Ideational Praxis, Play, and Playfulness: A Cross-Sectional Study of Autistic Children.

IMPORTANCE: Assessment of praxis skills is an essential aspect of understanding autistic children's development of play and playfulness. OBJECTIVE: To assess the relationship and influence of ideational praxis skills on play skills and playfulness among autistic children. DESIGN: A cross-sectional study. SETTINGS: Homes, schools, and early care centers across Spain. PARTICIPANTS: Children ages 4 yr 6 mo to 6 yr 11 mo (45 typically developing [TP] and 45 with autism spectrum disorder [ASD]). OUTCOMES AND MEASURES: Student's t tests were used to compare means between the two groups. Pearson's correlation and multiple linear regression were used to determine possible effects of ideational skills on play and playfulness. RESULTS: Scores for the TP group were significantly higher than those of the ASD group on all play dimensions-space management, t(88) = 4.58; material management, t(88) = 5.86; pretense-symbolism, t(88) = 8.12; and participation, t(88) = 7.31-and on the Test of Playfulness (ToP), t(88) = 10.18, and Test of Ideational Praxis (TIP), t(88) = 4.38 (all ps < .001). Multiple linear regression revealed a statistically significant effect of TIP dimensions-space management, F(3, 41) = 4.83, p < .042; material management, F(3.41) = 8.49. p < .001; pretense-symbolism, F(3, 41) = 5.66. p < .002; and participation, F(3.41) = 7.81. p < .001-and on the ToP, F(3, 41) = 5.96. p < .002. CONCLUSIONS AND RELEVANCE: Ideational praxis skills combined with diagnostic information significantly predicted play skills and playfulness, highlighting the influence of ideation on play. Plain-Language Summary: This article provides data supporting the influence of ideational praxis skills on the play skills and playfulness of autistic children. Understanding how ideational praxis skills affect the ability to recognize and act on object affordances might promote greater possibilities for play interactions among autistic children.

Controlled trial of balance training using a video game console in community-dwelling older adults.

BACKGROUND: gamification is a potentially attractive option for improving balance and reducing falls. OBJECTIVES: to assess the effect of balance training using the NintendoTM Wii game console on balance (primary outcome), falls and fear of falling. DESIGN: quasi-randomised, open-label, controlled clinical trial in parallel groups, carried out on community-dwelling patients over 70 years, able to walk independently. Participants were assigned 1:1 to the intervention or control group. Balance training was conducted using the Nintendo WiiFitTM twice a week for 3 months. Balance was assessed using the Tinetti balance test (primary outcome), the unipedal stance and the Wii balance tests at baseline, 3 months and 1 year. Falls were recorded and Fear of falling was assessed by the Falls Efficacy Scale (Short-FES-I). RESULTS: 1,016 subjects were recruited (508 in both the intervention and the control group; of whom 274 and 356 respectively completed the 3-month assessment). There was no between-group difference in the Tinetti balance test score, with a baseline mean of 14.7 (SD 1.8) in both groups, and 15.2 (1.3) at 3 months in the intervention group compared to 15.3 (1.7) in controls; the between-group difference was 0.06 (95% CI 0.30-0.41). No differences were seen in any of the other balance tests, or in incident falls. There was a reduction in the fear of falling at 3 months, but no effect at 1 year. CONCLUSIONS: the study found no effect of balance training using the NintendoTM Wii on balance or falls in older community-dwelling patients.The study protocol is available at clinicaltrials.gov under the code NCT02570178.

Austerity Policies and Mortality in Spain After the Financial Crisis of 2008.

