Search

BackgroundAtaxia is a rare neurological condition causing a deficit in the coordination of motor activities, preventing the fluidity of movements. Children with ataxia may show several different ataxic signs, along with difficulties in walking autonomously and ataxic gait often associated with trunk instability. Ataxic signs can be either acute or chronic, and in either case, the diagnosis can be extremely complex. Symptoms and their etiology are often widely heterogeneous, even within the same condition.MethodsThe guideline was developed based on the methodology defined by the Methodological Handbook of the Italian National Guideline System (SNLG) and was reported following the AGREE-II checklist. The SNLG methodology required the adoption of the GRADE approach for the whole development process. To facilitate the implementation of the contents and recommendations from the guideline, two care pathways were developed based on the NICE and the European Pathway Association (EPA) models.ResultsThe guideline included 28 clinical questions, 4 on the identification and management of acute ataxias, and 24 on the diagnosis and management of chronic ataxias. The document included 44 recommendations, 37 clinical recommendations, and 7 recommendations for research.ConclusionThe working group, despite the lack and methodological limitations of the evidence, deemed as essential to provide indications and recommendations, in particular in some clinically relevant areas. The care pathway was produced as a tool to facilitate the implementation of the contents and recommendations. The interactive version of the pathway is available on the SNLG website along with a leaflet dedicated to families and caregivers.

Abstract The evolution of the Sicily Channel Rift Zone (SCRZ) is thought to accommodate the regional tectonic stresses of the Calabrian subduction system. Much of the observations we have today are either limited to the surface or to the upper crust or deeper from regional seismic tomography, missing important details about the lithospheric structure and dynamics. It is unclear whether the rifting is passive from far‐field extensional stresses or active from mantle upwelling beneath. We measure Rayleigh‐and Love‐wave phase velocities from ambient seismic noise and invert for 3‐D shear‐velocity and radial anisotropic models. Variations in crustal S‐velocities coincide with topographic and tectonic features. The Tyrrhenian Sea has a ∼10 km thin crust, followed by the SCRZ (∼20 km). The thickest crust is beneath the Apennine‐Maghrebian Mountains (∼55 km). Areas experiencing extension and intraplate volcanism have positive crustal radial anisotropy (VSH > VSV); areas experiencing compression and subduction‐related volcanism have negative anisotropy. The crustal anisotropy across the Channel shows the extent of the extension. Beneath the Tyrrhenian Sea, we find very low sub‐Moho S‐velocities. In contrast, the SCRZ has a thin mantle lithosphere underlain by a low‐velocity zone. The lithosphere‐asthenosphere boundary rises from 60 km depth beneath Tunisia to ∼33 km beneath the SCRZ. Negative radial anisotropy in the upper mantle beneath the SCRZ is consistent with vertical mantle flow. We hypothesize a more active mantle upwelling beneath the rift than previously thought from an interplay between poloidal and toroidal fluxes related to the Calabrian slab, which in turn produces uplift at the surface and induces volcanism.

Background/Context: This paper is part of the special issue "Reimagining Research and Practice at the Crossroads of Philosophy, Teaching, and Teacher Education." We propose that there is a vital connection in teaching between curriculum and memories that should be fostered in our classrooms. Because memories are alive and bring meaning to our lives, they need to be handled with care. Unfortunately, however, much of teaching risks to simply embalm what is already dead. We examine how the living work of teachers might reposition curriculum as a body of dynamic memories: a constellation of struggles and belongings, failures and accomplishments. The role of the teacher, in this context, is as a handler of those memories. Research Design: Our approach derives from sustained interaction as we have sought to bring our scholarly backgrounds in philosophy of education and English teacher education, respectively, into dynamic contact. The methodology of the inquiry is mixed in that it combines teacher narratives (our own) with critical conceptual analysis, collective memory work, and phenomenology. Drawing on a bibliography of texts organized collaboratively by the larger research group, our main authors of reference are Freire, Gramsci, Anzaldua, Style, and Britzman. We also feature several fine-grained narratives that illuminate what we mean by "handlers of memory" in the educational setting. Conclusions/Recommendations: Our shared philosophizing in this paper is a response to the concern that classroom teaching contributes to the deadening of curriculum as a source of meaning and an avenue for students and teachers to learn about themselves. In response, we propose the image of teachers as handlers of memory who work to cultivate and keep memories alive and central to learning. We recommend that teachers explore collective memory work (Haug, 1999) and reflective teaching narratives (Furman, 2015) as ways to get a handle on their own powerful memories of teaching.

