Clonal Evolution and Blast Crisis Correlate with Enhanced Proteolytic Activity of Separase in BCR-ABL b3a2 Fusion Type CML under Imatinib Therapy.

Unbalanced (major route) additional cytogenetic aberrations (ACA) at diagnosis of chronic myeloid leukemia (CML) indicate an increased risk of progression and shorter survival. Moreover, newly arising ACA under imatinib treatment and clonal evolution are considered features of acceleration and define failure of therapy according to the European LeukemiaNet (ELN) recommendations. On the basis of 1151 Philadelphia chromosome positive chronic phase patients of the randomized CML-study IV, we examined the incidence of newly arising ACA under imatinib treatment with regard to the p210BCR-ABL breakpoint variants b2a2 and b3a2. We found a preferential acquisition of unbalanced ACA in patients with b3a2 vs. b2a2 fusion type (ratio: 6.3 vs. 1.6, p = 0.0246) concurring with a faster progress to blast crisis for b3a2 patients (p = 0.0124). ESPL1/Separase, a cysteine endopeptidase, is a key player in chromosomal segregation during mitosis. Separase overexpression and/or hyperactivity has been reported from a wide range of cancers and cause defective mitotic spindles, chromosome missegregation and aneuploidy. We investigated the influence of p210BCR-ABL breakpoint variants and imatinib treatment on expression and proteolytic activity of Separase as measured with a specific fluorogenic assay on CML cell lines (b2a2: KCL-22, BV-173; b3a2: K562, LAMA-84). Despite a drop in Separase protein levels an up to 5.4-fold increase of Separase activity under imatinib treatment was observed exclusively in b3a2 but not in b2a2 cell lines. Mimicking the influence of imatinib on BV-173 and LAMA-84 cells by ESPL1 silencing stimulated Separase proteolytic activity in both b3a2 and b2a2 cell lines. Our data suggest the existence of a fusion type-related feedback mechanism that posttranslationally stimulates Separase proteolytic activity after therapy-induced decreases in Separase protein levels. This could render b3a2 CML cells more prone to aneuploidy and clonal evolution than b2a2 progenitors and may therefore explain the cytogenetic results of CML patients.

Are there age-, strain-, and sex-differences in the prolonged exposure to methylphenidate?

Repeated treatment with psychostimulants produces behavioral sensitization that results in increased locomotor responses so that lower drug doses are required to obtain the same effect and cross-sensitization with other stimulants. Methylphenidate (MPD; Ritalin) is most frequently prescribed to treat children having attention deficit hyperactivity disorder (ADHD), a syndrome with onset in childhood characterized by high levels of inattention, hyperactivity, and impulsivity. Little is known of the consequences involving the long-term use of MPD as treatment for ADHD. This study investigates if there are age, genetic/strain, and sex differences in the prolonged exposure to MPD and cross-sensitization with amphetamine. The objective is to determine whether (a) early exposure to MPD in adolescent rats increases their sensitivity to the drug when they are adult rats, (b) there are strain and sex differences in the response to MPD, and (c) treatment with MPD in adolescent and adult Wistar-Kyoto (WKY), spontaneously hyperactive/hypertensive rat (SHR), and Sprague-Dawley (SD) rat results in cross-sensitization with amphetamine. The hypotheses are that (1) early exposure to MPD in adolescent rats increases their sensitivity to the drug when they reach adulthood, and that this hypersensitivity is dose-, strain-, and sex-dependent and (2) adult rats treated with MPD as adolescents will show a greater cross-sensitization to amphetamine than those adult rats treated with saline as adolescents, and that this cross-sensitization is dose-, strain-, and sex-dependent. The study consists of recording and evaluating locomotor activity of female and male WKY, SHR, and SD rats before and after acute and repeated MPD administration when these rats are young and as adults follows by an amphetamine treatment. Results showed that repeated treatment with MPD elicited behavioral sensitization and cross-sensitization with amphetamine in these animals. The study also found that strain and sex play a crucial role in the differentiated sensitivity to the acute and chronic effects of MPD. The development of behavioral sensitization and cross-sensitization are also dependent on the dose of MPD and the age of the rat. ^

Abnormal expression of E2F1 and E2F4 results in hyperproliferation of the ependyma and lethal hydrocephalus

