Fidelity of family centered care model to early disability diagnosis and rehabilitation in the United Arab Emirates.

BACKGROUND: The role of parents in supporting early intervention for young children with disabilities is critical. Indeed, models of family centered care (FCC), which emphasis strong partnerships between health professionals and families in disability health services delivery are now widely associated with best practice. While FCC is consistently argued to be an appropriate model for disability service delivery, its utilization is limited primarily to Western countries such as Australia and the United States. Countries such as the United Arab Emirates (UAE) have prioritized early childhood development and are thus in search of best practices for delivery of early intervention for children and their families. OBJECTIVE: The aim of this study was to explore the appropriateness of the FCC model in disability service delivery in the UAE. This study was conducted from the perspectives of health professionals who are involved in disability diagnosis, referral and ongoing support for families and children with disabilities. METHOD: A total of 150 health professionals were recruited from health facilities, rehabilitation centers and schools in the Emirates of Abu Dhabi. The 27-item Measure of Process of Care for Service Providers (MPOC-SP) was used for data collection. The data were subjected to confirmatory factor analysis to confirm applicability of the model to this context. Multivariate analysis of variance and moderation analysis were also conducted, to ascertain the relationship between participants' satisfaction levels with their ability to diagnose, refer and provide on-going support and their likelihood of practicing key components of FCC. RESULT: Computation of confirmatory factor analysis provided support for applicability of the MPOC-SP in the UAE context. Further inspection showed moderate to large correlations between the four components of FCC measured by MPOC-SP, providing further support for utilization of FCC in disability health service delivery in the UAE. CONCLUSION: The study concludes with a call to policymakers in the UAE to consider developing disability health policy based on key components of FCC. This could be supplemented by development of training modules on FCC to upskill health professionals involved in disability diagnosis and rehabilitation.

Systematic review of household transmission of Strep A: A potential site for prevention that has eluded attention.

BACKGROUND: Despite being the sixth most common infectious disease globally, transmission of Streptococcus pyogenes (Strep A) within the household remains an understudied driver of infection. We undertook a systematic review to better understand the transmission of Strep A between people within the home while highlighting opportunities for prevention. METHODS: A search strategy was applied to five databases between September 2022 and March 2023. Results were limited to those published between January 2000 and March 2023. Texts were reviewed by two authors and the following data extracted: article details (title, author, year), study type, transmission year, country, participant age/s, infection status, molecular testing, and transmission mode. Funding was provided by the Australian National Health and Medical Research Council (NHMRC, grant number GNT2010716). RESULTS: The final analysis comprised 28 texts. Only seven studies (25.0%) provided sufficient detail to identify the Strep A transmission mode. These were contact (4), vehicle (bedding; clothing; other fabric, and medical equipment, [2]), and contact with animals (1). All others were classified as household (specific mode unascertainable). Most articles reported outbreaks involving invasive Strep A infections. CONCLUSIONS: There is limited literature regarding household transmission of Strep A. Understanding transmission in this setting remains imperative to guide control methods.

'From my world to yours ': exploring the availability of social networks among parents from culturally diverse backgrounds caring for children with developmental disabilities in Australia.

This paper reports findings from an ethnographic study of families from culturally and linguistically diverse (CALD) families in Australia caring for children with disability. The study aimed to contribute insights into the unique experiences, challenges and supports that characterise experiences of families of a child with disability living in a country where the mainstream culture is different from their own. Four families from different cultural backgrounds participated in the study over a period of nine months. During this time, they participated in a series of semi-structured interviews during which they shared their encounters with formal early intervention services and reflected on important informal supports. Findings presented here indicate three key areas associated with accessing informal supports that can pose challenges for families who hold values that are different from those of the dominant culture: lack of social support; cultural adaptations, and socialization problems and coping strategies. The findings indicate that formal services could ameliorate feelings of social isolation by enabling parents to access informal supports such as parenting groups.

