Development of GO Move: A Website for Children With Unilateral Cerebral Palsy.

It is unknown if an online tool is wanted by therapists and parents of individuals with unilateral cerebral palsy (UCP) to support implementation of goal-directed home programs, and if wanted, the recommended features for the tool. The objective was to explore the experiences of therapists and parents who have implemented home programs, seek guidance on translating a paper-based home program toolbox into a mobile website, and develop the website. Qualitative descriptive methodology guided data collection using semi-structured interviews and thematic analysis, validated with field notes and member checking. A team science, iterative approach was used to integrate the themes into the development of the mobile website. Five primary themes including recommendations for the functionality, features, content, and naming of the mobile website were identified. Parents and therapists value home programs. Participants provided recommendations regarding content and features, and the GO Move mobile website was developed based on the recommendations.

Development of Go Move: A Website for Children With Unilateral Cerebral PalsyTherapists and parents of children with unilateral cerebral palsy were interviewed to understand their experience of home programs and gain input for creating a mobile website with information on goal setting and implementing home programs. The interviews provided valuable information about the functionality, features, content, and naming of the website. GO Move, a mobile website aimed to provide information on goal setting, activity selection, and tracking of exercises and activities in the home environment for children with unilateral cerebral palsy, was developed based on the information from the interviews.

Latin American Cerebral Palsy Register (LATAM-CPR): study protocol to develop a collaborative register with surveillance of children with cerebral palsy in Latin American countries.

INTRODUCTION: Cerebral palsy (CP) is one of the leading causes of childhood disability globally with a high burden in low-income and middle-income countries (LMICs). Preliminary findings from the global LMIC CP Register (GLM CPR) suggest that the majority of CP in LMICs are due to potentially preventable causes. Such data are lacking in the Latin American region. Generating comparable epidemiological data on CP from this region could enable translational research and services towards early diagnosis and early intervention. We aim to establish a Latin American multicountry network and online data repository of CP called Latin American Cerebral Palsy Register (LATAM-CPR). METHODS AND ANALYSIS: The LATAM-CPR will be modelled after the GLM CPR and will support new and emerging Latin American CP registers following a harmonised protocol adapted from the GLM CPR and piloted in Argentina (ie, Argentine Register of Cerebral Palsy). Both population-based and institution-based surveillance mechanisms will be adopted for registration of children with CP aged less than 18 years to the participating CP registers. The data collection form of the LATAM-CPR will include risk factors, clinical profile, rehabilitation, socioeconomical status of children with CP. Descriptive data on the epidemiology of CP from each participating country will be reported, country-specific and regional data will be compared. ETHICS AND DISSEMINATION: Individual CP registers have applied ethics approval from respective national human research ethics committees (HREC) and/or institutional review boards prior to the establishment and inclusion into the LATAM-CPR. Ethical approval for LATAM-CPR has already been obtained from the HREC in the two countries that started (Argentina and Mexico). Findings will be disseminated and will be made publicly available through peer-reviewed publications, conference presentations and social media communications.

Adaptación marginal e interna de cofias fabricadas por métodos convencionales, CAD/CAM de fresado y sinterizado por láser / Marginal and internal adaptation of copings manufactured by conventional methods, CAD/CAM milling and laser sintering

Introducción: la adaptación marginal e interna de nuestras restauraciones fabricadas por fundición sistemas de fresado y sinterización láser es uno de los factores clínicos más importantes para el éxito de las prótesis fijas, previniendo el riesgo de microfiltración y enfermedad periodontal. Objetivo: evaluar la adaptación marginal e interna de cofias metálicas en aleación Cr-Co confeccionadas por técnicas convencionales, CAD/ CAM de fresado y sinterizado por láser. Material y métodos: estudio de tipo experimental, comparativo e in vitro. Se imprimió un modelo maestro en Cr-Co, proveniente del escaneo de un premolar preparado para corona completa, sobre el cual se diseñaron 30 cofias divididas en tres grupos: el primero que corresponde al grupo cofias fundidas fresadas en disco de cera A (A = 10), el segundo grupo cofias fresadas en disco de metal presinterizado B (B = 10) y el tercer grupo cofias impresas por sinterización láser C (C = 10). Se empleó la réplica de silicona, colocando silicona al interior de cada cofia, sobre el modelo maestro, simulando al cemento, mediante una máquina de ensayo universal se realizó una compresión de 50 N. Luego de retirar cada cofia se rellenaron con silicona pesada de adición, obteniendo una réplica de silicona. Se efectuaron dos cortes transversales en sentido vestíbulolingual y mesiodistal. Se observó el espesor de silicona VPS (vinil poliéter silicona) mediante un estereomicroscopio (Nikon SMZ745T), obteniendo valores en micrómetros. Para el análisis estadístico se utilizó el software SPSS 25 con el fin de realizar la prueba de normalidad y ANOVA de dos vías bajo un nivel de confianza del 95%. Resultados: el menor gap lo obtuvo el grupo de fresadas, seguido de las impresas y por último las fundidas por métodos convencionales. ANOVA de dos vías reveló diferencias estadísticamente significativas entre los tres grupos (p < 0.0001). Conclusiones: se encontró que el gap varía con cada método de fabricación, la técnica convencional de fundido mostró un mayor gap, ninguna excediendo el rango clínicamente aceptable (AU)