The proliferative role of E2F has been under investigation for several years. However, while it is known that E2F1 and E2F4 play a part in development and differentiation, research has not been centered on determining the exact functions these E2Fs play in brain development, given there high expression levels throughout embryogenesis. A GFAP-E2F1 mouse model directing human E2F1 transgene expression to glial cells, such as ependymal cells, was used in the present study in combination with an E2F4 mutant mouse model. Interestingly, 20% of tgE2F1; E2F4 null mice developed a phenotype consisting of domed head, hunched posture, seizures, tremors, hyperactivity or hypeactivity, dysnea, and low body weight. These mice died during the first three weeks of severe hydrocephalus. Similarly, tgE2F1; E2F4 heterozygous mice also develop severe hydrocephalus, although this occurs at 6 weeks at a 2% frequency. Pathological examination of the brains of those animals uncovered enlarged cerebral ventricles with marked thinning of the cerebral cortices, confirming the diagnosis of three-ventricle hydrocephalus, and the absence of tumors. Careful examination of the aqueduct shows an excess of proliferating cells that may cause a blockage of CSF. Of significance, 44% of ependymal cells in hydrocephalic tgE2F1;E2F4-/- mouse brains were positive for BrdU incorporation. Studies determining the molecular rationale for the hydrocephalic phenotype suggest proliferative ependymal cells may not be exclusively related to dysregulated cell cycle in conjuction with E2F activity. Due in part to the deficiency of E2F4 in this mouse model, we find that differentiation of these ependymal cells is not complete and instead undergoes maturation arrest. This suggestion is confirmed by the expression of genes found in neural stem cells or precursor cell populations, in the ependymal cell region of tgE2F1; E2F4-/-. Therefore, from this study, we conclude that dysregulated E2F1 expression in combination with deficient E2F4 expression results in an undifferentiated ependymal cell population that is hyperproliferative in the ventricular system causing an impediment of CSF circulation. It is further concluded that normal E2F1 and E2F4 expression in brain development is crucial for the proper formation and function of the ventricular system.^

RELATIONSHIP OF ANTISOCIAL PERSONALITY SYNDROME IN BOYS TO PARENTAL ALCOHOL/DRUG DEPENDENCY

The study focused on the relationship between antisocial personality syndrome in boys ages 8-15 and parental alcohol/drug dependency. The population studied was case records of 101 boys coming to a private psychiatrist from 1966 through 1979. The boys were predominantly white and from middle to upper income families.^ A boy was determined to have antisocial personality syndrome if he exhibited antisocial behaviors in four or five major categories, did not exhibit a brain syndrome, and did not exhibit a thought disorder. The five major behavior categories were: (1) self-control (i.e., temper tantrums or hyperactivity), (2) behavior at home (i.e., disobedience or lying), (3) behavior at school (i.e., truancy or cheating), (4) behavior toward peers (i.e., bullying, fighting, or tattling), and (5) behavior against property (i.e., destructiveness or stealing). A boy was determined to be a control if he exhibited antisocial behaviors in two or less behavior categories.^ A parent was determined to have alcohol/drug dependency if s/he exhibited a score above the established threshold (1) for the MacAndrew Alcoholism Scale (28 or above), and (2) for the Holmes Alcoholism Scale (35 or above) which are used with the MMPI. A parent was classified not alcohol/drug dependent if s/he had scores below set thresholds (22 on the MacAndrew Alcoholism Scale and 28 on the Holmes Alcoholism Scale).^ For the final sample (N = 10), there was no reason to believe a relationship exists between antisocial personality syndrome in boys ages 8-15 and parental alcohol/drug dependency (Fisher's Exact Test {FET} P = 1.0). The small sample size primarily occurred as a result of 88.12% of the parents being classified in a questionable category in terms of alcohol/drug dependency.^ The sample was suggestive of a relationship between the fathers' Psychopathic Deviate (Pd) Scale scores as a measure of antisocial tendencies and the boy having antisocial personality syndrome (N = 75; P = .12). There was no evidence of such a relationship for mothers (N = 75; P = .97). ^

The illness experiences of African Americans residing in an inner city community, Houston, Texas

