Search

An earlier diagnosis of autism spectrum disorder might lead to an earlier intervention, yet knowledge and awareness of autism spectrum disorder in Latin America and Caribbean Countries are limited. A later autism spectrum disorder diagnosis has been associated with negative consequences, as it might imply later access to services. This study aims to identify factors associated with the age of autism spectrum disorder diagnosis as reported by 2520 caregivers of autistic children from six Latin America and Caribbean Countries. Results indicate that on average, caregivers were concerned about their child’s development by 22 months of age; however, the diagnosis was 24 months later. Current age of autistic individuals, better language abilities, and having public health coverage increased the age of diagnosis. On the contrary, the presence of medical comorbidities, severity level, and type of diagnosis decreased the age of diagnosis. The age of diagnosis of autistic individuals in Latin America and Caribbean Countries corresponded to the start of formal schooling despite a much earlier age of first noticed developmental concern, highlighting the need to reduce this age gap and increase children’s probability of benefiting from early intervention. Taken together, autism spectrum disorder personal/clinical characteristics and access to health service are the main determinants for the age of diagnosis. Lay abstract An earlier diagnosis of autism spectrum disorder might lead to earlier intervention. However, people living in Latin American and Caribbean countries do not have much knowledge about autism spectrum disorder symptoms. It has been suggested that the older a child is when diagnosed, the fewer opportunities he or she will have to receive services. We asked 2520 caregivers of autistic children in six different Latin America and Caribbean Countries, the child’s age when they noticed some developmental delays and their child’s age when they received their first autism spectrum disorder diagnosis. Results indicate that, on average, caregivers were concerned about their child’s development by 22 months of age; however, the diagnosis was received when the child was 46 months of age. In addition, older children with better language abilities and public health coverage (opposed to private health coverage) were diagnosed later. On the contrary, children with other medical problems and more severe behaviors received an earlier diagnosis. In our study, children were diagnosed around the time they entered formal schooling, delaying the access to early intervention programs. In summary, the characteristics of the autistic person and the type of health coverage influence the age of diagnosis in children living in Latin America and Caribbean Countries.

Educación laica, gratuita, obligatoria, integral, científica, democrática, nacionalista y de calidad, como valores para la educación pública que se han incorporado y evolucionado a través del tiempo, han dado sentido y orientación a la acción gubernamental durante gran parte del siglo que ha cumplido la Constitución mexicana de 1917; sin embargo, parecen aún lejanos e insuficientes para configurar el proyecto educativo del México futuro. Por ello, el debate sobre el derecho a la educación, si bien tiene varias décadas de estar presente entre especialistas y académicos, parece más pertinente hoy, frente a las dificultades y controversias que ha enfrentado la reforma educativa de 2013. El centenario del Artículo Tercero Constitucional es un marco simbólico que brinda la oportunidad de compendiar el estado actual de su debate, mismo que se ha logrado gracias a la colaboración entre la Universidad Pedagógica Nacional, la Facultad Latinoamericana de Ciencias Sociales-México (flacso) y la Comisión de Educación del Senado de la República lxiii Legislatura, que además abre la posibilidad para la reflexión permanente sobre los retos que deberá enfrentar, en los años venideros, este importante derecho humano. Para hacer un justo reflejo del debate nacional, la pluralidad se planteó como uno de los principales objetivos de esta obra. Las contribuciones que se encuentran incluidas fueron desarrolladas por sus autores, en respuesta a una convocatoria de la Universidad Pedagógica Nacional y la Comisión de Educación del Senado de la República lxiii Legislatura, buscando que todo interesado en el tema que tuviera algo que aportar al debate pudiese hacerlo, siempre en un marco de tolerancia al derecho de otros de disentir, condición que los autores participantes mostraron en un elevado ejemplo de capacidad de diálogo y debate entre pares, donde las posturas totalizantes cedieron el paso a la crítica reflexiva.

