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A mixed methodologies study was completed to evaluate an elementary school-based Community-Based Instruction (CBI) program for students with autism and secondary findings were identified in the focus group analysis related to barriers to program success, facilitators of program success and implications for practice including occupational therapy. Developed and coordinated by an occupational therapist, the program's mission was to develop work behaviors, job skills, social skills, career interests, and self-determination skills by generalizing knowledge from the classroom through the performance of jobs within the elementary school. Jobs in the school community included running a coffee cart, performing library jobs, organizing a Lost and Found, maintaining a garden, and running a farmer's market to name a few. The program evaluation results showed positive program knowledge and positive attitudes among three stakeholder groups (staff, parents, and administrators) through quantitative and qualitative findings. Through the thematic analysis of the focus groups, barriers to program implementation, facilitators of program success and implications for practice were identified including implications for school-based occupational therapy practitioners which this article further explains.

The frontal plane fractures of the distal humerus are rare. The small intraarticular fragments, the commonly encountered osteoporosis and the specific anatomy make the successful osteosynthesis a challenge. For a period of 15 years in First Clinic of Orthopaedic Traumatology 27 patients with capitulotrochlear fractures were treated. Of them, 12 women and 3 men were followed. The fractures were classified after Dubberley as follows: Type 1А - 1, type 2А - 2, type 2В - 3, type 3А - 5, type 3В – 1, and type 4В - 3. A plethora of surgical exposures were used - extended lateral, paratricipital, a combination of medial and lateral, dorsal with olecranon osteotomy. Primary TEA was performed in 3 patients: Type 3A - 1, type 3В – 1, and type 4В - 1. The patients were followed for a period of 12 months to 8 years. The results were evaluated by the MEPS, DASH and McGowan scores. The final ROM, compared to the contralateral side, was recorded. The average scores are comparable with the ones in a number of publications in the referent literature. As evaluated by MEPS, excellent results were found in 53% of patients, good – in 27%, fair in 7%, and poor –in 13%. The most serious problem was the elbow stiffness. Early deep infection was found in 1 patient with type 4B fracture. Ectopic ossification Hastings type I was found in 1 patient. The modern surgical treatment is based on anatomical reduction through fracture type-specific surgical exposure and rigid osteosynthesis. The treatment of choice for irreparable fractures is total elbow arthroplasty (TEA). We discuss the fixation devises, the surgical exposures and the osteosynthesis construct. Our own osteosynthesis preferences are centered around the fixation in the frontal plane and the additional augmentation with sagittal plane implants.

PurposeTo assess changes in retinopathy of prematurity (ROP) diagnosis in single and serial retinal images.DesignCohort study.ParticipantsCases of ROP recruited from the Imaging and Informatics in Retinopathy of Prematurity (i-ROP) consortium evaluated by 7 graders.MethodsSeven ophthalmologists reviewed both single and 3 consecutive serial retinal images from 15 cases with ROP, and severity was assigned as plus, preplus, or none. Imaging data were acquired during routine ROP screening from 2011 to 2015, and a reference standard diagnosis was established for each image. A secondary analysis was performed using the i-ROP deep learning system to assign a vascular severity score (VSS) to each image, ranging from 1 to 9, with 9 being the most severe disease. This score has been previously demonstrated to correlate with the International Classification of ROP. Mean plus disease severity was calculated by averaging 14 labels per image in serial and single images to decrease noise.Main outcome measuresGrading severity of ROP as defined by plus, preplus, or no ROP.ResultsAssessment of serial retinal images changed the grading severity for > 50% of the graders, although there was wide variability. Cohen's kappa ranged from 0.29 to 1.0, which showed a wide range of agreement from slight to perfect by each grader. Changes in the grading of serial retinal images were noted more commonly in cases of preplus disease. The mean severity in cases with a diagnosis of plus disease and no disease did not change between single and serial images. The ROP VSS demonstrated good correlation with the range of expert classifications of plus disease and overall agreement with the mode class (P = 0.001). The VSS correlated with mean plus disease severity by expert diagnosis (correlation coefficient, 0.89). The more aggressive graders tended to be influenced by serial images to increase the severity of their grading. The VSS also demonstrated agreement with disease progression across serial images, which progressed to preplus and plus disease.ConclusionsClinicians demonstrated variability in ROP diagnosis when presented with both single and serial images. The use of deep learning as a quantitative assessment of plus disease has the potential to standardize ROP diagnosis and treatment.