This dissertation documents health and illness in the context of daily life circumstances and structural conditions faced by African American families living in Clover Heights (pseudonym), an inner city public housing project in the Third Ward, Houston, Texas. Drawing from Kleinman's (1980) model of culturally defined health care systems and using the holistic-content approach to narrative analysis (Lieblich, Tuval- Mashiach, & Zilber, 1998) the purpose of this research was to explore the ways in which social and health policy, economic mobility, the inner city environment, and cultural beliefs intertwined with African American families' health related ideas, behaviors, and practices. I recruited six families using a convenience sampling method (Schensul, Schensul, & LeCompte, 1999) and followed them for fourteen months (2010–2011). Family was defined as a household unit, or those living in the same residence, short or long-term. Single, African American women ranging in age from 29–80 years headed all families. All but one family included children or grandchildren 18 years of age and younger, or children or other relative 18 years of age and older. I also recruited six residents with who I became acquainted over the course of the project. I collected data using traditional ethnographic methods including participant-observation, archive review, field notes, mapping, free-listing, in-depth interviews, and life history interviews. ^ Doing ethnography afforded the families who participated in this project the freedom to construct their own experiences of health and illness. My role centered on listening to, learning from, and interpreting participants' narratives, exploring similarities and differences within and across families' experiences. As the research progressed, a pattern concerning diagnosis and pharmacotherapy for children's behavioral and emotional problems, particularly attention-deficit hyperactivity disorder (ADHD) and pediatric bipolar disorder (PBD), emerged from my formal interactions with participants and my informal interactions with residents. The findings presented in this dissertation document this pattern, focusing on how mothers and families interpreted, organized, and ascribed meaning to their experiences of ADHD and PBD. ^ In the first manuscript presented here, I documented three mothers' narrative constructions of a child's diagnosis with and pharmacotherapy for ADHD or PBD. Using Gergen's (1997) relational perspective I argued that mothers' knowledge and experiences of ADHD and PBD were not individually constructed, but were linguistically and discursively constituted through various social interactions and relationships, including family, spirituality and faith, community norms, and expert systems of knowledge. Mothers' narratives revealed the complexity of children's behavioral and emotional problems, the daily trials of living through these problems, how they coped with adversity and developed survival strategies, and how they interacted with various institutional authorities involved in evaluating, diagnosing, and encouraging pharmaceutical intervention for children's behavior. The findings highlight the ways in which mothers' social interactions and relationships introduced a scientific language and discourse for explaining children's behavior as mental illness, the discordances between expert systems of knowledge and mothers' understandings, and how discordances reflected mothers' ‘microsources of power’ for producing their own stories and experiences. ^ In the second manuscript presented here, I documented the ways in which structural factors, including gender, race/ethnicity, and socioeconomic status, coupled with a unique cultural and social standpoint (Collins, 1990/2009) influenced the strategies this group of African American mothers employed to understand and respond to ADHD or PBD. The most salient themes related to mother-child relationships coalesced around mothers' beliefs about the etiology of ADHD and PBD, ‘conceptualizing responsibility,’ and ‘protection-survival.’ The findings suggest that even though mothers' strategies varied, they were in pursuit of a common goal. Mothers' challenged the status quo, addressing children's behavioral and emotional problems in the ways that made the most sense to them, specifically protecting their children from further marginalization in society more so than believing these were the best options for their children.^

Cellular Uptake of Neutrohpil Elastase Links Inflammation to Adaptive Immunity

Many tumors arise from sites of inflammation providing evidence that innate immunity is a critical component in the development and progression of cancer. Neutrophils are primary mediators of the innate immune response. Upon activation, an important function of neutrophils is release of an assortment of proteins from their granules including the serine protease neutrophil elastase (NE). The effect of NE on cancer has been attributed primarily to its ability to degrade the extracellular matrix thereby promoting invasion and metastasis. Recently, it was shown that NE could be taken up by lung cancer cells leading to degradation of insulin receptor substrate-1 thereby promoting hyperactivity of the phosphatidylinositol-3 kinase (PI3K) pathway and tumor cell proliferation. To our knowledge, nobody has investigated uptake of NE by other tumor types. In addition, NE has broad substrate specificity suggesting that uptake of NE by tumor cells could impact processes regulating tumorigenensis other than activation of the PI3K pathway. Neutrophil elastase has been identified in breast cancer specimens where high levels of NE have prognostic significance. These studies have assessed NE levels in whole tumor lysates. Because the major source of NE is from activated neutrophils, we hypothesized that breast cancer cells do not have endogenous NE but may take up NE released by tumor associated neutrophils in the tumor microenvironment and that this could provide a link between the innate immune response to tumors and specific adaptive immune responses. In this thesis, we show that breast cancer cells lack endogenous NE expression and that they are able to take up NE resulting in increased generation of low molecular weight cyclin E (CCNE) and enhanced susceptibility to lysis by CCNE-specific cytotoxic T lymphocytes. We also show that after taking up NE and proteinase 3 (PR3), a second primary granule protease with significant homology to NE, breast cancer cells cross-present the NE- and PR3-derived peptide PR1 rendering them susceptible to PR1-targeted therapies. Taken together, our data support a role for NE uptake in modulating adaptive immune responses against breast cancer.