OBJECTIVES: To analyze mortality in Spain and the United States before and after these countries implemented divergent policies in response to the financial crisis of 2008. METHODS: We examined mortality statistics in both countries in the years 2000 to 2015. Spain started austerity policies in 2010. We compared differences in mortality ratios, on the basis of trends and effect size analysis. RESULTS: During 2000 to 2010, overall mortality rates (r = 0.98; P < .001; Cohen's d = -0.228) decreased in both countries. In 2011, this trend changed abruptly in Spain, where observed mortality surpassed expected mortality by 29% in 2011 and by 41% in 2015. By contrast, observed mortality surpassed expected mortality in the United States by only 8% in 2015. As the mortality statistics diverged, the effect size greatly increased (d = 7.531). During this 5-year period, there were 505 559 more deaths in Spain than the expected number, while in the United States the difference was 431 501 more deaths despite the 7-fold larger population in the United States compared with Spain. CONCLUSIONS: The marked excess mortality in 2011 to 2015 in Spain is attributable to austerity policies.

[Application of the Smoking Scale for Primary Care (ETAP) in clinical practice]. / Aplicación de la Escala de Tabaquismo para Atención Primaria (ETAP) en la práctica clínica.

OBJECTIVE: To determine if the ETAP smoking scale, which measures accumulated exposure to tobacco, both actively and passively, is applicable and effective in the clinical practice of Primary Care for the prevention of acute myocardial infarction (AMI). Location Barranco Grande Health Centre in Tenerife, Spain. DESIGN: A study of 61 cases (AMI) and 144 controls. Sampling with random start, without matching. COR-II curves were analysed, and effectiveness was estimated using sensitivity and negative predictive value (NPV). A questionnaire was provided to participating family physicians on the applicability of ETAP in the clinic. RESULTS: The opinion of the participating physicians was unanimously favourable. ETAP was easy to use in the clinic, required less than 3min per patient, and was useful to reinforce the preventive intervention. The ETAP COR-II curve showed that 20years of exposure was the best cut-off point, with an area under the curve of 0.70 (95%CI: 0.62-0.78), and a combination of sensitivity (98%) and NPV (96%) for AMI. When stratifying age and gender, all groups achieved sensitivities and NPVs close to 100%, except for men aged ≥55years, in whom the NPV fell to 75%. CONCLUSIONS: The results indicate that ETAP is a valid tool that can be applied and be effective in the clinical practice of Primary Care for the prevention of AMI related to smoking exposure.

Study protocol of a randomized clinical trial evaluating the effectiveness of a primary care intervention using the Nintendo™ Wii console to improve balance and decrease falls in the elderly.

BACKGROUND: Balance alteration is a risk factor for falls in elderly individuals that has physical, psychological and economic consequences. The objectives of this study are to evaluate the usefulness of an intervention utilizing the Nintendo™ Wii console in order to improve balance, thereby decreasing both the fear of falling as well as the number of falls, and to evaluate the correlation between balance as determined by the console and the value obtained in the Tinetti tests and the one foot stationary test. METHODS/DESIGN: This is a controlled, randomized clinical trial of individual assignment, carried out on patients over 70 years in age, from five primary care centers in the city of Mataró (Barcelona). 380 patients were necessary for the intervention group that carried out the balance board exercises in 2 sessions per week for a 3 month period, and 380 patients in the control group who carried out their usual habits. Balance was evaluated using the Tinetti test, the one foot stationary test and with the console, at the start of the study, at the end of the intervention (3 months) and one year later. Quarterly telephone follow-up was also conducted to keep track of falls and their consequences. DISCUSSION: The study aimed to connect the community with a technology that may be an easy and fun way to assist the elderly in improving their balance without the need to leave home or join rehabilitation groups, offering greater comfort for this population and decreasing healthcare costs since there is no need for specialized personnel. TRIAL REGISTRATION: Current Control Trial NCT02570178.

Current approach to skin and soft tissue infections. Thinking about continuity of care.

