Functional outcomes in children related to self-care, mobility, and social function after stroke in early childhood: a cohort study.

BACKGROUND: Stroke has been increasingly recognized as an important morbidity and mortality factor in neonates and children. Children have different and more diverse risk factors than adults, commonly related to an underlying disease. Stroke may compromise functional capacity in children. Few studies have focused on functional outcomes related to activities and participation. OBJECTIVES: To investigate post-stroke functionality of children related to self-care, mobility, and social function. METHODS: We assessed the functional outcome of 14 children younger than 7.5 years who suffered a stroke in early childhood through the use of the Pediatric Evaluation of Disability Inventory (PEDI). RESULTS: The average age of the sample at assessment was 3.6 ± 1.4 years (2 - 6 years). The average scores in the PEDI functional domains of self-care, mobility, and social function were, respectively, 37.6 ± 15.4, 36.2 ± 15.4, and 48.7 ± 11.1. Children showed age-appropriate functional outcomes in the PEDI functional domains: 71.4% of them in self-care and mobility and 92.9% in social function. Children with bilateral injuries (p = 0.05) and longer hospital stays (r = -0.79, p = 0.001) showed the worst scores in ​​PEDI's social function domains. CONCLUSIONS: Overall, our sample of preschool children showed age-appropriate functional outcomes on self-care, mobility, and social function domains after stroke. However, children with bilateral injuries and longer hospital stays showed the worst scores in social function domains. We recommend focusing on functional rehabilitation to promote activities and participation and to monitor the development of children's social skills after stroke.

Functional outcomes in children related to self-care, mobility, and social function after stroke in early childhood: a cohort study / Evolução funcional de crianças em autocuidado, mobilidade e função social após acidente vascular cerebral na primeira infância: um estudo coorte

ABSTRACT Background: Stroke has been increasingly recognized as an important morbidity and mortality factor in neonates and children. Children have different and more diverse risk factors than adults, commonly related to an underlying disease. Stroke may compromise functional capacity in children. Few studies have focused on functional outcomes related to activities and participation. Objectives: To investigate post-stroke functionality of children related to self-care, mobility, and social function. Methods: We assessed the functional outcome of 14 children younger than 7.5 years who suffered a stroke in early childhood through the use of the Pediatric Evaluation of Disability Inventory (PEDI). Results: The average age of the sample at assessment was 3.6 ± 1.4 years (2 - 6 years). The average scores in the PEDI functional domains of self-care, mobility, and social function were, respectively, 37.6 ± 15.4, 36.2 ± 15.4, and 48.7 ± 11.1. Children showed age-appropriate functional outcomes in the PEDI functional domains: 71.4% of them in self-care and mobility and 92.9% in social function. Children with bilateral injuries (p = 0.05) and longer hospital stays (r = -0.79, p = 0.001) showed the worst scores in ​​PEDI's social function domains. Conclusions: Overall, our sample of preschool children showed age-appropriate functional outcomes on self-care, mobility, and social function domains after stroke. However, children with bilateral injuries and longer hospital stays showed the worst scores in social function domains. We recommend focusing on functional rehabilitation to promote activities and participation and to monitor the development of children's social skills after stroke.

RESUMO Antecedentes: O acidente vascular cerebral (AVC) tem sido reconhecido como um importante fator de morbimortalidade em neonatos e crianças. As crianças têm fatores de risco diferentes e mais variados que os adultos, comumente relacionados a uma doença subjacente. A funcionalidade das crianças pode estar comprometida após um AVC. Poucos estudos focaram em desfechos funcionais relacionados à atividade e participação. Objetivos: Investigar a funcionalidade de crianças com AVC, relacionada à autocuidado, mobilidade e função social. Métodos: Avaliamos a evolução funcional de 14 crianças com idade menor que 7,5 anos com AVC na primeira infância pela aplicação do PEDI. Resultados: A idade média de nossa amostra na avaliação foi de 3,6 ± 1,4 anos (2 - 6 anos). O escore médio nos domínios de autocuidado, mobilidade e função social do PEDI foram, respectivamente, 37,6 ± 15,4, 36,2 ± 15,4 e 48,7 ± 11,1. As crianças apresentaram evolução adequada para a idade nos domínios do PEDI: 71,4% delas em autocuidado e mobilidade e 92,9% em função social. Piores escores no domínio função social se relacionaram com lesões bilaterais (p = 0,05) e maior tempo de internação (r = -0,79; p = 0,001). Conclusões: Nossa amostra de crianças em idade pré-escolar mostrou, em geral, evolução funcional adequada para a faixa etária nos domínios de autocuidado, mobilidade e função social. Porém, lesões bilaterais e internações hospitalares mais longas se relacionaram com piores performances no domínio função social. Sugerimos focar na reabilitação funcional e acompanhar o desenvolvimento das habilidades sociais de crianças pós-AVC.