Abstract Direct disposal of used soft electronics into the environment can cause severe pollution to the ecosystem due to the inability of most inorganic materials and synthetic polymers to biodegrade. Additionally, the loss of the noble metals that are commonly used in soft electronics leads to a waste of scarce resources. Thus, there is an urgent need to develop “green” and sustainable soft electronics based on eco‐friendly manufacturing that may be recycled or biodegraded after the devices’ end of life. Here an approach to fabricating sustainable soft electronics is demonstrated where the expensive functional materials can be recycled and the soft substrate can be biodegradable. A stretchable agarose/glycerol gel film is used as the substrate, and silver nanowires (AgNWs) are printed on the film to fabricate the soft electronic circuits. The mechanical and chemical properties of the agarose/glycerol gel films are characterized, and the functionality of the printed AgNW electrodes for electrophysiological sensors is demonstrated. The demonstration of the biodegradability of the agarose/glycerol and the recyclability of AgNWs points toward ways to develop sustainable and eco‐friendly soft electronics.

Abstract Intervention by medical clowns was proven to have a positive effect in reducing stress and anxiety, increasing cooperation and improving the child's experience prior to a medical procedure and during the various stages of hospitalization. Sleep has long been known to be essential for recovery from injury and sickness, improving immune functions, and there is an emerging understanding of the restorative role quality sleep has on health and diseases. Hospitalized children are more exposed to sleep disorders and sleep deprivation due to the hospitalized environment, anxiety, and illness. Different behavioral interventions to promote sleep were previously studied in hospitalized children, some showing potential benefits. In this study, we sought to examine the ability of medical clowns to positively impact the child's sleep during hospitalization. The study is an observational matching (case–control) interventional study which took place at the department of pediatrics in Carmel Medical Center. Forty-two hospitalized children ages 2–17 were included in two equal groups of intervention or control. Children in the control group were recruited based on a method of matching the chief complaint plus the medical diagnosis and age of the children in the intervention group in a 1:1 matching. The children's sleep parameters were objectively evaluated for two consecutive nights using an Actigraph device and subjectively by parent's questionnaire. Additional factors such as hospital length of stay and demographics were also monitored. The study group had an encounter with a medical clown (15–30 min) before bedtime on either the first or the second night, and the control group was not exposed to a medical clown at all. We then compared the data from both groups using unpaired t-tests. Hospitalized children exposed to a medical clown prior to bedtime (n = 21) and children not exposed to a medical clown (n = 21) were comparable in age and clinical characteristics. The study group had a significantly delayed wake-up time compared to the control group (06:59 ± 46 min vs. 07:26 ± 42 min, p

The objective of this article is to make a historical journey of Honduran youth from the 19th century to the year 2018. Similarly, to contextualize this population from demography, legal and institutional. To achieve the above, a documentary review of the contributions made by previous research was carried out, which describes the agreements, legislation and statistical data of the National Institute of Statistics (ine). Based on the above, it was possible to show that the existing studies on the subject have distanced themselves from cultural interests and have insisted on employment issues. The latter, together with the issue of education and security, has been a problem that national youth have historically faced.

Traffic-related air pollution has a significant impact on the concentration of particulate matter (PM) and nitrogen oxides (NOx) in urban areas, but there are many uncertainties associated with the modeling of PM concentration due to non-exhaust emissions. Bulgarian weather, road surfaces and traffic conditions differ significantly from the UK’s and other EU countries’ averages, which underpin many assumptions in established models. The hypothesis is that the emission factors differ from those used to calculate traffic emissions using the EMIT model. The objective of this work is to adjust the emissions for PM and the relationship between the fractions of NOx and PM using the hourly mean concentrations from road transport and urban background automatic air quality stations in Sofia, Bulgaria. Various already-published and newly developed methods are applied to local observations to derive functions and relations that better represent Bulgarian road and traffic conditions. The ADMS-Urban model is validated and evaluated by comparing pollutant concentrations from simulations using original and adjusted emissions, showing an improvement in results after applying functions and relationships derived from local observations. This work is part of our efforts to improve air quality modeling in urban areas in Bulgaria.