Skin and soft tissue infections are a common reason for patients seeking inpatient and outpatient medical care. Surgery is an essential part of managing in many episodes. Careful evaluation of antibiotic therapy could help clinicians in early identification to patients with treatment failure and to consider an alternative approach or a new surgical revision in "focus control". With the arrival of new drugs, there is a need to refine the appropriate drug's decision-making. Drugs with a long half-life (long-acting lipoglycopeptides such as dalbavancin or oritavancin), which allows weekly administration (or even greater), can reduce hospital admission and length of stay with fewer healthcare resources through outpatient management (home hospitalization or day hospitals). New anionic fluoroquinolones (e.g. delafloxacin), highly active in an acidic medium and with the possibility of switch from the intravenous to the oral route, will also make it possible to achieve these new healthcare goals and promote continuity of care. Therefore, management should rely on a collaborative multidisciplinary group with experience in this infectious syndrome.

Prospective One-Year Follow-Up of Sensory Processing in Phelan-McDermid Syndrome.

BACKGROUND: Phelan-McDermid syndrome (PMS) is caused by the loss (deletion) of a small portion of chromosome 22 in a region designated q13.3 (22q13.3 deletion). PMS is one of the most common genetic forms of autism spectrum disorder (ASD) in which sensory reactivity difficulties have been described on limited occasions. METHODS: The objective of this study is to identify whether changes in sensory reactivity skills occur after one year of follow-up in a group of 44 participants diagnosed with PMS. All participants completed the Short Sensory Profile (SSP). Two-factor ANOVA tests were performed with repeated measures for the study of the evolution of the scores. RESULTS: Participants with PMS showed significant changes after one year of follow-up in sensory reactivity skills associated with tactile hyperreactivity (p = 0.003). The rest of the study variables did not show significant differences compared to the baseline assessment, showing definite differences associated with patterns of hypo-responsiveness and sensory seeking, low/weak energy, and difficulties in auditory filtering. CONCLUSIONS: Understanding the evolution of sensory reactivity skills can facilitate the adjustment to behavioral changes in people with PMS and design-targeted interventions to address sensory reactivity challenges.

The Impact of Social Distancing Due to COVID-19 on Activities of Daily Living in Parkinson's Disease.

INTRODUCTION: To explore the impact of the lockdown and social distancing measures, applied for one year, due to the COVID-19 pandemic on Activities of Daily Living in patients with Parkinson's disease, as well as to determine the association between daily performance and tasks requiring more manipulative dexterity. METHODS: Data collection was carried out between 18 January and 22 March 2021 through telephone interviews. Patients were recruited from associations of patients with Parkinson's disease in Spain. A questionnaire was designed including items from standardized tools of the Activities of Daily Living Questionnaire to measure the level of independence and from the Dexterity Questionnaire for manipulative dexterity. RESULTS: There were 126 participants aged 36-89 years, 58% of whom were male. The results of our study reveal a significant decline in almost all the ADLs assessed. There is a moderate correlation between the degree of dependence in ADLs and the difficulty in performing activities requiring manipulative dexterity. CONCLUSIONS: Social isolation related to the COVID-19 pandemic and its consequences may have contributed to an increase in the deterioration of manipulative ability, leading to a loss of ability to perform ADLs. These results show specific needs to be considered in the rehabilitation treatment of these patients.

Preparation and structural characterization of vulcanized natural rubber nanocomposites containing nickel-zinc ferrite nanopowders.

Single-phase polycrystalline mixed nickel-zinc ferrites belonging to Ni0.5Zn0.5Fe2O4 were prepared on a nanometric scale (mean crystallite size equal to 14.7 nm) by chemical synthesis named the modified poliol method. Ferrite nanopowder was then incorporated into a natural rubber matrix producing nanocomposites. The samples were investigated by means of infrared spectroscopy, X-ray diffraction, scanning electron microscopy and magnetic measurements. The obtained results suggest that the base concentration of nickel-zinc ferrite nanoparticles inside the polymer matrix volume greatly influences the magnetic properties of nanocomposites. A small quantity of nanoparticles, less than 10 phr, in the nanocomposite is sufficient to produce a small alteration in the semi-crystallinity of nanocomposites observed by X-ray diffraction analysis and it produces a flexible magnetic composite material with a saturation magnetization, a coercivity field and an initial magnetic permeability equal to 3.08 emu/g, 99.22 Oe and 9.42 x 10(-5) respectively.