The role of platelet -derived growth factor (PDGF) signaling in gliomagenesis

Gliomas are primary central nervous system (CNS) neoplasms that are believed to arise from astrocytes, oligodendrocytes or their precursors. Gliomas can be classified into two major histopathological groups: oligodendroglial and astroglial tumors. The most malignant of the astroglial tumors is glioblastoma multiforme (GBM). A great deal of genetic and epigenetic alterations have been implicated in gliomagenesis. In particular, PDGF signaling is frequently over-activated in a large number of human gliomas. In order to gain insights into the biology of gliomas, we manage to model human gliomas in mice using a somatic gene transfer approach—RCAS/TVA system. In our previous study, combined activation of AKT and RAS pathways gave rise to glioblastomas from CNS progenitors. In the present study, we demonstrate that in vivo autocrine PDGF stimulation induces oligodendrogliomas and mixed oligoastrocytomas from CNS progenitors and differentiated astrocytes respectively. In culture autocrine PDGF stimulation dedifferentiates astrocytes into progenitor-like cells and blockade of PDGF signaling reverses these phenotypic changes. Experimental disruption of cell cycle arrest pathway, such as Ink4a-Arf loss, is not required for the initiation of PDGF-induced gliomagenesis; instead, this mutation contributes to the tumor progression by enhancing tumor malignancy and shortening tumor latency. P53 deficiency does not promote the PDGF-induced gliomagenesis. In addition, 1p and 19q, often deleted in human oligodendrogliomas, remain intact in these PDGF-induced gliomas. Therefore, our studies suggest that autocrine PDGF stimulation alone may be sufficient to induce gliomagenesis. In contrast to transient stimulation in vitro, constitutive PDGF stimulation activates neither AKT nor RAS/MAPK pathways during gliomagenesis. This results in the formation of oligodendrogliomas, instead of glioblastomas. Sustained activation of the AKT pathway converts PDGF-induced oligodendrogliomas into astrocytomas. Our studies suggest that constitutive PDGF stimulation is not equivalent to transient PDGF stimulation, and that a transition between oligodendroglial and astroglial tumors in humans may be possible, depending on additional alterations. In summary, PDGF signaling plays a pivotal role in gliomagenesis in the mouse, and its hyperactivity is capable of contributing to both oligodendroglial and astroglial tumorigenesis. ^

Perfil clínico y social del paciente adicto hospitalizado

Objetivos: Determinar las características clínicas y morbilidad de los pacientes (pac.) adictos ingresados a un Servicio de Clínica Médica. Material y métodos: Estudio protocolizado, observacional, descriptivo y transversal. Criterio de inclusión: pac. adicto con consumo de sustancias ilícitas. Informe preliminar: Periodo: 24 meses. Datos analizados en Epi info 6.4 Resultados: Se incluyeron 40 pac. Prevalencia: 0.2/1000 egresos. El 82.5% eran hombres. Edad media: 31.5 años (DS±9.65). Permanencia media: 11 días (DS±13.98) vs 7.12 (DS±10.1) del Servicio (p=0.016). Consumían cocaína el 82.5% (IC95%67.22-92.66) marihuana el 77.5% (IC95% 61.65- 89.16), tolueno el 10% (IC95%2.79-23.66), floripondio y hachis el 2.5% (IC95% 0.06-13.16) cada uno. En el 2.5% la vía de administración era endovenosa y el 60% eran poliadictos. Solo el 10% recibió tratamiento para abandonar la adicción (100% tratamiento psicológico y 5.13% farmacológico). De clase social pobre el 75%. El 62.5% de los pac. estaban desocupados, tenían antecedentes judiciales el 10% y el 7.5% había estado en prisión. El 92.5% (IC95% 76.34-97.21) era heterosexual, 2.5% hombres que tenían sexo con hombres y bisexuales 5% (IC95% 0.61-16.92). Solo el 10% tenían secundaria completa. El 80% ingreso por Emergencias y por causa infecciosa el 45%. El 12.5% ingreso por complicaciones de la adicción. Las manifestaciones relacionadas con la adicción fueron: manifestaciones del sistema nervioso central: 12.5% (IC95%4.19-26.80); síndrome de abstinencia y temblor 7.5% cada uno y excitación psicomotriz, delirium, signo de foco neurológico y rigidez 5% cada uno. El 100% presentaba alguna comórbida; tabaquismo 80%, depresión 12.8% Y alcoholismo 57.5%, entre otras. Presentaban enfermedades de transmisión sexual 5 pac. (4 HIV, 2 VHC y 1 pediculus pubis). No hubo mortalidad hospitalaria. Conclusión: El paciente adicto internado se caracteriza por ser joven, pertenecer a un grupo social desprotegido, sin trabajo y sin educación, tener poliadicción, con alta carga de comórbidas y de internación, principalmente por complicaciones infecciosas.