espanolPresentamos un estudio multicentrico realizado a traves de una en-cuesta en linea a 1826 familias de personas con TEA de Argentina, Brasil, Chile, Mexico, Peru, Republica Dominicana, Uruguay y Venezuela. Nuestro objetivo es describir el impacto de la pandemia –y el aislamiento social– en la conducta, el es-tado de animo, el sueno y la alimentacion de las personas con TEA. A tal fin hemos relevado caracteristicas sociodemograficas, habitacionales y modalidad de confina-miento. Analizamos los efectos de la discontinuidad de los servicios educativos y te-rapeuticos y valoramos los alcances de las intervenciones a distancia. Algunas de las consecuencias del confinamiento –obligatorio para la mayoria– han sido el aumento de irritabilidad en las personas con TEA, el incremento de la conducta de deambular, mayores niveles de ansiedad, dificultades en alimentacion, sueno y concentracion. La mayor parte de las familias han notado retrocesos en sus hijos durante el encie-rro. Se destacan los efectos beneficiosos de salidas y paseos. Muchos tratamientos y clases se han suspendido. Se subrayan positivamente las intervenciones a distancia. La crisis actual deberia ser una oportunidad para reorganizar dispositivos de educa-cion y tratamiento, atendiendo a la necesidad de cambios, con una perspectiva mas ecologica, inclusiva y amigable con el autismo. EnglishWe present a multicenter study conducted through an online survey of 1826 families of people with ASD from Argentina, Brazil, Chile, Mexico, Peru, the Dominican Republic, Uruguay and Venezuela. Our objective is to describe the impact of the pandemic –and social isolation– on the behavior, mood, sleep and diet of people with ASD. To this end, we have surveyed sociodemographic and housing characteris-tics and the modality of confinement. We analyze the effects of discontinuity in edu-cational and therapeutic services and assess the scope of remote interventions.Some of the consequences of confinement –obligatory for the majority– has been increased ir-ritability in people with ASD, increased wandering behavior, higher levels of anxiety, and difficulties in eating, sleeping and concentrating. Most of the families have noticed setbacks in their children during the confinement. The beneficial effects of outings and walks are highlighted. Many treatments and classes have been discontinued. Remote interventions are positively highlighted.The current crisis should be an opportunity to reorganize education and treatment devices, attending to the need for changes, with a more ecological, inclusive and autism-friendly perspective.

Delayed diagnosis and a lack of adequate care for people with autism spectrum disorder (ASD) are related to worse outcomes and quality of life. This study aimed to identify the profile of service use, barriers to access care, and factors related to those barriers in Brazilian families with children with ASD. A total of 927 families with ASD children (3-17 years) from five Brazilian regions completed an online version of the Caregivers Needs Survey. Results showed that the most used services were behavioral interventions and pharmacotherapy, while the most used professionals were neurologists, nutritionists, speech therapists, psychiatrists, psychologists, and pediatricians. The main barriers included waiting lists, costs, and the absence of services or treatment. Service use varied according to age, the region of residence, the type of health care system used, and the parents/caregivers' education. Access to behavioral interventions was more frequent among users of the private system/health insurance and families whose caregivers had higher education. The absence of specialized services/treatments was less frequent among residents of state capitals and families whose caregivers had higher levels of education. This study highlights how families with children/adolescents with ASD in Brazil face significant barriers to access care related to sociodemographic factors.

The selectivity of two types of commercial fishing gear (crab hoop/traditional gear and rigid rectangular cage traps) targeting blue crabs (Callinectes arcuatus) in Cuyutlan Lagoon, Mexico, was assessed. The effect of soak time on crab catches versus the retention and escape rate of organisms was also evaluated. Results suggested that traps captured larger individuals than hoops. The carapace width of crabs was significantly different between the fishing gears used: 63.9% of crabs caught with hoops were < 95 mm (sizes ranged from 40 to 113 mm) and 40.7% of crabs caught with traps were < 95 mm (range: 49 to 120 mm). Results also showed that catch rates were high during the first two hours and decreased after the third hour. The crabs tended to escape after several hours of soak time. The study found that the traps captured larger crabs than the hoops, suggesting that traps are a suitable fishing gear for catching blue swimming crabs in Cuyutlan Lagoon.

