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The Mental Health Bill, 2025, proposes to remove autism and learning disability from the scope of Section 3 of the Mental Health Act, 1983 (MHA). The present article represents a professional and carer consensus statement that raises concerns and identifies probable unintended consequences if this proposal becomes law. Our concerns relate to the lack of clear mandate for such proposals, conceptual inconsistency when considering other conditions that might give rise to a need for detention and the inconsistency in applying such changes to Part II of the MHA but not Part III. If the proposed changes become law, we anticipate that detentions would instead occur under the less safeguarded Deprivation of Liberty Safeguards framework, and that unmanaged risks will eventuate in behavioural consequences that will lead to more autistic people or those with a learning disability being sent to prison. Additionally, there is a concern that the proposed definitional breadth of autism and learning disability gives rise to a risk that people with other conditions may unintentionally be unable to be detained. We strongly urge the UK Parliament to amend this portion of the Bill prior to it becoming law.
Bipolar disorders are a major cause of disability worldwide, with most of the disease burden attributed to those in low- and middle-income countries, including Nigeria. There is limited evidence on culturally appropriate interventions for bipolar disorders in Nigeria.
Aims
The study aims to examine the feasibility, and acceptability of culturally adapted psychoeducation (CaPE) for treating bipolar disorders.
Method
A randomised controlled trial (RCT) compared CaPE plus treatment as usual (TAU) with TAU alone among 34 persons with bipolar disorders in Jos, Nigeria. CaPE comprised 12 group sessions of in-person psychoeducation lasting approximately 90 min each, delivered on a weekly basis by clinical researchers supervised by clinical psychologists and consultant psychiatrists. The primary outcome was feasibility, measured by participants’ recruitment and retention rates. Other outcomes included acceptability as measured by the Service Satisfaction Scale (SSS), Brief Bipolar Disorder Symptom Scale (BBDSS), Patient Health Questionnaire (PHQ-9) and Quality-of-Life scale (EQ5D). Outcomes were assessed at baseline and weeks 12 and 24. Focus group (n = 10) and individual interviews (n = 5) were conducted with the CaPE + TAU group, recorded, transcribed verbatim and analysed using interpretative phenomenological analysis.
Results
The CaPE+TAU group (n = 17) recorded a high participant recruitment and retention rate of 86% across 12 sessions, and also recorded a higher level of satisfaction with SSS compared with the TAU alone group; 87.5% indicated very satisfied compared with 66.7% indicated not sure in the TAU group. In terms of clinical outcomes, for PHQ-9 scores the intervention group showed a reduction from baseline to end of intervention (EOI) and follow-up, with differences of −12.01 and −7.39, respectively (both P < 0.001). The EQ5D index showed a notable improvement in the intervention group at both EOI and follow-up (P < 0.001). Lastly, BBDS scores decreased significantly in the CaPE+TAU group at both EOI and follow-up, with differences of −21.45 and −15.76 (both P < 0.001).
Conclusions
The RCT of CaPE is a feasible, acceptable and culturally appropriate treatment option for bipolar disorders in Nigeria. Further adequately powered RCTs evaluating the intervention’s clinical and cost-effectiveness are warranted.
Oat being a rabi/winter crop in Kashmir, experiences extremely low temperatures which has detrimental effects on its growth and development. Therefore, this study was designed to evaluate a set of 130 oat genotypes in multi-location trials across temperate conditions of Kashmir valley from 2018 to 2022. From the preliminary data of 56 genotypes, including five checks, were selected and evaluated for nutritional and yield attributing traits under cold stress conditions at two locations. The results demonstrated significant genetic variation and high heritability for majority of traits, except for days to 50% flowering, days to maturity and dry fodder. Positive correlations were observed between green fodder yield and other traits, indicating their potential for enhancing yield. Principal component analysis identified four principal components that accounted for 69.87% of the total variation. Cluster analysis categorized the genotypes into two main clusters and six sub-clusters. Frost damage assessment was conducted at tillering stage after the snow melted in late January 2021 and 2022 using cold tolerance rating scale and subsequently tested for chilling injury through an electrolyte leakage test. From field and lab data analysis, five most promising cold tolerant, nutritious and high-yielding genotypes were identified. These genotypes have significant potential for utilization in future breeding programmes to improve cold tolerance in cultivated oats within the Kashmir valley thus promoting agricultural productivity and sustainability. The outcomes also provide valuable insights into the genetic variation, heritability, genotype-by-environment interactions, correlations and cold tolerance of oat genotypes in Kashmir.
