Occupational Therapy Practice in Schools: National Survey in Spain.

AIMS: Interdisciplinary collaboration between health and education professionals is one of the principles of inclusive education. This study aimed to describe the practices and service delivery by pediatric occupational therapists (OTs) in schools in Spain. METHODS: Data came from a convenience sample of pediatric OTs recruited through Spanish professional colleges and associations for a web-based survey, mixed-method research study. Thirty-five respondents were excluded because they didn't meet the eligibility criteria. Ninety-two responses were obtained for data analysis. Twenty-nine OTs (31.5%) work in schools (school-OTs), and sixty-three participants (68.5%) don't work there but collaborate with schools (non-school OTs). RESULTS: Participants support students with and without a medical diagnosis. Services provided by OTs external to the educational system are mainly funded by families or only partially covered. Findings show that most participants use standardized assessments and apply several intervention approaches. They believe there are barriers to the collaboration and implementation of occupational therapy services in schools. CONCLUSIONS: This preliminary study shows a need for changes in Spain's State and Regional Education legislation and provides recommendations to improve school service delivery. Pediatric OTs are encouraged to reflect on and identify opportunities for changes to enhance school-based occupational therapy practice in Spain.

Prognostic factors for satellitosis or in-transit metastasis in cutaneous squamous cell carcinoma: A multicentric cohort study.

BACKGROUND: Satellitosis or in-transit metastasis (S-ITM) has clinical outcomes comparable to node-positivity in cutaneous squamous cell carcinoma (cSCC). There is a need to stratify the risk groups. OBJECTIVE: To determine which prognostic factors of S-ITM confer an increased risk of relapse and cSCC-specific-death. METHODS: A retrospective, multicenter cohort study. Patients with cSCC developing S-ITM were included. Multivariate competing risk analysis evaluated which factors were associated with relapse and specific death. RESULTS: Of a total of 111 patients with cSCC and S-ITM, 86 patients were included for analysis. An S-ITM size of ≥20 mm, >5 S-ITM lesions, and a primary tumor deep invasion was associated with an increased cumulative incidence of relapse (subhazard ratio [SHR]: 2.89 [95% CI, 1.44-5.83; P = .003], 2.32 [95% CI, 1.13-4.77; P = .021], and 2.863 [95% CI, 1.25-6.55; P = .013]), respectively. Several >5 S-ITM lesions were also associated with an increased probability of specific death (SHR: 3.48 [95% CI, 1.18-10.2; P = .023]). LIMITATIONS: Retrospective study and heterogeneity of treatments. CONCLUSION: The size and the number of S-ITM lesions confer an increased risk of relapse and the number of S-ITM an increased risk of specific-death in patients with cSCC presenting with S-ITM. These results provide new prognostic information and can be considered in the staging guidelines.

Enhanced nitrogen and carbon removal in natural seawater by electrochemical enrichment in a bioelectrochemical reactor.

Municipal and industrial wastewater discharges in coastal and marine environments are of major concern due to their high carbon and nitrogen loads and the resulted phenomenon of eutrophication. Bioelectrochemical reactors (BERs) for simultaneous nitrogen and carbon removal have gained attention owing to their cost efficiency and versatility, as well as the possibility of electrochemical enrich specific groups. This study presented a scalable two-chamber BERs using graphite granules as electrode material. BERs were inoculated and operated for 37 days using natural seawater with high concentrations of ammonium and acetate. The BERs demonstrated a maximum current density of 0.9 A m-3 and removal rates of 7.5 mg NH4+-N L-1 d-1 and 99.5 mg L-1 d-1 for total organic carbon (TOC). Removals observed for NH4+-N and TOC were 96.2% and 68.7%, respectively. The results of nutrient removal (i.e., ammonium, nitrate, nitrite and TOC) and microbial characterization (i.e., next-generation sequencing of the 16S rRNA gene and fluorescence in situ hybridization) showed that BERs operated with a poised cathode at -260 mV (vs. Ag/AgCl) significantly enriched nitrifying microorganisms in the anode and denitrifying microorganisms and planctomycetes in the cathode. Interestingly, the electrochemical enrichment did not increase the total number of microorganisms in the formed biofilms but controlled their composition. Thus, this work shows the first successful attempt to electrochemically enrich marine nitrifying and denitrifying microorganisms and presents a technique to accelerate the start-up process of BERs to remove dissolved inorganic nitrogen and total organic carbon from seawater.

Microbial Electrochemical Technologies for Sustainable Nitrogen Removal in Marine and Coastal Environments.

For many years, the world's coastal marine ecosystems have received industrial waste with high nitrogen concentrations, generating the eutrophication of these ecosystems. Different physicochemical-biological technologies have been developed to remove the nitrogen present in wastewater. However, conventional technologies have high operating costs and excessive production of brines or sludge which compromise the sustainability of the treatment. Microbial electrochemical technologies (METs) have begun to gain attention due to their cost-efficiency in removing nitrogen and organic matter using the metabolic capacity of microorganisms. This article combines a critical review of the environmental problems associated with the discharge of the excess nitrogen and the biological processes involved in its biogeochemical cycle; with a comparative analysis of conventional treatment technologies and METs especially designed for nitrogen removal. Finally, current METs limitations and perspectives as a sustainable nitrogen treatment alternative and efficient microbial enrichment techniques are included.