Angel Riviere’s concern for understanding autism ‘from within’ positioned him in different settings that converge in shared coordinates. Topics such as internal experience, future thinking and emot...

Lack of access to services and support is an important issue for people with autism, but in low- and middle-income countries there is a lack of data on this problem. The aims of this study were to describe the challenges and priorities, identify barriers to care, and map stigma among families of individuals with autism in Latin America. This survey was undertaken by the Red Espectro Autista Latinoamerica network, a coalition of researchers/clinicians from six Latin American countries; it comprised 2942 caregivers of children with autism from Brazil, Argentina, Chile, Uruguay, Venezuela, and the Dominican-Republic, who completed the Spanish/Portuguese version of the Caregiver Needs Survey. The survey showed that the main priorities were greater community awareness and improvements in education. The main barriers to care were waiting lists (50.2%), treatment costs (35.2%), and lack of specialized services (26.1%). Stigma experienced by families was frequent: one-third reported feeling discriminated against and helpless for having a child with autism, 48.8% reported some type of financial problem, 47.4% had to reduce work hours, and 35.5% had to stop working because of their child’s autism. This survey describes the main needs/challenges faced by individuals with autism in Latin America, helping to build data-driven strategies at a national/regional level. Lay abstract Approximately 6 million individuals with autism spectrum disorder live in Latin America. In order to strengthen autism spectrum disorder research collaborations and awareness in the region, the Latin American Autism Spectrum Network ( Red Espectro Autista Latinoamerica) was constituted in 2015, comprising researchers and clinicians from the following six countries: Brazil Argentina, Chile, Uruguay, Venezuela, and the Dominican Republic. This first multisite study from the Red Espectro Autista Latinoamerica network aims to describe the challenges and priorities to identify barriers to care and to map stigma among families of individuals with autism spectrum disorder living in Latin America. A total of 2942 caregivers from these six countries completed an online survey showing that the main priorities were greater community awareness and improvements in the educational system for individuals with autism spectrum disorder. In addition to that, the main barriers to care were related to lack of structure, mainly waiting lists (50.2%), high treatment costs (35.2%), and lack of specialized services (26.1%). Stigma experienced by families was frequent: one third reported feeling discriminated against and helpless for having a child with autism spectrum disorder. Also, 48.8% of the caregivers declared financial problems, 47.4% of them had to cut down work hours, and 35.5% had to leave their jobs because of their child’s autism spectrum disorder. This is a pioneer study providing a description of the needs and challenges faced by families affected by autism spectrum disorder in Latin America, helping to build data-driven strategies at the national and regional levels.

Artista audiovisual. Cursó la Maestría en Estudios Curatoriales. Su obra se ha presentado en diversos espacios del país, entre ellos el Centro de Cultura Digital, Cineteca Nacional, Museo Universitario del Chopo, Centro Cultural Universitario, entre otros, así como en festivales de Latinoamerica y Europa. Fue becario del FONCA, Jóvenes creadores, 2017. Actualmente es candidato a doctor en Historia del Arte por la UNAM.

Image retargeting changes the aspect ratio of images while aiming to preserve content and minimise noticeable distortion. Fast and high-quality methods are particularly relevant at present, due to the large variety of image and display aspect ratios. We propose a retargeting method that quantifies and limits warping distortions with the use of content-aware cropping. The pipeline of the proposed approach consists of the following steps. First, an importance map of a source image is generated using deep semantic segmentation and saliency detection models. Then, a preliminary warping mesh is computed using axis aligned deformations, enhanced with the use of a distortion measure to ensure low warping deformations. Finally, the retargeted image is produced using a content-aware cropping algorithm. In order to evaluate our method, we perform a user study based on the RetargetMe benchmark. Experimental analyses show that our method outperforms recent approaches, while running in a fraction of their execution time., Comment: 5 pages