Workforce preparation for delivery of nurturing care in low- and middle-income countries: Expert consensus on critical multisectoral training needs.

BACKGROUND: Services to support nurturing care through early childhood development (ECD) in low- and middle-income countries are hampered by significant workforce challenges. The global early childhood workforce is both diverse and complex, and it supports the delivery of a wide range of services in extremely diverse geographical and social settings. In the context of contemporary global goals for the universal provision of quality early childhood provision, there is an urgent need to build appropriate platforms for strengthening and supporting this workforce. However, the evidence base to support this work is severely limited. METHODS: To contribute to evidence on how to strengthen the ECD workforce in low- and middle-income countries, this study used a Delphi methodology involving three rounds of data collection with 14 global experts, to reach consensus on the most critical training needs of three key early childhood workforce groups: (i) health; (ii) community-based paraprofessionals, and (iii) educational professionals working across ECD programmes. RESULTS: The study identified a comprehensive set of shared, as well as distinct, training needs across the three groups. Shared training needs include the following: (i) nurturing dispositions that facilitate work with children and families in complex settings; (ii) knowledge and skills to support responsive, adaptable delivery of ECD programmes; and (iii) systems for ECD training and professional pathways that prioritise ongoing mentoring and support. CONCLUSIONS: The study's detailed findings help to address a critical gap in the evidence on training needs for ECD workers in low-resource contexts. They provide insights into how to strengthen content, systems, and methods of training to support intersectoral ECD work in resource-constrained contexts.

Revisiting the Conformational Isomerism of Dihaloethanes: A Hybrid Computational and Experimental Laboratory for the Undergraduate Curriculum.

The conformational isomerism of disubstituted ethanes is a well-known concept that is part of every chemistry curriculum. Due to the species' simplicity, studying the (free) energy difference between the gauche and anti isomers has been the testing ground of experimental and computational techniques, such as Raman and IR spectroscopy, quantum chemistry, and atomistic simulations. While students normally receive formal training in spectroscopic techniques during their early undergraduate years, computational methods often receive less attention. In this work, we revisit the conformational isomerism of 1,2-dichloroethane and 1,2-dibromoethane and design a hybrid computational and experimental laboratory for our undergraduate chemistry curriculum with a focus on introducing computational techniques as a complementary research tool to experimentation. We show how commonly available Raman spectrometers and atomistic simulations performed on desktop computers can be combined to study the conformational isomerism of disubstituted ethanes while discussing the advantages and limitations of the different approaches.

Changing epidemiology of acute kidney injury in critically ill patients with COVID-19: a prospective cohort.

BACKGROUND: Acute kidney injury (AKI) is common in critically ill patients with coronavirus disease-19 (COVID-19). We aimed to explore the changes in AKI epidemiology between the first and the second COVID wave in the United Kingdom (UK). METHODS: This was an observational study of critically ill adult patients with COVID-19 in an expanded tertiary care intensive care unit (ICU) in London, UK. Baseline characteristics, organ support, COVID-19 treatments, and patient and kidney outcomes up to 90 days after discharge from hospital were compared. RESULTS: A total of 772 patients were included in the final analysis (68% male, mean age 56 ± 13.6). Compared with wave 1, patients in wave 2 were older, had higher body mass index and clinical frailty score, but lower baseline serum creatinine and C-reactive protein (CRP). The proportion of patients receiving invasive mechanical ventilation (MV) on ICU admission was lower in wave 2 (61% vs 80%; p < 0.001). AKI incidence within 14 days of ICU admission was 76% in wave 1 and 51% in wave 2 (p < 0.001); in wave 1, 32% received KRT compared with 13% in wave 2 (p < 0.001). Patients in wave 2 had significantly lower daily cumulative fluid balance (FB) than in wave 1. Fewer patients were dialysis dependent at 90 days in wave 2 (1% vs. 4%; p < 0.001). CONCLUSIONS: In critically ill adult patients admitted to ICU with COVID-19, the risk of AKI and receipt of KRT significantly declined in the second wave. The trend was associated with less MV, lower PEEP and lower cumulative FB. TRIAL REGISTRATION: NCT04445259.

