Games Used With Serious Purposes: A Systematic Review of Interventions in Patients With Cerebral Palsy

The purpose of the present systematic review was to examine extant research regarding the role of games used seriously in interventions with individuals with cerebral palsy. Therefore, PubMed, PsyINFO, Web of Science, Scopus, and IEEE databases were used. Search terms included: “serious games” OR “online games” OR “video games” OR “videogame” OR “game based” OR “game” AND “intervention” AND “cerebral palsy.” After the full reading and quality assessment of the papers, 16 studies met the inclusion criteria. The majority of the studies reported high levels of compliance, motivation, and engagement with game-based interventions both at home and at the clinical setting intervention. Regarding the effectiveness of the use of games, the results of the studies show both positive and negative results regarding their effectiveness. The efficacy was reported to motor function (i.e., improvements in the arm function, hand coordination, functional mobility, balance and gait function, postural control, upper-limbs function) and physical activity. Findings of this review suggest that games are used as a complement to conventional therapies and not as a substitute. Practitioners often struggle to get their patients to complete the assigned homework tasks, as patients display low motivation to engage in prescribed exercises. Data of this review indicates the use of games as tools suited to promote patients’ engagement in the therapy and potentiate therapeutic gains.

Risk factors for hospital death in conditions needing palliative care: Nationwide population-based death certificate study

BACKGROUND

Most people would prefer to die at home as opposed to hospital; therefore, understanding mortality patterns by place of death is essential for health resources allocation.

AIM

We examined trends and risk factors for hospital death in conditions needing palliative care in a country without integrated palliative care.

DESIGN

This is a death certificate study. We examined factors associated with hospital death using logistic regression.

SETTING/PARTICIPANTS

All adults (1,045,381) who died between 2003 and 2012 in Portugal were included. We identified conditions needing palliative care from main causes of death: cancer, heart/cerebrovascular, renal, liver, respiratory and neurodegenerative diseases, dementia/Alzheimer's/senility and HIV/AIDS.

RESULTS

Conditions needing palliative care were responsible for 70.7% deaths ( N = 738,566, median age 80); heart and cerebrovascular diseases (43.9%) and cancer (32.2%) accounted for most. There was a trend towards hospital death (standardised percentage: 56.3% in 2003, 66.7% in 2012; adjusted odds ratio: 1.04, 95% confidence interval: 1.04-1.04). Hospital death risk was higher for those aged 18-39 years (3.46, 3.25-3.69 vs aged 90+), decreasing linearly with age; lower in dementia/Alzheimer's/senility versus cancer (0.13, 0.13-0.13); and higher for the married and in HIV/AIDS (3.31, 3.00-3.66). Effects of gender, working status, weekday and month of death, hospital beds availability, urbanisation level and deprivation were small.

CONCLUSION

The upward hospital death trend and fact that being married are risk factors for hospital death suggest that a reliance on hospitals may coexist with a tradition of extended family support. The sustainability of this model needs to be assessed within the global transition pattern in where people die.

¿Por qué este niño es especial? La importancia de una dieta educativa en niños con Parálisis Cerebral hemipléjica: un estudio de caso

Este estudio describe el caso de un niño con Parálisis Cerebral de tipo hemipléjica según su nivel de funcionalidad, cognitivo y rendimiento neuropsicológico y, también, el rol de la "dieta educativa " en su rendimiento escolar. Es esperado que niños hemipléjicos tengan una disfunción ejecutiva, pero incluso aquellos con funcionamiento cognitivo normal, es muy probable que presenten dificultades específicas de aprendizaje. En este caso el perfil presenta resultados distintos a lo que sería esperable. Los resultados confirmaron la alta funcionalidad del niño, FA, en todos los dominios. Además, la entrevista con los padres permitió verificar que la dieta educativa seguida puede ser un importante aspecto que está contribuyendo a los resultados divergentes que este niño presenta.

How Executive Functions Are Evaluated in Children and Adolescents with Cerebral Palsy? A Systematic Review

Aims: The aim of the present study was to examine how executive functions are assessed in children and adolescents with Cerebral Palsy.

Method: A systematic literature review was conducted using four bibliographic databases (WebScience, Scopus, PubMed, and Psycinfo), and only studies that evaluated at least one executive function were selected. Both the research and reporting of results were based on Cochrane's recommendations and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines.