People on the Autism Spectrum (AS) face multiple health, education, social, and economic pro blems. There is limited available information in Chile.To describe the access and satisfac tion with health and education services, family and economic impact, stigma, and quality of life of people with AS and their families in Chile.Parents/caregivers of AS persons completed the Caregiver Needs Survey, developed by Autism Speaks, which includes demographic information, characteristics of AS persons (previously published), use of health and education servi ces, parents/caregivers' perceptions of satisfaction, impact, stigma, and quality of life.291 caregivers (86% mothers) of 291 AS persons participated, 89% were male, aged 1-40 years (X:10.4 SD:6.1). Limited and unspecific access to health services is reported. 77% are regularly attending a standard or special school system. Families pay for over 60% of therapies/medical care and over 40% of specific educational support, and 25% report difficulties in accessing services. The family income is affected by resignation (35%) or reduced working hours (46%). Stigma is associated with possi ble discrimination and feelings of helplessness. The main priorities mentioned for a better quality of life are support for inclusive schooling, better adjustment at home, and improved socialization.This survey provides relevant information about the needs, barriers, and challenges of AS people in Chile and highlights the difficulties in accessing health services and the severe impact on family income. Feelings of stigma, discrimination, and helplessness are reported. Collaborative strategies are needed to improve the quality and access to services and to reduce the economic and mental health burden on the family.

ASD is a neurodevelopmental disorder that affects people across the entire lifespan, yet most of the research identifying the health and medical needs for autistic individuals have been among minors. As individuals with ASD transition to emerging adulthood, the services, already limited, become less available. This study aimed to identify the use of services for Latin American adults on the spectrum. We surveyed 295 caregivers of adults with ASD from six Latin American countries. Comparing the results for all the possible services observed in this study, the adults in our sample were primarily underserved: 84.4%-95.9% were receiving zero hours per week, 3.7%-12.9% 1%-10 h, 0%-1.7% 11-20, and only 0%-1% above 20 h of services. Almost half of the sample used medication, and neurologists were the most consulted health providers. Next to inexistent health care usage in Latin American adults with ASD highlights socioeconomic and health disparities in service provision for ASD in the region. The lack of services places adults with ASD in Latin America at a higher risk of worse symptom severity than autistic adults from regions with broader access to services. LAY SUMMARY: This study aimed to identify the quantity of services received by adults with autism in Latin America. Most of our sample was not receiving health services yet almost half had access to medication. This could mean that adults with autism in Latin America are at higher risk for poorer health.

Las personas del Espectro Autista (EA) enfrentan múltiples necesidades de salud, educación, problemas sociales y económicos. La información disponible en Chile es insuficiente. Objetivo: Conocer el acceso y satisfacción con servicios de salud y educación, el impacto familiar y económico, estigma y calidad de vida de personas EA y sus familias en Chile. Sujetos y Método: Padres/cuidadores de personas EA respondieron la Encuesta de Necesidades de Cuidadores, desarrollada por Autism Speaks, que comprende: información demográfica, características de las personas EA (publicado previamente), utilización de servicios de salud y educación, percepciones de padres/cuidadores en satisfacción, impacto, estigma y calidad de vida (que presenta esta publicación). Resultados: Participaron 291 cuidadores (86% madres), de 291 personas EA, 89% varones, de 1-40 años (X:10,4 DE:6,1). Se reporta un acceso insuficiente y poco específico a servicios de salud. Un 77% asiste regularmente a algún sistema escolar regular o especial. Las familias financian sobre 60% de terapias/atención médica y sobre 40% de apoyos educacionales específicos; un 25% refiere dificultades de acceso a servicios. La economía familiar se afecta por renuncia (35%) o reducción de jornadas laborales de los cuidadores (46%). El estigma se asocia a posible discriminación y sentimientos de impotencia. Las principales prioridades mencionadas para una mejor calidad de vida son apoyos para escolaridad inclusiva, mejor adaptación en el hogar y mejorar la socialización. Conclusiones: Esta encuesta aporta información relevante acerca de las necesidades, barreras y desafíos de las personas EA en Chile. Destacan las dificultades de acceso a servicios de salud y el severo impacto sobre el ingreso económico familiar. Existe estigma, discriminación e impotencia. Se requiere elaborar estrategias colaborativas para mejorar la calidad y acceso a servicios y reducir la carga económica y de salud mental familiar.

