El uso del iPad con el programa AUGIE, ¿mejora la comunicación en personas con autismo?

La hipótesis básica de esta investigación es valorar si el programa AUGIE es una herramienta tecnológica que ayuda a las personas con autismo a comunicarse y a implementar aprendizajes. Partiendo de la base de que, en el trastorno del espectro del autismo (TEA), existen cuatro aspectos básicos característicos: las deficiencias en comunicación, socialización e imaginación, y los patrones de actividad e intereses restringidos y repetitivos, este trabajo se ha centrado fundamentalmente en una de las áreas afectadas: la comunicación. Todas las personas con TEA muestran alteraciones en la comunicación y en el lenguaje de forma muy heterogénea: desde la persona con mutismo pasando por la ecolálica, que repite frases sin cesar, hasta los que tienen lenguaje verbal pero carecen de habilidades a nivel pragmático. Dada la importancia del desarrollo comunicativo como mecanismo de control del entorno, de autodeterminación y de relación social, este trabajo pretende demostrar cómo la intervención de las nuevas tecnologías, en este caso del iPad a través de un programa específico como el AUGIE, maximiza las posibilidades comunicativas por encima de métodos clásicos, como sistema de comunicación por intercambio de imágenes (Picture Exchange Communication System PECS). Tras realizar una búsqueda bibliográfica, en primer lugar, se describen las hipótesis explicativas de las causas del autismo desde diferentes perspectivas como el psicoanálisis, conductismo y el cognitivismo pasando por las explicaciones biológicas o la hiper o hiposensibilidad a diferentes estímulos. A continuación, se explican las características del trastorno y se hace un especial énfasis en el aspecto comunicativo como se ha explicado anteriormente. Seguidamente, se abordan las necesidades educativas de las personas con TEA desde las necesidades de interacción social y de comunicación. Posteriormente, se explica cómo las tecnologías de la información y de la comunicación (TIC) constituyen un área de rápido desarrollo e implementación en el ámbito educativo. Las TIC son un medio tecnológico de intervención educativa para las personas con discapacidad y, en concreto, para las personas con TEA. Son un potente recurso para varios ámbitos de su vida: educación, comunicación, ocio y tiempo libre. Un objetivo de las TIC es proporcionar un modelo de comunicación válido a una persona que no es capaz de verbalizar. Una de las principales ventajas de las TIC es que se erigen como un poderoso aliado a la hora de potenciar y mejorar la comunicación de las personas con TEA. Dentro de las TIC, destaca el uso del iPad ya que proporciona inmediatez, movilidad y autonomía; proporciona una enseñanza individualizada. Los objetivos específicos de este trabajo son: 1. Comprobar que, si se usa el iPad con el AUGIE, se facilita que las personas con TEA realicen intercambios comunicativos, peticiones y transmitan necesidades. 2. Valorar que, si se utiliza el iPad con el AUGIE, se facilitan aprendizajes a través de la secuenciación visual mediante imágenes de pasos para lograr ejecutar una tarea (Método TEACCH, Treatment and Education of Autistic related Communication Handicapped Children) como, por ejemplo, poner la mesa, vestirse, ir al baño, etc. (autonomía personal), comprar en el supermercado siguiendo los pasos de la lista de la compra, desplazarse y tener una conducta adecuada en un lugar público como una cafetería (habilidades sociocomunitarias). 3. Verificar que, si se usa el iPad con el AUGIE, se puede favorecer el aprendizaje de los tiempos de espera. 