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A cross-cultural examination of bi-directional mentalising in autistic and non-autistic adults
Get PDFBackground: So-called ‘mismatch accounts’ propose that, rather than arising from a socio-cognitive deficit present in autistic people, mentalising difficulties are the product of a mismatch in neurotype between interaction partners. Although this idea has grown in popularity over recent years, there is currently only limited empirical evidence to support mismatch theories. Moreover, the social model of disability such theories are grounded in demands a culturally situated view of social interaction, yet research on mentalising and/or autism is largely biased towards Western countries, with little knowledge on how successful mentalising is defined differently, and how tools to assess socio-cognitive ability compare, across cultures. Methods: Using a widely employed mentalising task—the animations task—, the current study investigated and compared the bi-directional mentalising performance of British and Japanese autistic and non-autistic adults and assessed observer-agent kinematic similarity as a potential dimension along which mismatches may occur between neurotypes. Participants were asked to depict various mental state- and action-based interactions by moving two triangles across a touch-screen device before viewing and interpreting stimuli generated by other participants. Results: In the UK sample, our results replicate a seminal prior study in showing poorer mentalising abilities in non-autistic adults for animations generated by the autistic group. Crucially, the same pattern did not emerge in the Japanese sample, where there were no mentalising differences between the two groups. Limitations: Limitations of the current study include that efforts to match all samples within and across cultures in terms of IQ, gender, and age were not successful in all comparisons, but control analyses suggest this did not affect our results. Furthermore, any performance differences were found for both the mental state- and action-based conditions, mirroring prior work and raising questions about the domain-specificity of the employed task. Conclusions: Our results add support for a paradigm shift in the autism literature, moving beyond deficit-based models and towards acknowledging the inherently relational nature of social interaction. We further discuss how our findings suggest limited cultural transferability of common socio-cognitive measures rather than superior mentalising abilities in Japanese autistic adults, underscoring the need for more cross-cultural research and the development of culturally sensitive scientific and diagnostic tools
PrEP Uptake and Utilisation Among Adolescent Girls and Young Women in Sub-Saharan Africa: A Scoping Review
Get PDFAdolescent girls and young women (AGYW) in sub-Saharan Africa (SSA) are disproportionately affected by HIV. Despite the effectiveness of oral pre-exposure prophylaxis (PrEP) in preventing HIV, uptake and effective utilisation among AGYW remain suboptimal. This scoping review maps research on PrEP delivery outside clinical trials to AGYW in SSA. Quantitative and qualitative data were extracted from 58 studies on the facilitators and barriers to PrEP uptake and utilisation (including initiation, persistence, and adherence), and recommendations for effective PrEP delivery from AGYW and PrEP providers. Only studies on oral PrEP met the inclusion criteria. Facilitators of effective PrEP utilisation included social support with strong familial and peer networks positively influencing PrEP adherence and persistence. Healthcare provider interactions were pivotal in promoting PrEP uptake through dissemination of accurate information and ongoing support. Studies reported consistent barriers to PrEP uptake and utilisation including anticipated or experienced stigma, pill burden, and side effects. Addressing identified barriers and leveraging facilitators can enhance future effectiveness for PrEP delivery. There is a lack of strategies to support AGYW in long-term persistence and engagement with PrEP services. Our findings emphasise the urgent need for people-centred and localised, context-specific strategies to improve PrEP delivery among AGYW in SSA. Effective PrEP delivery strategies should include differentiated service delivery models, innovative approaches such as digital health, and integration with existing services such as antenatal care for pregnant and breastfeeding AGYW. More data is needed for PrEP delivery among AGYW across the region, including other PrEP modalities as they roll out
The diversity of rotation curves of galaxies in the NewHorizon cosmological simulation