SN2 versus E2 Competition of F- and PH2- Revisited.

We have quantum chemically analyzed the competition between the bimolecular nucleophilic substitution (SN2) and base-induced elimination (E2) pathways for F- + CH3CH2Cl and PH2- + CH3CH2Cl using the activation strain model and Kohn-Sham molecular orbital theory at ZORA-OLYP/QZ4P. Herein, we correct an earlier study that intuitively attributed the mechanistic preferences of F- and PH2-, i.e., E2 and SN2, respectively, to a supposedly unfavorable shift in the polarity of the abstracted ß-proton along the PH2--induced E2 pathway while claiming that ″...no correlation between the thermodynamic basicity and E2 rate should be expected.″ Our analyses, however, unequivocally show that it is simply the 6 kcal mol-1 higher proton affinity of F- that enables this base to engage in a more stabilizing orbital interaction with CH3CH2Cl and hence to preferentially react via the E2 pathway, despite the higher characteristic distortivity (more destabilizing activation strain) associated with this pathway. On the other hand, the less basic PH2- has a weaker stabilizing interaction with CH3CH2Cl and is, therefore, unable to overcome the characteristic distortivity of the E2 pathway. Therefore, the mechanistic preference of PH2- is steered to the SN2 reaction channel (less-destabilizing activation strain).

Conformational preferences of fluorine-containing agrochemicals and their implications for lipophilicity prediction.

Molecular polarity governs lipophilicity, which in turn determines important agrochemical and environmental properties, such as soil sorption and bioconcentration of organic compounds. Since the C-F bond is the most polar in organic chemistry, the orientation of fluorine substituents originating from the rotation around C-C(F) bonds should affect the polarity and, consequently, the physicochemical and biological properties of fluorine-containing agrochemicals. Accordingly, this study aims to determine the most likely conformers of some fluorine-containing agrochemicals and to correlate their molecular dipole moments with the respective n-octanol/water partition coefficients (log P), in order to investigate the dependence of the lipophilicity with the molecular conformation.

Molecular Modelling of Potential Candidates for the Treatment of Depression.

A lot of research initiatives in the last decades have been focused on the search of new strategies to treat depression. However, despite the availability of various antidepressants, current treatment is still far from ideal. Unwanted side effects, modest response rates and the slow onset of action are the main shortcomings. As a strategy to improve symptomatic relief and response rates, the dual modulation of the serotonin transporter and the histamine H3 receptor by a single chemical entity has been proposed in the literature. Accordingly, this work aims to elucidate key structural features responsible for the dual inhibitory activity of the hexahydro-pyrrolo-isoquinoline derivatives. For this purpose, two approaches were employed, four-dimensional quantitative structure-activity relationship (4D-QSAR) and molecular docking. The 4D-QSAR models for both receptors allowed the identification of the pharmacophore groups critical for the modelled biological activity, whereas the binding mode of this class of compounds to the human serotonin transporter was assessed by molecular docking. The findings can be applicable to design new antidepressants.

Asymmetric biodegradation of the nerve agents Sarin and VX by human dUTPase: chemometrics, molecular docking and hybrid QM/MM calculations.