El alumnado con TDAH (hiperactividad) como colectivo en riesgo de exclusión social: propuestas de acción y de mejora

La hiperactividad es algo más que un trastorno simple, negativo y defectuoso. Las personas con TDAH tienen un potencial latente del que nadie habla (como la creatividad, el ingenio, la hiperconcentración, la sensibilidad, entre otros). Ser hiperactivo es positivo si tenemos la habilidad de comprender y tratar el trastorno desde una perspectiva educativa diferente ya que el alumnado con TDAH es uno de los colectivos que suman más amonestaciones, sanciones y expulsiones en los centros educativos de nuestro país. Sin embargo, estos niños pueden tener éxito académico y, posteriormente, en su vida laboral y afectiva, si previamente hemos sabido comprenderlos y actuar con un proceso educativo adecuado a su idiosincrasia y si hemos sabido otorgar cierto grado de organización y reencauzamiento en sus mentes a veces infravaloradas. Para ello, las administraciones públicas educativas deben desarrollar estrategias de formación eficientes para formar a un profesorado que, muchas veces, asiste desorientado e impotente a un comportamiento caótico, desordenado e impulsivo que puede provocar serios conflictos no sólo en la enseñanza sino en el mismo clima de convivencia escolar.

La hiperactividad y el empuje de la civilización

La clínica y el trabajo en las instituciones nos muestran cambios dramáticos en la subjetividad contemporánea. Las personas se encuentran expuestas a demandas sociales que tienen consecuencias funestas sobre ellas. Y que se manifiestan en grados diversos de hiperactividad, o actividad compulsiva, hasta el colapso subjetivo bajo la forma de depresión o irrupciones masivas de angustia. En los niños se verifica desde hace un tiempo un fenómeno al que se le ha dado un nombre Trastorno por Déficit Atencional con Hiperactividad, y cuyo tratamiento se confía al uso paradójico de estimulantes. En este artículo se relacionan las causas de este fenómeno, con las modalidades culturales que propician el reemplazo de la experiencia subjetiva por protocolos de acción predeterminados.

Toxina botulínica para la secreción descontrolada de saliva : presentación de un caso

La neurotoxina botulínica es producida por la bacteria anaerobia Clostridium botulinum (NTBo). Bloquea la transmisión neuromuscular por lo cual es utilizada para el tratamiento de enfermedades con hiperactividad muscular, bloqueando la liberación de acetilcolina y así la transmisión sináptica en la unión neuromuscular, lo que lleva al debilitamiento y atrofia de los músculos. Este mecanismo de acción motivó el uso de la toxina botulínica en las enfermedades con elevado tono muscular, como la distonía y la espasticidad, por lo cual también ha revolucionado la opción de tratamiento de los trastornos autónomos de hipersecreción. La sialorrea es un síntoma común en diversas enfermedades neurológicas. Las inyecciones de toxina botulínica, guiadas por ultrasonidos en las glándulas salivales, produce una disminución de la salivación excesiva en niños con deficiencias neurológicas como parálisis cerebral. La utilización de la toxina botulínica tipo A ha sido sugerida como tratamiento de la sialorrea en pacientes con parálisis cerebral (PC). Esta recomendación ha sido hecha por el efecto anticolinérgico de esta sustancia, principalmente por su capacidad para bloquear la liberación de acetilcolina a nivel de las membranas pre-sinápticas Aunque la respuesta al tratamrento es distinta en cada niño, en general se ha observado que cuanto más a menudo se utiliza la toxlna botulínica y más alta es la dosis utilizada, los resultados son mejores. Los expertos consideran conveniente el procedimiento porque muchos de estos pacientes están utilizando la toxina botulínica para sus problemas musculares y las distrntas condiciones pueden ser tratadas al mismo tiempo Se reporta la descripción de la aplicación de toxina botulínica en una paciente niña que concurre al Instituto de Rehabilitación Infantil TELETON de la ciudad de Valparaíso, Chile, con un trastorno motor severo y con salivación incontrolada persistente que provoca enfermedades respiratorias a repetición

Perseveration in a guessing task by laying hens selected for high or low levels of feather pecking does not support classification of feather pecking as a stereotypy.

