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Background: As autistic children are being diagnosed at a younger age, the need to identify appropriate early supports has increased. Therapist-delivered and parent-mediated autism intervention may benefit children and parents. Objective: This pilot study examined developmental outcomes for autistic pre-schoolers and mental health and wellbeing outcomes for their parents (n = 53) following a 10-month intervention period. Methods: All families were accessing therapist-delivered interventions--the Early Start Denver Model (ESDM) or usual community services--and some families also received additional parent-coaching ESDM (P-ESDM). Families were assessed at 3 timepoints. Results: Overall children made significant gains in cognitive skills and adaptive behaviour, with no differences between groups. Parents overall reported increased parenting stress over time. P-ESDM conferred no added benefit for child outcomes, and similarly, no clear benefit for parent outcomes. Conclusions: Our findings suggest that children receiving early intervention make developmental gains, regardless of type of intervention, and challenges assumptions that, as an adjunct to other intervention programs, P-ESDM improves child or parent outcomes. Further research is needed to explore the effects of parent-mediated programs.

The award of a PhD degree is based on a rigorous examination process which is unique in that examiners can recommend that the degree is awarded subject to minor or major amendments to the thesis. In their examiner reports, examiners also include formative feedback that is intended to help the doctoral researchers improve their work. Using data from examiner reports from two faculties at the University of Malta (Arts and Science) for the years 2017-2018, the study looks at the formative feedback comments provided by doctoral examiners. Results suggest that the feedback comments provided can be described as editorial, instructional and reflective, with the most common type of feedback comments being editorial and instructional. This indicates that the focus of doctoral examiner reports is on giving advice to doctoral researchers so that it reaches the expected doctoral standards. This study points to: the need for a rethinking of the way in which feedback is provided in doctoral examiner reports so that the focus is shifted to reflective comments that lead to in-depth learning; and for more professional development for doctoral examiners to that they can make this shift in their provision of formative feedback.

Both the amount "and" responsiveness of adult language input contribute to the language development of autistic and non-autistic children. From parent-child interaction footage, we measured the amount of adult language input, overall parent responsiveness, and six discrete parent responsive behaviours ("imitations, expansions, open-ended questions, yes/no questions, comments" and "acknowledgements") to explore which types of responsiveness predicted autistic preschoolers' language five months later, after controlling for adult language input. We found "expansions" and particularly "imitations" to be more important for later language than overall responsiveness. This study emphasises the need to capture what exactly about parent language input influences child language acquisition, and adds to the evidence that imitating and expanding early language might be particularly beneficial for autistic preschoolers.

PollinERA aims to reverse pollinator population declines and reduce the harmful impacts of pesticides. It addresses the call through four objectives: SO1 filling ecotoxicological data gaps to enable realistic prediction of the source and routes of exposure and impact of pesticides on pollinators and their sensitivity to individual pesticides and mixtures. SO2 developing and testing a co-monitoring scheme for pesticides and pollinators across European cropping systems and landscapes, developing risk indicators and mixture exposure information. SO3 developing models for predicting pesticide toxicological effects on pollinators for chemicals and organisms, environmental fate, toxicokinetic/ toxicodynamic, and population models. SO4 developing a population-level systems-based approach to risk and policy assessment considering multiple stressors and long-term spatiotemporal dynamics at the landscape scale and generating an open database for pollinator/pesticide data and tools.This will be achieved through developing knowledge and protocols for a broad range of toxicological testing, feeding to in silico models (QSARS, toxicokinetic/toxicodynamic, and population). Using a strong stakeholder co-development approach, these models will be combined in a One System framework taking a systems view on risk assessment and policy evaluation, including an international monitoring program.The One System framework is based on EFSA’s system ERA view, expanding on the tools used for bees to include butterflies, moths and hoverflies. The consortium partners are experts in the field needed for this development and are well-placed to facilitate the uptake of tools by European bodies to guarantee the project's future impact.Expected impacts target Destination impacts of better understanding and addressing drivers of biodiversity decline, interconnected biodiversity research using digital technologies, and understanding the biodiversity and health nexus at the ecosystem level.