Get PDFWe use the cosmological hydrodynamical simulation NewHorizon to study the effects of the baryonic component on the inner mass profile of dark matter haloes of isolated galaxies (). Dark matter deficits (‘cores’) develop only in galaxies in a narrow range of stellar mass, . The lower stellar mass limit arises because a minimum amount of star formation is required to drive the baryonic outflows that redistribute dark matter and create a core. The upper limit roughly coincides with the total amount of dark matter initially contained within the innermost 2 kpc (), which roughly coincides with the stellar half-mass radius of these dwarfs. This enclosed mass is quite insensitive to the total virial mass of the system. The same upper limit applies to other simulations, like NIHAO and EAGLE-CHT10, despite their rather different galaxy formation efficiencies. This suggests that it is the galaxy total stellar mass that determines when a core is formed, and not the galaxy-to-dark halo mass ratio, as argued in earlier work. This is consistent with a back-of-the-envelope estimate for a SN-induced rate of orbital diffusion. Although NewHorizon dwarfs reproduce the observed diversity of rotation curves better than other simulations, there are significant differences in the gravitational importance of baryons in the inner regions of dwarfs compared to observations. These differences prevent us from concluding that cosmological simulations are currently fully able to account for the observed diversity of rotation curve shapes
An integrated education and exercise programme for Tamil people with osteoarthritis knee
No full textBackground: Osteoarthritis knee (OA knee) is a chronic joint condition associated with pain, disability and reduced quality of life. Guidelines recommend self-management, patient education, behavioural support and tailored exercise as core components of non-surgical treatment.
Purpose: To develop and evaluate an OA knee patient education booklet and a physiotherapist-led integrated programme involving the core components of non-surgical care to improve clinical outcomes in Tamil-speaking people with OA knee of Tamil Nadu state (Population 72.1 million, 2011 census), India.
Methods: A patient education booklet was developed through an iterative process and evaluated in 50 patients, carers, and physiotherapists. The impact of the integrated programme on knee pain, function, physical performance, and adherence was assessed at six weeks and during a follow-up at six months.
Results: The Tamil booklet was easy to read, useful and relevant. 31 patients (26 women; 5 men, average age 60.4 years) took part in the integrated programme. Improvements in pain, function and performance measures were statistically significant and clinically meaningful. The majority of them found the programme useful and satisfactory and reported that their condition improved. There were no adverse events.
Conclusions: Our Tamil OA knee education booklet was deemed relevant and useful. The integrated education and exercise programme was feasible and acceptable and our findings provided preliminary evidence on its clinical benefits in people with OA knee
High effectiveness tip cooling using inclined slots
Get PDFThe tip of the high-pressure turbine blade is critical for gas turbine performance. Hot gas leaking through the tip gap tends to oxidize and erode the blade while generating significant aerodynamic loss. Squealer tips are often used to maximize efficiency, but the thin rims are thermally vulnerable and difficult to cool. The resultant degradation often limits engine life, turbine entry temperatures, and thermal efficiency. This work considers means to improve the cooling of squealer tips to minimize degradation. Compared to conventional, cylindrical-hole designs, a step-change improvement in cooling effectiveness can be achieved using near-tip slots. In this configuration, coolant is ejected in an approximately streamwise direction along the pressure side rim, cooling a large area with high effectiveness. Experiments characterizing cooling and aerodynamics are performed in a representative linear cascade on an inclined slot design developed to enhance manufacturability while retaining high cooling effectiveness. This design is shown to more than double the cooling effectiveness on the pressure side rim compared to a conventional discrete-hole baseline. Improved coolant shielding is retained for varying mass flowrates, tip clearances, and density ratios. Aerodynamic measurements show that the slot design can outperform the baseline provided the coolant mass fraction between the slots is suitably optimized
COMBO-Grasp: learning constraint-based manipulation for bimanual occluded grasping
Get PDFThis paper addresses the challenge of occluded robot grasping, i.e. grasping in situations where the desired grasp poses are kinematically infeasible due to environmental constraints such as surface collisions. Traditional robot manipulation approaches struggle with the complexity of non-prehensile or bimanual strategies commonly used by humans in these circumstances. State-of-the-art reinforcement learning (RL) methods are unsuitable due to the inherent complexity of the task. In contrast, learning from demonstration requires collecting a significant number of expert demonstrations, which is often infeasible. Instead, inspired by human bimanual manipulation strategies, where two hands coordinate to stabilise and reorient objects, we focus on a bimanual robotic setup to tackle this challenge. In particular, we introduce Constraint-based Manipulation for Bimanual Occluded Grasping (COMBO-Grasp), a learning-based