pourraient être nécessaires. Par conséquent cette étude s'est donné pour but d'explorer les opinions d'experts cliniques et les perceptions des personnes prenant soin d'un bébé quant à l'utilisation de l'ABC pour des enfants avec ID/DD en Afrique du Sud. On a aussi cherché à incorporer les expériences de familles d'enfants avec ID/DD qui ont reçu l'ABC, ainsi que des intervenants qui l'ont facilité, dans sa première mise en oeuvre en Afrique du Sud. Des entretiens semi-structurés ont été faits avec 18 participants. Une analyse thématique a explicité 12 thèmes principaux: Forces de l'Intervention, Points d'Inquiétude, et Recommandations (Experts); Accent sur la Relation Personne prenant soin de l'enfant-enfant et Cibles d'Intervention et Durée d'Intervention (Personnes prenant soin d'un bébé); Bénéfices de l'ABS, et Considérations Culturels (personnes ayant reçu l'ABC); Ciblé et Centré, Valeur du Retour, Supervision de Soutien, Alliance entre entités, et Défis Vécus (Intervenants ABC). Les recommandations de pratique et de formation incluent une psychoéducation pour les parents, une formation pour les intervenants qui est spécifique à l'ID/DD, l'élargissement de la capacité de supervision, le développement de la sensibilité et de la compétence culturelle/linguistique des intervenants, l'accès aux réseau d'orientation, y compris des Travailleurs de Santé Communautaires en tant qu'intervenants, et une plus grande flexibilité dans la manière dont les sessions sont organisées.

Using Attachment and Biobehavioral Catch-up with young children with developmental delays: A multiple-baseline trial of attachment, sensitivity, and cortisol.

The Attachment and Biobehavioral Catchup intervention potentially offsets psychosocial risks facing dyads in which children have intellectual disability or developmental delays. In this single-case multiple-baseline study the efficacy of this intervention was tested across three such South African families. Maternal sensitivity, attachment security, and child affect regulation were measured weekly during a baseline and intervention period, using the Ainsworth Maternal Sensitivity Scales, Attachment Q-sort and salivary cortisol, respectively. Furthermore, post-intervention interviews invited parents' and intervenors' evaluations of the intervention. Visual analysis broadly indicated improvement in maternal sensitivity and attachment security across subjects over time following the introduction of the intervention, although randomisation tests were not statistically significant. Effects on affect regulation were not clearly observed and may have been influenced by case-specific variables. Parent-participants and intervenors also identified particularly helpful contributions from the intervention. Findings underscore the importance of individual-level effects evaluation, especially when implementing interventions outside the original population.

Clinical Presentation, Diagnostic Approach, Laparoscopic Evaluation and Treatment of Impalpable Testis.

OBJECTIVE: To find out the clinical presentation, utility of ultrasound for diagnosis, laparoscopic findings and treatment for clinically impalpable testis. STUDY DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: Department of Paediatric Surgery, National Institute of Child Health, Jinnah Sindh Medical University Karachi, from September 2019 to April 2020. METHODOLOGY: Patients with clinically impalpable testis were included. Ultrasound of inguinal region was done to locate testis. Presence of testis and its position was confirmed at laparoscopy and surgical procedure done according to the findings. Data was stratified according to the age and Chi-square test and Student t-test were applied to find out statistical significance among different variables in children below and above five years of age. A p <0.05 was taken as significant. RESULTS: Ninety-one patients with 113 testes were included. The median age of the children was 48 months. Sixty-nine (75.8%) patients had unilateral undescended testis and 22 (24.2%) bilateral undescended testes. Fifty-three (58.2%) patients were less than five years of age. On ultrasound, testis was found near deep ring in 23 (25.3%) patients. At laparoscopy, 74 (81.3%) testes were found within the abdominal cavity. In 7 (7.7%) patients, only nubbin of tissue was identified and removed. The first stage of Fowler Stephen procedure was done in the majority of the patients. There was statistically no significant difference following stratification in relation to laterality and position of undescended testis (p = 0.556 and p = 0.846, respectively). However, mean size of the testis was found statistically significant (p = 0.032). CONCLUSIONS: Most of the patients were above five years of age. Ultrasound helped in identifying low-lying intra-abdominal testis in more than 80% of patients. Laparoscopy was helpful in further defining the position of the testis and selection of surgical procedure. KEY WORDS: Undescended testis, Cryptorchidism, Laparoscopy, Orchiopexy.