Abstract We tested the potential for Gazefinder eye-tracking to support early autism identification, including feasible use with infants, and preliminary concurrent validity of trial-level gaze data against clinical assessment scores. We embedded the ~ 2-min ‘Scene 1S4’ protocol within a comprehensive clinical assessment for 54 consecutively-referred, clinically-indicated infants (prematurity-corrected age 9–14 months). Alongside % tracking rate as a broad indicator of feasible assessment/data capture, we report infant gaze data to pre-specified regions of interest (ROI) across four trial types and associations with scores on established clinical/behavioural tools. Most infants tolerated Gazefinder eye-tracking well, returning high overall % tracking rate. As a group, infants directed more gaze towards social vs. non-social (or more vs. less socially-salient) ROIs within trials. Behavioural autism features were correlated with increased gaze towards non-social/geometry (vs. social/people) scenes. No associations were found for gaze directed to ROIs within other stimulus types. Notably, there were no associations between developmental/cognitive ability or adaptive behaviour with gaze towards any ROI. Gazefinder assessment seems highly feasible with clinically-indicated infants, and the people vs. geometry stimuli show concurrent predictive validity for behavioural autism features. Aggregating data across the ~ 2-min autism identification protocol might plausibly offer greater utility than stimulus-level analysis alone.

Abstract This study aimed at determining the intra- and inter-rater reliability in ultrasound body composition measurements and investigating the differences between malnourished and non-malnourished infants. Sonographic images for measurements of fat and muscle thickness were compared between 9 malnourished and 9 non-malnourished hospitalized infants. The mean of fat and muscle thickness sums were 12.44 ± 7.58 mm and 28.98 ± 7.18 mm, respectively. The intra- and inter-rater intraclass correlation coefficient were above 0.9 for both measurements, indicating high intra- and inter-rater reliability. Compared to non-malnourished infants, malnourished infants have 45% of fat thickness sum and 71% of muscle thickness sum. Ultrasound measurements of body composition in infants were different between hospitalized malnourished and non-malnourished infants. This approach has the potential to be utilized more broadly, from assessing the nutritional status of critically ill infants in intensive care units to screening for malnutrition in high-risk infant populations.

While hundreds of complexes of the general formula [Ni(η5-C5H5)(NHC)(X)] exist (NHC = a N-heterocyclic carbene, X = Cl, Br, I), none is yet known with X = F. We attempted to prepare such a species by reacting nickelocene with imidazolium fluorides. Three imidazolium fluorides (ImH)+ F− [Im = (N,N′-bis-(R)-imidazolium: 1a, IMe, R = Me; 1b, IMes, R = 2,4,6-trimethylphenyl; 1c, IPr, R = 2,6-diisopropylphenyl)] were prepared and characterized by spectroscopic methods. In addition, the salts 1b [(IMesH)+ F−] and 1c [(IPrH)+ F−] were subjected single-crystal X-ray diffraction experiments. The reactions of these imidazolium fluorides with nickelocene did not lead to [Ni(η5-C5H5)(NHC)(F)] species. Instead, the reaction of 1a [(IMeH)+ F−] and 1b [(IMesH)+ F−] with nickelocene led to the salt 2 [Ni(η5-C5H5)(IMe)2]+ F− and to the square planar complex 3atrans-[NiF2(IMes)2] respectively. Both complexes were characterized spectroscopically and by single crystal X-ray diffraction. All four X-ray diffraction studies reveal hydrogen bonding and hydrogen interactions with the F atom or anion, and in some cases with solvent molecules of crystallization, and these phenomena are all discussed. Complex 2, in particular, exhibited a wide range of interesting H-bonded interactions in the solid state. Complexes 2 and 3a were tested as catalysts for Suzuki–Miyaura coupling but were not promising: complex 2 was inactive, and while 3a did indeed catalyze the reaction, it gave widely diverging results owing to its instability in solution.