Results: The instrument most frequently used was the D-KEFS. All studies point to the existence of impairments in the executive functions among children and adolescents with Cerebral Palsy with an impact on several cognitive and life domains.

Interpretation: There is a need to further systematize the research protocols to study the executive functions and their assessment in the intervention context. Findings of this review presented a diversity of tests (e.g., D-KEFS) or tasks (e.g., The inhibitory ability task) used with children with Cerebral Palsy. However, no information was given about adaptations performed to the test/task to meet Cerebral Palsy's specificities. Future research could consider including this information, which is key both to researchers and practitioners. The results of this study have important implications and suggestions for future avenues and guidelines for research and practice.

Paget disease of the male breast

Paget disease of the breast is an uncommon tumor of the nipple-areola complex that usually presents as an erythematous and erosive lesion. We report the case of a 61-year-old man that presented with a three-year history of an erythematous lesion of the right areola, first treated with topical corticosteroids without benefit. He was then referred to our dermatology department and the clinical suspicion of Paget disease was considered. The diagnosis was later confirmed by biopsy. This case report highlights the importance of clinical recognition of this entity along with other diseases that mimic these skin changes in order to allow earlier diagnosis and proper follow-up.

Outcome and risk factors assessment for adverse events in advanced esophageal cancer patients after self-expanding metal stents placement

Self-expanding metal stents (SEMS) are the treatment of choice for advanced esophageal cancers. Literature is scarce on risk factors predictors for adverse events after SEMS placement. Assess risk factors for adverse events after SEMS placement in advanced esophageal cancer and evaluate survival after SEMS placement. Cross-sectional study of patients with advanced esophageal cancer referred for SEMS placement, during a period of 3 years. Ninety-seven patients with advanced esophageal cancer placed SEMS. Adverse events were more common when tumors were located at the level of the distal esophagus/cardia (47% vs 23%, P = 0.011, OR 3.1), with statistical significance being kept in the multivariate analysis (OR 3.1, P = 0.018). Time until adverse events was lower in the tumors located at the level of the distal esophagus/cardia (P = 0.036). Survival was higher in patients who placed SEMS with curative intent (327 days [126-528] vs. 119 days [91-147], P = 0.002) and in patients submitted subsequently to surgery compared with those who did just chemo/radiotherapy or who did not do further treatment (563 days [378-748] vs. 154 days [133-175] vs. 46 days [20-72], P < 0.001). Subsequent treatment kept statistical significance in the multivariate analysis (HR 3.4, P < 0.001). SEMS allow palliation of dysphagia in advanced esophageal cancer and are associated with an increased out-of-hospital survival, as long as there are conditions for further treatments. Tumors located at the level of the distal esophagus/cardia are associated with a greater number of adverse events, which also occur earlier.

A Influência das Características dos Prestadores e dos Utentes no Consumo de Recursos em Unidades de Cuidados Continuados

<b><i>Introdução:</i></b> O envelhecimento populacional, o aumento da prevalência de doenças crónicas e de multipatologia, são fenómenos que encontraram novas respostas com a criação da Rede Nacional de Cuidados Continuados Integrados (RNCCI) em Portugal, a partir de 2006. É esperado que esta estrutura adicional de oferta de cuidados permita contribuir para a criação de valor aos seus utentes. <b><i>Objetivo:</i></b> O presente estudo teve como objetivos estimar o consumo de recursos medido através da duração de internamento em unidades de internamento em cuidados continuados (UICC) em Portugal e analisar a associação com as características dos utentes e dos prestadores de cuidados. <b><i>Método:</i></b> Foi realizado um estudo transversal e retrospetivo, que utilizou informação da atividade das unidades da RNCCI entre 2010 e 2012. Recorreu-se a modelos de regressão lineares múlti­plos, utilizando a duração de internamento como variável dependente e, como preditores, variáveis representativas das características individuais dos utentes e dos prestadores. <b><i>Resultados:</i></b> Para os 30.090 episódios incluídos, a duração média de internamento foi de 34,2 dias nas unidades de convalescença, 84,1 dias nas unidades de média duração e reabilitação e 106 dias nas unidades de longa duração e manutenção. A dispersão da duração de internamento foi elevada em todas as tipologias e regiões. Isoladamente, as variáveis associadas às características dos utentes apresentaram capacidade preditiva muito reduzida. A inclusão das variáveis associadas à organização da oferta de cuidados aumentou a capacidade do modelo explicar a variabilidade do tempo de internamento dos utentes. <b><i>Conclusão:</i></b> Os resultados do modelo de regressão linear múltipla sugerem que são as características associadas à oferta de cuidados que apresentam maior relevância para explicar a variabilidade da duração de internamento em cuidados continuados. Sugere-se que futuros desenvolvimentos incluam melhorias nas práticas de registo e a implementação de um sistema de classificação de utentes específico, internacionalmente validado para a estratificação do risco em cuidados continuados.