Legumes-A Comprehensive Exploration of Global Food-Based Dietary Guidelines and Consumption.

Despite the well-known human and planetary health benefits of legumes, consumption is often low. This scoping review aimed to evaluate the inclusion of legumes in global food-based dietary guidelines (FBDG), and to review consumption data against global food group classifications for legumes. The review of FBDG from 94 countries identified legume-based key messaging, the key terms used to define legumes, recommended serving size and frequency of consumption and the classification of legumes into food groups as depicted by food guides. The 2018 Global Dietary Database isolated consumption data of legumes and beans using individual-level, nationally representative dietary survey data for matched countries. Food-based dietary guidelines from 40/94 countries most often identified legumes utilising the term legumes, followed by beans (n = 13), pulses (n = 10), or as beans, peas and lentils (n = 5). The serving size recommendations for legume consumption varied widely, and there was no consistency in the suggested frequency of consumption. Median bean and legume consumption for countries with FBDG ranged from 1.2 g/d (Norway) to 122.7 g/d (Afghanistan). Classification of legumes into food groups varied, with 38% of countries categorising legumes in the protein-rich food group, 20% were in a group on their own and 15% were in the starchy staples group. In countries where legumes were together with either nuts or seeds had the greatest range in intake (11.6-122.7 g/day), followed by those that grouped legumes together with protein-rich foods (4.0-104.7 g/day), while countries that grouped legumes into two food groups, in an attempt to promote consumption, tended to have a lower consumption. Greater emphasis and perhaps repositioning of legumes in dietary guidelines may be required to encourage consumption for health, environmental and economic benefits.

An Alternative to Traditional Bedside Teaching During COVID-19: High-Fidelity Simulation-Based Study.

BACKGROUND: Bedside teaching is integral to medical education and has been highlighted to improve clinical and communication skills, as well as clinical reasoning. Despite the significant advantages of bedside teaching, its usage within medical education has been declining, and COVID-19 has added additional challenges. The pandemic has resulted in a significant reduction in opportunities to deliver bedside teaching due to risk of viral exposure, patients declining student interactions, and ward closures. Educators have therefore been required to be innovative in their teaching methods, leading to the use of online learning, social media platforms, and simulation. Simulation-based education allows for learning in a low-risk environment and affords the opportunity for deliberated repeated practice with case standardization. The results demonstrate that simulation-based training can increase students' confidence, increase the rates of correct clinical diagnoses, and improve retention of skills and knowledge when compared with traditional teaching methods. OBJECTIVE: To mitigate the impact of COVID-19 upon bedside teaching for third year students at Hull York Medical School amid closure of the cardiorespiratory wards, a high-fidelity simulation-based model of traditional bedside teaching was designed and implemented. The objectives of the teaching session were to enable students to perform history taking and a focused cardiorespiratory clinical examination in a COVID-19-safe environment using SimMan 3G. METHODS: Four clinical teaching fellows with experience of simulation-based medical education scripted histories for 2 common cardiorespiratory cases, which were asthma and aortic stenosis. The simulation sessions were designed for students to take a focused cardiorespiratory history and clinical examination using SimMan 3G. All cases involved dynamic vital signs, and the simulator allowed for auscultation of an ejection systolic murmur and wheezing in accordance with the cases chosen. Key aspects of the pathologies, including epidemiology, differential diagnoses, investigations, and management, were summarized using an interactive PowerPoint presentation, followed by a debriefing session. RESULTS: In total, 12 third year medical students undertook the sessions, and overall feedback was highly positive. Of the 10 students who completed the feedback questionnaires, 90% (n=9) felt more confident in their clinical examination skills following the teaching; 100% (n=10) of the students responded that they would recommend the session to a colleague; and implementation of regular simulation was frequently requested on feedback. These results are in keeping with the current literature. CONCLUSIONS: Bedside teaching continues to face ongoing challenges from the COVID-19 pandemic as well as declining patient recruitment and fluctuations in clinical findings. The support for simulation-based medical education is derived from high-quality studies; however, studies describing the use of this technology for bedside teaching in the undergraduate curriculum are limited. The authors describe a highly effective teaching session amid the pandemic, which allowed for maintenance of staff and student safety alongside continued education during a challenging time for educators globally.