Undergraduate medical teaching with remote consultations in general practice: a realist evaluation.

BACKGROUND: Supervisors historically educated students in primary care in face-to-face contexts; as a result of COVID-19, students now experience patient consultations predominantly remotely. There is a paucity of evidence regarding the facilitators and barriers to supervising students for excellent educational impact in the remote consultation environment. AIM: To understand the facilitators and barriers to educating medical students using remote consultations in primary care, and the consequences for students in terms of educational impact. DESIGN & SETTING: A realist evaluation methodology was adopted to identify causal chains of contexts, mechanisms, and outcomes, describing how the teaching and learning functioned on a sample of medical students and GP tutors from two medical schools in London, UK. METHOD: An initial programme theory was developed from the literature and a scoping exercise informed the data collection tools. Qualitative data were collected through online questionnaires (49 students, 19 tutors) and/or a semi-structured interview (eight students, two tutors). The data were coded to generate context-mechanisms-outcome configurations outlining how the teaching and learning operated. RESULTS: The results demonstrated a sequential style of supervision can positively impact student engagement and confidence, and highlighted a need to address student preparation for remote patient examinations. Students found passive observation of remote patient encounters disengaging, and, in addition, reported isolation that impacted negatively on their experiences and perceptions of primary care. CONCLUSION: Student and tutor experiences may improve through considering the supervision style adopted by tutors, and through interventions to reduce student isolation and disengagement when using remote patient consultations in primary care.

Critical review of microplastics removal from the environment.

Globally, microplastics pollution has become a serious environmental threat due to their multitude sources, widespread occurrence, persistence, and adverse effects to ecosystem and the human health. Addressing this multifaceted threat requires innovative technologies that can efficiently remove microplastics from the environment. In this review, we first overviewed the source, occurrence, and potential adverse impacts of microplastics to human health. We then identified promising technologies for microplastics removal, including physical, chemical, and biological approaches. A detailed analysis of the advantages and limitations of different techniques was provided. We concluded this review with the current challenges and future research priorities, which will guide us through the path addressing microplastics contamination.

Fallow time determination in dentistry using aerosol measurement in mechanically and non-mechanically ventilated environments.

Aim To calculate fallow time (FT) required following dental aerosol generating procedures (AGPs) in both a dental hospital (mechanically ventilated) and primary care (non-mechanically ventilated). Secondary outcomes were to identify spread and persistence of aerosol in open clinics compared to closed surgeries (mechanically ventilated environment), and identify if extraoral scavenging (EOS) reduces FT and production of aerosol.Methods In vitro simulation of fast handpiece cavity preparations using a manikin was conducted in a mechanically and non-mechanically ventilated environment using Optical Particle Sizer and NanoScan at baseline, during the procedure and fallow period.Results AGPs carried out in the non-mechanically, non-ventilated environment failed to achieve baseline particle levels after one hour. In contrast, when windows were opened after AGPs, there was an immediate reduction in all particle sizes. In mechanically ventilated environments, the baseline levels of particles were very low and particle count returned to baseline within ten minutes following the AGP. There was no detectable difference between particles in mechanically ventilated open bays and closed surgeries. The effect of the EOS on reducing the particle count was greater in the non-mechanically ventilated environment; additionally, it also reduced the spikes in particle counts in mechanically ventilated environments.Conclusion High-efficiency particulate, air-filtered mechanical ventilation, along with mitigation (high-volume suction), resulted in reduction of fallow time (ten minutes). Non-ventilated rooms failed to reach baseline level even after one hour of fallow time. There was no difference in particle counts in open bays or closed surgeries in mechanically ventilated settings with an extraoral suction device reducing particulate spikes. This study confirms that AGPs are not recommended in dental surgeries where no ventilation is possible.

Innovation in the time of SARS-CoV-2: A collaborative journey between NHS clinicians, engineers, academics and industry.

During the pandemic healthcare faced great pressure on the availability of protective equipment. This paper describes the entire novel innovative process of design optimisation, production and deployment of face-visors to NHS frontline workers during SARS-CoV-2 pandemic. The described innovative journey spans collaboration between clinicians and academic colleagues for design to the implementation with industry partners of a face-visor for use in a healthcare setting. It identifies the enablers and barriers to development along with the strategies employed to produce a certified reusable, adjustable, high volume and locally produced face-visor. The article also explores aspects of value, scalability, spread and sustainability all of which are essential features of innovation.