Joint toxicity prediction of nanoparticles and ionic counterparts: Simulating toxicity under a fate scenario

The joint effects of NPs with other chemicals is not fully yet understood along with the joint effects of the particulate and dissolved forms/fractions. The predictability of joint effects is of great importance for environmental risk assessment. Therefore this study aimed at inferring on the predictability of NPs binary mixture toxicity based on their ionic counterparts' mixtures, and evaluating if the joint toxicity of two forms of the same element (NP and ion) acts as dilution of each other. Effects of individual and mixtures of ZnO and Ag NPs and their respective salts (AgNO₃ and ZnCl₂) were studied in immobilization and feeding tests using Daphnia magna. NPs mixture toxicity patterns did not mirror their ionic counterparts' mixture toxicity responses and therefore their prediction should not rely on the available knowledge for regular chemicals. Regarding mixtures from the same element with different forms (NP and ions), both Zn and Ag mixtures showed a deviation from additivity, relying on the interaction between NP and ions. A synergistic effect was depicted when the concentrations of Ag ions increased, while antagonism was observed with AgNP increase in suspension. This is an expected pattern in long term studies due to dissolution, relating fate and toxicity.

"My Child has Cerebral Palsy": Parental Involvement and Children's School Engagement

Engaged students tend to show school-committed behaviors (e.g., attend classes, get involved with the learning process), high achievement, and sense of belonging. However, students with disabilities are prone to show a lack of engagement with school due to the specific difficulties they have to handle. In fact, children with disabilities are likely to show poor participation in school when compared with children without disabilities. This poor involvement is related to their low autonomy to participate in the school activities, which, in turn, results in low school engagement. Parents play a crucial role in their children's education. Parental involvement in school activities promotes autonomous behaviors and, consequently, school engagement. In fact, extant literature has shown close relationships between parental involvement, school engagement, and academic performance. Yet, parental involvement in school activities of children with Cerebral Palsy (CP) has received little direct attention from researchers. These children tend to display lower participation due to the motor, or cognitive, impairments that compromise their autonomy, and have a high likelihood to develop learning disabilities, with special incidences in reading and arithmetic. Therefore, our aim is twofold, to understand the parental styles; and how the perceived parental involvement in school activities is related to their children school engagement. Hence, 19 interviews were conducted with one of the parents of 19 children with CP. These interviews explored the school routines of children and the perceived involvement of parents in those routines. Additionally, children filled out a questionnaire on school engagement. Results show that the majority of the parents were clustered in the Autonomy Allowance and Acceptance and Support parental style, and the majority of their children were perceived as autonomous. Moreover, about a half of the children reported a high level of school engagement. Finally, neither children's autonomous behaviors reported by parents, nor parental style, seem to be related with the children's level of school engagement. Rehabilitation centers and schools could consider training parents/caregivers focusing on their educational needs, promotion of reflections on the usefulness of applying autonomy promotion strategies with their child, and foster their involvement.

Proactive therapeutic drug monitoring of infliximab: a comparative study of a new point-of-care quantitative test with two established ELISA assays

BACKGROUND

Therapeutic drug monitoring is a powerful strategy known to improve the clinical outcomes and to optimise the healthcare resources in the treatment of autoimmune diseases. Currently, most of the methods commercially available for the quantification of infliximab (IFX) are ELISA-based, with a turnaround time of approximately 8 h, and delaying the target dosage adjustment to the following infusion.

AIM

To validate the first point-of-care IFX quantification device available in the market - the Quantum Blue Infliximab assay (Buhlmann, Schonenbuch, Switzerland) - by comparing it with two well-established methods.