Feather pecking is a behaviour by which birds damage or destroy the feathers of themselves (self-pecking) or other birds (allo feather pecking), in some cases even plucking out feathers and eating these. The self-pecking is rarely seen in domestic laying hens but is not uncommon in parrots. Feather pecking in laying hens has been described as being stereotypic, i.e. a repetitive invariant motor pattern without an obvious function, and indeed the amount of self-pecking in parrots was found to correlate positively with the amount of recurrent perseveration (RP), the tendency to repeat responses inappropriately, which in humans and other animals was found to correlate with stereotypic behaviour. In the present experiment we set out to investigate the correlation between allo feather pecking and RP in laying hens. We used birds (N = 92) from the 10th and 11th generation (G10 and G11) of lines selectively bred for high feather pecking (HFP) and low feather pecking (LFP), and from an unselected control line (CON) with intermediate levels of feather pecking. We hypothesised that levels of RP would be higher, and the time taken (standardised latency) to repeat a response lower, in HFP compared to LFP hens, with CON hens in between. Using a two-choice guessing task, we found that lines differed significantly in their levels of RP, with HFP unexpectedly showing lower levels of RP than CON and LFP. Latency to make a repeat did not differ between lines. Latency to make a switch differed between lines with a shorter latency in HFP compared to LFP (in G10), or CON (in G11). Latency to peck for repeats vs. latency to peck for switches did not differ between lines. Total time to complete the test was significantly shorter in HFP compared to CON and LFP. Thus, our hypotheses were not supported by the data. In contrast, selection for feather pecking seems to induce the opposite effects than would be expected from stereotyping animals: pecking was less sequenced and reaction to make a switch and to complete the test was lower in HFP. This supports the hyperactivity-model of feather pecking, suggesting that feather pecking is related to a higher general activity, possibly due to changes in the dopaminergic system.

