Psychometric Properties and Clinical Usefulness of the Spanish Version of the Toe Walking Tool.

BACKGROUND: The Toe Walking Tool (TWT) was developed in Australia as a valid and reliable screening tool for children who toe-walk. However, psychometric properties of the Spanish version of the TWT have not been studied. The aim of this study was to assess psychometric properties and clinical usefulness of the Spanish version of the TWT. METHODS: A cross-sectional study was conducted. Twelve children were assessed with the TWT. Intrarater and interrater reliability and agreement were calculated using the intraclass correlation coefficient (ICC) and the Fleiss kappa method for multiple raters. Internal consistency and construct validity were assessed with the Kuder-Richardson formula 20 coefficient and known-group methods, respectively. Sensitivity and specificity were analyzed using the receiver operating characteristic curve. The Content Validity Index was calculated to determine clinical usefulness. RESULTS: An excellent intrarater (ICC = 1) and interrater reliability (ICC = 0.8), moderate interrater agreement (Fleiss kappa, 0.6), strong internal consistency (Kuder-Richardson formula 20 coefficient, 0.86), and very good construct validity were found. Sensitivity and specificity results were appropriate (area under the curve, 0.845). The Content Validity Index was 0.906, suggesting high usefulness. CONCLUSIONS: The Spanish version of the TWT was found to be a valid, reliable and useful screening tool for children who toe-walk, providing evidence for its recommendation.

Unique properties of dually innervated dendritic spines in pyramidal neurons of the somatosensory cortex uncovered by 3D correlative light and electron microscopy.

Pyramidal neurons (PNs) are covered by thousands of dendritic spines receiving excitatory synaptic inputs. The ultrastructure of dendritic spines shapes signal compartmentalization, but ultrastructural diversity is rarely taken into account in computational models of synaptic integration. Here, we developed a 3D correlative light-electron microscopy (3D-CLEM) approach allowing the analysis of specific populations of synapses in genetically defined neuronal types in intact brain circuits. We used it to reconstruct segments of basal dendrites of layer 2/3 PNs of adult mouse somatosensory cortex and quantify spine ultrastructural diversity. We found that 10% of spines were dually innervated and 38% of inhibitory synapses localized to spines. Using our morphometric data to constrain a model of synaptic signal compartmentalization, we assessed the impact of spinous versus dendritic shaft inhibition. Our results indicate that spinous inhibition is locally more efficient than shaft inhibition and that it can decouple voltage and calcium signaling, potentially impacting synaptic plasticity.

Influence of Clinical, Physical, Psychological, and Psychophysical Variables on Treatment Outcomes in Somatic Tinnitus Associated With Temporomandibular Pain: Evidence From a Randomized Clinical Trial.

OBJECTIVE: To assess the influence of clinical, psychological, and psychophysical variables on treatment outcomes after application of exercise combined with education with/without manual therapy in people with tinnitus associated with temporomandibular disorder (TMD). METHODS: A secondary analysis of a clinical trial was performed investigating the effectiveness of including cervico-mandibular manual therapy into an exercise combined with education program in 61 subjects with TMD-related tinnitus. Clinical outcomes including tinnitus severity and tinnitus-related handicap were assessed at 3 and 6 months post-intervention. Patients were assessed at baseline for clinical (tinnitus severity, tinnitus-related handicap, quality of life), physical (range of motion), psychological (depression), and psychophysical (pressure pain thresholds [PPTs]) variables that were included as predictors. RESULTS: The regression models indicated that higher scores of tinnitus severity at baseline predicted better outcomes 3 and 6 months post-intervention (explaining 13% to 41% of the variance) in both groups. Higher scores of tinnitus-related handicap at baseline predicted better outcome of tinnitus-related handicap (45% variance) in the manual therapy with exercise/education group. Lower PPTs over the temporalis muscle at baseline predicted poorer clinical outcomes (10.5% to 41% of the variance) in both groups. Other predictors were sex and quality of life (6.7% variance) in the manual therapy group and PPTs over the masseter muscle (5.8% variance) in the exercise/education group. CONCLUSION: This study found that baseline tinnitus severity and localized PPT over the temporalis muscle were predictive of clinical outcomes in individuals with TMD-related tinnitus following physical therapy. Other predictors (eg, sex, quality of life) were less influential.

Effects of Cervico-Mandibular Manual Therapy in Patients with Temporomandibular Pain Disorders and Associated Somatic Tinnitus: A Randomized Clinical Trial.