4. Cotejar que, si se emplea el iPad con el AUGIE, se puede facilitar el juego y el entretenimiento (ocio) de las personas con TEA. A continuación se describen diferentes programas informáticos como el AZHAR, e-Mitnza, Sc@out, Picaa y el AUGIE, analizando las ventajas y las desventajas de cada uno de ellos. Durante los últimos años, el iPad se ha convertido en una tecnología popular para la educación de las personas con TEA. La popularidad del iPad en la educación de estudiantes con TEA puede relacionarse con su portabilidad (Shah, 2011; VanLaarhoven, Johnson, VanLaarhoven-Myles, Grider y Grider, 2009), el diseño de gran pantalla táctil (Shah, 2011), la facilidad en la individualización de la presentación de materiales educativos y una multitud de aplicaciones educativas (Kagohara, Sigafoos, Acmadi, Van der Meer, O´Reilly y Lancioni, 2011; Kagohara, Van der Meer, et al., 2013; Shah, 2011). Aunque los iPads son ampliamente utilizados, hay poca investigación para apoyar sus beneficios de aprendizaje (Kagohara, Sigafoos, et al., 2011; Kagohara et al., 2013). Se ha escogido el programa americano AUGIE para la investigación puesto que se trata de un programa muy completo y sólo se puede utilizar con el iPad. Este programa, AUGIE AAC Aumentative and Alternative Communication; (Comunicación Aumentativa y Alternativa), fue creado por Víctor Morris (2010) en Illinois (Estados Unidos). De la población de 80 usuarios que posee un Centro de Educación Especial de la Comunidad Valenciana, se ha seleccionado una muestra de forma incidental que consiste en seis personas con autismo de entre 18 y 30 años de edad, los cuales, se han dividido en dos grupos de tres sujetos. Un grupo (experimental) ha utilizado el iPad con el AUGIE y el otro grupo (convencional) ha utilizado un sistema de comunicación más tradicional con pictogramas utilizando el sistema PECS. Se ha creado una hoja de registro para la observación participante realizada. Esta hoja de registro es una plantilla en donde se registra a mano toda la información sobre cómo utilizan las personas con TEA el programa. Del mismo modo, se han registrado los avances comunicativos y las diferentes características asociadas al grupo de sujetos que no trabajan con el AUGIE y utilizan el sistema PECS. El programa se ha probado con las personas con autismo de manera individualizada en sala y con un ambiente estructurado. El tipo observación por parte del investigador principal ha sido de observación participante. En total se han realizado 12 sesiones de trabajo con cada sujeto (6 sujetos) dando a lugar 72 registros realizados de forma cualitativa. Así mismo, a cada sujeto se le ha aplicado un total de 28 variables relacionas con las peticiones, pasos a seguir realizando tareas, elecciones, juegos, etc. Los resultados muestran que el AUGIE en el iPad consigue mejorar la comunicación de las personas con TEA por encima del método tradicional PECS ya que, en la primera sesión, consiguen alcanzar una media de 13 habilidades siendo estadísticamente significativo dicho resultado y cumpliendo la hipótesis alternativa de que existe diferencia en la consecución de habilidades comunicativas entre ambos grupos (uso del iPad y uso de PECS). De esta forma, el programa AUGIE en formato iPad aparece como una herramienta muchísimo más ventajosa que los medios tradicionales como el PECS ya que los sujetos aprenden en menor tiempo a pedir de forma espontánea, piden más cantidad de cosas, solicitan más información, aprenden antes a rechazar cosas, piden acciones como, por ejemplo, descansar o beber agua, reduce estereotipias, centra la atención, favorece el desapego hacia objetos, no hay conductas disruptivas y les hace comprender antes y de forma más adecuada la espera y el paso del tiempo.