Organophosphorus compounds (OP) nerve agents are among the most toxic chemical substances known. Their toxicity is due to their ability to bind to acetylcholinesterase. Currently, some enzymes, such as phosphotriesterase, human serum paraoxonase 1 and diisopropyl fluorophosphatase, capable of degrading OP, have been characterized. Regarding the importance of bioremediation methods for detoxication of OP, this work aims to study the interaction modes between the human human deoxyuridine triphosphate nucleotidohydrolase (dUTPase) and Sarin and VX, considering their Rp and Sp enantiomers, to evaluate the asymmetric catalysis of those compounds. In previous work, this enzyme has shown good potential to degrade phosphotriesters, and based on this characteristic, we have applied the human dUTPase to the OP degradation. Molecular docking, chemometrics and mixed quantum and molecular mechanics calculations have been employed, showing a good interaction between dUTPase and OP. Two possible reaction mechanisms were tested, and according to our theoretical results, the catalytic degradation of OP by dUTPase can take place via both mechanisms, beyond being stereoselective, that is, dUTPase cleaves one enantiomer preferentially in relation to other. Chemometric techniques provided excellent assistance for performing this theoretical investigation. The dUTPase study shows importance by the fact of it being a human enzyme. Communicated by Ramaswamy H. Sarma.

Should Live Patient Licensing Examinations in Dentistry Be Discontinued? Two Viewpoints: Viewpoint 1: Alternative Assessment Models Are Not Yet Viable Replacements for Live Patients in Clinical Licensure Exams and Viewpoint 2: Ethical and Patient Care Concerns About Live Patient Exams Require Full Acceptance of Justifiable Alternatives.

This Point/Counterpoint article addresses a long-standing but still-unresolved debate on the advantages and disadvantages of using live patients in dental licensure exams. Two contrasting viewpoints are presented. Viewpoint 1 supports the traditional use of live patients, arguing that other assessment models have not yet been demonstrated to be viable alternatives to the actual treatment of patients in the clinical licensure process. This viewpoint also contends that the use of live patients and inherent variances in live patient treatment represent the realities of daily private practice. Viewpoint 2 argues that the use of live patients in licensure exams needs to be discontinued considering those exams' ethical dilemmas of exposing patients to potential harm, as well as their lack of reliability and validity and limited scope. According to this viewpoint, the current presence of viable alternatives means that the risk of harm inherent in live patient exams can finally be eliminated and those exams replaced with other means to confirm that candidates are qualified for licensure to practice.

Projeto Jovem Doutor: o aprendizado prático de estudantes de medicina por meio de atividade socioeducativa / Young Doctor Project-Health in Schools: potential learning of medical students through taking part in socio-educational activity

O trabalho mostra a potencialização no aprendizado de estudantes de medicina (graduandos) através de participação em atividade sócio-educacional (Projeto Jovem Doutor-Saúde nas Escolas - PJD) usando recursos de educação interativa, vídeos, computação gráfica 3D e estruturas produzidas por impressora 3D (Homem Virtual). O PJD usou educação híbrida, reunindo plataforma educacional, ferramentas de mídias sociais, webconferências e objetos educacionais de aprendizagem com dinâmicas presenciais na estruturação de sistemática que proporcionou aprendizado flexível e em serviço, agregando experiências e conhecimentos complementares aos graduandos participantes do projeto. Baseado em conteúdos que seguiam as prioridades do Ministério da Saúde do Brasil, os graduandos puderam conhecer aspectos da Atenção Primária, desenvolver várias atitudes e aprender conhecimentos não previstos na grade curricular médica normal. Por meio de responsabilidades atribuídas a cada um, os graduandos desenvolveram postura ativa para aprender os assuntos de forma contextualizada (pesquisa de temas, debate com professores e profissionais especialistas). Ao final do projeto, 81,9% (8 de 11) graduandos do PJD responderam que tiveram uma formação crítica, reflexiva e maior habilidade em comunicação. Todos (100%), consideraram ter ampliado a capacidade de trabalho em equipe e conhecimentos em novas tecnologias. A interação dos graduandos com professores das escolas onde foram implantados o PJD levou-os a se tornarem "símbolos" para alunos do ensino fundamental II, promoveu a percepção dos futuros médicos sobre o seu papel no contexto social da saúde e estimulou a formação de vínculo social com alunos do ensino fundamental II. O aprendizado em serviço, através de uma ação sócio-educacional, sob orientação de professores e profissionais especialistas, é uma boa forma de estimular o aprendizado dos alunos de medicina e está em conformidade com as diretrizes de 2014 do CNE/MEC para graduação em Medicina.