approach which leverages two coordinated policies: a constraint policy trained using self-supervised datasets to generate stabilising poses and a grasping policy trained using RL that reorients and grasps the target object. A key contribution lies in value function-guided policy coordination. Specifically, during RL training for the grasping policy, the constraint policy's output is refined through gradients from a jointly trained value function, improving bimanual coordination and task performance. Lastly, COMBO-Grasp employs teacher-student policy distillation to effectively deploy point cloud-based policies in real-world environments. Empirical evaluations demonstrate that COMBO-Grasp significantly improves task success rates compared to competitive baseline approaches, with successful generalisation to unseen objects in both simulated and real-world environments
A three-dimensional high throughput assay identifies novel antibacterial molecules with activity against intracellular Shigella
Get PDFThe Gram-negative bacterial species Shigella is the second leading cause of diarrhea among children in low and middle-income countries (LMICs) and is a World Health Organization (WHO) priority pathogen. Shigella infections are becoming increasing difficult to treat due to antimicrobial resistance (AMR), leading to an urgent need for new antimicrobial agents with novel modes of action. Shigella pathogenesis is largely intracellular and antibacterial chemicals that preferentially work inside cells may be desirable to limit collateral AMR and block key components of the Shigella infection cycle. Aiming to facilitate the process of identifying antibacterial chemicals that kill intracellular Shigella, we developed a high-throughput screening (HTS) cell-based chemical screening assay. The three-dimensional (3-D) assay, incorporating Shigella invasion into Caco-2 cells on Cytodex 3 beads, was scaled into a 384-well platform for screening chemical compound libraries. Using this assay, we evaluated >500,000 compounds, identifying 12 chemical hits that inhibit Shigella replication inside cells. This simple, efficient and HTS-compatible assays circumvents many of the limitations of traditional screening methods with cell monolayers and may be deployed for antibacterial compound screening for other intracellular pathogens
Fatal Mycobacterium avium meningitis in an HIV-negative Vietnamese man: a case report
Get PDFBackground: Nontuberculous mycobacteria are environmental mycobacteria that rarely cause human disease, especially in the central nervous system. Central nervous system infection by Mycobacterium avium complex, the most common pathogen among nontuberculous mycobacteria species, is rare and seldom reported, even in those with advanced human immunodeficiency virus infection. We describe a case of Mycobacterium avium complex meningitis with cerebral hemorrhage in an human immunodeficiency virus uninfected man in Vietnam. Case presentation: A 56-year-old Vietnamese man with hypertension was hospitalized with a 5-day history of headache, dizziness, low-grade fever, and unresponsive to 5 days of oral antibiotics. A brain magnetic resonance imaging, performed on day 12, showed hydrocephalus and lacunar infarct. The patient did not improve with 8 days of empirical treatment with ceftriaxone, vancomycin, dexamethasone, and meropenem, and was transferred to a referral hospital for tropical diseases. At the second hospital admission, a cerebrospinal fluid analysis showed a white cell count of 22,518 cells/μL with 81% neutrophils, protein 1.72 g/L, and glucose 0.85 mmol/L. Acid-fast bacilli smear of the cerebrospinal fluid was positive. Molecular testing of the cerebrospinal fluid was negative on GeneXpert Ultra testing, while the line probe assay was positive for Mycobacterium avium. Blood cultures at two sites, cerebrospinal fluid cultures for bacteria and fungi, and human immunodeficiency virus Ag/Ab test were negative. The patient was continuously administered meropenem with the addition of azithromycin, rifampin, and ethambutol. Then, 1 day after nontuberculous mycobacteria treatment, he developed right-sided hemiplegia, and brain computed tomography showed a hemorrhage in the parietal area, adjacent to the left lateral ventricle, and left lateral intraventricular hemorrhage shifts the midline to the right. He was transferred to the third referral general hospital and died 22 days after the onset of symptoms. Conclusion: Nontuberculous mycobacteria-central nervous system infection might mimic unresponsive pyogenic bacterial meningitis. A rapid and accurate diagnosis is essential for initiating appropriate therapy for this deadly disease
Oxygen therapy in early warning scores: a systematic review and meta-analysis
Get PDFBackground Early warning systems (EWS) used across the world typically assign a fixed number of points to patients receiving supplemental oxygen, regardless of amount. This ordinal binary approach may fail to recognise deteriorating patients who have an increasing oxygen requirement with otherwise stable observations. It is unclear whether weighting oxygen beyond binary scoring improves recognition of deterioration.
