Effect of Different Karyophilic Peptides on Physical Characteristics and In Vitro Transfection Efficiency of Chitosan-Plasmid Nanoparticles as Nonviral Gene Delivery Systems.

A strategy to increase the transfection efficiency of chitosan-based nanoparticles for gene therapy is by adding nuclear localization signals through karyophilic peptides. Here, the effect of the length and sequence of these peptides and their interaction with different plasmids on the physical characteristics and biological functionality of nanoparticles is reported. The karyophilic peptides (P1 or P2) were used to assemble nanoparticles by complex coacervation with pEGFP-N1, pQBI25 or pSelect-Zeo-HSV1-tk plasmids, and chitosan. Size, polydispersity index, zeta potential, and morphology, as well as in vitro nucleus internalization and transfection capability of nanoparticles were determined. The P2 nanoparticles resulted smaller compared to the ones without peptides or P1 for the three plasmids. In general, the addition of either P1 or P2 did not have a significant impact on the polydispersity index and the zeta potential. P1 and P2 nanoparticles were localized in the nucleus after 30 min of exposure to HeLa cells. Nevertheless, the presence of P2 in pEGFP-N1 and pQBI25 nanoparticles raised their capability to transfect and express the green fluorescent protein. Thus, karyophilic peptides are an efficient tool for the optimization of nonviral vectors for gene delivery; however, the sequence and length of peptides have an impact on characteristics and functionality of nanoparticles.

Yeast diversity in open agave fermentations across Mexico.

Yeasts are a diverse group of fungal microorganisms that are widely used to produce fermented foods and beverages. In Mexico, open fermentations are used to obtain spirits from agave plants. Despite the prevalence of this traditional practice throughout the country, yeasts have only been isolated and studied from a limited number of distilleries. To systematically describe the diversity of yeast species from open agave fermentations, here we generate the YMX-1.0 culture collection by isolating 4524 strains from 68 sites with diverse climatic, geographical, and biological contexts. We used MALDI-TOF mass spectrometry for taxonomic classification and validated a subset of the strains by ITS and D1/D2 sequencing, which also revealed two potential novel species of Saccharomycetales. Overall, the composition of yeast communities was weakly associated with local variables and types of climate, yet a core set of six species was consistently isolated from most producing regions. To explore the intraspecific variation of the yeasts from agave fermentations, we sequenced the genomes of four isolates of the nonconventional yeast Kazachstania humilis. The genomes of these four strains were substantially distinct from a European isolate of the same species, suggesting that they may belong to different populations. Our work contributes to the understanding and conservation of an open fermentation system of great cultural and economic importance, providing a valuable resource to study the biology and genetic diversity of microorganisms living at the interface of natural and human-associated environments.

Anti-Diabetic Activity of Glycyrrhetinic Acid Derivatives FC-114 and FC-122: Scale-Up, In Silico, In Vitro, and In Vivo Studies.

Type 2 diabetes (T2D) is one of the most common diseases and the 8th leading cause of death worldwide. Individuals with T2D are at risk for several health complications that reduce their life expectancy and quality of life. Although several drugs for treating T2D are currently available, many of them have reported side effects ranging from mild to severe. In this work, we present the synthesis in a gram-scale as well as the in silico and in vitro activity of two semisynthetic glycyrrhetinic acid (GA) derivatives (namely FC-114 and FC-122) against Protein Tyrosine Phosphatase 1B (PTP1B) and α-glucosidase enzymes. Furthermore, the in vitro cytotoxicity assay on Human Foreskin fibroblast and the in vivo acute oral toxicity was also conducted. The anti-diabetic activity was determined in streptozotocin-induced diabetic rats after oral administration with FC-114 or FC-122. Results showed that both GA derivatives have potent PTP1B inhibitory activity being FC-122, a dual PTP1B/α-glucosidase inhibitor that could increase insulin sensitivity and reduce intestinal glucose absorption. Molecular docking, molecular dynamics, and enzymatic kinetics studies revealed the inhibition mechanism of FC-122 against α-glucosidase. Both GA derivatives were safe and showed better anti-diabetic activity in vivo than the reference drug acarbose. Moreover, FC-114 improves insulin levels while decreasing LDL and total cholesterol levels without decreasing HDL cholesterol.

Chitin/chitosan extraction from shrimp shell waste by a completely biotechnological process.