Orbital controls on eastern African hydroclimate in the Pleistocene.

Understanding eastern African paleoclimate is critical for contextualizing early human evolution, adaptation, and dispersal, yet Pleistocene climate of this region and its governing mechanisms remain poorly understood due to the lack of long, orbitally-resolved, terrestrial paleoclimate records. Here we present leaf wax hydrogen isotope records of rainfall from paleolake sediment cores from key time windows that resolve long-term trends, variations, and high-latitude effects on tropical African precipitation. Eastern African rainfall was dominantly controlled by variations in low-latitude summer insolation during most of the early and middle Pleistocene, with little evidence that glacial-interglacial cycles impacted rainfall until the late Pleistocene. We observe the influence of high-latitude-driven climate processes emerging from the last interglacial (Marine Isotope Stage 5) to the present, an interval when glacial-interglacial cycles were strong and insolation forcing was weak. Our results demonstrate a variable response of eastern African rainfall to low-latitude insolation forcing and high-latitude-driven climate change, likely related to the relative strengths of these forcings through time and a threshold in monsoon sensitivity. We observe little difference in mean rainfall between the early, middle, and late Pleistocene, which suggests that orbitally-driven climate variations likely played a more significant role than gradual change in the relationship between early humans and their environment.

Effect of one anastomosis gastric bypass on liver function tests: A comparison between 150 cm and 200 cm biliopancreatic limbs.

CONTEXT: Some studies have shown that one anastomosis gastric bypass (OAGB) results in the derangement of liver function tests (LFTs). We wanted to study this in our patients. AIMS: The aims are to study the effect of OAGB on LFTs and to compare the effect of a biliopancreatic limb (BPL) of 150 cm (OAGB-150) to a BPL of 200 cm (OAGB-200). SETTINGS AND DESIGN: The study was a retrospective cohort study conducted at a university hospital. MATERIALS AND METHODS: Information was obtained from our prospectively maintained database and hospital's computerised records. STATISTICAL ANALYSIS: A P < 0.05 was regarded statistically significant; however, given the number of variables examined, findings should be regarded as exploratory. RESULTS: A total of 405 patients underwent an OAGB-200 (n = 234) or OAGB-150 (n = 171) in our unit between October 2012 and July 2018. There were significant improvements in gamma-glutamyl transpeptidase (GGT) levels at 1 and 2 years after OAGB-200 and significant worsening in the levels of alkaline phosphatase (ALP) and albumin at 1 and 2 years. There was a significant improvement in GGT levels at 1 and 2 years after OAGB-150 and in alanine transaminase levels at 1 year. There was a significant worsening in ALP and albumin levels at both follow-up points in this group. OAGB-150 group had a significantly lower bilirubin level at 1 year and significantly fewer abnormal ALP values at 2 years in comparison with OAGB-200 patients. CONCLUSIONS: This exploratory study demonstrates the overall safety of OAGB with regard to its effect on LFTs, with no remarkable difference between OAGB-150 and OAGB-200.

Charity preferences and perceived impact moderate charitable giving and associated neural response.