Benzodiazepines and SSRIs are considered as standard treatment options for anxiety and depression, hallmarks of Post-Traumatic Stress Disorder (PTSD), although their use is often limited by adverse effects. While promising evidence emerged with β-adrenergic receptor (β-AR) antagonists (or ‘β-blockers’) and PTSD relief, efficacy issues dampened the excitement. However, we believe it is premature to completely eliminate a beneficial role of β-blockers. Our previous work has suggested that social defeat (SD) results in anxiety-like and depression-like behaviors in rats. Here, using the SD paradigm, we examined the effect of several β-adrenergic receptor antagonists (propranolol, nadolol, bisoprolol) on these behaviors in rats. Following acclimatization, Sprague-Dawley rats received no treatment (for control groups) or treated with ; propranolol (50 mg/kg/day in water), or nadolol (18 mg/kg/day in rats’ chow), or bisoprolol (15 mg/kg/day in water). The treatment lasted for 36 days, following which rats were subjected to SD/control exposures (1 week). Later, anxiety-like and depression-like behaviors, social interaction and learning-memory function tests were conducted. SD rats exhibited anxiety- and depression-like behavior as well as learning-memory impairment. Propranolol and nadolol protected SD rats from exhibiting anxiety-or depression-like behaviors. Bisoprolol treatment did not mitigate SD-induced behavioral impairments in rats. Nadolol, propranolol or bisoprolol have no effect in attenuating SD-induced memory function tests. These results suggest that certain ‘β-blockers’ have the potential to mitigate the negative psychological effects of traumatic events.

Background Relationship of perceived stigma and barrier to service access among Latino populations with autism in cross-cultural settings has not been fully explored. Aim The present study explored the relationship between difficulty accessing services and perceived stigma among caregivers of autistic children in Latin America. Additionally, explore contextual factors that better explain the perception of stigma when accessing services. Methods and Procedure Approximately 2500 caregivers from six Latin American countries completed an online survey. Descriptive inferential analysis and a pointbiserial correlation were conducted to understand direct relationship between difficulty accessing services and perceived stigma and to test their relationship. Added contextual factors contributing to this relationship were examined through a binary logistic regression. Outcomes and Results Barriers to accessing services predicted stigma. Contextual factors such as country of residence, frustration experienced by caregivers, gender of autistic child and challenging behaviours had higher odds of experiencing some form of perceived stigma. Conclusions and Implications These results suggest experiences with stigma to be heavily influenced by environmental factors such cultural differences which in combination with contextual factors could further increase the likelihood of perceiving stigma. When observing stigma within a social–cognitive approach, it is possible that a strong-held adherence to cultural norms, in addition to negative experiences (e.g., frustration) when accessing services, could be influencing caregivers perceived stigma.

Our previous studies suggested certain β-adrenoceptor blockers (β-blockers) attenuate the asthma phenotype in ovalbumin driven murine models of asthma. However, the ovalbumin model has been criticized for lack of clinical relevance.We tested the non-selective β-blockers, carvedilol and nadolol, in house dust mite (HDM) driven murine asthma models where drugs were administered both pre- and post-development of the asthma phenotype. We measured inflammation, mucous metaplasia, and airway hyper-responsiveness (AHR). We also measured the effects of the β-blockers on extracellular-signal regulated kinase (ERK 1/2) phosphorylation in lung homogenates.We show that nadolol, but not carvedilol, attenuated inflammation and mucous metaplasia, and had a moderate effect attenuating AHR. Following HDM exposure, ERK1/2 phosphorylation was elevated, but the level of phosphorylation was unaffected by β-blockers, suggesting ERK1/2 phosphorylation becomes dissociated from the asthma phenotype.Our findings in HDM models administering drugs both pre- and post-development of the asthma phenotype are consistent with previous results using ovalbumin models and show differential effects for nadolol and carvedilol on the asthma phenotype. Lastly, our data suggest that ERK1/2 phosphorylation may be involved in development of the asthma phenotype, but may have a limited role in maintaining the phenotype.