Two lactic bacteria were used in sequential co-cultures to demineralize (DM) and deproteinize (DP) shrimp shells (SS) to obtain chitin. During the first 24 h, Lactobacillus delbrueckii performed the DM in a minimal medium containing 100 g/L SS and 50 g/L glucose. Then, three different conditions were assayed to complete DM and perform the DP stage: 1) Bifidobacterium lactis was added with 35 g/L of glucose (Ld-G â†’ Bl-G); 2) only B. lactis was added (Ld-G â†’ Bl); and 3) a 35 g/L pulse of glucose was added, and at 48 h, B. lactis was inoculated (Ld-G â†’ G â†’ Bl). The highest DM (98.63 %) and DP (88 %) were obtained using a glucose pulse in the DM step and controlling the pH value above 6.0 in the DP step. Finally, a deacetylases cocktail produced by Aspergillus niger catalyzed the deacetylation of the resulting chitin. The chitosan samples had a deacetylation degree higher than 78 % and a solubility of 25 % in 1.0 N acetic acid. The deacetylation yield was 74 % after a mild chemical treatment, with a molecular weight of 71.31 KDa. This work reports an entirely biological process to get chitin and chitosan from SS with high yields.

Comorbidity identification and referral in atopic dermatitis: a consensus document.

BACKGROUND: Atopic dermatitis (AD) is associated with different comorbidities. OBJECTIVE: To develop evidence-based and practical recommendations for comorbidity detection in patients with AD in daily practice. METHODS: We employed a modified RAND/UCLA methodology, including a systematic literature review (SLR). A group of six experts on AD was established. We conducted a comprehensive search strategy on Medline, Embase, and Cochrane Library up to June 2020. The selection criteria included studies with AD patients with any comorbidity reporting data on comorbidity prevalence, burden, and management. The included studies quality was assessed. The SLR results were discussed in a nominal group meeting, and several recommendations were generated. The recommendation agreement grade was tested on additional experts through a Delphi process. RESULTS: The recommendations cover the following issues: (1) Which comorbidities should be investigated at the first and subsequent visits; (2) how and when should comorbidities be investigated (screening); (3) how should patients with specific comorbidities be referred to confirm their diagnosis and initiate management; (4) specific recommendations to ensure an integral care approach for AD patients with any comorbidity. CONCLUSIONS: These recommendations seek to guide dermatologists, patients, and other stakeholders in regard to early comorbidity identification and AD patient referral to improve decision-making.

Quantifying Physician Preferences for Systemic Atopic Dermatitis Treatments Using a Discrete-Choice Experiment.

INTRODUCTION: As research continues, new drugs will no doubt be added to the current pool of treatments for moderate-to-severe atopic dermatitis (AD). This raises the need for studies to determine prescriber preferences for different pharmacological options and the factors that influence their choice of treatment. Here we aim to explore physician preferences in the systemic treatment of moderate-to-severe AD, identify the sociodemographic characteristics that can influence physician preferences, and evaluate their satisfaction with current AD therapies. METHODS: A discrete-choice experiment (DCE) survey was administered to physicians treating patients with AD in Spain. Results were analyzed using a conditional logit model to estimate the relative importance of each attribute and the maximum risk accepted to achieve therapeutic benefit. RESULTS: A total of 28 respondents completed the DCE survey (67.9% female, mean age 45.9 years). Participants identified objective clinical efficacy and risk of severe adverse events (AEs) as the most important attributes, followed by improvement in sleep and pruritus and faster onset of action from the start of the treatment. Respondents gave less importance to mode of administration and therapeutic benefit in other atopic conditions. Respondents were willing to accept an increased risk of severe AEs and mild-to-moderate AEs leading to treatment discontinuation due to intolerance in order to obtain improvements in efficacy, sleep, and pruritus, and long-term clinical benefit. CONCLUSION: Our findings can help prescribers choose the most appropriate systemic AD therapy.