Studies of the general population suggest that the risk for mental health difficulties conferred by dispositional behavioural inhibition (BI) may be modified by self-regulation; however, this possibility has not been explored in the context of autism. This study investigated the moderating effects of attentional-, activation-, and inhibitory control on the relationship between childhood BI and anxiety and depression among 47 autistic youths (55% male, M[subscript age] = 19.09 years, SD = 2.23). Childhood BI was associated with anxiety at low but not high levels of attentional- and activation control, and depression at low but not high levels of attentional control. However, there were no moderating effects of inhibitory control. These preliminary findings are partially consistent with those from the general population and point to avenues for future work.

Many autistic children have co-occurring behavioural problems influencing core autism symptomology potentially relevant for intervention planning. Parental Expressed Emotion -- reflecting critical, hostile and overprotective comments -- contributes to understanding and predicting behaviour in autistic school-aged children, adolescents and adults and is typically measured using the Five-Minute Speech Sample. However, limitations exist for its use with parents of younger autistic children and so the Autism-Specific Five-Minute Speech Sample was adapted with the goal of better measuring parent Expressed Emotion in the context of childhood autism. The Autism-Specific Five-Minute Speech Sample has not yet been used to explore Expressed Emotion in parents of autistic "preschoolers," nor has the relative predictive utility of the Autism-Specific Five-Minute Speech Sample and Five-Minute Speech Sample been evaluated in the same sample. We compared the two measures from speech samples provided by 51 Australian parents with newly diagnosed autistic preschoolers, including investigating their predictive value for concurrent and subsequent child internalising and externalising behaviour problems. While Autism-Specific Five-Minute Speech Sample Expressed Emotion and Five-Minute Speech Sample Expressed Emotion were associated in this sample, only Autism-Specific Five-Minute Speech Sample codes contributed significant predictive value for concurrent and subsequent child problem behaviour. These preliminary data strengthen the position that the Autism-Specific Five-Minute Speech Sample may better capture Expressed Emotion, than the Five-Minute Speech Sample, among parents of autistic preschool-aged children.

Abstract Fermionic artificial matter realized with cold atoms grants access to an unprecedented degree of control on sophisticated many-body effects with an enhanced flexibility of the operating conditions. Here, we consider three-component fermions with attractive interactions to study the formation of complex bound states, whose nature goes beyond the standard fermion pairing occurring in quantum materials. Such systems display clear analogies with quark matter. We address the nature of the bound states of a three-component fermionic system in a ring-shaped trap through the persistent current. In this way, we demonstrate that we can distinguish between color superfluid and trionic bound states. By analyzing finite temperature effects, we show how finite temperature can lead to the deconfinement of bound states. For weak interactions, the deconfinement occurs because of scattering states. In this regime, the deconfinement depends on the trade-off between interactions and thermal fluctuations. For strong interactions the features of the persistent current result from the properties of a suitable gas of bound states.

Achieving a PhD degree is viewed by academic institutions as a major landmark of success and achievement. It gives recognition to researchers and provides entry into academia. A PhD degree is not awarded lightly and doctoral candidates undergo a rigorous examination process. This study seeks to gain a better understanding of the way in which examiners go about assessing doctoral work. Data for the study included written examiner reports presented to the University of Malta from four different faculties: Arts, Education, Science and Medicine & Surgery for the years 2017-2018. The findings suggest that the doctoral examination is a social practice with examiners using a combination of explicit criteria outlined in the University of Malta regulations, and implicit criteria based on their own personal expectations. Using a combination of these criteria, examiners look for doctoral work that makes a contribution to knowledge, is critical and analytical and is not marred by typographical or grammatical errors. The study also highlights a number of disciplinary differences in the expectations of examiners in different faculties and the need for more formal professional development for examiners to ensure a shared interpretation of criteria within a community of assessors.