Objective Natural language processing (NLP) engines such as the clinical Text Analysis and Knowledge Extraction System are a solution for processing notes for research, but optimizing their performance for a clinical data warehouse remains a challenge. We aim to develop a high throughput NLP architecture using the clinical Text Analysis and Knowledge Extraction System and present a predictive model use case. Materials and Methods The CDW was comprised of 1 103 038 patients across 10 years. The architecture was constructed using the Hadoop data repository for source data and 3 large-scale symmetric processing servers for NLP. Each named entity mention in a clinical document was mapped to the Unified Medical Language System concept unique identifier (CUI). Results The NLP architecture processed 83 867 802 clinical documents in 13.33 days and produced 37 721 886 606 CUIs across 8 standardized medical vocabularies. Performance of the architecture exceeded 500 000 documents per hour across 30 parallel instances of the clinical Text Analysis and Knowledge Extraction System including 10 instances dedicated to documents greater than 20 000 bytes. In a use–case example for predicting 30-day hospital readmission, a CUI-based model had similar discrimination to n-grams with an area under the curve receiver operating characteristic of 0.75 (95% CI, 0.74–0.76). Discussion and Conclusion Our health system’s high throughput NLP architecture may serve as a benchmark for large-scale clinical research using a CUI-based approach.

Background Core symptoms of Autism Spectrum Disorder (ASD) continue to affect everyday life as children grow and transition into adulthood. That way, different services may be needed at various stages of their lifetimes. This study aimed to describe service encounters and hours of service per week for individuals with ASD in Latin American countries and compare the data from three age groups (preschoolers, school-aged, and adolescents). Methods The data were obtained from an online survey adapted by Red Espectro Autista Latinoamerica (REAL) in 6 different South & Central American countries. The total sample was composed of 2520 caregivers of children and adolescents with ASD. Results Service encounters for Speech, Occupational, and Behavioral Therapies decreased with patient age, while medication increased. Regardless of the age group, a large proportion of individuals (19–37 %) were not receiving treatment, and those receiving treatment got fewer hours than best practice recommendations. For adolescents, the gaps in treatment are even greater and less consistent. Discussion Failure to offer timely identification and intervention for ASD will result in more impairment of the individual and the family burden. Although there are several initiatives to develop more resources for this population in Latin-America, the provision of services for ASD is still undervalued. Many such individuals might not be receiving the services they need, while most children are mainly receiving therapies with low to moderate evidence at a frequency below the recommended standards.

Background and purpose Our previous studies have shown the β2 -adrenoceptor and its endogenous ligand, adrenaline, are required for development of the asthma phenotype in murine asthma models. Chronic administration of some, but not other, β-blockers attenuated the asthma phenotype and led us to hypothesize that biased signalling was the basis of their differential effects, experimentally and clinically. Experimental approach We used mice with no detectable systemic adrenaline (PNMT(-/-) ) and wild-type (WT) mice to study the effects of four β-blockers, alprenolol, carvedilol, propranolol and nadolol, in an ovalbumin sensitization and challenge (Ova S/C) murine model of asthma. The parameters measured were inflammatory cell infiltration, mucous metaplasia and airway hyperresponsiveness. To interpret the pharmacological action of these ligands quantitatively, we conducted computer simulations of three-state models of receptor activation. Key results Ova S/C PNMT(-/-) mice do not develop an asthma phenotype. Here, we showed that administration of alprenolol, carvedilol or propranolol in the absence of interference from adrenaline using Ova S/C PNMT(-/-) mice resulted in the development of an asthma phenotype, whereas nadolol had no effect. Ova S/C WT mice did develop an asthma phenotype, and administration of alprenolol, propranolol and carvedilol had no effect on the asthma phenotype. However, nadolol prevented development of the asthma phenotype in Ova S/C WT mice. Computer simulations of these four ligands were consistent with the isolated three-state receptor model. Conclusion and implications β-Blockers have different effects on the murine asthma phenotype that correlate with reported differences in activation or inhibition of downstream β2 -adrenoceptor signalling pathways.