Quantitative analysis of particulate matter release during orthodontic procedures: a pilot study.

Introduction Transmission of SARS-CoV-2 through aerosol has been suggested, particularly in the presence of highly concentrated aerosols in enclosed environments. It is accepted that aerosols are produced during a range of dental procedures, posing potential risks to both dental practitioners and patients. There has been little agreement concerning aerosol transmission associated with orthodontics and associated mitigation.Methods Orthodontic procedures were simulated in a closed side-surgery using a dental manikin on an acrylic model using composite-based adhesive. Adhesive removal representing debonding was undertaken using a 1:1 contra-angle handpiece (W&H Synea Vision WK-56 LT, Bürmoos, Austria) and fast handpiece with variation in air and water flow. The removal of acid etch was also simulated with the use of combined 3-in-1 air-water syringe. An optical particle sizer (OPS 3330, TSI Inc., Minnesota, USA) and a portable scanning mobility particle sizer (NanoScan SMPS Nanoparticle Sizer 3910, TSI Inc., Minnesota, USA) were both used to assess particulate matter ranging in dimension from 0.08 to 10 µm.Results Standard debonding procedure (involving air but no water) was associated with clear increase in the 'very small' and 'small' (0.26-0.9 µm) particles but only for a short period. Debonding procedures without supplementary air coolant appeared to produce similar levels of aerosol to standard debonding. Debonding in association with water tended to produce large increases in aerosol levels, producing particles of all sizes throughout the experiment. The use of water and a fast handpiece led to the most significant increase in particles. Combined use of the 3-in-1 air-water syringe did not result in any detectable increase in the aerosol levels.Conclusions Particulate matter was released during orthodontic debonding, although the concentration and volume was markedly less than that associated with the use of a fast handpiece. No increase in particulates was associated with prolonged use of a 3-in-1 air-water syringe. Particulate levels reduced to baseline levels over a short period (approximately five minutes). Further research within alternative, open environments and without air exchange systems is required.

Serologic Evidence of Severe Fever with Thrombocytopenia Syndrome Virus and Related Viruses in Pakistan.

We describe the seroprevalence of severe fever with thrombocytopenia syndrome virus (SFTSV) and the association of antibody occurrence with location, sex, and age among the human population in Pakistan. Our results indicate substantial activity of SFTSV and SFTSV-related viruses in this country.

Right Ventricular to Left Ventricular Ratio at CT Pulmonary Angiogram Predicts Mortality in Interstitial Lung Disease.

BACKGROUND: Patients with interstitial lung disease (ILD) may develop pulmonary hypertension (PH), often disproportionate to the severity of the ILD. The right ventricular to left ventricular diameter (RV:LV) ratio measured at CT pulmonary angiogram (CTPA) has been shown to provide valuable information in patients with pulmonary arterial hypertension and to predict death or deterioration in acute pulmonary embolism. METHODS: Demographic characteristics, ILD subtype, echocardiography, and detailed CTPA measurements were collected in consecutive patients undergoing both CTPA and right heart catheterization at the Royal Brompton Hospital between 2005 and 2015. Fibrosis severity was formally scored according to CT criteria. The RV:LV ratio at CTPA was evaluated by using three different methods. Cox proportional hazards analysis was used to assess the relation of CTPA-derived parameters to predict death or lung transplantation. RESULTS: A total of 92 patients were included (64% male; mean age 65 ± 11 years) with an FVC 57 ± 20% predicted, corrected transfer factor of the lung for carbon monoxide 22 ± 8% predicted, and corrected transfer coefficient of the lung for carbon monoxide 51 ± 17% predicted. PH was confirmed at right heart catheterization in 78%. Of all the CTPA-derived measures, an RV:LV ratio ≥ 1.0 strongly predicted mortality or transplantation at univariate analysis (hazard ratio, 3.26; 95% CI, 1.49-7.13; P = .003), whereas invasive hemodynamic data did not. The RV:LV ratio remained an independent predictor at multivariate analysis (hazard ratio, 3.19; 95% CI, 1.44-7.10; P = .004), adjusting for an ILD diagnosis of idiopathic pulmonary fibrosis and CT imaging-derived ILD severity. CONCLUSIONS: An increased RV:LV ratio measured at CTPA provides a simple, noninvasive method of risk stratification in patients with suspected ILD-PH. This should prompt closer follow-up, more aggressive treatment, and consideration of lung transplantation.