Screening for Chagas' disease in HIV-positive immigrants from endemic areas.

Chagas' disease is an opportunistic infection in the setting of HIV/AIDS. The arrival of HIV-positive immigrants from endemic areas to non-endemic countries makes possible the detection of Chagas' disease in this group of patients. We describe the results of a screening programme conducted in the HIV-positive immigrant population arriving from endemic areas who attended the Tropical Medicine Unit of Hospital Universitario Central of Asturias during 2008. We determined anti-T. cruzi antibodies in all HIV patients arriving from endemic areas who were followed up. The ID-Chagas antibody test was used as a screening assay. The positive cases were confirmed with ELISA, IFAT and PCR. We analysed 19 HIV-positive immigrants, of which two (10·5%) had a positive antibody test for Chagas' disease confirmed. PCR was positive in both cases. There was no difference between the co-infected and the non-co-infected patients with respect to race, place of birth and residence, CD4+ cell count, and HIV viral load count. Direct microscopic examination of blood was negative in both positive cases. The positive patients were a man from Bolivia and woman from Paraguay. The overlap of HIV and T. cruzi infection occurs not only in endemic areas but also in non-endemic areas of North America and Europe where the diagnosis may be even more difficult due to low diagnostic suspicion. The implementation of screening programmes in this population group is needed for the early diagnostic of Chagas' disease.

Parasitism by the endoparasitoid, Cotesia flavipes induces cellular immunosuppression and enhances susceptibility of the sugar cane borer, Diatraea saccharalis to Bacillus thuringiensis.

Cotesia flavipes Cameron (Hymenoptera: Braconidae), is a gregarious larval endoparasitoid of the sugarcane borer, Diatraea saccharalis Fabricius (Lepidoptera: Crambidae). The aim of this research was to analyze cellular immunosuppression of D. saccharalis parasitized by C. flavipes in terms of encapsulation, melanization, and hemocyte nodule formation. The encapsulation assay was done 1 and 6 days after parasitoid oviposition. In addition, the susceptibility of parasitized and nonparasitzed larvae to Bacillus thuringiensis HD 73 strain was assessed. 3, 12, and 24 h after bead injection; the percentages of encapsulation were significantly higher in unparasitized larvae compared to larvae parasitized 1 and 6 days after oviposition. Interestingly, there was a significant reduction in numbers of beads encapsulated at 1 day after oviposition compared to 6 days, and unparasitized larvae. The percentage of melanized beads decreased significantly in parasitized larvae compared to control. There was a reduction in the number of nodules in parasitized larvae compared to unparasitized controls. Larvae that were injected with polyndavirus 24 h before beads were injected showed significantly reduced encapsulation responses relative to control larvae. The D. saccharalis parasitized by C. flavipes exhibited higher susceptibility to B. thuringiensis. These results suggest that parasitization induced host immunosuppression, and the immunosuppression factors could impair the defense capacity against microbial pathogens--causing an increase in pathogen susceptibility.

Analysis of Milk Using a Portable Potentiometric Electronic Tongue Based on Five Polymeric Membrane Sensors.