In this study, gallic acid and its complexes with aluminum and iron were investigated for their antibacterial, pro-oxidative, and genotoxic properties at alkaline pH. At 4.0μmol/mL, gallic acid displayed bacteriostatic property while aluminum-gallic acid and iron-gallic acid complexes showed bactericidal property against Escherichia coli ATCC 25922. A higher antibacterial activity was observed in the turbidimetric assay compared to the well-diffusion assay. The metal complexes of gallic acid also generated a higher concentration of malondialdehyde and hydrogen peroxide compared to gallic acid alone at > 0.50µmol/mL. Using the SOS response of the DNA repair-deficient Escherichia coli PQ37, the metal complexes of gallic acid resulted to a significantly higher SOS Induction Factors (ρ

To determine the frequency of medication errors in prehospital care and to investigate the influencing factors – diagnostic agreement (DA), the medical educational status, the specialty, the approval for emergency medicine of the prehospital emergency physician, the patient age and sex and the time of deployment. We retrospectively reviewed 708 patients from 2013 to 2015, treated by the prehospital emergency physicians of the emergency medical service center Bad Belzig, Germany. The medication appropriateness was determined by a systematic comparison of the administered medication in prehospital deployments with the discharge diagnosis, according to current guidelines. The influencing factors were examined by univariate analysis of medication appropriateness (MA), using the χ2, the Mann–Whtiney U and the Welch tests. We calculated a cut-off value with the Youden index to predict absent MA, according to patients age. The significance level was P = .05. MA was absent in 220 of 708 patients (31.1%). In the case of present DA, MA was absent in 103 of 491 patients (20.9%). In the case of absent DA, MA was absent in 117 of 217 patients (53.9%) (P = .01). MA was absent in 82 of 227 patients (36.1%), treated by specialist and in 138 of 481 patients (28.7%), treated by resident physicians (P = .04). The calculated cut-off value to predict absent MA was 75.5 years. MA was absent in 100 of 375 patients (26.7%) of the younger patient age group (≤75.5 years), MA was absent 120 of 333 patients (36.0%) of the older patient age group (>75.5 years) (P = .01). Absent MA showed peak values (46.7%–60%) at night from 3 to 6 AM (P = .01) The other investigated factors had no influence on MA. The correctness of medication as a quality feature in prehospital care shows a necessity for improvement with a proportion of 31.1% medication errors. The correct diagnosis by the prehospital emergency physician and his rapid accumulation of experience had an impact on the correctness of medication in prehospital care. Elderly patients (75+ years) and nighttime prehospital deployments (3–6 AM) were identified as high risk for medication errors by the emergency physicians.

A massively parallel SPH scheme using heterogeneous clusters of Central Processing Units (CPUs) and Graphics Processing Units (GPUs) has been developed. The new implementation originates from the single-GPU DualSPHysics code previously demonstrated to be powerful, stable and accurate. A combination of different parallel programming languages is combined to exploit not only one device (CPU or GPU) but also the combination of different machines. Communication among devices uses an improved Message Passing Interface (MPI) implementation which addresses some of the well-known drawbacks of MPI such as including a dynamic load balancing and overlapping data communications and computation tasks. The efficiency and scalability (strong and weak scaling) obtained with the new DualSPHysics code are analysed for different numbers of particles and different number of GPUs. Last, an application with more than 10 9 particles is presented to show the capability of the code to handle simulations that otherwise require large CPU clusters or supercomputers.