Taking into consideration the growing resistance towards currently available antimycobacterials, there is still an unmet need for the development of new chemotherapeutic agents to combat the infectious agents. This study presents X-ray single-crystal analysis to verify the structure of leading sulfonyl hydrazone 3b, which has proven its potent antimycobacterial activity against Mycobacterium tuberculosis H37Rv with an MIC value of 0.0716 μM, respectively, low cytotoxicity, and very high selectivity indexes (SI = 2216), and which has been fully characterized by Nuclear Magnetic Resonance (NMR) and High-Resolution Mass Spectrometry (HRMS) methods. Furthermore, this study assessed the ex vivo antioxidant activity, acute and subacute toxicity, and in vitro inhibition capacity against enoyl-ACP reductase of hydrazones 3a and 3b, as 3a was identified as the second leading compound in our previous research. Compared to isoniazid, compounds 3a and 3b demonstrated lower acute toxicity for intraperitoneal administration, with LD50 values of 866 and 1224.7 mg/kg, respectively. Subacute toxicity tests, involving the repeated administration of a single dose of the test samples per day, revealed no significant deviations in hematological and biochemical parameters or pathomorphological tissues. The compounds exhibited potent antioxidant capabilities, reducing malondialdehyde (MDA) levels and increasing reduced glutathione (GSH). Enzyme inhibition assays of the sulfonyl hydrazones 3a and 3b with IC50 values of 18.2 µM and 10.7 µM, respectively, revealed that enoyl acyl carrier protein reductase (InhA) could be considered as their target enzyme to exhibit their antitubercular activities. In conclusion, the investigated sulfonyl hydrazones display promising drug-like properties and warrant further investigation.

PurposeTo describe ocular outcomes in eyes with cytomegalovirus (CMV) retinitis treated with adoptive immunotherapy using systemic administration of CMV-specific cytotoxic Tlymphocytes (CMV-specific CTLs).DesignRetrospective cohort study.ParticipantsPatients with active CMV retinitis evaluated at a tertiary care academic center.MethodsTreatment of CMV retinitis with standard-of-care therapy (systemic or intravitreal antivirals) or CMV-specific CTLs (with or without concurrent standard-of-care therapies).Main outcome measuresThe electronic medical record was reviewed to determine baseline characteristics, treatment course, and ocular outcomes, including best-corrected visual acuity (BCVA), treatments administered (CMV-specific CTLs, systemic antivirals, intravitreal antivirals), resolution of CMV retinitis, any occurrence of immune recovery uveitis, cystoid macular edema, retinal detachment, or a combination thereof.ResultsSeven patients (3 of whom had bilateral disease [n = 10 eyes]) were treated with CMV-specific CTLs, whereas 20 patients (6 of whom had bilateral disease [n = 26 eyes]) received standard-of-care treatment. Indications for CMV-specific CTL therapy included persistent or progressive CMV retinitis (71.4% of patients); CMV UL54 or UL97 antiviral resistance mutations (42.9%); side effects or toxicity from antiviral agents (57.1%); patient intolerance to longstanding, frequent antiviral therapy for persistent retinitis (28.6%); or a combination thereof. Two patients (28.6%; 4 eyes [40%]) received CMV-specific CTL therapy without concurrent systemic or intravitreal antiviral therapy for active CMV retinitis, whereas 5 patients (71.4%; 6 eyes [60%]) continued to receive concurrent antiviral therapies. Resolution of CMV retinitis was achieved in 9 eyes (90%) treated with CMV-specific CTLs, with BCVA stabilizing (4 eyes [40%]) or improving (4 eyes [40%]) in 80% of eyes over an average follow-up of 33.4 months. Rates of immune recovery uveitis, new-onset cystoid macular edema, and retinal detachment were 0%, 10% (1 eye), and 20% (2 eyes), respectively. These outcomes compared favorably with a nonrandomized cohort of eyes treated with standard-of-care therapy alone, despite potentially worse baseline characteristics.ConclusionsCMV-specific CTL therapy may represent a novel monotherapy or adjunctive therapy, or both, for CMV retinitis, especially in eyes that are resistant, refractory, or intolerant of standard-of-care antiviral therapies. More generally, adoptive cell transfer and adoptive immunotherapy may have a role in refractory CMV retinitis. Larger prospective, randomized trials are necessary.