A cultura organizacional em tempos de pandemia pela COVID-19: repercussões nos enfermeiros especialistas e gestores / The organizational culture in times of COVID-19 pandemic: repercussions on specialist nurses and nurse managers

Objetivo:refletir sobre a cultura organizacional, em contexto de pandemia pela COVID-19, e as repercussões no exercício profissional dos enfermeiros especialistas e enfermeiros gestores.Método: estudo teórico-reflexivo, elaborado entre outubro e novembrode 2020, a partir da revisão da literatura e experiência dos autores. Resultados: perante uma adversidade, nunca antes vivida, as instituições de saúde são confrontadas com inúmeros desafios. A existência de uma cultura organizacional consistente torna-sefundamental, mostrando a dinâmica da instituição para a sociedade e o objetivo comum de todos os seus profissionais de saúde. Os enfermeiros especialistas e enfermeiros gestores desempenham um papel de destaque junto dasequipes, através de estratégias deliderança e de gestão de cuidados, recorrendo à reflexão sobre a prática e à capacitação dos enfermeiros de cuidados gerais.Conclusão: os enfermeiros especialistas e gestores em contexto depandemia poderão ser elementos promotores da cultura organizacional, garantindo a qualidade da assistência em saúde

Objective: to reflect on the organizational culture, in the context of the COVID-19 pandemic, and the repercussions on the professional practice of specialistnursesand nurse managers. Method:theoretical-reflective study, carried out between October and November 2020, based on a review of the literature and the authors'experience. Results:in the face of difficulties, never experienced before, health institutions are dealingwith severalchallenges. Havingan established organizational culture is highly relevant,showing the institution's dynamics to society and the common objective of all its health professionals.Specialistnurses and nurse managersplay a prominent role with the teams, through leadership and care management strategies, employing reflection on the practice and training of general care nurses. Conclusion:specialistnurses and nurse managersin a pandemic context may be elements that promote organizational culture, ensuring the quality of health care.

Efficacy of Tofacitinib in the Treatment of Psoriatic Arthritis: A Systematic Review.

INTRODUCTION: Therapeutic approaches for psoriatic arthritis (PsA) include non-pharmacologic therapies, symptomatic treatments, tumor necrosis factor inhibitors, interleukin inhibitors, cytotoxic T lymphocyte antigen 4 immunoglobulin, and Janus kinase inhibitors. This systematic review aimed to provide complete and up-to-date information on efficacy of tofacitinib in the treatment of PsA, giving special attention to non-skin manifestations (peripheral arthritis, axial disease, enthesitis, and dactylitis). METHODS: A search of studies published between January 2016 and June 2020 was carried out on PubMed and Google Scholar. RESULTS: The number of studies with tofacitinib in PsA is limited and most of them are post hoc analyses from OPAL Broaden and OPAL Beyond. Tofacitinib has been demonstrated to be efficacious for the treatment of all disease manifestations in PsA. Superior effectivity to placebo is achieved at the earliest time point evaluated, and maintained over time. Patients who switch from placebo to tofacitinib show the same improvements; however, the time to initial response is faster in patients who firstly receive tofacitinib, compared with those switching subsequently. Additional data suggest that tofacitinib may be also effective for the treatment of the axial domain. CONCLUSIONS: Tofacitinib has been demonstrated to be efficacious for the treatment of peripheral and axial involvement, enthesitis, and dactylitis manifestation in PsA. Further prospective and long-term studies are required to corroborate and complete the present results. Similarly, real-world evidence is also necessary to complement the information obtained in clinical trials, and thereby to have a better overview of real efficacy and safety of the drug.

PROFAST: A randomised trial implementing enhanced recovery after surgery for highcomplexity advanced ovarian cancer surgery.

BACKGROUND: Enhanced recovery after surgery (ERAS) programs include multiple perioperative elements designed to achieve early recovery after surgery and a shorter length of stay (LOS) in hospital. The PROFAST trial aimed to expand the evidence base for implementing ERAS in advanced gynaecologic oncology surgery. METHODS: This prospective, interventional randomised clinical trial enrolled women undergoing surgery for either suspected or diagnosed advanced ovarian cancer, at a reference hospital in gynaecologic oncology in Barcelona (Spain) and who were treated after either an ERAS protocol or conventional management (CM) protocol. All enrolled women who underwent cytoreductive surgery were included in the primary analysis. The primary outcome was reduction in LOS, and secondary outcomes were incidence and type of intraoperative and postoperative complications, rate of readmission and mortality within a 30-d follow-up period. This trial is registered at ClinicalTrials.gov, number NCT02172638. FINDINGS: From June 2014 to March 2018, 110 women were recruited, of which eleven were excluded. The ERAS group comprised 50 patients, and the CM group, 49 patients. Both groups were comparable with respect to baseline characteristics and complexity of the cytoreductive surgery, with an overall medium/high Aletti surgical complexity score of 7.4. Overall compliance to the ERAS protocol was 92%. As compared with the patients in the CM group, patients in the ERAS group had a decreased median of LOS of two days (7 versus 9 days; p = 0.0099) and a decreased rate of readmission (6% versus 20%, p = 0.0334). No further significant differences were detected with respect to incidence of intraoperative or postoperative complications, severe (Clavien-Dindo grade IIIB-IV) complications, Comprehensive Complication Index, reoperation during primary stay, or mortality. INTERPRETATION: Patients with advanced ovarian cancer in the ERAS program had a decreased LOS and decreased rate of readmission as compared with those in CM, with no increased morbidity or mortality. This study provides important evidence for the benefits of ERAS management even for gynaecologic surgeries of medium/high complexity and suggests that ERAS should be a standard practice for cytoreductive surgeries for peritoneal carcinomatosis.