Mice lacking the endogenous β2-adrenoceptor (β2AR) agonist epinephrine (phenylethanolamine N-methyltransferase [PNMT]-knockout mice) are resistant to developing an "asthma-like" phenotype in an ovalbumin sensitization and challenge (Ova S/C) model, and chronic administration of β2AR agonists to PNMT-KO mice restores the phenotype. Based on these and other studies showing differential effects of various β2AR ligands on the asthma phenotype, we have speculated that the permissive effect of endogenous epinephrine and exogenous β2AR agonists on allergic lung inflammation can be explained by qualitative β2AR signaling. The β2AR can signal through at least two pathways: the canonical Gαs-cAMP pathway and a β-arrestin-dependent pathway. Previous studies suggest that β-arrestin-2 is required for allergic lung inflammation. On the other hand, cell-based assays suggest antiinflammatory effects of Gαs-cAMP signaling. This study was designed to test whether the in vitro antiinflammatory effects of phosphodiesterase 4 inhibitors, known to increase intracellular cAMP in multiple airway cell types, attenuate the asthma-like phenotype produced by the β2AR agonists formoterol and salmeterol in vivo in PNMT-KO mice, based on the hypothesis that skewing β2AR signaling toward Gαs-cAMP pathway is beneficial. Airway inflammatory cells, epithelial mucus production, and airway hyperresponsiveness were quantified. In Ova S/C PNMT-KO mice, formoterol and salmeterol restored the asthma-like phenotype comparable to Ova S/C wild-type mice. However, coadministration of either roflumilast or rolipram attenuated this formoterol- or salmeterol-driven phenotype in Ova S/C PNMT-KO. These findings suggest that amplification of β2AR-mediated cAMP by phosphodiesterase 4 inhibitors attenuates the asthma-like phenotype promoted by β-agonists.

Argentina is on track toward inclusive education. To achieve this it is necessary to change practices so as to overcome the exclusion or segregation of students with disabilities. In that sense, in recent years, and in line with the guidelines of the Convention on the Rights of Persons with Disabilities (United Nations, 2006/2008), state policies promoted inclusive practices in schools, providing financial support to families to cope with the necessary tools including children in mainstream schools. Currently one of the resources used for this purpose is “integrators teachers.” This chapter provides an example and a description of the consideration of inclusive education for young children with autism spectrum disorders (ASD) in a South American country, Argentina, by analyzing the experience of inclusive education of children with ASD with the assistance of support teachers in mainstream schools in different regions of Argentina.

Historia del Arte

ResumenEste trabajo esta dirigido al estudio de las estereotipias motoras en varios grupos de ninos con y sin dificultades en el desarrollo. El trabajo se concreta en dos estudios: en el primero analizamos si cambios en la situacion estimular producen efectos en la presencia de estereotipias en los diferentes grupos y, en el segundo, estudiamos como se insertan las estereotipias en la situacion de interaccion, si interfieren o si, por el contrario, se ajustan a la actividad que estan llevando acabo los ninos. Nuestros resultados parecen apuntar que, en todos los grupos estudiados, las estereotipias se ven influidas de forma similar cuando se producen cambios en la situacion estimular y, ademas, parece que, tambien en todos los grupos, las estereotipias pueden convivir con una interaccion correcta y ajustada

ResumenAnalizamos desde una perspectiva critica los estudios realizados sobre funcion ejecutiva, especialmente dentro del campo del autismo. Desde hace una decada han proliferado estudios que tratan de elaborar perfiles de funcionamiento, aislando distintos componentes de funcion ejecutiva. En ellos se evidencia una alta heterogeneidad de resultados y se proponen algunos posibles fallos metodologicos como responsables de la misma. Por otro lado, es frecuente que en la literatura se aluda a la presencia de disfuncion ejecutiva en el autismo como responsable de alguna de las conductas observadas en esta poblacion, en concreto, se da por hecha la relacion entre estereotipias y fallos ejecutivos. Sin embargo, apenas se han realizado trabajos de investigacion que establezcan esta relacion. Nosotros presentamos dos estudios. En el primero se analiza la presencia de fallos de inhibicion y generatividad en autismo, tratando de cubrir en el diseno algunos de los errores caracteristicos detectados en la literatura....