OBJECTIVE: This randomized clinical trial investigated the effects of adding cervico-mandibular manual therapies into an exercise and educational program on clinical outcomes in individuals with tinnitus associated with temporomandibular disorders (TMDs). METHODS: Sixty-one patients with tinnitus attributed to TMD were randomized into the physiotherapy and manual therapy group or physiotherapy alone group. All patients received six sessions of physiotherapy treatment including cranio-cervical and temporomandibular joint (TMJ) exercises, self-massage, and patient education for a period of one month. Patients allocated to the manual therapy group also received cervico-mandibular manual therapies targeting the TMJ and cervical and masticatory muscles. Primary outcomes included TMD pain intensity and tinnitus severity. Secondary outcomes included tinnitus-related handicap (Tinnitus Handicap Inventory [THI]), TMD-related disability (Craniofacial Pain and Disability Inventory [CF-PDI]), self-rated quality of life (12-item Short Form Health Survey [SF-12]), depressive symptoms (Beck Depression Inventory [BDI-II]), pressure pain thresholds (PPTs), and mandibular range of motion. Patients were assessed at baseline, one week, three months, and six months after intervention by a blinded assessor. RESULTS: The adjusted analyses showed better outcomes (all, P < 0.001) in the exercise/education plus manual therapy group (large effect sizes) for TMD pain (η 2 P = 0.153), tinnitus severity (η 2 P = 0.233), THI (η 2 P = 0.501), CF-PDI (η 2 P = 0.395), BDI-II (η 2 P = 0.194), PPTs (0.363 < η 2 P < 0.415), and range of motion (η 2 P = 0.350), but similar changes for the SF-12 (P = 0.622, η 2 P = 0.01) as the exercise/education alone group. CONCLUSIONS: This clinical trial found that application of cervico-mandibular manual therapies in combination with exercise and education resulted in better outcomes than application of exercise/education alone in individuals with tinnitus attributed to TMD.

Topological Constraints in Directed Polymer Melts.

Polymers in a melt may be subject to topological constraints, as in the example of unlinked polymer rings. How to do statistical mechanics in the presence of such constraints remains a fundamental open problem. We study the effect of topological constraints on a melt of directed polymers, using simulations of a simple quasi-2D model. We find that fixing the global topology of the melt to be trivial changes the polymer conformations drastically. Polymers of length L wander in the transverse direction only by a distance of order (lnL)^{ζ} with ζ≃1.5. This is strongly suppressed in comparison with the Brownian L^{1/2} scaling which holds in the absence of the topological constraint. It is also much smaller than the predictions of standard heuristic approaches-in particular the L^{1/4} of a mean-field-like "array of obstacles" model-so our results present a sharp challenge to theory. Dynamics are also strongly affected by the constraints, and a tagged monomer in an infinite system performs logarithmically slow subdiffusion in the transverse direction. To cast light on the suppression of the strands' wandering, we analyze the topological complexity of subregions of the melt: the complexity is also logarithmically small, and is related to the wandering by a power law. We comment on insights the results give for 3D melts, directed and nondirected.

Síndrome de burnout en estudiantes de medicina pertenecientes a sociedades científicas peruanas: un estudio multicéntrico / Burnout syndrome in medical students belonging to Peruvian scientific societies: A multicenter study

Identificar la frecuencia de síndrome de burnout (SBO) en los estudiantes de Medicina pertenecientes a sociedades científicas peruanas en el 2015. Material y Métodos: Estudio observacional, descriptivo y transversal. La población estudiada fueron todos los estudiantes de medicina humana pertenecientes a 9 sociedades científicas de diferentes departamentos del Perú y afiliadas a la Sociedad Científica Médica Estudiantil Peruana (SOCIMEP). La recolección de datos fue a través de un cuestionario para datos biográficos y el Maslach Burnout Inventory. Resultados: Se encuestó a 158 estudiantes de medicina humana pertenecientes a 9 sociedades científicas peruanas. El 24,1 % tuvo un nivel severo de agotamiento emocional, el 45,6% un nivel severo de despersonalización, el 25,3% un nivel bajo de realización personal y 57,6% tuvieron SBO. El 60,8% de los estudiantes se encontraba realizando algún trabajo de investigación y el 49,4% ocupaba algún cargo en su sociedad científica. Conclusiones: Se identificó una importante frecuencia de SBO en los estudiantes de Medicina pertenecientes a las sociedades científicas estudiadas...

To identify the frequency of burnout syndrome (BOS) in medical students belonging to Peruvian scientific societies (2015). Material and Methods: It is an observational, descriptive and transversal study. The study population was all students of human medicine belonging to 9 scientific societies involving different departments of Peru and affiliated to the Sociedad Científica Médica Estudiantil Peruana (SOCIMEP). The data collection was through a biographical data questionnaire and the Maslach Burnout Inventory. Results: We surveyed 158 students of Human Medicine belonging to 9 Peruvian scientific societies. The 24.1% had a severe emotional exhaustion level, 45.6% a severe level of depersonalization, 25.3% reported low level of personal accomplishment, and 57.6% had BOS. The 60.8% of students were doing some research and 49.4% occupied a position in the scientific society. Conclusions: An important frequency of BOS was identified in the medical students belonging to scientific societies of the study...