Corrigendum: Genetic Modification of Closely Related Candida Species.

[This corrects the article DOI: 10.3389/fmicb.2019.00357.].

The Impact of Comorbidity on Patient-Reported Outcomes in Psoriatic Arthritis: A Systematic Literature Review.

INTRODUCTION: A systematic literature review was conducted with the aim to analyse the impact of comorbidity on patient-reported outcomes (PROs) in patients with psoriatic arthritis (PsA). METHODS: A sensitive search strategy of the Medline, Embase and the Cochrane Library (up to March 2019) was applied to retrieve studies for inclusion in this systematic literature review. Abstracts of the ACR and EULAR scientific meetings were also searched. The selection criteria were: (1) patients with PsA (population) with a comorbidity (intervention) and (2) report of any impact of the comorbidity on PROs. Systematic literature reviews, randomized controlled trials and observational were included in this systematic literature review. Two of the authors selected the articles and collected the data. RESULTS: Eighteen articles were included in this systematic literature review, with most being cross-sectional studies that included more than 9000 patients with PsA. Some studies analysed the impact of an individual comorbidity, such as fibromyalgia (FM), and in others the analysis was according to the number of comorbidities. The most frequently analysed PROs were function, quality of life and fatigue. Analysis of the studies included in the review showed that patients with a higher number of comorbidities and/or more severe comorbidities reported worse impacts of their disease on function, patient's global assessment (PGA), pain, fatigue, work disability and quality of life. Specifically, FM had a negative impact on the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), function, quality of sleep and quality of life; anxiety and depression had a negative impact on function and fatigue; metabolic syndrome had a negative impact on BASDAI, function, PGA and quality of life; obesity had a negative impact on function and pain; smoking (current and ex-smokers) had a negative impact on pain, function, fatigue, quality of life and overall health; alcohol intake had a negative impact on pain, function, fatigue, quality of life and overall health. CONCLUSIONS: The prevalence and impact of medical comorbidity on PROs are very high in patients with PsA.

"There is something you must see": breaking down the remission concept in rheumatoid arthritis from a rheumatologist's perspective.

OBJECTIVES: To explore the remission concept in rheumatoid arthritis (RA) and the implications of the existing definitions when applied to clinical practice among rheumatologists with different profiles. METHODS: A qualitative study through focus groups was conducted. Three focus groups were organised from February to March 2016. Each group was composed of rheumatologists with extensive clinical experience with different profiles; experts in basic research (RBR), experts in imaging techniques research (RIR), and experts in clinical research (RCR). The data was collected with audio recording. Verbatim transcriptions of the audio files were made, and a subsequent reflexive thematic analysis assisted by ATLAS.ti (GmbH, Berlin, v. 7) software was performed. RESULTS: From the reflexive thematic analysis, three main themes were generated: (1) remission limitations, (2) instruments or measures to assess remission, and (3) a new definition of remission. Rheumatologists mentioned frequently that the following variables should be considered when developing a new remission definition: inflammatory activity, calprotectin, psychological variables, sex, disease stage, and sociocultural factors. Contrary to what could be expected, all groups acknowledged that their research field could contribute with domains for a gold standard remission instrument, but not in a hierarchical arrangement of importance. The dissonance existing in the entire remission evaluation process was outlined: remission in clinical practice versus remission in clinical trials, remission following the American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) Boolean versus Musculoskeletal Ultrasound (US) remission, and remission from the rheumatologist's point of view versus the patient's point of view. CONCLUSIONS: Currently, rheumatologists would not accept a domain as more important than others in remission. Our suggestion is, not to generate a universal definition of remission - one that could cover all aspects - but rather to develop definitions of remission for the different settings that could be pondered by the patient's perspective.