OBJECTIVE To determine the clinical and analytical accuracy of a new veterinary-calibrated portable blood glucose monitor (PBGM) compared to a reference laboratory analyzer. ANIMALS Client-owned dogs (n = 77) and cats (n = 64). METHODS Peripheral and paired capillary whole-blood glucose concentrations measured via PBGM were compared to plasma glucose concentrations measured via a Cobas c501 reference analyzer (Roche). Analytical accuracy was evaluated with the Spearman rank correlation coefficient, Bland-Altman difference plot analysis, and Deming regression. Clinical accuracy was evaluated with Parkes error grid analysis. Paired peripheral and capillary blood samples were compared with the Wilcoxon matched-pairs signed-rank test. RESULTS There was a high correlation between PBGM and reference analyzer readings in dogs and cats. Human quality assurance standards (International Organization for Standardization 15197:2013 guidelines) for analytical accuracy were met for 95% of feline peripheral blood samples and 89% of canine samples. Similar veterinary standards (American Society of Veterinary Clinical Pathology guidelines) were met for 89% of canine and 92% of feline peripheral blood glucose measurements. Error grid analysis showed that all peripheral canine and 97% of feline measurements were clinically accurate (zone A). Any altered clinical decision for the remaining feline measurements was expected to minimally impact outcome (zone B). No significant difference was found between peripheral and capillary blood glucose measurements in either species. CLINICAL RELEVANCE The PBGM produced clinically accurate results and is suitable for use in veterinary and home settings to measure blood glucose. [ABSTRACT FROM AUTHOR]

Background: Many studies reporting neonatal outcomes in birth centers include births with risk factors not acceptable for birth center care using the evidence‐based CABC criteria. Accurate comparisons of outcomes by birth setting for low‐risk patients are needed. Methods: Data from the public Natality Detailed File from 2018 to 2021 were used. Logistic regression, including adjusted and unadjusted odds ratios, compared neonatal outcomes (chorioamnionitis, Apgar scores, resuscitation, intensive care, seizures, and death) between centers and hospitals. Covariates included maternal diabetes, body mass index, age, parity, and demographic characteristics. Results: The sample included 8,738,711 births (8,698,432 (99.53%) in hospitals and 40,279 (0.46%) in birth centers). There were no significant differences in neonatal deaths (aOR 1.037; 95% CI [0.515, 2.088]; p‐value 0.918) or seizures (aOR 0.666; 95% CI [0.315, 1.411]; p‐value 0.289). Measures of morbidity either not significantly different or less likely to occur in birth centers compared to hospitals included chorioamnionitis (aOR 0.032; 95% CI [0.020, 0.052]; p‐value < 0.001), Apgar score < 4 (aOR 0.814, 95% CI [0.638, 1.039], p‐value 0.099), Apgar score < 7 (aOR 1.075, 95% CI [0.979, 1.180], p‐value 0.130), ventilation >6 h (aOR 0.349; [0.281,0.433], p‐value < 0.001), and intensive care admission (aOR 0.356; 95% CI [0.328, 0.386], p‐value < 0.001). Birth centers had higher odds of assisted neonatal ventilation for <6 h as compared to hospitals (aOR 1.373; 95% CI [1.293, 1.457], p‐value < 0.001). Conclusion: Neonatal deaths and seizures were not significantly different between freestanding birth centers and hospitals. Chorioamnionitis, Apgar scores < 4, and intensive care admission were less likely to occur in birth centers. [ABSTRACT FROM AUTHOR]

Abstract Mapping variations in the attenuation of seismic energy is important for understanding dissipative mechanisms in the lithosphere, and for modeling ground shaking associated with earthquakes. We cross-correlate ambient seismic signal recorded across the EarthScope Transportable Array in the 3–15 s period range. We apply to the resulting cross correlations a new method to estimate lateral variations in Rayleigh-wave attenuation, as a function of period, beneath North America. Between 3 and 6 s, our maps are dominated by a strong eastward decrease in attenuation. This pattern vanishes at longer periods, confirming early observations based on regional earthquakes. Attenuation maps and phase-velocity maps are anti-correlated at periods between 3 and 6 s, but the anti-correlation is also largely lost at longer periods. This corresponds to the attenuation coefficient decreasing with period more rapidly in the west than in the east, while the change in phase velocity with period is more uniform across the continent. Our results point to a transition in the properties of upper-crustal materials with depth, probably related to the closure of fluid-filled cracks and pores, and imply that measures of attenuation from seismic noise carry significant information on crustal rheology.