Charitable giving depends on individuals' abilities to make altruistic decisions. Previous studies suggest that altruism involves recruitment of neural resources in regions including social processing, reward/reinforcement learning, emotional response, and cognition. Despite evolutionary and social benefits to altruism, we know that humans do not always engage in altruistic behavior, like charitable giving. Understanding the underlying processes leading to decisions to donate is vital to improve prosocial community engagement. The present study examined how characteristics of the charitable giving opportunity influence an individual's decision to give and the neural engagement underlying these features. Twenty-nine participants subjectively rated ten charities on their value, effectiveness, and the subject's personal chance of donating. Participants then completed an fMRI task requiring them to decide to donate to certain charities given the probability of the donation helping, their personal preference for the charity, and whether the donation came at cost to themselves. There was a significant reduction in donating when the probability of helping was low versus high, and subjects were significantly less likely to donate to their lowest-rated charities. Further, probability of a donation being helpful and how much the subject favored a charity moderated PCC and left IFG engagement. Interestingly, reward neurocircuitry did not demonstrate similar sensitivity to these variations. These results may suggest individuals engage motivated reasoning to justify failure to donate, while donations are driven by emotion mentalizing that focuses on the welfare of others. This may provide valuable insight into how to engage individuals in altruistic giving.

Effect of One Anastomosis Gastric Bypass on Haematinics, Vitamin D and Parathyroid Hormone Levels: a Comparison Between 150 and 200 cm Bilio-Pancreatic Limbs.

INTRODUCTION: There is little data on the effect of one anastomosis gastric bypass (OAGB) on haematinics, vitamin D and parathyroid hormone levels. It is further unclear if an OAGB with a bilio-pancreatic limb (BPL) of 150 cm (OAGB-150) would deliver better outcomes than that with a BPL of 200 cm (OAGB-200). MATERIALS AND METHODS: We investigated our records to obtain information on patients who underwent an OAGB-200 or OAGB-150 until 31st July 2018 in our unit. RESULTS: A total of 405 patients underwent either an OAGB-200 (n = 234) or OAGB-150 (n = 171). The mean age was 46 ± 10.98 years and 276 (68.1%) were females. The mean preoperative weight and the body mass index (BMI) were 139 ± 29.96 kg and 49 ± 8.14 kg/m2 respectively. With OAGB-200, there was a significant increase in anaemia rates at 1 and 2 years compared to preoperative levels with a significant fall in haemoglobin levels. After OAGB-150, there was a significant fall in haemoglobin levels at 1 and 2 years but the increase in anaemia rate was only significant at 2 years. There was a significant increase in PTH levels and the number of abnormal values at 1 and 2 years with OAGB-200. With OAGB-150, PTH changes were significant at 2 years only. CONCLUSION: We found that both OAGB-200 and OAGB-150 are associated with a significant increase in anaemia and secondary hyperparathyroidism. Our findings should prompt the evaluation of supplementation protocols with higher dosages than we recommend for iron, folate and calcium. Consideration should also be given to evaluating shorter BPL lengths than 150 cm with OAGB.

Adding team-based financial incentives to the Carrot Rewards physical activity app increases daily step count on a population scale: a 24-week matched case control study.

BACKGROUND: Mobile health applications (mHealth apps) targeting physical inactivity have increased in popularity yet are usually limited by low engagement. This study examined the impact of adding team-based incentives (Step Together Challenges, STCs) to an existing mHealth app (Carrot Rewards) that rewarded individual physical activity achievements. METHODS: A 24-week quasi-experimental study (retrospective matched pairs design) was conducted in three Canadian provinces (pre-intervention: weeks 1-12; intervention: weeks 13-24). Participants who used Carrot Rewards and STCs (experimental group) were matched with those who used Carrot Rewards only (controls) on age, gender, province and baseline mean daily step count (±500 steps/d). Carrot Rewards users earned individual-level incentives (worth $0.04 CAD) each day they reached a personalized daily step goal. With a single partner, STC users could earn team incentives ($0.40 CAD) for collaboratively reaching individual daily step goals 10 times in seven days (e.g., Partner A completes four goals and Partner B completes six goals in a week). RESULTS: The main analysis included 61,170 users (mean age = 32 yrs.; % female = 64). Controlling for pre-intervention mean daily step count, a significant difference in intervention mean daily step count favoured the experimental group (p < 0.0001; ηp2 = 0.024). The estimated marginal mean group difference was 537 steps per day, or 3759 steps per week (about 40 walking min/wk). Linear regression suggested a dose-response relationship between the number of STCs completed (app engagement) and intervention mean daily step count (adjusted R2 = 0.699) with each new STC corresponding to approximately 200 more steps per day. CONCLUSION: Despite an explosion of physical activity app interest, low engagement leading to small or no effects remains an industry hallmark. In this paper, we found that adding modest team-based incentives to the Carrot Rewards app increased mean daily step count, and importantly, app engagement moderated this effect. Others should consider novel small-teams based approaches to boost engagement and effects.