METHODS

The three methods were used to assay the IFX concentration of spiked samples and of the serum of 299 inflammatory bowel diseases (IBD) patients undergoing IFX therapy.

RESULTS

The point-of-care assay had an average IFX recovery of 92%, being the most precise among the tested methods. The Intraclass Correlation Coefficients of the point-of-care IFX assay vs. the two ELISA-based established methods were 0.889 and 0.939. Moreover, the accuracy of the point-of-care IFX compared with each of the two reference methods was 77% and 83%, and the kappa statistics revealed a substantial agreement (0.648 and 0.738).

CONCLUSIONS

The Quantum Blue IFX assay can successfully replace the commonly used ELISA-based IFX quantification kits. This point-of-care IFX assay is able to deliver the results within 15 min makes it ideal for an immediate target concentration adjusted dosing. Moreover, it is a user-friendly desktop device that does not require specific laboratory facilities or highly specialised personnel.

Parametric estimation and spectral analysis of piecewise linear maps of the interval

We present an estimation procedure and analyse spectral properties of stochastic processes of the kind Zt = Xt + ξt = ϕ(Tt(ψ)) + ξt, for t ∊ Z, where T is a deterministic map, ϕ is a given function and ξt is a noise process. The examples considered in this paper generalize the classical harmonic model Zt = Acos(ω0t + ψ) + ξt, for t ∊ Z. Two examples are developed at length. In the first one, the spectral measure is discrete and in the second it is continuous. In the second example, the time series is obtained from a chaotic map. These two examples exhibit the extremal cases of different possibilities for the spectral measure of time series and they are both associated with ergodic deterministic transformations with noise. We present a method for obtaining explicitly the spectral density function (second example) and the autocorrelation coefficients (first example). In the first example the rotation number plays an important role. We also consider large deviation properties of the estimated parameters of the model.

Recommendations for aetiological diagnosis of bronchiectasis

The number of bronchiectasis diagnoses has increased in the last two decades due to several factors. Research carried out over the last years showed that an aetiological diagnosis could change the approach and treatment of a relevant percentage of patients and consequently the prognosis. Currently, systematic investigation into aetiology, particularly of those disorders that can be subject to specific treatment, is recommended. Given the complexity of the aetiological diagnosis, the Pulmonology Portuguese Society Bronchiectasis Study Group assembled a working group which prepared a document to guide and standardize the aetiologic investigation based on available literature and its own expertise. The goal is to facilitate the investigation, rationalize resources and improve the delivery of care, quality of life and prognosis of patients with bronchiectasis.

[Home based and group based exercise programs in patients with ankylosing spondylitis: systematic review]

<p>

INTRODUCTION

Ankylosing Spondylitis (AS) is a chronic inflammatory rheumatic disease characterized by inflammation of the joints of the spine and sacroiliac and to a lesser percentage of the peripheral joints. It is a debilitating condition which reduces quality of life in patients with AS. The practice of physical therapy is recommended as non-pharmacological treatment as well as the treatment and prevention of associated deformities.

OBJECTIVE

To collect and summarize the available evidence in scientific databases to realize the effectiveness of home based and group based programs in patients with AS.

METHODS

Systematic review, where articles for the study were collected from scientific database PubMed. We have found 65 articles with publication date between January 1, 2004 and January 31, 2014. Inclusion and exclusion criteria were established to make the selection of articles to include in the study. All investigators provided their agreement in presencial meeting for a final selection, and at a later stage, the articles were read in full by the three investigators.

RESULTS

The present systematic review includes eight randomized controlled trials. All articles show functional benefits in patients with AS subject to exercise programs in group based and / or home based. From the eight articles, 4 addressed programs conducted in home based context and 4 addressed in group based context programs.

CONCLUSION

There appears to be evidence that the programs carried out based on group are more effective than those home based conducted in patients with AS. It was concluded also be advantageous to carry out home based exercise programs than the absence of any exercise program.</p>.