Introduction: the marginal and internal adaptation of our restorations manufactured by casting, milling systems and laser sintering is one of the most important clinical factors for the success of fixed prostheses, preventing the risk of microleakage and periodontal disease. Objective: evaluate the marginal and internal adaptation of metal copings in Cr-Co alloy made by conventional techniques, CAD/CAM milling and laser sintering. Material and methods: an experimental, comparative and in vitro study, a Cr-Co master model was printed from the scan of a premolar prepared for a full crown. An experimental, comparative and in vitro study, a Cr-Co master model was printed from the scan of a premolar prepared for a full crown, on which 30 caps divided into three groups were designed; the first group corresponds to the cast copings milled on a wax disc A (A = 10), the second group milled copings on a presintered metal disc B (B = 10) and the third group printed by laser sintering copings C (C = 10). The silicone replica was used, placing silicone inside each coping, on the master model, simulating cement, using a universal testing machine, a 50 N compression was performed. After removing each coping, they were filled with heavy addition silicone, obtaining a silicone replica. Two cross-sections were made in the buccolingual and mesiodistal direction., observing the thickness of the VPS (vinyl polyeter silicone) silicone using a stereomicroscope (Nikon SMZ745T), obtaining values in micrometers. For the statistical analysis, the SPSS 25 software was used in order to perform the normality and two-way ANOVA tests under a 95% confidence level. Results: the smallest gap was obtained by the milled group, followed by the printed ones and finally those cast by conventional methods. Two-way ANOVA revealed statistically significant differences between the three groups (p < 0.0001). Conclusions: the gap was found to vary with each fabrication method, the conventional casting technique showed a larger gap, none exceeding the clinically acceptable range (AU)

Efficacy of Repeat AbobotulinumtoxinA (Dysport®) Injections in Improving Gait in Children with Spastic Cerebral Palsy.

Purpose: This secondary analysis of a randomized, double-blind study plus open-label extension (NCT01249417/NCT01251380) evaluated the efficacy of abobotulinumtoxinA versus placebo in improving gait pattern in children with dynamic equinus due to cerebral palsy (CP) as assessed by the observational gait scale (OGS). Methods: Ambulatory children with CP (N = 241, aged 2-17) and dynamic equinus were randomized to treatment with abobotulinumtoxinA (10 or 15U/kg/leg) or placebo injected into the gastrocsoleus. All children received abobotulinumtoxinA in the open-label phase. Results: In the double-blind phase, abobotulinumtoxinA significantly improved OGS total scores versus placebo at Week 4 (treatment effect vs. placebo: 10U/kg/leg: 1.5 [0.7, 2.3], p = .0003; 15U/kg/leg: 1.1 [0.3, 1.9], p = .01). In the open-label phase, treatment with abobotulinumtoxinA continued to improve the OGS score at the same magnitude as seen in the double-blind study. Conclusion: Repeat treatment with abobotulinumtoxinA improved gait in children with dynamic equinus.

Safety and Efficacy of Repeat Open-Label AbobotulinumtoxinA Treatment in Pediatric Cerebral Palsy.

This was a prospective, repeat-treatment, open-label study (NCT01251380) of abobotulinumtoxinA for the management of lower limb spasticity in children who had completed a double-blind study. Children (2-17 years) received injections into the gastrocnemius-soleus complex, and other distal and proximal muscles as required (maximum total dose per injection cycle: 30 U/kg or 1000U). A total of 216 of the 241 double-blind patients entered the extension study and 207 received ≥1 open label injection into the gastrocnemius-soleus; 17-24% of patients also had injections into the hamstrings. The most frequent adverse events were related to common childhood infections and the most frequent treatment-related adverse event was injection site pain (n = 10). There was no evidence of a cumulative effect on adverse events. Sustained significant clinical improvements in muscle tone (Modified Ashworth Scale), spasticity (Tardieu Scale), overall clinical benefit (Physicians Global Assessment), and goal attainment (Goal Attainment Scale) were also observed across treatment cycles.