Monitorización y optimización de terapias de tele-neurorrehabilitación cognitiva

El Daño Cerebral Adquirido (DCA) se define como una lesión cerebral que ocurre después del nacimiento y que no guarda relación con defectos congénitos o enfermedades degenerativas. En el cerebro, se llevan a cabo las funciones mentales superiores como la atención, la memoria, las funciones ejecutivas y el lenguaje, consideradas pre-requisitos básicos de la inteligencia. Sea cual sea su causa, todo daño cerebral puede afectar a una o varias de estas funciones, de ahí la gravedad del problema. A pesar de los avances en nuevas técnicas de intervención precoz y el desarrollo de los cuidados intensivos, las afectaciones cerebrales aún no tienen tratamiento ni quirúrgico ni farmacológico que permita una restitución de las funciones perdidas. Los tratamientos de neurorrehabilitación cognitiva y funcional pretenden, por tanto, la minimización o compensación de las alteraciones ocasionadas por una lesión en el sistema nervioso. En concreto, la rehabilitación cognitiva se define como el proceso en el que personas que han sufrido un daño cerebral trabajan de manera conjunta con profesionales de la salud para remediar o aliviar los déficits cognitivos surgidos como consecuencia de un episodio neurológico. Esto se consigue gracias a la naturaleza plástica del sistema nervioso, donde el cerebro es capaz de reconfigurar sus conexiones neuronales, tanto creando nuevas como modificando las ya existentes. Durante los últimos años hemos visto una transformación de la sociedad, en lo que se ha denominado "sociedad de la información", cuyo pilar básico son las Tecnologías de la Información y las Comunicaciones (TIC). La aplicación de estas tecnologías en medicina ha revolucionado la manera en que se proveen los servicios sanitarios. Así, donde tecnología y medicina se mezclan, la telerrehabilitación se define como la rehabilitación a distancia, ayudando a extender los servicios de rehabilitación más allá de los centros hospitalarios, rompiendo las barreras geográficas, mejorando la eficiencia de los procesos y monitorizando en todo momento el estado y evolución del paciente. En este contexto, el objetivo general de la presente tesis es mejorar la rehabilitación neuropsicológica de pacientes que sufren alteraciones cognitivas, mediante el diseño, desarrollo y validación de un sistema de telemedicina que incorpora las TIC para avanzar hacia un nuevo paradigma personalizado, ubicuo y ecológico. Para conseguirlo, se han definido los siguientes objetivos específicos: • Analizar y modelar un sistema de telerrehabilitación, mediante la definición de objetivos y requisitos de usuario para diseñar las diferentes funcionalidades necesarias. • Definir una arquitectura de telerrehabilitación escalable para la prestación de diferentes servicios que agrupe las funcionalidades necesarias en módulos. • Diseñar y desarrollar la plataforma de telerrehabilitación, incluida la interfaz de usuario, creando diferentes roles de usuario con sus propias funcionalidades. • Desarrollar de un módulo de análisis de datos para extraer conocimiento basado en los resultados históricos de las sesiones de rehabilitación almacenadas en el sistema. • Evaluación de los resultados obtenidos por los pacientes después del programa de rehabilitación, obteniendo conclusiones sobre los beneficios del servicio implementado. • Evaluación técnica de la plataforma de telerrehabilitación, así como su usabilidad y la relación coste/beneficio. • Integración de un dispositivo de eye-tracking que permita la monitorización de la atención visual mientras los pacientes ejecutan tareas de neurorrehabilitación. •Diseño y desarrollo de un entorno de monitorización que permita obtener patrones de atención visual. Como resumen de los resultados obtenidos, se ha desarrollado y validado técnicamente la plataforma de telerrehabilitación cognitiva, demostrando la mejora en la eficiencia de los procesos, sin que esto resulte en una reducción de la eficacia del tratamiento. Además, se ha llevado a cabo una evaluación de la usabilidad del sistema, con muy buenos resultados. Respecto al módulo de análisis de datos, se ha diseñado y desarrollado un algoritmo que configura y planifica sesiones de rehabilitación para los pacientes, de manera automática, teniendo en cuenta las características específicas de cada paciente. Este algoritmo se ha denominado Intelligent Therapy Assistant (ITA). Los resultados obtenidos por el asistente muestran una mejora tanto en la eficiencia como en la eficacia de los procesos, comparado los resultados obtenidos con los de la planificación manual llevada a cabo por los terapeutas. Por último, se ha integrado con éxito el dispositivo de eye-tracking en la plataforma de telerrehabilitación, llevando a cabo una prueba con pacientes y sujetos control que ha demostrado la viabilidad técnica de la solución, así como la existencia de diferencias en los patrones de atención visual en pacientes con daño cerebral. ABSTRACT Acquired Brain Injury (ABI) is defined as brain damage that suddenly and unexpectedly appears in people’s life, being the main cause of disability in developed countries. The brain is responsible of the higher cognitive functions such as attention, memory, executive functions or language, which are considered basic requirements of the intelligence. Whatever its cause is, every ABI may affects one or several functions, highlighting the severity of the problem. New techniques of early intervention and the development of intensive ABI care have noticeably improved the survival rate. However, despite these advances, brain injuries still have no surgical or pharmacological treatment to re-establish lost functions. Cognitive rehabilitation is defined as a process whereby people with brain injury work together with health service professionals and others to remediate or alleviate cognitive deficits arising from a neurological insult. This is achieved by taking advantage of the plastic nature of the nervous system, where the brain can reconfigure its connections, both creating new ones, and modifying the previously existing. Neuro-rehabilitation aims to optimize the plastic nature by inducing a reorganization of the neural network, based on specific experiences. Personalized interventions from individual impairment profile will be necessary to optimize the remaining resources by potentiating adaptive responses and inhibiting maladaptive changes. In the last years, some applications and software programs have been developed to train or stimulate cognitive functions of different neuropsychological disorders, such as ABI, Alzheimer, psychiatric disorders, attention deficit or hyperactivity disorder (ADHD). The application of technologies into medicine has changed the paradigm. Telemedicine allows improving the quality of clinical services, providing better access to them and helping to break geographical barriers. Moreover, one of the main advantages of telemedicine is the possibility to extend the therapeutic processes beyond the hospital (e.g. patient's home). As a consequence, a reduction of unnecessary costs and a better costs/benefits ratio are achieved, making possible a more efficient use of the available resources In this context, the main objective of this work is to improve neuro-rehabilitation of patients suffering cognitive deficits, by designing, developing and validating a telemedicine system that incorporates ICTs to change this paradigm, making it more personalized, ubiquitous and ecologic. The following specific objectives have been defined: • To analyse and model a tele-rehabilitation system, defining objectives and user requirements to design the different needed functionalities. • To define a scalable tele-rehabilitation architecture to offer different services grouping functionalities into modules. • To design and develop the tele-rehabilitation platform, including the graphic user interface, creating different user roles and permissions. • To develop a data analysis module to extract knowledge based on the historic results from the rehabilitation sessions stored in the system. • To evaluate the obtained results by patients after the rehabilitation program, arising conclusions about the benefits of the implemented service. • To technically evaluate the tele-rehabilitation platform, and its usability and the costs/benefit ratio. • To integrate an eye-tracking device allowing the monitoring of the visual attention while patients execute rehabilitation tasks. •To design and develop a monitoring environment that allows to obtain visual attention patterns. Summarizing the obtained results, the cognitive tele-rehabilitation platform has been developed and evaluated technically, demonstrating the improvements on the efficiency without worsening the efficacy of the process. Besides, a usability evaluation has been carried out, with very good results. Regarding the data analysis module, an algorithm has been designed and developed to automatically select and configure rehabilitation sessions, taking into account the specific characteristics of each patient. This algorithm is called Intelligent Therapy Assistant (ITA). The obtained results show an improvement both in the efficiency and the efficacy of the process, comparing the results obtained by patients when they receive treatments scheduled manually by therapists. Finally, an eye-tracking device has been integrated in the tele-rehabilitation platform, carrying out a study with patients and control subjects demonstrating the technical viability of the developed monitoring environment. First results also show that there are differences between the visual attention patterns between ABI patients and control subjects.