Functional leaf traits of understory species: strategies to different disturbance severities

The specific leaf area (SLA) has been related to environmental disturbances, showing a positive correlation between the disturbances intensities and SLA in a plant community. These studies, however, assessed the responses of plant community as a whole, neglecting species attributes, such as the position in the vertical stratum of forests. Considering the importance of SLA to understand forest ecological processes, this study aimed to determine the influence of the disturbance regime on the SLA of understory species, considering that, unlike for communities as a whole, an increase in the disturbance intensity implies a decrease in SLA of understory species. This study was conducted in nine understories of seasonal forests in Brazil. The most abundant species were selected and their SLA were evaluated. The variability of SLA among populations in different forests was analyzed by Student's t-tests. The SLA of the understories (SLAU) was also compared by an adaptation of the Community-weighted mean index. The comparison of species SLA showed significant differences among the populations of understories under different disturbance regime, showing a decrease in SLA with an increase in the disturbance intensity. Similar results were found for the SLA of understories communities (SLAU), corroborating our hypothesis. The correlation between a reduction in species SLA and in SLA of understory with an increase in disturbance intensity, contradicted the trend observed in the literature for the community as a whole. This study highlights the importance of the evaluation of SLA in understories, as an indicator of the successional stage of communities.

Effect of microsatellite selection on individual and population genetic inferences: an empirical study using cross-specific and species-specific amplifications

Although whole-genome sequencing is becoming more accessible and feasible for nonmodel organisms, microsatellites have remained the markers of choice for various population and conservation genetic studies. However, the criteria for choosing microsatellites are still controversial due to ascertainment bias that may be introduced into the genetic inference. An empirical study of red deer (Cervus elaphus) populations, in which cross-specific and species-specific microsatellites developed through pyrosequencing of enriched libraries, was performed for this study. Two different strategies were used to select the species-specific panels: randomly vs. highly polymorphic markers. The results suggest that reliable and accurate estimations of genetic diversity can be obtained using random microsatellites distributed throughout the genome. In addition, the results reinforce previous evidence that selecting the most polymorphic markers leads to an ascertainment bias in estimates of genetic diversity, when compared with randomly selected microsatellites. Analyses of population differentiation and clustering seem less influenced by the approach of microsatellite selection, whereas assigning individuals to populations might be affected by a random selection of a small number of microsatellites. Individual multilocus heterozygosity measures produced various discordant results, which in turn had impacts on the heterozygosity-fitness correlation test. Finally, we argue that picking the appropriate microsatellite set should primarily take into account the ecological and evolutionary questions studied. Selecting the most polymorphic markers will generally overestimate genetic diversity parameters, leading to misinterpretations of the real genetic diversity, which is particularly important in managed and threatened populations.

Zinc oxide nanoparticles toxicity to Daphnia magna: size-dependent effects and dissolution

As the production of zinc oxide nanoparticles (ZnO-NPs) and other metal oxides is exponentially increasing, it is important to investigate potential environmental and health impacts of such nanoparticles. Nanoparticles' properties (e.g., size, dissolution rate) may change in different water media, and their characterization is essential to derive conclusions about toxicity results. Therefore, an aquatic model organism, Daphnia magna, was used to investigate the effect of ZnO-NPs with 2 different particle sizes (30 nm and 80-100 nm) and then compare these effects with ZnO microsized particles (>200 nm) and the ionic counterpart (in the form of ZnCl2 ) on immobilization, feeding inhibition, and reproduction endpoints. The 48-h median lethal concentration (LC50) for immobilization ranged between 0.76 mg Zn L(-1) for the ionic zinc and 1.32 mg Zn L(-1) for ZnO-NPs of 80 nm to 100 nm. For the chronic exposures, the reproduction output was impaired similarly among zinc exposures and possibly driven mainly by the zinc ionic form. The concentrations used showed a total dissolution after 48 h. On the other hand, feeding activity was more affected by the 30 nm ZnO-NPs than by the ionic zinc, showing that the particulate form was also playing an important role in the feeding inhibition of D. magna. Dissolution and particle size in the daphnia test media were found to be essential to derive conclusions on toxicity. Therefore, they can possibly be considered critical for evaluating nanoparticles' toxicity and fate.