AbobotulinumtoxinA for Equinus Foot Deformity in Cerebral Palsy: A Randomized Controlled Trial.

BACKGROUND: Although botulinum toxin is a well-established treatment of focal spasticity in cerebral palsy, most trials have been small, and few have simultaneously assessed measures of muscle tone and clinical benefit. METHODS: Global, randomized, controlled study to assess the efficacy and safety of abobotulinumtoxinA versus placebo in cerebral palsy children with dynamic equinus foot deformity. Patients were randomized (1:1:1) to abobotulinumtoxinA 10 U/kg/leg, 15 U/kg/leg, or placebo injections into the gastrocnemius-soleus complex (1 or both legs injected). In the primary hierarchical analysis, demonstration of benefit for each dose required superiority to placebo on the primary (change in Modified Ashworth Scale from baseline to week 4) and first key secondary (Physician's Global Assessment at week 4) end points. RESULTS: Two hundred and forty-one patients were randomized, and 226 completed the study; the intention to treat population included 235 patients (98%). At week 4, Modified Ashworth Scale scores significantly improved with abobotulinumtoxinA; mean (95% confidence interval) treatment differences versus placebo were -0.49 (-0.75 to -0.23; P = .0002) for 15 U/kg/leg and -0.38 (-0.64 to -0.13; P = .003) for 10 U/kg/leg. The Physician's Global Assessment treatment differences versus placebo of 0.77 (0.45 to 1.10) for 15 U/kg/leg and 0.82 (0.50 to 1.14) for 10 U/kg/leg were also significant (both Ps < .0001). The most common treatment-related adverse event was muscular weakness (10 U/Kg/leg = 2; placebo = 1). CONCLUSIONS: AbobotulinumtoxinA improves muscle tone in children with dynamic equinus resulting in an improved overall clinical impression and is well tolerated.

[Familial risk factors for suicide among adolescents with depression]. / Factores de riesgo familiares asociados a la conducta suicida en adolescentes con trastorno depresivo.

BACKGROUND: Suicide is the second or third cause of death among Chilean teenagers aged 15 to 19 years. AIM: To evaluate familial risk factors associated to suicidal attempt in adolescents with a depressive disorder. MATERIAL AND METHODS: Thirty two teenagers with depression, aged between 13 and 18 years, receiving psychological treatment in six public Mental Health Centers in Santiago and 32 fathers, mothers or tutors were evaluated. Beck's Depression Inventory and the Family Adaptability and Cohesion Evaluation Scale (FACES III, family version) were applied to adolescents. Adults were evaluated by the Goldberg's General Health Questionnaire and the FACES III parents version. RESULTS: No meaningful statistical association between adolescents suicidal attempt and family risk factors (family order, presence of family stressors and parent's mental health), was observed. However, there was a significant association between suicidal ideation of teenagers, their familiar adaptability and suicidal ideation of close relatives. CONCLUSIONS: Suicidal attempt in this group of teenagers was associated with familial adaptability and suicidal ideation by close relatives. Therefore close relatives must be integrated to the prevention programs for adolescents' suicide.

Factores de riesgo familiares asociados a la conducta suicida en adolescentes con trastorno depresivo / Familial risk factors for suicide among adolescents with depression

Background: Suicide is the second or third cause of death among Chilean teenagers aged 15 to 19 years. Aim: To evaluate familial risk factors associated to suicidal attempt in adolescents with a depressive disorder. Material and methods: Thirty two teenagers with depression, aged between 13 and 18 years, receiving psychological treatment in six public Mental Health Centers in Santiago and 32 fathers, mothers or tutors were evaluated. Beck's Depression Inventory and the Family Adaptability and Cohesión Evaluation Scale (FACES III, family versión) were applied to adolescents. Aduits were evaluated by the Goldberg's General Health Questionnaire and the FACES III parents versión. Results: No meaningful statistical association between adolescents suicidal attempt and family risk factors (family order, presence of family stressors and parent's mental health), was observed. However, there was a significant association between suicidal ideation of teenagers, their familiar adaptability and suicidal ideation of close relatives. Conclusions: Suicidal attempt in this group of teenagers was associated with familial adaptability and suicidal ideation by close relatives. Therefore close relatives must be integrated to the prevention programs for adolescents' suicide.