Síndrome demencial reversível : caso clínico

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014

Schistosoma haematobium in Guinea-Bissau: unacknowledged morbidity due to a particularly neglected parasite in a particularly neglected country

Schistosomiasis is the major neglected tropical helminthic disease worldwide. Current knowledge on the epidemiology of schistosomiasis in Guinea-Bissau is scarce and regarding to the absence of Schistosoma haematobium (S.h.). Therefore, a pilot study was undertaken to assess the prevalence and morbidity due to S.h. infection in randomly selected 90 children and adolescents aged 6 to 15 years. Prevalence of S.h. infection was 20.00 % (18/90). Microhematuria was observed in 61.11 % (11/18) of S.h.-egg-excreting vs. 37.50 % (27/72) of non-S.h.-egg-excreting children p ≤ 0.01. Body mass index (BMI) was less than 15 kg/m(2) in 52/90 (57.78 %) of all children and adolescents, but this proportion increased to 66.67 % (12/18) in S.h.-infected children who were more frequently stunted and wasted than in non-infected children. The mean weight-for-age Z score (WAZ) was reduced in S.h. infected as compared to non-infected children (-1.48 ± 1.08 SD vs. -0.80 ± 1.11 SD; p ≤ 0.01). To our knowledge, this is the first epidemiologic report on S. haematobium infection in Guinea-Bissau since 22 years. Even in this relatively small study sample, it appears that S. haematobium, besides the well-known symptoms such as hematuria, leads to significant, albeit commonly unacknowledged morbidity such as stunting and wasting. These observations underscore the notion that this vulnerable but neglected population urgently needs to be targeted for implementation of measures for treatment and control.

Inhibition of Hippocampal Regeneration by Adjuvant Dexamethasone in Experimental Infant Rat Pneumococcal Meningitis

Pneumococcal meningitis (PM) causes neurological sequelae in up to half of surviving patients. Neuronal damage associated with poor outcome is largely mediated by the inflammatory host response. Dexamethasone (DXM) is used as an adjuvant therapy in adult PM, but its efficacy in the treatment of pneumococcal meningitis in children is controversially discussed. While DXM has previously been shown to enhance hippocampal apoptosis in experimental PM, its impact on hippocampal cell proliferation is not known. This study investigated the impact of DXM on hippocampal proliferation in infant rat PM. Eleven-day-old nursing Wistar rats (n = 90) were intracisternally infected with Streptococcus pneumoniae to induce experimental meningitis. Treatment with DXM or vehicle was started 18 h after infection, concomitantly with antibiotics (ceftriaxone 100 mg/kg of body weight twice a day [b.i.d.]). Clinical parameters were monitored, and the amount of cells with proliferating activity was assessed using in vivo incorporation of bromodeoxyuridine (BrdU) and an in vitro neurosphere culture system at 3 and 4 d postinfection. DXM significantly worsened weight loss and survival. Density of BrdU-positive cells, as an index of cells with proliferating activity, was significantly lower in DXM-treated animals compared to vehicle controls (P < 0.0001). In parallel, DXM reduced neurosphere formation as an index for stem/progenitor cell density compared to vehicle treatment (P = 0.01). Our findings provide clear evidence that DXM exerts an antiproliferative effect on the hippocampus in infant rat PM. We conclude that an impairment of regenerative hippocampal capacity should be taken into account when considering adjuvant DXM in the therapeutic regimen for PM in children.

Polymeric grafting of acrylic acid onto poly(3-hydroxybutyrate-co-3-hydroxyvalerate): Surface functionalization for tissue engineering applications

Poly(3-hydroxybutyrate-co-3-hydroxyvalerate) (PHBV) melt processed disks and solvent cast films were modified by graft co-polyinerization with acrylic acid (AAc) in methanol solution at ambient temperature using gamma irradiation (dose rate of 4.5 kGy/h). To assess the presence of carboxylic acid groups on the surface, reaction with pentafluorophenol was performed prior to X-ray photoelectron spectroscopy analysis. The grafting yield for all samples increased with monomer concentration (2-15%), and for the solvent cast films, it also increased with dose (2-9 kGy). However, the grafting yield of the melt processed disks was largely independent of the radiation dose (2-8 kGy). Toluidine blue was used to stain the modified materials facilitating, visual information about the extent of carboxylic acid functionalization and depth penetration of the grafted copolymer. Covalent linking of glucosamine to the functionalized surface was achieved using carbodimide chemistry verifying that the modified substrates are suitable for biomolecule attachment.