Doctors' Interactions with Pharmaceutical Sales Representatives: Modelling Doctors Prescription Behaviour.

Using theory of planned behaviour, this study seeks to examine the effect of health practitioner's interaction with pharmaceutical sales representatives on their prescription behaviour. Data was collected from 248 health practitioners working in the city of Attock and from five Tehsils of Attock District through questionnaires with a net response rate of 82%. The hypothesis was tested by PLS Path Modelling. The major findings of the study were that physicians' interactions with pharmaceutical sales representatives in terms of market knowledge, product knowledge, corporate reputation and tangible rewards affect the prescription behaviour of physicians directly as well as through the mediating effect of the attitudinal component. The findings of the study would be helpful for the pharmaceutical industry as well as for drug regulatory authorities and health policy makers towards unethical practices in the medical field. Study provided practical implications for policy makers and health practitioners. Moreover, future directions for research were also provided.

Synthesis of Hollow Pt-Ni Nanoboxes for Highly Efficient Methanol Oxidation.

In direct methanol fuel cell technology, highly stable electrochemical catalysts are critically important for their practical utilization at the commercial scale. In this study, sub ~10 nm hollow Pt-Ni (1:1 at. ratio) nanoboxes supported on functionalized Vulcan carbon (Pt-Ni/C-R2) were synthesized through a facile method for the efficient electrooxidation of methanol. Two reaction procedures, namely, a simultaneous reduction and a modified sequential reduction method using a reverse microemulsion (RME) method, were adopted to synthesize solid Pt-Ni NPs and hollow nanoboxes, respectively. To correlate the alloy composition and surface structure with the enhanced catalytic activity, the results were compared with the nanocatalyst synthesized using a conventional NaBH4 reduction method. The calculated electroactive surface area for the Pt-Ni/C-R2 nanoboxes was 190.8 m2.g-1, which is significantly higher compared to that of the Pt-Ni nanocatalyst (96.4 m2.g-1) synthesized by a conventional reduction method. Hollow nanoboxes showed 34% and 44% increases in mass activity and rate of methanol oxidation reaction, respectively, compared to solid NPs. These results support the nanoreactor confinement effect of the hollow nanoboxes. The experimental results were supported by Density Functional Theory (DFT) studies, which revealed that the lowest CO poisoning of the Pt1Ni1 catalyst among all Ptm-Nin mixing ratios may account for the enhanced methanol oxidation. The synthesized hollow Pt-Ni/C (R2) nanoboxes may prove to be a valuable and highly efficient catalysts for the electrochemical oxidation of methanol due to their low cost, numerous catalytically active sites, low carbon monoxide poisoning, large electroactive surface area and long-term stability.

Study of impact of acids and comparison of adsorption efficiency of Pb(II) from carbon and its modified nano-nickel coated version.

Acidic content in wastewaters poses greater difficulty in lead removal from most adsorbents as their removal efficiency significantly decreases in acidic media. Nano-nickel coated carbon (Ni/C), compared with uncoated carbon (C), has shown a much enhanced (almost 80% higher) tendency of Pb(II) removal from solutions having different acid concentrations. All of the characterization results show the creation of more active sites and functional groups on Ni/C. The pertinent kinetic models and thermodynamics of Pb(II) adsorption have demonstrated much improved efficiency by Ni/C. Various isotherms subjected to the sorption data revealed significant increase in the sorption capacities for Ni/C. The adsorption (evidently chemisorption) kinetics are best represented by a pseudo-second-order equation. The adsorption rates in acidic solutions were much higher for Ni/C. The temperature-dependent study enabled thermodynamic parameters to be worked out for C and Ni/C; for C the values are ΔH: 19.4 ± 0.5 kJ·mol-1, ΔS: 76.1 ± 2.1 J·mol-1·K-1, ΔG298: -0.37 ± 0.01 kJ·mol-1 while for Ni/C the values are ΔH: 30 ± 1 kJ·mol-1, ΔS: 114 ± 4 J·mol-1·K-1, ΔG298: -4.56 ± 0.02 kJ·mol-1. Both cases indicate endothermic, spontaneous and entropy-driven processes.

Stevens-Johnson syndrome and toxic epidermal necrolysis-like cutaneous presentation of chikungunya fever: A case series.