The views and aspirations of young people with autism spectrum disorders and their provision in the new Education Health and Care plans in England.

Background: The new special educational needs and disability legislation in England has introduced Education Health and Care plans as statutory documents for children with special educational needs, and has extended provision beyond compulsory education, placing transition in a compelling position. This policy recognises the need to include the views, wishes and aspirations of children and young people in the development of provision to cater for their needs. For young people with autism spectrum disorders and their families, transition to post-16 education and employment could be challenging. This study aimed to explore how voices of young people with autism spectrum disorders are captured in their Education Health and Care plans.Methods: These views were collected from the Education Health and Care plans of 12 young people with autism spectrum disorders. These plans were analysed inductively and deductively through content analysis, using the International Classification of Functioning, Disability and Health: Children and Youth Version as a coding framework.Results: Discrepancies were found between plans concerning the ways in which the voices of young people with ASD were elicited. A total of 189 functioning codes were identified, with a prevalence of activities and participation codes to reflect their views, followed by body functions and lastly environmental factors.Conclusion: These disparities are discussed in light of the biopsychosocial model of functioning and health, and the new English policy. Implications for adopting the International Classification of Functioning framework to give voice to young people with autism spectrum disorders are also discussed.Implications for rehabilitationYoung people with autism spectrum disorders face many challenges in their transition to post-16 education and employment.Engaging young people with autism spectrum disorders in matters that affect their own lives contribute to the development of provision that is aligned with their wishes and aspirations.Practitioners collaborating in the development of Education Health and Care plans should ensure that young people are effectively involved in the development of their own plans.The International Classification of Functioning, Disability and Health, Children and Youth Version provides a systematic framework and language for coding and recording data from different sources with which to capture young people's views.

"No policy is an island": how the ICF international classification system may support local education planning in England.

Background: A crucial issue in special educational needs and disability policy and provision is the documentation of children's functioning, for which many countries have a statutory document. In England this is the education health and care plan. Recent research challenges the quality of these plans. Purpose: To provide evidence on the usefulness of the international classification of functioning, disability and health as a system with potential to support the development of higher quality plans in England. Methods: Twenty-five professionals participated in a one-day training session on the international classification of functioning disability and health, with a focus on designing higher quality SMART targets to be included in children's plans. Results: Overall, participants regarded the system as useful. Comparison of targets written before and after the training show improvements in relevance, specificity and on the extent to which they were action-oriented and measurable. Conclusions: Results are discussed in light of international lessons learned around the potential of the international classification of functioning disability and health to support policy change. A "no policy is an island" approach is proposed, suggesting local policy-makers should open horizons beyond geographical boundaries in evidence-based decision-making for supporting children with disabilities.Implications for rehabilitationThe ICF can be regarded as a useful framework for supporting professionals developing targets for children with Education Health and Care (EHC) plans in England.For developing SMART targets with the ICF, professionals can use the taxonomy to look for detailed aspects of functioning, relevant to a certain developmental stage.Using the ICF can support in making more measurable targets in EHC plans if the universal qualifier scale is applied when describing detailed aspects of functioning.Professionals trained on the ICF recognise its usefulness for writing EHC targets.More in-depth training is recommended for supporting the development of more holistic biopsychosocial EHC plans in England.

Identificação do paciente como estratégia de segurança / Patient identification as a safety strategy

Objetivo: relatar a experiência na construção de um projeto de melhoria contínua da qualidade para a identificação inequívoca do paciente. Método: trata-se de um descritivo, tipo relato de experiência, que compartilha a construção de um projeto que tem como finalidade a identificação inequívoca do paciente, no contexto hospitalar, segundo o referencial da Ordem dos Enfermeiros de Portugal. Resultados: apresentaram-se em oito etapas: identificação e descrição do problema; percepção do problema e suas causas; formulação de objetivos; definição do público-alvo e critérios de inclusão/exclusão; planejamento e execução das atividades; verificação dos resultados; proposta de medidas corretivas; uniformização e capacitação da equipe e, finalmente, reconhecimento e compartilhamento do sucesso. Conclusão: conclui-se que a identificação inequívoca do paciente se torna fundamental para diminuir os incidentes no decorrer da prestação de cuidados. Sugere-se, assim, criar estratégias para sensibilizar os profissionais para a implementação do procedimento de modo a garantir a qualidade e segurança dos cuidados prestados.