Bipolar disorder (BD) is a source of marked disability, morbidity, and premature death. There is a paucity of research on personalized psychosocial interventions for BD, especially in lowresource settings. A previously published pilot randomized controlled trial (RCT) of a Culturally adapted PsychoEducation (CaPE) intervention for BD in Pakistan reported higher patient satisfaction, enhanced medication adherence, knowledge and attitudes towards BD, and improvement in mood symptom scores and health-related quality of life measures compared to treatment-as-usual (TAU).
Objectives
This protocol describes a larger multicentre RCT to confirm the clinical and cost-effectiveness of CaPE in Pakistan.
Methods
A multicentre individual, parallel arm, RCT of CaPE in 300Pakistani adults with BD. Participants over the age of 18, with adiagnosis of bipolar I and II and who are currently euthymic, will berecruited from seven sites including Karachi, Lahore, Multan, Rawalpindi,Peshawar, Hyderabad and Quetta. Time to recurrence will be the primaryoutcome assessed using Longitudinal Interval Follow-up Evaluation(LIFE). Secondary measures will include mood symptomatology, qualityof life and functioning, adherence to psychotropic medications, andknowledge and attitudes towards BD.
Results
Full ethics approval has been received from National Bioethics Committee (NBC) of Pakistan and Centre for Addiction and Mental Health (CAMH), Toronto, Canada. The study has completed sixty-five screening across the seven centres, of which forty-eight participants have been randomised.
Conclusions
A successful trial will lead to rapid implementation of CaPE in clinical practice, not only in Pakistan, but also in other low-resource settings including those in high-income countries, to improve clinical outcomes, social and occupational functioning, and quality of life in South Asian and other minority patients with BD.
For 147 hospital-onset bloodstream infections, we assessed the sensitivity, specificity, positive predictive value, and negative predictive value of the National Healthcare Safety Network surveillance definitions of central-line–associated bloodstream infections against the gold standard of physician review, examining the drivers of discrepancies and related implications for reporting and infection prevention.
OBJECTIVES/GOALS: Supported by the State of Alabama, the Alabama Genomic Health Initiative (AGHI) is aimed at preventing and treating common conditions with a genetic basis. This joint UAB Medicine-HudsonAlpha Institute for Biotechnology effort provides genomic testing, interpretation, and counseling free of charge to residents in each of Alabama’s 67 counties. METHODS/STUDY POPULATION: Launched in 2017, as a state-wide population cohort, AGHI (1.0) enrolled 6,331 Alabamians and returned individual risk of disease(s) related to the ACMG SF v2.0 medically actionable genes. In 2021, the cohort was expanded to include a primary care cohort. AGHI (2.0) has enrolled 750 primary care patients, returning individual risk of disease(s) related to the ACMG SF v3.1 gene list and pre-emptive pharmacogenetics (PGx) to guide medication therapy. Genotyping is done on the Illumina Global Diversity Array with Sanger sequencing to confirm likely pathogenic / pathogenic variants in medically actionable genes and CYP2D6 copy number variants using Taqman assays, resulting in a CLIA-grade report. Disease risk results are returned by genetic counselors and Pharmacogenetics results are returned by Pharmacists. RESULTS/ANTICIPATED RESULTS: We have engaged a statewide community (>7000 participants), returning 94 disease risk genetic reports and 500 PGx reports. Disease risk reports include increased predisposition to cancers (n=38), cardiac diseases (n=33), metabolic (n=12), other (n=11). 100% of participants harbor an actionable PGx variant, 70% are on medication with PGx guidance, 48% harbor PGx variants and are taking medications affected. In 10% of participants, pharmacists sent an active alert to the provider to consider/ recommend alternative medication. Most commonly impacted medications included antidepressants, NSAIDS, proton-pump inhibitors and tramadol. To enable the EMR integration of genomic information, we have developed an automated transfer of reports into the EMR with Genetics Reports and PGx reports viewable in Cerner. DISCUSSION/SIGNIFICANCE: We share our experience on pre-emptive implementation of genetic risk and pharmacogenetic actionability at a population and clinic level. Both patients and providers are actively engaged, providing feedback to refine the return of results. Real time alerts with guidance at the time of prescription are needed to ensure future actionability and value.
Bipolar disorder is a source of marked disability, morbidity and premature death. There is a paucity of research on personalised psychosocial interventions for bipolar disorder, especially in low-resource settings. A pilot randomised controlled trial (RCT) of a culturally adapted psychoeducation intervention for bipolar disorder (CaPE) in Pakistan reported higher patient satisfaction, enhanced medication adherence, knowledge and attitudes regarding bipolar disorder, and improvement in mood symptom scores and health-related quality of life measures compared with treatment as usual (TAU).