Contextual, Client-Centred Coaching Following a Workshop: Assistants Capacity Building in Special Education.

Assistants serve an essential role in special education to support children with disabilities, but they should be properly trained and supervised. The coaching approach represents one trend that has been gradually implemented in occupational therapy (OT) and rehabilitation services. Still, few studies clearly define the coaching intervention, measure the fidelity of coaching practices, or evaluate capacity building of the caregivers in the long term. This quasi-experimental study compared one-on-one coaching in natural environments following a workshop with a training workshop. Both public schools do not have regular OT services. The primary outcome was the assistant's performance, measured with the Goal Attainment Scaling (GAS). The secondary outcome was the fidelity of coaching implementation, measured with the Coaching Practices Rating Scale (CPRS). The GAS showed an increased performance of the assistants after the intervention, with significant differences between groups post-intervention (p = 0.015) and large effect size (r = 0.55), but no long-term significant improvements were found at the follow-up (p = 0.072). The CPRS showed an adequate implementation of the five coaching components (joint planning, observation, action, reflection, and feedback), with a total score of 3.5 ± 0.72 (mean ± SD). The results suggest that coaching sessions provided by OTs in schools may improve assistants' skills to facilitate the student's participation.

Electrochemical Bacterial Enrichment from Natural Seawater and Its Implications in Biocorrosion of Stainless-Steel Electrodes.

Microbial electrochemical technologies have revealed the opportunity of electrochemical enrichment for specific bacterial groups that are able to catalyze reactions of interest. However, there are unsolved challenges towards their application under aggressive environmental conditions, such as in the sea. This study demonstrates the impact of surface electrochemical potential on community composition and its corrosivity. Electrochemical bacterial enrichment was successfully carried out in natural seawater without nutrient amendments. Experiments were carried out for ten days of exposure in a closed-flow system over 316L stainless steel electrodes under three different poised potentials (-150 mV, +100 mV, and +310 mV vs. Ag/AgCl). Weight loss and atomic force microscopy showed a significant difference in corrosion when +310 mV (vs. Ag/AgCl) was applied in comparison to that produced under the other tested potentials (and an unpoised control). Bacterial community analysis conducted using 16S rRNA gene profiles showed that poised potentials are more positive as +310 mV (vs. Ag/AgCl) resulted in strong enrichment for Rhodobacteraceae and Sulfitobacter. Hence, even though significant enrichment of the known electrochemically active bacteria from the Rhodobacteraceae family was accomplished, the resultant bacterial community could accelerate pitting corrosion in 316 L stainless steel, thereby compromising the durability of the electrodes and the microbial electrochemical technologies.

Cutaneous presentation of chronic lymphocytic leukemia as unique extramedullar involvement in a patient with normal peripheral blood lymphocyte count (monoclonal B-cell lymphocytosis).

Skin infiltration by chronic lymphocytic leukemia (CLL) is very rare and almost all reported cases occur in advanced stage. We report a patient with no relevant past medical history who presented with cutaneous erythematous plaques. A punch biopsy showed typical CLL morphologic and immunophenotypic features. Subsequent studies revealed a normal lymphocyte count in peripheral blood, and there was no evidence of lymphadenopathy or organomegaly. Flow cytometry demonstrated a clonal B-cell population both in the bone marrow and peripheral blood (1.60 × 10(9)/l) with a CLL phenotype, but it did not fulfill required criteria for CLL diagnosis. Without cutaneous involvement, this case should be classified as monoclonal B-cell lymphocytosis.

Effects of narrowband UV-B on pharmacodynamic markers of response to therapy: an immunohistochemical study over sequential samples.

BACKGROUND: To evaluate the effects of narrow-band UV-B (NBUVB) on the immunohistochemical markers of cellular and cytokine activation as well as of abnormal epidermal differentiation and proliferation--pharmacodynamic markers of response to therapy (PMT)--in psoriatic lesions. METHODS: Clinical assessments and immunohistological staining of formalin-fixed paraffin sections of biopsies from psoriatic skin were done at baseline and at the end of the treatment period. RESULTS: Ten patients with chronic plaque-type psoriasis were included. After treatment with NBUVB, the total number of CD3+, CD4+ and CD8+ T cells was reduced by an average of 86.6%, 86% and 85% in the epidermis and 70.3%, 70% and 62% in the dermis, respectively. Only the decrease in the number of epidermal CD4+ cells was statistically related with long-lasting remissions. The mean reduction in the expression of keratinocyte proliferation markers after NBUVB was 62%, 68% and 81% for Ki-67, cyclin A and cyclin B, respectively. Expression of suprabasal keratin 16 and filaggrin was almost normalized in most cases. All patients in whom expression of keratin16 remained after finishing UV-B therapy had an early relapse. CONCLUSIONS: NBUVB is associated with changes in PMT close to those seen after remittive therapies. The normalization of immunohistochemical parameters of differentiation and the reduction/depletion in epidermal CD4+ cells was the most important markers of long-lasting remissions.