Timely and accurate estimation of plant nitrogen (N) status is crucial to the successful implementation of precision N management. It has been a great challenge to non-destructively estimate plant N status across different agro-ecological zones (AZs). The objective of this study was to use random forest regression (RFR) models together with multi-source data to improve the estimation of winter wheat (Triticum aestivum L.) N status across two AZs. Fifteen site-year plot and farmers' field experiments involving different N rates and 19 cultivars were conducted in two AZs from 2015 to 2020. The results indicated that RFR models integrating climatic and management factors with vegetation index (R2 = 0.72–0.86) outperformed the models by only using the vegetation index (R2 = 0.36–0.68) and performed well across AZs. The Pearson correlation coefficient-based variables selection strategy worked well to select 6–7 key variables for developing RFR models that could achieve similar performance as models using full variables. The contributions of climatic and management factors to N status estimation varied with AZs and N status indicators. In higher-latitude areas, climatic factors were more important to N status estimation, especially water-related factors. The addition of climatic factors significantly improved the performance of the RFR models for N nutrition index estimation. Climatic factors were important for the estimation of the aboveground biomass, while management variables were more important to N status estimation in lower-latitude areas. It is concluded that integrating multi-source data using RFR models can significantly improve the estimation of winter wheat N status indicators across AZs compared to models only using one vegetation index. However, more studies are needed to develop unmanned aerial vehicles and satellite remote sensing-based machine learning models incorporating multi-source data for more efficient monitoring of crop N status under more diverse soil, climatic, and management conditions across large regions.

Purpose The presence of distinct child and adolescent mental health services (CAMHS) and adult mental health services (AMHS) impacts continuity of mental health treatment for young people. However, we do not know the extent of discontinuity of care in Europe nor the effects of discontinuity on the mental health of young people. Current research is limited, as the majority of existing studies are retrospective, based on small samples or used non-standardised information from medical records. The MILESTONE prospective cohort study aims to examine associations between service use, mental health and other outcomes over 24 months, using information from self, parent and clinician reports.Participants Seven hundred sixty-three young people from 39 CAMHS in 8 European countries, their parents and CAMHS clinicians who completed interviews and online questionnaires and were followed up for 2 years after reaching the upper age limit of the CAMHS they receive treatment at.Findings to date This cohort profile describes the baseline characteristics of the MILESTONE cohort. The mental health of young people reaching the upper age limit of their CAMHS varied greatly in type and severity: 32.8% of young people reported clinical levels of self-reported problems and 18.6% were rated to be ‘markedly ill’, ‘severely ill’ or ‘among the most extremely ill’ by their clinician. Fifty-seven per cent of young people reported psychotropic medication use in the previous half year.Future plans Analysis of longitudinal data from the MILESTONE cohort will be used to assess relationships between the demographic and clinical characteristics of young people reaching the upper age limit of their CAMHS and the type of care the young person uses over the next 2 years, such as whether the young person transitions to AMHS. At 2 years follow-up, the mental health outcomes of young people following different care pathways will be compared.Trial registration number NCT03013595.

ABSTRACT Objectives: to create and validate the content of a guide for monitoring the communication of the HIV diagnosis in childhood. Methods: methodological study, with a design guided by the Knowledge-to-Action (KTA) Framework, supported by a participatory approach. The guide’s content was structured according to the communication elements proposed by Lasswel from review studies. Results: the content was validated by 26 experts from nursing, medicine, psychology and pedagogy, using a Likert-type scale for relevance, clarity and precision. Data collection took place online and achieved a Content Validity Index of 0.94. Conclusions: the guide can contribute to the practice of professionals who care for children living with HIV, to support the family in communication and to the child’s right to know their diagnosis. For further research, it is recommended to create and validate the face of the technology in order to implement it.

ABSTRACT Objective To know the dehospitalization of technology-dependent children from a multiprofessional perspective. Method A qualitative, exploratory and descriptive study, carried out in 2018 at a Teaching Hospital in the city of Porto Alegre. The participants were 15 members of the multidisciplinary health team. In data production, we used the Dynamics of Creativity and Sensitivity, “Creative Storm”, which is part of the Sensitive Creative Method. Data interpretation occurred based on Thematic Content Analysis. The study was approved by the Ethics Committee. Results Dehospitalization is influenced by the absence of planning according to the reality of the child and the family. In addition, there is predominance of health services with a physician-centered model, unscheduled discharge, overload of professionals, and communication problems between the staff, the health network and the family. Final Considerations Despite knowing the importance of dehospitalization, it still occurs in a fragmented manner, with hasty hospital discharge, preventing safe dehospitalization and with greater planning.