Aims
The current protocol describes a larger multicentre RCT to confirm the clinical and cost-effectiveness of CaPE in Pakistan. Trial registration: NCT05223959.
Method
A multicentre individual, parallel-arm RCT of CaPE in 300 Pakistani adults with bipolar disorder. Participants over the age of 18, with a diagnosis of bipolar I or II disorder who are currently euthymic, will be recruited from seven sites: Karachi, Lahore, Multan, Rawalpindi, Peshawar, Hyderabad and Quetta. Time to recurrence will be the primary outcome assessed using the Longitudinal Interval Follow-up Evaluation (LIFE). Secondary measures will include mood symptoms, quality of life and functioning, adherence to psychotropic medications, and knowledge and attitudes regarding bipolar disorder.
Results
This trial will assess the effectiveness of the CaPE intervention compared with TAU in reducing the time to recurrence for people with bipolar disorder currently in remission in Pakistan and determine the effect on clinical outcomes, quality of life and functioning.
Conclusions
A successful trial might lead to rapid implementation of CaPE in clinical practice, not only in Pakistan, but also in other low-resource settings, including those in high-income countries, to improve clinical outcomes, social and occupational functioning, and quality of life in South Asian and other minority group patients with bipolar disorder.
Based on morphometric, morphological and molecular characterization using partial small subunit 18S ribosomal DNA (rDNA) and the D2/D3 domain of large subunit 28S rDNA, we described a new species Mononchoides kanzakii collected from manure, and the known species Mononchoides composticola Steel, Moens, Scholaert, Boshoff, Houthoofd and Bert, 2011, isolated from the dung beetle Oniticellus cinctus (Fabricius, 1775). Phylogenetic trees based on the evolutionary model (GTR + I + G) were inferred by Bayesian inference algorithms. Mononchoides kanzakii sp. n. is characterized by 28–32 longitudinal ridges, discontinuous at level of stoma; amphidial apertures inconspicuous; metastegostom armed with thorn-shaped dorsal tooth; a flattened, claw-like right subventral tooth, and left subventral denticulate ridge with 12–14 fine denticles delimited by a group of five denticles in females vs. triangular, flattened right subventral tooth, 5–8 prominent denticles at left subventral sector in males; cloacal lips with a distinct rim; and gubernaculum with cuticularized, proximal and distal extensions of equal length, each constituting half of the length of the wider part of gubernaculum.
Transition metal dichalcogenides are 2D structures with remarkable electronic, chemical, optical and mechanical properties. Monolayer and crystal properties of these structures have been extensively investigated, but a detailed understanding of the properties of their few-layer structures are still missing. In this work we investigated the mechanical differences between monolayer and multilayer WSe2 and MoSe2, through fully atomistic molecular dynamics simulations (MD). It was observed that single layer WSe2/MoSe2 deposited on silicon substrates have larger friction coefficients than 2, 3 and 4 layered structures. For all considered cases it is always easier to peel off and/or to fracture MoSe2 structures. These results suggest that the interactions between first layer and substrate are stronger than interlayer interactions themselves. Similar findings have been reported for other nanomaterials and it has been speculated whether this is a universal-like behavior for 2D layered materials. We have also analyzed fracture patterns. Our results show that fracture is chirality dependent with crack propagation preferentially perpendicular to W(Mo)-Se bonds and faster for zig-zag-like defects.
Phase relations along the Li2O⋅2B2O3-Yb2O3⋅B2O3 polythermal section of the Li2O –B2O3–Yb2O3 system were investigated by differential thermal analysis, x-ray diffraction, and microstructural analysis. The state phase diagram of the Li2O⋅2B2O3-Yb2O3⋅B2O3 section is an eutectic system with invariant eutectic point corresponding to ∼0.2 mole fraction of Yb2O3⋅B2O3 and 800 °C. According to physico-chemical analysis, the Li2O⋅2B2O3-Yb2O3⋅B2O3 polythermal section is quasi-binary, allowing us to partially triangulate the Li2O-B2O3-Yb2O3 system. The borders of the glass formation region were defined in the Li2O⋅2B2O3-B2O3-Yb2O3⋅B2O3 concentration triangle. The vitreous samples showed a semiconducting nature.