A portable potentiometric electronic tongue (PE-tongue) was developed and applied to evaluate the quality of milk with different fat content (skimmed, semi-skimmed, and whole) and with different nutritional content (classic, calcium-enriched, lactose-free, folic acid-enriched, and enriched in sterols of vegetal origin). The system consisted of a simplified array of five sensors based on PVC membranes, coupled to a data logger. The five sensors were selected from a larger set of 20 sensors by applying the genetic algorithm (GA) to the responses to compounds usually found in milk including salts (KCl, CaCl2, and NaCl), sugars (lactose, glucose, and galactose), and organic acids (citric acid and lactic acid). Principal component analysis (PCA) and support vector machine (SVM) results indicated that the PE-tongue consisting of a five-electrode array could successfully discriminate and classify milk samples according to their nutritional content. The PE-tongue provided similar discrimination capability to that of a more complex system formed by a 20-sensor array. SVM regression models were used to predict the physicochemical parameters classically used in milk quality control (acidity, density, %proteins, %lactose, and %fat). The prediction results were excellent and similar to those obtained with a much more complex array consisting of 20 sensors. Moreover, the SVM method confirmed that spoilage of unsealed milk could be correctly identified with the simplified system and the increase in acidity could be accurately predicted. The results obtained demonstrate the possibility of using the simplified PE-tongue to predict milk quality and provide information on the chemical composition of milk using a simple and portable system.

Use of serology in a systematic screening programme for strongyloidiasis in an immigrant population.

OBJECTIVES: The aim of this cross-sectional study was to describe the results of a systematic serological screening programme for strongyloidiasis. METHODS: A prospective serological screening programme for strongyloidiasis was performed between 2009 and 2014 for all immigrant patients attending the Tropical Medicine Unit. Three formalin-ether concentrated stool samples and an ELISA for anti-Strongyloides stercoralis antibodies were used as screening tools. RESULTS: Of 659 patients screened, 79 (12%) were positive for S. stercoralis regardless of the diagnostic method used. The prevalence of infection was 42.9% in East African patients, 16.3% in Central African patients, 10.9% in those from South America, and 10% in the case of West Africa. Univariate analysis showed that infection by S. stercoralis was significantly more frequent in patients from Central Africa (p=0.026; OR 1.72, 95% CI 1.03-2.85) and East Africa (p<0.001; OR 5.88, 95% CI 1.75-19.32). Taking West Africa as the reference (as the area of lowest prevalence among the positive prevalence areas), the statistical analysis showed that the risk of infection was higher in East Africa (p=0.001; OR 6.750, 95% CI 2.127-21.423) and Central Africa (p=0.065; OR 1.747, 95% CI 0.965-3.163). CONCLUSIONS: Due to the potential complications of strongyloidiasis infection, we recommend that immigrant patients from developing countries be routinely screened for S. stercoralis, especially those from East Africa. A serological test is a highly appropriate screening tool.

First Record of Culex (Microculex) daumastocampa (Diptera: Culicidae) in Mexico, with Notes on Cx. rejector and Cx. imitator.

Culex (Microculex) daumastocampa Dyar & Knab was originally described by Dyar and Knab (Proc US Nat Mus 35:53-70, 1908) from larvae collected at axils of bromeliads in Port San Felipe, Panama. Culex daumastocampa is found in Colombia, Venezuela, Panama, Suriname, Costa Rica, Nicaragua, Guatemala, and Mexico, although its presence had not been reported suggesting its northernmost distribution. In Mexico, the subgenus Microculex had included Cx. rejector Dyar and Knab, and Cx. imitator Theobald. However, after that collection specimens were re-examined along with other specimens collected during 2016 in Chiapas (all specimens are available in the Culicidae Collection of the Universidad Autonoma Agraria Antonio Narro Unidad Laguna [UAAAN-UL], Mexico). Culex daumastocampa is now reported for the first time in Mexico, Cx. rejector for Chiapas, and Cx. imitator removed from the checklist of previous reports as to be present in Mexico.

Shorter telomeres in non-smoking patients with airflow limitation.