Abstract Background A key question for any psychopathological diagnosis is whether the condition is continuous or discontinuous with typical variation. The primary objective of this study was to use a multi‐method approach to examine the broad latent categorical versus dimensional structure of autism spectrum disorder (ASD). Method Data were aggregated across seven independent samples of participants with ASD, other neurodevelopmental disorders (NDD), and non‐ASD/NDD controls (aggregate Ns = 512–16,755; ages 1.5–22). Scores from four distinct phenotype measures formed composite “indicators” of the latent ASD construct. The primary indicator set included eye gaze metrics from seven distinct social stimulus paradigms. Logistic regressions were used to combine gaze metrics within/across paradigms, and derived predicted probabilities served as indicator values. Secondary indicator sets were constructed from clinical observation and parent‐report measures of ASD symptoms. Indicator sets were submitted to taxometric‐ and latent class analyses. Results Across all indicator sets and analytic methods, there was strong support for categorical structure corresponding closely to ASD diagnosis. Consistent with notions of substantial phenotypic heterogeneity, the ASD category had a wide range of symptom severity. Despite the examination of a large sample with a wide range of IQs in both genders, males and children with lower IQ were over‐represented in the ASD category, similar to observations in diagnosed cases. Conclusions Our findings provide strong support for categorical structure corresponding closely to ASD diagnosis. The present results bolster the use of well‐diagnosed and representative ASD groups within etiologic and clinical research, motivating the ongoing search for major drivers of the ASD phenotype. Despite the categorical structure of ASD, quantitative symptom measurements appear more useful for examining relationships with other factors.

Extensive research has shown elevated mental health difficulties among parents of children with autism compared to other parents. Although several studies have explored factors related to mental health among parents of children with autism, the factors that influence and promote well-being remain poorly characterised. Parents of young, newly diagnosed autistic children may also be particularly vulnerable to stressors that impact mental health and well-being. We examined child-, parent-, and family/socioeconomic factors associated with concurrent mental health and well-being among 136 parents of young children with autism, aged 13-48 months. Parental mental health was predicted by both trait negative emotionality and reported child autism symptoms, while well-being was predicted by parent factors alone, including trait extraversion and mindfulness. Broader child characteristics and family/socioeconomic contextual factors made no significant contribution in regression models. While the mental health and well-being of parents with young autistic children are associated with one another, unique predictors seem to exist. That well-being was uniquely predicted by a modifiable parent characteristic -- mindfulness -- suggests the potential for early supports to bring direct benefits for parents, in the context of raising a young child with autism.

Abstract Background Cerebral malaria (CM) results in significant paediatric death and neurodisability in sub-Saharan Africa. Several different alterations to typical Transcranial Doppler Ultrasound (TCD) flow velocities and waveforms in CM have been described, but mechanistic contributors to these abnormalities are unknown. If identified, targeted, TCD-guided adjunctive therapy in CM may improve outcomes. Methods This was a prospective, observational study of children 6 months to 12 years with CM in Blantyre, Malawi recruited between January 2018 and June 2021. Medical history, physical examination, laboratory analysis, electroencephalogram, and magnetic resonance imaging were undertaken on presentation. Admission TCD results determined phenotypic grouping following a priori definitions. Evaluation of the relationship between haemodynamic, metabolic, or intracranial perturbations that lead to these observed phenotypes in other diseases was undertaken. Neurological outcomes at hospital discharge were evaluated using the Paediatric Cerebral Performance Categorization (PCPC) score. Results One hundred seventy-four patients were enrolled. Seven (4%) had a normal TCD examination, 57 (33%) met criteria for hyperaemia, 50 (29%) for low flow, 14 (8%) for microvascular obstruction, 11 (6%) for vasospasm, and 35 (20%) for isolated posterior circulation high flow. A lower cardiac index (CI) and higher systemic vascular resistive index (SVRI) were present in those with low flow than other groups (p

Often included within 'high-risk sibling' studies, the Autism Observation Scale for Infants (AOSI) has only one independent replication study and no evaluation with community-ascertained cohorts. We administered the AOSI and established clinical measures with 103 infants (68% male) at 'high autism likelihood' on the Social Attention and Communication Surveillance - Revised (SACS-R) tool, at 9-14 months of age and again 6months later. AOSI Total scores showed adequate internal consistency and strong inter-rater agreement (live- or video-coded) and were approximately normally distributed at each visit. Modest significant associations presented between Time 1 AOSI scores and concurrent developmental/adaptive skills measures. Concurrent associations were stronger at Time 2, particularly between AOSI Total and Autism Diagnostic Observation Schedule (ADOS) Social Affect scores. AOSI scores were only moderately associated across Time 1 and 2 assessments, as were Time 1 AOSI with Time 2 ADOS scores. These data from a clinically indicated cohort broadly replicate previous AOSI validity accounts from 'high-risk sibling' studies, particularly beyond the first year. Strong inter-rater agreement indicates viable AOSI inclusion within protocols necessitating blinded evaluation (e.g. intervention trials). Moderate within-participant stability suggests that, like 'high-risk siblings,' community-ascertained infants experience variable early trajectories. [This article was co-written by the AICES Team.]