Penetration of chlorhexidine into human skin

This study evaluated a model of skin permeation to determine the depth of delivery of chlorhexidine into full-thickness excised human skin following topical application of 2% (wt/vol) aqueous chlorhexidine digluconate. Skin permeation studies were performed on full-thickness human skin using Franz diffusion cells with exposure to chlorhexidine for 2 min, 30 min, and 24 h. The concentration of chlorhexidine extracted from skin sections was determined to a depth of 1,500 µm following serial sectioning of the skin using a microtome and analysis by high-performance liquid chromatography. Poor penetration of chlorhexidine into skin following 2-min and 30-min exposures to chlorhexidine was observed (0.157 ± 0.047 and 0.077 ± 0.015 µg/mg tissue within the top 100 µm), and levels of chlorhexidine were minimal at deeper skin depths (less than 0.002 µg/mg tissue below 300 µm). After 24 h of exposure, there was more chlorhexidine within the upper 100-µm sections (7.88 ± 1.37 µg/mg tissue); however, the levels remained low (less than 1 µg/mg tissue) at depths below 300 µm. There was no detectable penetration through the full-thickness skin. The model presented in this study can be used to assess the permeation of antiseptic agents through various layers of skin in vitro. Aqueous chlorhexidine demonstrated poor permeation into the deeper layers of the skin, which may restrict the efficacy of skin antisepsis with this agent. This study lays the foundation for further research in adopting alternative strategies for enhanced skin antisepsis in clinical practice.

β-catenin mutations in craniopharyngiomas and pituitary adenomas

Craniopharyngiomas and pituitary adenomas are both tumors of the hypothalamic and pituitary region, respectively that are frequently associated with endocrine defects either because of direct involvement of hormone producing cells (most pituitary tumors) or because of secondary defects due to disturbance of hypothalamic function (some pituitary tumors and craniopharyngiomas). Some studies suggest that mutant β-catenin gene cells in craniopharyngiomas and pituitary adenomas contribute to their tumorigenesis. DNA was extracted from 73 cranial tumors and subjected to polymerase chain reaction (PCR) with previously described primers encompassing glycogen synthase kinase-3β phosphorylation sites of the β-catenin gene. Sequenced PCR products for possible β-catenin gene mutations showed a total of 7/43 alterations in adamantinomatous craniopharyngioma-derived DNA samples. Two previously described β-catenin mutations in codon 33 TCT(Ser) > TGT(Cys) and codon 37 TCT(Ser) > TTT(Phe), whereas three novel mutations in codon 41 ACC(Thr) > ATC(Ile), codon 33 TCT(Ser) > TAT(Tyr) and codon 32 GAC(Asp) > AAC(Asn) were observed. None of the 22 pituitary adenomas and the eight papillary craniopharyngiomas analyzed presented any sequence alterations. These findings demonstrate an association between β-catenin gene alterations and craniopharyngiomas of the adamantinomatous type. Since this gene product is involved with development, these results suggest that β-catenin mutations may contribute to the initiation and subsequent growth of congenital craniopharyngiomas. © Springer 2005.

Personal Storytelling : Using Natural Language Generation for Children with Complex Communication Needs, in the Wild...

Acknowledgements The authors thank the children, their parents and school staff, who participated in this research, and who so willingly gave us their time, help and support. They also thank Steven Knox and Alan Clelland for their work on programming the mobile phone application. Additional thanks to DynaVox Inc. for supplying the Vmax communication devices to run our system on and Sensory Software Ltd for supplying us with their AAC software. This research was supported by the Research Council UKs Digittal Economy Programme and EPSRC (Grant numbers EP/F067151/1, EP/F066880/1, EP/E011764/1, EP/H022376/1, and EP/H022570 /1).

The economic activities and functional organization of the Asturias coast

This paper proposes a methodology for analyze coastal territories focused on the functional analysis. It establishes analysis and diagnosis procedures for the activities of a coastal territory, and organizes its monitoring during time, allowing a consistent definition for the coastal territories as engines spaces or integrated spaces

Bacteriophage Can Prevent Encrustation and Blockage of Urinary Catheters by Proteus mirabilis.