Objective: to report the experience in the construction of a project of continuous quality improvement for the unequivocal identification of the patient. Method: it is a descriptive, type of experience report, which shares the construction of a project that aims to unequivocally identify the patient, in the hospital context, according to the framework of the Order of Nurses of Portugal. Results: presented in eight stages: identification and description of the problem; perception of the problem and its causes; formulation of objectives; definition of the target audience and inclusion / exclusion criteria; planning and execution of activities; verification of results; corrective measures proposal; uniformity and training of the team and, finally, recognition and sharing of success. Conclusion: it is concluded that the unequivocal identification of the patient becomes essential to reduce the incidents during the provision of care. It is suggested, therefore, to create strategies to sensitize professionals to the implementation of the procedure in order to guarantee the quality and safety of the care provided.

Objetivo: reportar la experiencia en la construcción de un proyecto de mejora continua de la calidad para la identificación inequívoca del paciente. Método: es un informe descriptivo, de tipo de experiencia, que comparte la construcción de un proyecto que tiene como objetivo identificar inequívocamente al paciente, en el contexto hospitalario, de acuerdo con el marco de la Orden de Enfermeros de Portugal. Resultados: presentados en ocho etapas: identificación y descripción del problema; percepción del problema y sus causas; formulación de objetivos; definición del público objetivo y criterios de inclusión / exclusión; planificación y ejecución de actividades; verificación de resultados; propuesta de medidas correctivas; uniformidad y formación del equipo y, finalmente, reconocimiento y reparto del éxito. Conclusión: se concluye que la identificación inequívoca del paciente se vuelve esencial para reducir los incidentes durante la prestación de la atención. Se sugiere, por lo tanto, crear estrategias para sensibilizar a los profesionales sobre la implementación del procedimiento a fin de garantizar la calidad y seguridad de la atención brindada.

Genetic Modification of Closely Related Candida Species.

Species from the genus Candida are among the most important human fungal pathogens. Several of them are frequent commensals of the human microbiota but are also able to cause a variety of opportunistic infections, especially when the human host becomes immunocompromised. By far, most of the research to understand the molecular underpinnings of the pathogenesis of these species has focused on Candida albicans, the most virulent member of the genus. However, epidemiological data indicates that related Candida species are also clinically important. Here, we describe the generation of a set of strains and plasmids to genetically modify C. dubliniensis and C. tropicalis, the two pathogenic species most closely related to C. albicans. C. dubliniensis is an ideal model to understand C. albicans pathogenesis since it is the closest species to C. albicans but considerably less virulent. On the other hand, C. tropicalis is ranked among the four most common causes of infections by Candida species. Given that C. dubliniensis and C. tropicalis are obligate diploids with no known conventional sexual cycle, we generated strains that are auxotrophic for at least two amino acids which allows the tandem deletion of both alleles of a gene by complementing the two auxotrophies. The strains were generated in two different genetic backgrounds for each species - one for which the genomic sequence is available and a second clinically important one. In addition, we have adapted plasmids developed to delete genes and epitope/fluorophore tag proteins in C. albicans so that they can be employed in C. tropicalis. The tools generated here allow for efficient genetic modification of C. dubliniensis and C. tropicalis, and thus facilitate the study of the molecular basis of pathogenesis in these medically relevant fungi.

Evaluating the quality of outcomes defined for children with Education Health and Care plans in England: A local picture with global implications.

Recently, the Children and Families Act 2014 was introduced in England to regulate provision for children with disabilities. According to this policy, statements of special educational needs were replaced with education, health and care plans, which should include high-quality, holistic and participation-focused outcomes to regulate provision; this change aligns with international recommendations regarding provision for children with disabilities. This study aimed to evaluate the outcomes defined for children with education, health and care plans in England. 236 Education Health and Care plans were included in the analysis, providing 2813 outcomes to be examined, which came from 11 local authorities and 42 schools and belong to 69 girls and 167 boys from 4 to 21 years of age. The outcomes were independently rated by two experienced researchers using a Goal Functionality Scale. Inter-rater agreement was calculated for 10% of the outcomes. Most outcomes were considered not to be functional or high-quality; differences in quality were found between local authorities, types of school, type of outcome, and the children's main need. There are important quality concerns regarding the outcomes that have been designed for children with disabilities in England, which should be addressed through standardised training and guidelines on procedures.