This article presents the learning potentiation of medical students (undergraduates) through participation in socio-educational activity (Young Doctor Project-Health in Schools -YDP), using interactive educational resources, videos, 3D computer graphics and by 3D printer produced structures (Virtual Man). The YDP used hybrid education, bringing together educational platform, social media tools, web conferencing and educational learning objects with dynamic presence in the system structuring that provided flexible learning and in service, gathering experience and complementary expertise to the participants. Based on content that followed the priorities of the Ministry of Health of Brazil, the graduate students were able to learn aspects of primary care, develop various attitudes and acquire knowledge not covered by conventional medical curriculum. By being assigned to specific responsibilities, students developed active approach to learning the subjects in context (subjects research, discussion with teachers and professional experts). At the end of the project, 81.9% (8 of 11) of the YDP academics said that they had a critical training, reflective and greater communication skills. All (100%), considered to have expanded the ability to work in teams and knowledge in new technologies. The interaction of the undergraduate with teachers from cities where the YDP were implemented led them to become "symbols" for middle school, promoted the perception of future doctors about their role in the social context of health and stimulated the formation of social bond with middle school. Learning in service, through a socio-educational action, under the guidance of teachers and professional experts is a good way to encourage the learning of medical students and complies with the guidelines of 2014 CNE / MEC for undergraduates in medicine.

QSAR Models Guided by Molecular Dynamics Applied to Human Glucokinase Activators.

In this study, quantitative structure-activity relationship studies which make use of molecular dynamics trajectories were performed on a set of 54 glucokinase protein activators. The conformations obtained by molecular dynamics simulation were superimposed according to the twelve alignments tested in a virtual three-dimensional box comprised of 2 Å cells. The models were generated by the technique that combines genetic algorithms and partial least squares. The best alignment models generated with a determination coefficient (r(2)) between 0.674 and 0.743 and cross-validation (q(2)) between 0.509 and 0.610, indicating good predictive capacity. The 4D-QSAR models developed in this study suggest novel molecular regions to be explored in the search for better glucokinase activators.

Creating a new generation of pediatric dentists: a paradigm shift in training.

The University of California, Los Angeles (UCLA) School of Dentistry has implemented a Health Resources and Services Administration-funded program to prepare dentists for the complex and comprehensive needs of pediatric patients within rapidly changing demographics and a paradigm shift in dentistry. Traditional dental education has focused on how to respond to oral disease, whereas UCLA's program shifts the paradigm to emphasize early assessment, risk-based prevention, and disease management. A holistic approach to dental care that considers social and environmental determinants is used with minimally invasive techniques for restorative care. To support this change, pediatric dental residents receive traditional training combined with new didactics, advocacy opportunities, and applied learning experiences at community-based organizations. These new elements teach residents to recognize the causal factors of disease and to identify interventions that promote oral health at the individual, family, community, and policy level. Consequently, they are better prepared to treat a diverse group of patients who historically have faced the greatest burden of disease as well as an increased number of barriers to accessing oral health care; these consist of low-income, minority, and/or pediatric populations including children with special health needs. The program's ultimate goal is for residents to deploy these skills in treating vulnerable populations and to demonstrate greater interest in collaborating with non-dental health providers and community organizations to increase access to dental services in private or public health practice settings.