Proteus mirabilis forms dense crystalline biofilms on catheter surfaces that occlude urine flow, leading to serious clinical complications in long-term catheterized patients, but there are presently no truly effective approaches to control catheter blockage by this organism. This study evaluated the potential for bacteriophage therapy to control P. mirabilis infection and prevent catheter blockage. Representative in vitro models of the catheterized urinary tract, simulating a complete closed drainage system as used in clinical practice, were employed to evaluate the performance of phage therapy in preventing blockage. Models mimicking either an established infection or early colonization of the catheterized urinary tract were treated with a single dose of a 3-phage cocktail, and the impact on time taken for catheters to block, as well as levels of crystalline biofilm formation, was measured. In models of established infection, phage treatment significantly increased time taken for catheters to block (∼ 3-fold) compared to untreated controls. However, in models simulating early-stage infection, phage treatment eradicated P. mirabilis and prevented blockage entirely. Analysis of catheters from models of established infection 10 h after phage application demonstrated that phage significantly reduced crystalline biofilm formation but did not significantly reduce the level of planktonic cells in the residual bladder urine. Taken together, these results show that bacteriophage constitute a promising strategy for the prevention of catheter blockage but that methods to deliver phage in sufficient numbers and within a key therapeutic window (early infection) will also be important to the successful application of phage to this problem.

Antimicrobial susceptibility of Pseudomonas aeruginosa isolated from cystic fibrosis patients through Northern Europe

Pseudomonas aeruginosa is a major cause of morbidity and mortality in cystic fibrosis patients. This study compares the antimicrobial susceptibility of 153 P. aeruginosa isolates from the United Kingdom (UK) (n=58), Belgium (n=44), and Germany (n=51) collected from 120 patients during routine visits over the 2006-2012 period. MICs were measured by broth microdilution. Genes encoding extended spectrum β-lactamases (ESBL), metallo-β-lactamases and carbapenemases were detected by PCR. Pulsed Field Gel Electrophoresis and Multi-Locus Sequence Typing were performed on isolates resistant to ≥ 3 antibiotic classes among penicillins/cephalosporins, carbapenems, fluoroquinolones, aminoglycosides, polymyxins. Based on EUCAST/CLSI breakpoints, susceptibility was ≤ 30%/≤ 40% (penicillins, ceftazidime, amikacin, ciprofloxacin), 44-48%/48-63% (carbapenems), 72%/72% (tobramycin), and 92%/78% (colistin) independently of patient's age. Sixty percent of strains were multidrug resistant (MDR; European Centre for Disease prevention and Control criteria). Genes encoding ESBL (most prevalent BEL, PER, GES, VEB, CTX-M, TEM, SHV, and OXA), metallo β-lactamases (VIM, IMP, NDM), or carbapenemases (OXA-48, KPC) were not detected. The Liverpool Epidemic Strain (LES) was prevalent in UK isolates only (75% of MDR isolates). Four MDR ST958 isolates were found spread over the three countries. The other MDR clones were evidenced in ≤ 3 isolates and localized in a single country. A new sequence type (ST2254) was discovered in one MDR isolate in Germany. Clonal and non-clonal isolates with different susceptibility profiles were found in 21 patients. Thus, resistance and MDR are highly prevalent in routine isolates from 3 countries, with carbapenem (meropenem), tobramycin and colistin remaining the most active drugs.

Exploring hydrocarbonoclastic bacterial communities in the estuarine surface microlayer

Bacteria that degrade polycyclic aromatic hydrocarbons (PAHs) in the estuarine surface microlayer (SML) of the Ria de Aveiro, Portugal—which is chronically polluted with oil hydrocarbons (OH)—were isolated and characterized; Pseudomonas was dominant among the PAH-degrading bacteria. Screening for PAH dioxygenase genes detected almost identical nahAc genes (encoding the alpha subunits of naphthalene dioxygenase) in 2 phylogenetically distinct isolates: Pseudomonas sp. and an unknown species of the family Enterobacteriaceae; this suggested that horizontal transfer of nah genes might be involved in PAH degradation in the SML. We also investigated the effect of PAH contamination on the spatial variability of the bacterioneuston along a gradient of pollution in the estuarine system of the Ria de Aveiro. Culture-independent techniques—fluorescence in situ hy - bridization (FISH) and denaturing-gradient gel electrophoresis (DGGE)—revealed a similar structure among the bacterioneuston communities along the estuary. In contrast, we detected differences in the relative abundance and diversity of organisms of the Gammaproteobacteria, including those of the genus Pseudomonas (which belongs to the Gammaproteobacteria). This is the first insight into the hydrocarbonoclastic bacterial communities in the SML of an estuarine area polluted with hydrocarbons. Our findings highlight the importance of SML-adapted hydrocarbonoclastic bacterioneuston as a potential source of new PAH-degrading bacteria (including new pseudomonads) with potential use in the bioremediation of hydrocarbon-polluted ecosystems.