Introducing the Parkinson's KinetiGraph into Routine Parkinson's Disease Care: A 3-Year Single Centre Experience.

In an effort to provide timely clinical input for people with Parkinson's disease (PD) in the face of increasing demand and resource limitation in our UK based service, we introduced remote management in place of clinic appointment, including the use of the Parkinson's KinetiGraph (PKG™), a wrist-worn device that provides a continuous measure of movement. We evaluated our reporting methods and findings, the nature of unmet need we identified, our treatment recommendations and the degree of their implementation in our patients whose feedback guided our service developments. Our evaluation highlighted opportunities and challenges associated with incorporating digital data into care traditionally delivered via in-person contact.

A Distinct Neurophenotype of Fearful Face Processing in Alcohol Use Disorder With and Without Comorbid Anxiety.

BACKGROUND: Individuals with alcohol use disorder (AUD) can present with comorbid anxiety symptoms and often have deficits in emotional processing. Previous research suggests brain response is altered during facial affect recognition tasks, especially in limbic areas, due to either AUD or anxiety symptomology; however, the impact of both AUD and clinically significant anxiety symptoms during these tasks has not yet been examined. METHODS: In this study, we investigated neural activation differences during an emotional face-matching task. Participants (N = 232) underwent fMRI scanning, as part of a larger study. Three groups were investigated: individuals with diagnosed AUD and elevated anxiety traits (AUD + ANX, n = 90), individuals with diagnosed AUD but non-clinically significant levels of anxiety (AUD-ANX, n = 39), and healthy controls (HC, n = 103). RESULTS: Our results illustrate distinct neurophenotypes of AUD, where individuals with comorbid anxiety symptomology have blunted emotional face processing while those with singular AUD are hyperresponsive. CONCLUSIONS: This suggests AUD with anxiety symptomology may have a unique neurobiological underpinning, and treatment and intervention should be tailored to individual constellations of symptoms.

Human settlement of East Polynesia earlier, incremental, and coincident with prolonged South Pacific drought.

The timing of human colonization of East Polynesia, a vast area lying between Hawai'i, Rapa Nui, and New Zealand, is much debated and the underlying causes of this great migration have been enigmatic. Our study generates evidence for human dispersal into eastern Polynesia from islands to the west from around AD 900 and contemporaneous paleoclimate data from the likely source region. Lake cores from Atiu, Southern Cook Islands (SCIs) register evidence of pig and/or human occupation on a virgin landscape at this time, followed by changes in lake carbon around AD 1000 and significant anthropogenic disturbance from c. AD 1100. The broader paleoclimate context of these early voyages of exploration are derived from the Atiu lake core and complemented by additional lake cores from Samoa (directly west) and Vanuatu (southwest) and published hydroclimate proxies from the Society Islands (northeast) and Kiribati (north). Algal lipid and leaf wax biomarkers allow for comparisons of changing hydroclimate conditions across the region before, during, and after human arrival in the SCIs. The evidence indicates a prolonged drought in the likely western source region for these colonists, lasting c. 200 to 400 y, contemporaneous with the phasing of human dispersal into the Pacific. We propose that drying climate, coupled with documented social pressures and societal developments, instigated initial eastward exploration, resulting in SCI landfall(s) and return voyaging, with colonization a century or two later. This incremental settlement process likely involved the accumulation of critical maritime knowledge over several generations.