Improving outcome of human immunodeficiency virus-infected patients in a Mexican intensive care unit.

BACKGROUND: In Latin America, insufficient data are available to improve local admission policies for human immunodeficiency virus (HIV) patients in the intensive care units (ICU). We undertook this study to evaluate the outcome and survival determinants of HIV patients in a Mexican ICU during three time periods. METHODS: From December 1985 through January 2006, a clinical chart-based, retrospective study of all HIV patients admitted to the ICU was conducted. Demographic, clinical and laboratory data; disease severity score (APACHE II) and mortality were evaluated. A comprehensive database was created and data were analyzed using survival and regression models. RESULTS: Ninety HIV patients were admitted to the ICU during the study: 16 (18%) in 1985-1992 (non-antiretroviral [ARV]-period), 21 (23%) in 1993-1996 (ARV-period), and 53 (58%) in 1996-2006 (highly active antiretroviral treatment [HAART] period). Leading reasons for admission were the need for mechanical ventilatory support (MVS, 85.5%), septic shock (23%), and non-HIV/AIDS complications (15.5%). Survival in the ICU increased from 12.5% (non-ARV period) to 57% (HAART period). Mortality during ICU stay was associated with MVS (HR: 3.2; 95% CI 1.0-10.2) and APACHE II > or =13 points (HR: 2.2; 95% CI 1.3-4.0). Use of steroids (HR: 0.4; 95% CI 0.2-0.8) and HAART (HR: 0.25; 95% CI 0.1-0.5) were associated with a lower risk of death. In multivariate analysis, septic shock was the main predictor of death in the ICU (HR: 2.4; 95% CI 1.1-5.2) and after discharge. HAART remained as a significant protective factor. CONCLUSIONS: Overall survival in Mexican HIV patients admitted to an ICU has substantially increased in recent years. These data should encourage policies that consider HIV patients as good candidates for receiving intensive care.

Comparison of nonintensified and intensified CCD detectors for laser-induced breakdown spectroscopy.

The performance and sensitivity of an intensified CCD array system and a nonintensified CCD array detector system are compared for laser-induced breakdown spectroscopy (LIBS). LIBS measurements were recorded in a calcium-based aerosol-seeded gas stream at ambient pressure. The signal-to-noise ratio based on the 393.37-nm calcium emission line was calculated as a function of detector delay with respect to the plasma-initiating laser pulse. Both ensemble-averaging and single-shot spectral analyses were performed. For all conditions, the intensified CCD system provided an enhanced signal-to-noise ratio compared with the nonintensified CCD system.

Conditional data processing for single-shot spectral analysis by use of laser-induced breakdown spectroscopy.

Schemes of conditional data processing are evaluated based on either the peak-to-base ratio or the signal-to-noise ratio as a metric for analyte detection in single-shot laser-induced breakdown spectra. The analyte signal investigated is the 288.1-nm Si I emission line provided by an aerosol stream of monodisperse 2.5-microm-sized silica microspheres. Both the Si emission line and a spectral region corresponding to continuum emission are used to evaluate the statistical distribution of spectral noise. The probability of false hits is determined by evaluating various conditional processing thresholds. As the detection threshold increases, the rate of detected silica particle hits decreases along with the expected fraction of false-particle hits (i.e., spectral noise). For all threshold values the signal-to-noise ratio is found to provide a more robust metric for single-shot analyte detection compared with the peak-to-base ratio.

Assessment of the upper particle size limit for quantitative analysis of aerosols using laser-induced breakdown spectroscopy.

The laser-induced plasma vaporization of individual silica microspheres in an aerosolized air stream was investigated. The upper size limit for complete particle vaporization corresponds to a silica particle diameter of 2.1 microm for a laser pulse energy of 320 mJ, as determined by the deviation from a linear mass response of the silicon atomic emission signal. Comparison of the measured silica particle sampling rates and those predicted based on Poisson sampling statistics and the overall laser-induced plasma volume suggests that the primary mechanism of particle vaporization is related to direct plasma-particle interactions as opposed to a laser beam-particle interaction. Finally, temporal and spatial plasma evolution is discussed in concert with factors that may influence the vaporization dynamics of individual aerosol particles, such as thermophoretic forces and vapor expulsion.