Biogeochemical response of Tagus Estuary to climate change : a modelling study

Estuaries are highly dynamic systems which may be modified in a climate change context. These changes can affect the biogeochemical cycles. Among the major impacts of climate change, the increasing rainfall events and sea level rise can be considered. This study aims to research the impact of those events in biogeochemical dynamics in the Tagus Estuary, which is the largest and most important estuary along the Portuguese coast. In this context a 2D biophysical model (MOHID) was implemented, validated and explored, through comparison with in-situ data. In order to study the impact of extreme rainfall events, which can be characterized by an high increase in freshwater inflow, three scenarios were set by changing the inputs from the main tributaries, Tagus and Sorraia Rivers. A realistic scenario considering one day of Tagus and Sorraia River extreme discharge, a scenario considering one day of single extreme discharge of the Tagus River and finally one considering the extreme runoff just from Sorraia River. For the mean sea level rise, two scenarios were also established. The first with the actual mean sea level value and the second considering an increase of 0.42 m. For the extreme rainfall events simulations, the results suggest that the biogeochemical characteristics of the Tagus Estuary are mainly influenced by Tagus River discharge. For sea level rise scenario, the results suggest a dilution in nutrient concentrations and an increase in Chl-a in specific areas.For both scenarios, the suggested increase in Chl-a concentration for specific estuarine areas, under the tested scenarios, can lead to events that promote an abnormal growth of phytoplankton (blooms) causing the water quality to drop and the estuary to face severe quality issues risking all the activities that depend on it.

Contributo e caracterização de PM da ressuspensão rodoviária

Nos últimos anos, tem-se assistido a um crescimento no interesse do estudo da ressuspensão de pó de estrada, dado o reconhecimento da importância que esta fração representa para os níveis de partículas atmosféricas em ambiente urbano. Dada a prematuridade deste tema e, de forma a compreender e conhecer a sua contribuição e caracterização, realizou-se um estudo sobre a ressuspensão de pó de estrada urbano para as cidades do Porto e Braga. No âmbito do projeto AIRUSE e URBE, realizaram-se amostragens de PM10 no terreno com um dispositivo de amostragem móvel e em ambiente laboratorial com uma câmara de ressuspensão, sendo posteriormente analisado o seu conteúdo carbonoso por um sistema de análise termo-ótico de transmitância e, os elementos por ICP-MS e ICP-AES. Da campanha in situ resultaram cargas de PM10 compreendidas entre 0.190 e 49.5 mg.m-2 para a cidade do Porto e 0.577 mg.m-2 para o túnel rodoviário em Braga. As amostras caracterizam-se por serem dominadas pelos elementos Al, Fe, K, e Ca e conterem enriquecimentos de Sb, Fe, Cu, Sn e Zn, fruto da contaminação antropogénica da atividade rodoviária. No que respeita às amostragens em laboratório, utilizou-se uma câmara de ressuspensão e o dispositivo móvel aplicado na campanha anteriormente descrita para estudar e caracterizar a fração PM10 do pó de estrada urbano proveniente do Túnel Avenida da Liberdade (Braga). Os resultados obtidos para as duas metodologias foram de um modo geral similares, com o carbono total a representar cerca de 6% da massa total de PM10. Esta última é composta maioritariamente por Al, Fe, Ca e K, elementos característicos da crosta terrestre. Quanto ao fatores de enriquecimento calculados, denotou-se a presença de Sb, Zn, Cu e Sn, tendo-se associando ao desgaste dos travões e pneus.