Chikungunya fever is a benign, self-limiting, acute viral illness. An epidemic occurred in New Delhi, India, in August and September 2016. We observed many cases with atypical cutaneous features mimicking Stevens-Johnson syndrome and toxic epidermal necrolysis during this epidemic, especially in infants and children. Twenty-one children (13 [61.9%] boys, 8 [38%] girls) presenting with vesico-bullous and necrotic lesions were reviewed. Cutaneous presentation included vesicles and bullae with purpuric macules and necrosis, seen in 16 (76%) patients. Skin lesions resolved in 5-7 days, leaving behind hyperpigmentation in seven (33.3%) patients and hypopigmentation in three (14.2%). Minor oral erosions were observed in three (14.2%) patients, and palmoplantar erythema was seen in four (19.04%). It is essential for dermatologists to understand the Stevens-Johnson syndrome and toxic epidermal necrolysis-like presentation of chikungunya and not to misinterpret it as true Stevens-Johnson syndrome and toxic epidermal necrolysis, which will lead to unnecessary intervention and management.

An unusual presentation of primary cutaneous amyloidosis.

Primary localized cutaneous amyloidosis refers to a group of disorders characterized by deposition of amyloid in the dermis without any systemic involvement. It comprises the following clinical types: macular, lichenoid, nodular, and biphasic. There are also rare variants such as amyloidosis cutis dyscromica and poikiloderma-like cutaneous amyloidosis. We report a case of primary cutaneous amyloidosis in a 17-year-old boy with unusual pigmentation of various patterns (reticulate and diffuse pigmentation with mottling and rippling at places) and hypopigmented atrophic macules. Our patient also had nail, oral, and mucosal pigmentation that have not been described. Amyloid deposits were shown histopathologically in both hyperpigmented and hypopigmented macules.

Urdu Nasta'liq text recognition using implicit segmentation based on multi-dimensional long short term memory neural networks.

The recognition of Arabic script and its derivatives such as Urdu, Persian, Pashto etc. is a difficult task due to complexity of this script. Particularly, Urdu text recognition is more difficult due to its Nasta'liq writing style. Nasta'liq writing style inherits complex calligraphic nature, which presents major issues to recognition of Urdu text owing to diagonality in writing, high cursiveness, context sensitivity and overlapping of characters. Therefore, the work done for recognition of Arabic script cannot be directly applied to Urdu recognition. We present Multi-dimensional Long Short Term Memory (MDLSTM) Recurrent Neural Networks with an output layer designed for sequence labeling for recognition of printed Urdu text-lines written in the Nasta'liq writing style. Experiments show that MDLSTM attained a recognition accuracy of 98% for the unconstrained Urdu Nasta'liq printed text, which significantly outperforms the state-of-the-art techniques.

USE OF A SPECIAL SPLINT IN REVERSE SURAL ARTERY FLAP TO REDUCE VENOUS CONGESTION AND FLAP NECROSIS.

BACKGROUND: Distally based sural fascio-cutaneous flap is a commonly performed plastic surgery procedure for the coverage of distal third of leg, ankle and foot defects. However congestion is the main complication of this flap which results into partial or complete loss of the flap. We devised a special splint to reduce this complication and retrospectively reviewed its effect on this complication between two groups. METHODS: This retrospective study was carried out at Northwest General hospital between 1995 and 2012. Group-A included 30 patients who were managed without the splint between 1995 and 2005 and group-B comprised of 35 patients were treated with the splint between 2006 and 2012. Complications like venous congestion, epidermolysis, and partial and complete flap failure were documented. Data were analyzed by SPSS.16.5 software. Chi-square test was used for data analysis. p-value less than 0.05 was considered as the level of significance. RESULTS: Total 65 patients were operated. Age of the patients ranged from 7 to 60 years. Road traffic accident and spoke wheel injury was the main cause of soft tissue loss in our patients. In group-A 12 patients suffered from venous congestion. Out of 12, three patients had epidermolysis while partial flap necrosis occurred in 9 patients. Only 3 patients had venous congestion in group-B. Two patients suffered from epidermolysis and one had partial flap necrosis. None of patient suffered from complete flap loss in both groups. CONCLUSION: Reverse sural artery flap continues to be a versatile flap for distal lower extremity reconstruction. By using a special splint to reduce pressure on the pedicle site as a modification, flap complication rate can be decreased significantly.