Little is known about institutional radiation doses during transcatheter valve interventions. The authors sought to evaluate institutional variability in radiation doses during transcatheter valve interventions. Using a large statewide registry, transcatheter edge-to-edge mitral valve repair, transcatheter mitral valve replacement, and transcatheter aortic valve replacement procedures between January 1, 2020, and December 31, 2022, with an air kerma (AK) recorded were analyzed. Patient and procedural characteristics were compared between cases with AK ≥2 and <2 Gy. Associations of variables with AK ≥2 Gy were investigated using Bayesian random effects modeling and median ORs for the performing hospital. Among 9,446 procedures across 30 hospitals, median (Q1-Q3) procedural AK was 0.592 Gy (0.348-0.989 Gy) with AK ≥2 Gy in 533 cases (5.6%). Wide variation in procedural AK was observed, with an institutional frequency of AK ≥2 Gy ranging from 0.0% to 29.5%. Bayesian modeling identified the performing hospital as more strongly associated with the odds of a procedural AK ≥2 Gy than any patient or procedural factors (hospital median OR: 3.54 [95% credible interval: 2.52-16.66]). In a large, multicenter state-wide registry, there is wide institutional variability in patient-level radiation doses during transcatheter valve interventions, with the performing hospital having a higher odds of an AK ≥2 Gy than any patient or procedural factors. Future interventions are warranted to reduce procedural-related variation in radiation exposure. [Display omitted] [ABSTRACT FROM AUTHOR]

Interacting N-component fermions spatially confined in ring-shaped potentials display specific coherence properties. The orbital angular momentum per particle of such systems can be quantized to fractional values specifically depending on the particle-particle interaction. Here we demonstrate how to monitor the state of the system through homodyne (momentum distribution) and self-heterodyne system's expansion. For homodyne protocols, the momentum distribution is affected by the particle statistics in two distinctive ways. The first effect is a purely statistical one: at zero interactions, the characteristic hole in the momentum distribution around the momentum k=0 opens up once half of the SU(N) Fermi sphere is displaced. The second effect originates from the interaction: The fractionalization in the interacting system manifests itself by an additional "delay" in the flux for the occurrence of the hole, that now becomes a characteristic minimum at k=0. We demonstrate that the angular momentum fractional quantization is reflected in the self-heterodyne interference as specific dislocations in interferograms. Our analysis demonstrates how the study of the interference fringes grants us access to both number of particles and number of components of SU(N) fermions.

Background: Diagnostic and therapeutic decisions in nephrology in low-resource settings are frequently based on ultrasound assessment of kidney size. An understanding of reference values is critical, particularly given the rise of non-communicable disease and the expanding availability of point-of-care ultrasound. However, there is a paucity of normative data from African populations. We determined estimates of kidney ultrasound measures, including kidney size based on age, sex, and HIV status, among apparently healthy outpatient attendees of Queen Elizabeth Central hospital radiology department, Blantyre, Malawi. Methods: We performed a cross-sectional cohort study of 320 adults attending the radiology department between October 2021 and January 2022. Bilateral kidney ultrasound was performed on all participants using a portable Mindray DP-50 machine and a 5MHz convex probe. The sample was stratified by age, sex, and HIV status. Predictive linear modelling was used to construct reference ranges for kidney size estimating the central 95 percentiles of 252 healthy adults. Exclusion criteria for the healthy sample were known kidney disease, hypertension, diabetes, BMI > 35, heavy alcohol intake, smoking and ultrasonographic abnormalities. Results: There were 162/320 (51%) male participants. The median age was 47 (interquartile range [IQR] 34-59). Among people living with HIV 134/138 (97%) were receiving antiretroviral therapy. Men had larger average kidney sizes: mean 9.68 cm (SD 0.80 cm), compared to 9.46 cm (SD 0.87 cm) in women (p = 0.01). Average kidney sizes in people living with HIV were not significantly different from those who were HIV-negative, 9.73 cm (SD 0.93 cm) versus 9.58 cm (SD 0.93 cm) (p = 0.63). Conclusions: This is the first report of the apparently healthy kidney size in Malawi. Predicted kidney size ranges may be used for reference in the clinical assessment of kidney disease in Malawi.