In a field study it was found that application of high P induced Zn deficiency symptoms on onion (Allium cepa L.) plants, increased P concentration but decreased that of Zn. Conversely, application of Zn tended to increase Zn concentration of both tops and bulbs and lowered P concentration. Effectiveness of Zn varied with the amount of P applied. Evidently P and Zn are mutually antagonistic. Using sub-soil on the top of raised beds and heavy P fertilization appear to be responsible for inducing Zn deficiency in onions in northern Nigeria.
The absorption and movement of 14C-labelled maleic hydrazide (2000 mg/1) and 2,4-D (250 mg/1) were studied in seedlings and mature plants of a local strain of onion (Allium cepa L.) from Kano, Nigeria, in the presence and absence of N (20 mg/1).
Plants absorbed and accumulated considerable amounts of both the chemicals. Addition of N to the treatment solution reduced the absorption of 2,4-D. Also, N reduced the mobility of the chemicals from the roots to the tops which resulted in accumulation of the chemicals in the bulbs.
The effect of morphactin sprayed at 0, 0·5, 1·0, 1·5 or 2·0 mg/1 on the concentrations of several nutrients in snapdragons (Antirrhinum, majus L.) were studied under glasshouse conditions. Snapdragon plants treated with morphactin increased in K, and Mg but decreased in Ca, Mn, Cu, Fe, and Zn. Action of morphactin and nutrient element relationships are suggested.
Anomalous origin of the left coronary artery from the pulmonary trunk is rare, occurring at an incidence of 1 in 300 000. If not diagnosed and treated early, it is life-threatening. Children with the anomaly usually present in infancy with congestive cardiac failure, and are occasionally referred for cardiac transplant. We investigated the medium term outcome for patients following creation of a two-coronary arterial circulation.
Methods
Between 1992 and 2007, we diagnosed 15 patients seen at our Institution as having anomalous origin of the left coronary artery from the pulmonary trunk. Over a period of 13 years, aortic reimplantation was undertaken in 12 of these patients, who form the studied cohort.
Results
Direct reimplantation was performed in 5 patients. In 3 cases, a tension-free anastomosis was created using a caudally based flap. In another 3 cases, an extended flap was used, while a patch arterioplasty was fashioned in the final patient. There were no deaths. Left ventricular function recovered in all but one of the patients, and all patients had a reduction in the degree of mitral regurgitation.
Conclusions
Among the variety of surgical techniques, transfer of the anomalous left coronary artery to the aorta is the ideal method for long-term patency and adequate blood supply. This can be achieved by creating flaps based on the walls of the pulmonary trunk and aorta, producing a dual coronary arterial supply with no mortality and low morbidity.
We report on the integration of flowable oxide based Fresnel microlenses with AlGaN based 280 nm light emitting diodes (LED). The lenses were fabricated on the back side of the LED sapphire substrates using direct electron beam writing. Ten concentric rings with different width and variable thickness were designed for 360 degree phase correction. Within each ring the thickness was varied in five steps to approximate a linear profile. The width of each thickness step varied from 100 nm to several microns. Outer diameter of the lens was 65μm. A focal distance of 68 μm was measured for the fabricated microlenses. At the focal plane a FWHM of intensity profile as small as 14 μm was measured for lenses integrated with 30 μm diameter UV LEDs . The maximum intensity at focal plane exceeded the background radiation by a factor of 50. Comparison of the LED performance before and after the lens fabrication did not reveal any degradation of integral efficiency of devices. These results demonstrate the feasibility of using flowable oxide Fresnel microlenses in optical systems based on micro-pixel deep UV AlGaN LEDs.
The evolution of stress during the MOCVD growth of AlN thin films on sapphire substrates under both low and high temperature conditions has been evaluated. The final stress state of the films is assumed to consist of the summation of stresses from three different sources: (1) the stress which arises from residual lattice mismatch between film and substrate i.e. that which persists after partial relaxation by misfit dislocation formation. The extent of relaxation is determined from High Resolution TEM analysis of the substrate/film interface; (2) the stress arising from the coalescence of the 3D islands nucleated in this high mismatch epitaxy process. This requires knowledge of the island sizes just prior to coalescence and this was provided by AFM studies of samples grown under the conditions of interest; and (3) the stress generated during post-growth cooling which arises from the differences in thermal expansion coefficient between AlN and sapphire. The final resultant stress, comprising the summation of stresses arising from these three sources, is found to be tensile in the sample grown at lower temperature and compressive in the sample grown at higher temperature. These results are in general qualitative agreement with results of TEM and High resolution X-ray diffraction (HRXRD) studies, which show evidence for tensile and compressive stresses in the low temperature and high temperature cases, respectively.