Aims We aimed to describe all general adult EWS that grade oxygen beyond binary scoring (part 1). Where reported, we summarised the performance of graded oxygen EWS in comparison to binary scoring (part 2).
Methods We systematically reviewed the literature, searching Embase, MEDLINE, CINAHL, Cochrane Central and Web of Science. We included studies of vital-sign-only EWS, for adult inpatients, which included grades of oxygen therapy above binary weighting (‘graded oxygen weighting’). We summarised methods of including graded oxygen therapy. We performed a random-effects meta-analysis of the effects of graded oxygen weighting inclusion in comparison to binary weighting. Risk of bias was assessed using the Prediction model Risk Of Bias ASsessment Tool.
Results 15 studies reported the development of 16 EWS with graded oxygen weighting, classified by flow rate, delivery device and/or fraction of inspired oxygen. Four studies compared graded oxygen EWS to binary oxygen EWS. Meta-analysis showed a significant improvement in the performance of graded oxygen EWS over binary oxygen EWS (logit(AUROC)=0.19; 95% CI 0.094 to 0.285; p=0.002). 15/16 models were at high risk of bias.
Conclusions 16 EWS with graded oxygen weighting were identified. Graded oxygen models had improved recognition of deterioration. Future work should explore the optimal method of oxygen classification and how this could be integrated into future EWS.
PROSPERO registration number CRD42024443362
Incidence, outcomes and management of spontaneous haemoperitoneum in pregnancy: a UK population-based study
Get PDFBackground: Spontaneous haemoperitoneum in pregnancy (SHiP) is the occurrence during pregnancy of sudden intra-abdominal haemorrhage unrelated to extrauterine pregnancy, trauma or uterine rupture. SHiP is uncommon but is associated with preterm birth, high perinatal mortality and, more rarely, maternal mortality. We investigated the incidence of SHiP in the UK and its diagnosis, management and outcomes.
Methods: This two-year, prospective surveillance study used the UK Obstetric Surveillance System to collect anonymous data on all women who gave birth in a UK consultant-led maternity unit in 2016 and 2017 and who experienced SHiP.
Results: We confirmed 20 cases of SHiP, giving an estimated incidence of 1.3 cases per 100,000 maternities, or 1 per 75,614 maternities. The median gestational age at diagnosis was 35.7 weeks (IQR 29.9–38.4 weeks). A minority of affected women were receiving anticoagulant agents for prophylaxis (2/20) or treatment (4/20). The most common initial suspected diagnosis was placental abruption (7/20), followed by intra-abdominal bleeding, uterine rupture, or infection. SHiP was diagnosed using ultrasound in four women, using CT in five, and solely at surgery in 14. Aneurysms (4/20) and organ rupture or haematoma (5/20) were the most common bleeding source, and the condition was most commonly diagnosed and treated by laparotomy (11/20). Perinatal morbidity and mortality were high, with 16% of infants stillborn, an over 80% admission rate to the neonatal unit among the 16 live-born infants, major complications in a third of these infants, and one neonatal death. Maternal morbidity was also high, with 60% of women admitted to the intensive care unit, over half of whom experienced major morbidity, and one maternal death.
Conclusions: SHiP is rare in the UK but when it occurs, it can be associated with major maternal morbidity and mortality, and perinatal outcomes are poor. International comparisons are complicated by differing definitions of SHiP