BackgroundIn late 2020, the European Centre for Disease Prevention and Control and Epiconcept started implementing a surveillance system for severe acute respiratory infections (SARI) across Europe. ObjectiveWe sought to describe the process of digitizing and upgrading SARI surveillance in Malta, an island country with a centralized health system, during the COVID-19 pandemic from February to November 2021. We described the characteristics of people included in the surveillance system and compared different SARI case definitions, including their advantages and disadvantages. This study also discusses the process, output, and future for SARI and other public health surveillance opportunities. MethodsMalta has one main public hospital where, on admission, patient data are entered into electronic records as free text. Symptoms and comorbidities are manually extracted from these records, whereas other data are collected from registers. Collected data are formatted to produce weekly and monthly reports to inform public health actions. From October 2020 to February 2021, we established an analogue incidence-based system for SARI surveillance. From February 2021 onward, we mapped key stakeholders and digitized most surveillance processes. ResultsBy November 30, 2021, 903 SARI cases were reported, with 380 (42.1%) positive for SARS-CoV-2. Of all SARI hospitalizations, 69 (7.6%) were admitted to the intensive care unit, 769 (85.2%) were discharged, 27 (3%) are still being treated, and 107 (11.8%) died. Among the 107 patients who died, 96 (89.7%) had more than one underlying condition, the most common of which were hypertension (n=57, 53.3%) and chronic heart disease (n=49, 45.8%). ConclusionsThe implementation of enhanced SARI surveillance in Malta was completed by the end of May 2021, allowing the monitoring of SARI incidence and patient characteristics. A future shift to register-based surveillance should improve SARI detection through automated processes.

Objectives Acute kidney injury (AKI) is a common and severe complication of community acquired infection, but data on impact in sub-Saharan Africa (SSA) are lacking. We determined prevalence, risk factors and outcomes of infection associated kidney disease in adults in Malawi.Design A prospective cohort study of adults admitted to hospital with infection, from February 2021 to June 2021, collecting demographic, clinical, laboratory and ultrasonography data.Setting Adults admitted to a regional hospital in Southern Region, Malawi.Primary and secondary outcome measures The primary outcomes were prevalence of kidney disease and mortality by Cox proportional hazard model. AKI was defined according to Kidney Disease Improving Global Outcomes (KDIGO) guidelines. Secondary outcomes were risk factors for AKI identified by logistic regression and prevalence of chronic kidney disease at 3 months.Results We recruited 101 patients presenting to hospital with infection. Median age was 38 years (IQR: 29–48 years), 88 had known HIV status of which 53 (60%) were living with HIV, and of these 42 (79%) were receiving antiretroviral therapy. AKI was present in 33/101 at baseline, of which 18/33 (55%) cases were severe (KDIGO stage 3). At 3 months, 28/94 (30%) participants had died, while 7/61 (11%) of survivors had chronic kidney disease. AKI was associated with older age (age: 60 years vs 40 years, OR: 3.88, 95% CI 1.82 to 16.64), and HIV positivity (OR: 4.08, 95% CI 1.28 to 15.67). Living with HIV was independently associated with death (HR: 3.97, 95% CI 1.07 to 14.69).Conclusions Kidney disease is common among hospitalised adults with infection in Malawi, with significant kidney impairment identified at 3 months. Our study highlights the difficulty in diagnosing acute and chronic kidney disease, and the need for more accurate methods than creatinine based estimated glomerular filtration rate (eGFR) equations for populations in Africa. Patients with kidney impairment identified in hospital should be prioritised for follow-up.