BACKGROUND: Cross-sectional and longitudinal studies describe shorter telomeres in patients with chronic obstructive pulmonary disease (COPD) compared to matched non-COPD controls, but the relationship is confounded by tobacco consumption. We hypothesized that telomere shortening would be similar between non-smoking and smoking individuals with airflow limitation and shorter than non-obstructed controls. METHODS: Telomere length (T/S) was measured by qPCR in blood leukocytes of 80 non-smoking patients and 80 age-matched smokers with airflow limitation. Forty non-smoker healthy individuals served as controls. Anthropometrics, lung function, previous and current comorbidities were recorded in all individuals. Relationship between telomere length and clinical and functional variables were explored in the three groups. RESULTS: Telomeres length was similar in non-smokers and smoker individuals with airflow limitation (T/S = 0.61 ±â€¯0.19 vs. 0.60 ±â€¯0.23, p > 0.05) respectively. Telomere length was significantly shorter in both groups compared to healthy controls (T/S 0.79 ±â€¯0.40; p = 0.01) independent from age and sex. No significant association was found between the telomere length and clinical or lung function parameters. CONCLUSIONS: Telomere shortening is associated with airflow limitation independent of smoking status. Weather premature ageing or biologically determined shorter telomeres are responsible for this finding remain to be determined.

Microhardness of starch based biomaterials in simulated physiological conditions.

In this work the variation of the surface mechanical properties of starch-based biomaterials with immersion time was followed using microhardness measurements. Two blends with very distinct water uptake capabilities, starch/cellulose acetate (SCA) and starch/poly(epsilon-caprolactone) (SPCL), were immersed in a phosphate buffer solution (PBS) at 37.5 degrees C for various times. The microhardness of the blends decreased significantly ( approximately 50% for SPCL and approximately 94% for SCA), within a time period of 30 days of immersion, reflecting the different hydrophilic character of the synthetic components of the blends. The dependence of microhardness on the applied loading time and load was also analysed and showed a power law dependency for SCA. Water uptake and weight loss measurements were performed for the same immersion times used in the microhardness experiments. The different swelling/degradation behaviour presented by the blends was related to the respective variation in microhardness. Moreover, complementary characterization of the mechanical properties of SCA and SPCL was accomplished by dynamic mechanical analysis (DMA) and creep measurements. Microhardness measurements proved to be a useful technique for characterizing the mechanical behaviour near the surface of polymeric biomaterials, including in simulated physiological conditions.

Preparation and characterization of poly(L-lactic acid)-chitosan hybrid scaffolds with drug release capability.

Novel poly(L-lactic acid) (PLLA)-chitosan hybrid scaffolds were developed in order to be used as tissue-engineering scaffolds and drug release carriers. The incorporation of chitosan into the PLLA porous structure allows for producing chitosan-based scaffold devices with interesting damping and stiffness aimed at being used in tissue engineering of bone or cartilage. The pore structure of the hybrid scaffolds was influenced by the concentration of the chitosan solution introduced into the PLLA scaffold. For lower concentrations, chitosan was mainly deposited onto the PLLA surface, whereas for higher concentration chitosan formed also microfibrilar structures within the pore walls of the PLLA foam that may act as additional soft anchorage sites for cells. Equilibrium water uptakes up to about 110% were achieved in 24 h. An anti-inflammatory drug, ketoprofen, was loaded within the chitosan component of the hybrid scaffolds by immersing the scaffolds in a drug-ethanol solution. The drug was released sharply within the initial periods ( approximately 2-4 h), but the rate decreased further, showing a sustained release. The drug release rate can be controlled by the chitosan content and cross-link densities, suggesting the effectiveness of the hybrid scaffold as a drug delivery system.

[Patient safety]. / Seguridad del paciente.

Ensuring patient safety is essential for better heath care. Safety have gripped public attention ever since the release of the report "To Err is Human". To find strategies of promotion of patient safety has stimulated models that improve knowledge of adverse events. Adverse drug events are the most common cause of injury to hospitalized patients and are often preventable. Many tactics are available to make system changes to reduce errors and adverse events; they fall into five categories: Reduce complexity, optimise information processing, automate wisely, use constraints, and mitigate the unwanted side effects of change. These tactics can be deployed to support any of the three strategic components of error prevention, detection, and mitigation. Although progress has been slow, the pace of change is likely to accelerate, particularly in implementation of electronic health records and diffusion of safe practices.