Development of microsatellite markers for the Neotropical endemic Brazilian Guanabara frog, Euparkerella brasiliensis, through 454 shotgun pyrosequencing

The new-generation 454 GS-FLX Titanium pyrosequencing was used to isolate microsatellite markers for the Brazilian Guanabara frog, Euparkerella brasiliensis, an Atlantic forest endemic species. Three multiplex polymerase chain reaction sets were optimized for genotyping of 11 polymorphic (di- and tetranucleotide) microsatellite markers. Genetic diversity was assessed in 21 individuals from a population (Reserva Ecológica de Guapiaçu, REGUA) located in the central region of the Rio de Janeiro State, in Brazil. The mean number of alleles per locus ranged from 3 to 12. Observed and expected heterozygosities ranged from 0.095 to 0.905 and from 0.094 to 0.904, respectively. After using the Bonferroni correction for multiple tests, there was no evidence of linkage disequilibrium between pairs of loci but deviations for Hardy-Weinberg equilibrium were found in 4 loci. We found no evidence for allele dropouts or stuttering, but we detected the presence of null alleles at loci Eb10 and Eb36. These markers will be useful for analyses of fine-scale population structure and determination of relative effects of habitat loss and fragmentation on population genetic variability within species.

Anti-TNF-alpha induced psoriasiform eruptions with severe scalp involvement and alopecia: report of five cases and review of the literature

We describe 5 cases of anti-tumor necrosis factor-alpha (anti-TNF-α) induced psoriasiform eruptions with severe scalp involvement inducing inflammatory alopecia and review the literature on this subject. All our 5 patients were provided topical therapy, with good results in only 1 case. The remaining 4 were provided systemic therapy (methotrexate ± cyclosporine): 3 concomitantly suspended the anti-TNF-α treatment (2 are currently clear/almost clear but 1 has so far only observed mild improvement) and 1 switched anti-TNF-α (recurrent flare-ups of the disease continue). So far, no patient has developed scarring alopecia. To our knowledge, a total of 15 cases of anti-TNF-α induced psoriatic alopecia have been described. Anti-TNF-α was discontinued in 9 of the 15 patients and systemic therapy was provided to 9 of the 15 patients. Nonetheless, 2 patients developed scarring alopecia. We conclude that in anti-TNF-α induced psoriasiform eruptions some patients may respond to topical treatment, however in cases of severe scalp involvement anti-TNF-α suspension and systemic treatment should be considered in order to avoid scarring alopecia.

Intestinal nodular lymphoid hyperplasia and extraintestinal lymphoma--a rare association

Nodular lymphoid hyperplasia of the gastrointestinal tract is characterized by the presence of innumerable small discrete nodules involving a variable segment of the gastrointestinal tract. The association between nodular lymphoid hyperplasia and other benign and malignant diseases has been clearly described, with an increased risk of gastrointestinal tumours, namely gastrointestinal lymphoma. However, the association with extraintestinal lymphoma seems extremely rare. The authors present a clinical case of a patient with nodular lymphoid hyperplasia of the small and large intestine that subsequently developed an extraintestinal lymphoma (diffuse large B-cell lymphoma).

How to manage pouchitis in ulcerative colitis?

It is estimated that 50% of patients who have undergone ileal pouch-anal anastomosis (IPAA) surgery for UC will develop at least one episode of pouchitis. The risk of developing pouchitis is much higher in patients with preoperative extraintestinal manifestations and primary sclerosing cholangitis. In acute pouchtis metronidazole or ciprofloxacin have shown efficacy, however there is some evidence that ciprofloxacin may have better and has less toxic. In patients with chronic pouchitis antibiotics are less effective, and maintenance therapy may be required. In cases of refractoriness to conventional therapy a combination of two antibiotics for a prolonged period or infliximab may be effective. Starting maintenance treatment with highly concentrated probiotics is recommended as primary and secondary prophylaxis.

Theoretical investigation of transcranial alternating current stimulation using laminar model

Transcranial alternating current stimulation (tACs) has been gaining an increased interest in the last few years due to its capacity to modulate non-invasively high-order cortical processes, such as decision-making, language and sensory perception. Nevertheless, the underlying mechanisms of activation of this brain stimulation technique are still poorly understood. Herein, we use a finite element modelling (FEM) technique to investigate the penetration and focality of tACs in comparison to a time invariant (DC) stimulation. We show that AC stimulations generate cerebral fields that are an order of magnitude larger in the radial direction, approximately 5 times larger in the tangential direction and more focused than DC stimulations. We argue that the basis for this effect is the reduced scalp's conductivity, which minimizes the surface shunting of the stimulating currents. The outcomes of this study may help tACs users to design better protocols and interpret experimental results.