Traditionally, face-to-face bullying has been major problem among adolescents, especially those deemed at-risk. With the rise in the use of and advancements in mobile technologies, the Internet 2.0, and smart phones, a new form of bullying has been on the rise resulting from the increase in access to technologies and by association, social media outlets such as Facebook, Instagram, and Twitter. Cyberbullying, as it has been denoted, can occur at any time of the day on all social media platforms resulting in the potential of face-to-face victims enduring the abuse of their aggressors on an almost 24/7 basis. As such, cyberbullying can trigger numerous emotional and physical stressors among students. The purpose of this study was to discover the perceptions middle school students have about cyberbullying and their role as either victim, perpetrator, or bystander. The results of the study speak to a broader and emerging narrative indicating the psychological challenges faced by developing adolescent minds in negotiating face-to-face and virtual relationships.

Abstract Fossil endocasts record features of brains from the past: size, shape, vasculature, and gyrification. These data, alongside experimental and comparative evidence, are needed to resolve questions about brain energetics, cognitive specializations, and developmental plasticity. Through the application of interdisciplinary techniques to the fossil record, paleoneurology has been leading major innovations. Neuroimaging is shedding light on fossil brain organization and behaviors. Inferences about the development and physiology of the brains of extinct species can be experimentally investigated through brain organoids and transgenic models based on ancient DNA. Phylogenetic comparative methods integrate data across species and associate genotypes to phenotypes, and brains to behaviors. Meanwhile, fossil and archeological discoveries continuously contribute new knowledge. Through cooperation, the scientific community can accelerate knowledge acquisition. Sharing digitized museum collections improves the availability of rare fossils and artifacts. Comparative neuroanatomical data are available through online databases, along with tools for their measurement and analysis. In the context of these advances, the paleoneurological record provides ample opportunity for future research. Biomedical and ecological sciences can benefit from paleoneurology’s approach to understanding the mind as well as its novel research pipelines that establish connections between neuroanatomy, genes and behavior.

Considerable controversy exists about which hypotheses and variables best explain mammalian brain size variation. We use a new, high-coverage dataset of marsupial brain and body sizes, and the first phylogenetically imputed full datasets of 16 predictor variables, to model the prevalent hypotheses explaining brain size evolution using phylogenetically corrected Bayesian generalized linear mixed-effects modelling. Despite this comprehensive analysis, litter size emerges as the only significant predictor. Marsupials differ from the more frequently studied placentals in displaying a much lower diversity of reproductive traits, which are known to interact extensively with many behavioural and ecological predictors of brain size. Our results therefore suggest that studies of relative brain size evolution in placental mammals may require targeted co-analysis or adjustment of reproductive parameters like litter size, weaning age or gestation length. This supports suggestions that significant associations between behavioural or ecological variables with relative brain size may be due to a confounding influence of the extensive reproductive diversity of placental mammals.

Introduction: COVID-19 outbreak has caused changes around the world with many polices remade to stop the spread of this virus since it started in 2019. Indonesia with the overall highest positive cases in South-East Asia has been challenged with prolonged restriction policy issued from early 2020 until now due to continuous increase of cases. This study aims to know the mental health of Indonesia citizens during early quarantine before it changed into restriction. Method: Indonesian version DASS-21 questionnaire was used in this cross-sectional study to assess Indonesian adults aged > 25 years old using an online platform from 22nd April, 2020 to 28th May, 2020, then analyzed using T-test and one-way ANOVA. Result: All participants have no depression and stress symptoms that meet the threshold for probable depression according to the DASS-21 instrument. On the other hand, 26.3% participants showed anxiety symptom with severity classified into mild (16.0%), moderate (8.9%), and severe (0.4%). Conclusion: This study also found relationship of depression, anxiety, and stress characteristic with gender, age marital status, and income in adults during pandemic. Where in this study shows male, younger age, unmarried status, and lower income people have higher scale of depression, anxiety, and stress characteristic. This finding may help Indonesia’s government and citizens to assess the restriction to mental health of Indonesian adults for further effective policy implementation.