Beyond diagnosis: the relevance of social interactions for participation in inclusive preschool settings.

Purpose: This study aims to explore the role of three specific factors within the child-environment interaction process - engagement, independence and social interactions - in influencing development and learning of children with disabilities in inclusive preschool settings. The main question is whether children can be categorised in homogenous groups based on engagement, independence and social interactions (proximal variables within a biopsychosocial framework of human development). The study also examined whether children with the same diagnosis would group together or separately, when trying to identify clusters of engagement, independence and social interactions, and additionally whether such clusters vary as a function of individual child characteristics, and/or as a function of structural and process characteristics of preschool environment. Methods: Data was taken from an intervention study conducted in mainstream preschools in Portugal. A person-centered cluster analysis was conducted to explore group membership of children with various diagnoses, based on their engagement, independence and social interaction profiles. Results: Results show that children clustered based on similarity of engagement, independence and social interaction patterns, rather than on diagnosis. Besides, it was found that quality of peer interaction was the only predictor of cluster membership. Conclusion: These findings support the argument that participation profiles may be more informative for intervention purposes than diagnostic categories, and that preschool process quality, namely peer interaction, is crucial for children's participation.

Hidrotórax como complicación de la derivación ventriculoperitoneal: caso clínico / Hydrothorax as a complication of a ventricle peritoneal shunt. A case report

La derivación ventriculoperitoneal (DVP) es el tratamiento habitual en caso de hidrocefalia. Se trata de una técnica sencilla y eficaz, pero hasta un 70% de los pacientes presentan algún tipo de complicación a lo largo de su vida. La mayoría de ellas son debidas a infección o disfunción mecánica, siendo las complicaciones torácicas poco frecuentes. El presente caso es uno de los pocos encontrados en la literatura en el que se objetiva hidrotórax como complicación de la DVP sin migración de la punta de catéter y sin ascitis. Describimos el caso de una niña de 2años con DVP. La paciente es diagnosticada de derrame pleural compatible con hidrotórax. Tras análisis de β2-transferrina en líquido pleural se comprobó que se trataba de líquido cefalorraquídeo. El TAC craneal mostró un catéter de DVP normoposicionado. La radiografía y la ecografía de abdomen mostraron punta de catéter bien situada en peritoneo

The ventricle peritoneal (VP) shunt is commonly used in the treatment of hydrocephalus. It is a relatively simple and effective technique, but around 70% of the patients with a VP shunt have a complication in their lifetime. Most of these complications are due to infection or mechanical dysfunction. The thoracic complications are rare. The present case is one of the small number of them found in the literature, describing hydrothorax as a complication of a VP shunt without catheter migration and without ascites. The case is presented of a 2 year-old girl with VP shunt. The patient was diagnosed with pleural effusion compatible with hydrothorax. After finding beta-2-transferrin in the pleural fluid, it was it was shown to be from cerebrospinal fluid. Cranial CT showed the catheter in a proper position, and the Xray and ultrasound showed the catheter correctly positioned in the peritoneum

Exploring the remission concept in rheumatoid arthritis with patients and rheumatologists: time for a new approach?

OBJECTIVES: To explore the remission concept in rheumatoid arthritis (RA) and to compare remission definitions and related concepts between rheumatologists and patients with the purpose of identifying similarities and disparities to comprehend the different perspectives of the disease. METHODS: This was a qualitative study of discourse and content analysis through focus groups, conducted from February to March 2016. Four focus groups were set up, each one with different interests: rheumatologists involved in basic research (BR), rheumatologists with high specialisation in imaging techniques (IR), clinical rheumatologists (CR), and patients (PA). RESULTS: There is no consensus in a remission definition in RA; differences exist between-groups, rheumatologists and patients value remission differently, and there are discrepancies within the group of rheumatologists. Rheumatologists highlight quantifiable objective parameters, in contrast, patients did not consider objective measures as the best instruments, and they prefer subjective measures of remission. The data confirmed the existence of two sources of knowledge of the disease, technical (physicians) and experiential (patients). These sources of knowledge should concur in order to establish new remission criteria well-adjusted to reality. CONCLUSIONS: The lack of consensus between key groups implicated in defining remission and remission criteria suggests a new strategy for its operational definition. Our group proposes that subjects with a balance between experiential and technical knowledge, should be the ones in charge of this assignment.