Como estudantes compreendem uma reação química? Concepções sobre um processo de combustão / How do students understand a chemical reaction? Conceptions of a combustion process

O presente trabalho tem por objetivo conhecer as concepções de estudantes ingressantes no ensino médio a respeito de conceitos fundamentais que caracterizam as transformações químicas. Trata-se de um estudo de caso, em que dezessete estudantes de uma instituição pública de ensino propuseram explicações para um problema sobre um processo de combustão. As respostas por eles elaboradas foram categorizadas por meio da análise de conteúdo. Foi evidenciado que os estudantes utilizam distintos modelos para interpretar o que acontece durante uma reação química e que, na maioria das situações, esses modelos constituem obstáculos para a aprendizagem dos conceitos que são objeto de estudo da química. Embora indiquem a não conservação das substâncias como critério para justificar a ocorrência de uma reação química, a não conservação da matéria e da massa estão presentes nas ideias de transmutação, desaparecimento, substituição, entre outras. Além disso, foram explicitadas confusões conceituais no emprego da linguagem científica e na representação da combustão (desenho), de modo que, ressalta-se a importância dos resultados evidenciados nesta investigação para a proposição de ações que busquem qualificar o ensino e da aprendizagem da química na educação básica (AU)

This paper aims understanding students’ conceptions of fundamental concepts that characterize the chemical transformations. Thisis a case study in which seventeen students of the first year in a public high school proposed explanations for a problem about a combustion process. The answers given were categorized by means of content analysis. It was evident thatstudents use different models to interpret what happens during a chemical reaction and that, in most situations, these models constitute barriers that prevent students from learning the concepts that are the object of study of chemistry. Althoughthey mention the loss of substance as a criterion to justify the occurrence of a chemical reaction, the notion of mass and matter loss is present in the ideas of transmutation, disappearance and replacement, among others. Furthermore, conceptual misunderstandings were explicitin the use of scientific language and in the representation of combustion (drawings), so that the study emphasizes the relevance of the results found in this research to propose actions that seek to qualify the teaching and learning processes of chemistry in basic education (AU)

Como estudantes compreendem uma reação química? Concepções sobre um processo de combustão / How do students understand a chemical reaction? Conceptions of a combustion process

O presente trabalho tem por objetivo conhecer as concepções de estudantes ingressantes no ensino médio a respeito de conceitos fundamentais que caracterizam as transformações químicas. Trata-se de um estudo de caso, em que dezessete estudantes de uma instituição pública de ensino propuseram explicações para um problema sobre um processo de combustão. As respostas por eles elaboradas foram categorizadas por meio da análise de conteúdo. Foi evidenciado que os estudantes utilizam distintos modelos para interpretar o que acontece durante uma reação química e que, na maioria das situações, esses modelos constituem obstáculos para a aprendizagem dos conceitos que são objeto de estudo da química. Embora indiquem a não conservação das substâncias como critério para justificar a ocorrência de uma reação química, a não conservação da matéria e da massa estão presentes nas ideias de transmutação, desaparecimento, substituição, entre outras. Além disso, foram explicitadas confusões conceituais no emprego da linguagem científica e na representação da combustão (desenho), de modo que, ressalta-se a importância dos resultados evidenciados nesta investigação para a proposição de ações que busquem qualificar o ensino e da aprendizagem da química na educação básica

This paper aims understanding students' conceptions of fundamental concepts that characterize the chemical transformations. Thisis a case study in which seventeen students of the first year in a public high school proposed explanations for a problem about a combustion process. The answers given were categorized by means of content analysis. It was evident thatstudents use different models to interpret what happens during a chemical reaction and that, in most situations, these models constitute barriers that prevent students from learning the concepts that are the object of study of chemistry. Althoughthey mention the loss of substance as a criterion to justify the occurrence of a chemical reaction, the notion of mass and matter loss is present in the ideas of transmutation, disappearance and replacement, among others. Furthermore, conceptual misunderstandings were explicitin the use of scientific language and in the representation of combustion (drawings), so that the study emphasizes the relevance of the results found in this research to propose actions that seek to qualify the teaching and learning processes of chemistry in basic education

Self-injurious behavior as a challenge for the dental practice: a case report.

Patients who present self-injurious behavior (SIB) can be considered a treatment challenge in the dental office or hospital setting. Oral structures can play various roles in the process of self injury. In this paper, the authors report a case of SIB in the form of cheek-biting on an adolescent with a history of hydrocephalus and developmental delay, which was successfully treated with a modified standard maxillary orthodontic retainer. Early detection and intervention in SIB cases in patients with developmental disabilities influence the successful outcome of the therapeutic interventions, enhancing the patient's quality of life.