Effect of cage type on the behaviour pattern of rabbit does at different physiological stages

Interest in commercially farmed rabbit welfare has increased in recent years. As a result, new alternative housing systems have been developed, although they require evaluation in order to demonstrate their potential for improving welfare. The aim of this trial was to study the behavioural traits of rabbit does housed in 2 different types of cage (TC): conventional vs. alternative with an elevated platform, at different physiological stages (PS); lactation and gestation. Behavioural observations were carried out on 12 rabbit commercial does using continuous 24 h video recording. Independently of PS and TC, rabbit does spent most of their time on foot mats (on av. 57.7%). However, due to the use of platforms (on av. 23.0% of time), lactating does spent 36.6% less time on foot mats (P<0.001) and gestating does spent 27.0% less time on wire mesh (P<0.001) in alternative cages than in conventional cages. Alternative cages allowed for standing posture, but this behaviour was only observed in gestating does (on av. 4.6 times a day). Frequency of drinking was higher in conventional than in alternative cages (24.6 vs. 19.1 times a day; P<0.05). Gestating does housed in conventional cages reached the highest duration and frequency of interacting with neighbours (276 s/d and 4.6 times/d; P<0.05). The frequency of interacting with kits was lower in alternative than in conventional cages (2.4 vs. 8.6 times a day; P<0.01). Doe behaviour was influenced by the time of day, with less activity during the midday hours. During dark hours, rabbit does more frequently performed restless behaviour such as hyperactivity or nursing, matching the time at which rabbit does spent more time on the platform. The platform was frequently used by rabbit does, regardless of their physiological stage, and during late lactation phase, when mothers were not receptive to nursing, does housed in alternative cages used the platform as a mean to flee from kits trying to suckle. Use of the platform might lead to hygienic problems due to retained faeces on the platform and faeces and urine falling onto animals located in the lower part of the cage. The absence of stereotypies in rabbit does of this trial, suggested that animal welfare was not compromised by the type of housing (conventional or alternative cages).

Análisis sistemático de pautas para la accesibilidad TIC para personas con discapacidad cognitiva

Este trabajo de investigación presenta los resultados de una revisión sistemática realizada a partir de la recopilación, lectura y análisis de distintas fuentes bibliográficas dentro de un conjunto heterogéneo consistente de 175 estudios que forman la base bibliográfica actual del documento “Cognitive Accessibility User Research” (W3C, 2015a) del W3C. Esta base bibliográfica está compuesta por publicaciones científicas basadas en libros, artículos, conferencias y sitios Web especializados, en los cuales se potencia como objeto particular de análisis, la indagación en la búsqueda de pautas de accesibilidad en las tecnologías Web que apoyen la integración a personas con discapacidad cognitiva. Como parte de este proceso de investigación se ha recopilado y descrito la situación actual, particularmente, de los retos en la utilización de las tecnologías de la información y la comunicación (TIC) en relación a personas con dificultades de aprendizaje o discapacidades cognitivas, tales como la Dislexia, Afasia, Trastorno de Aprendizaje No verbal, Envejecimiento-Demencia, Trastornos por Déficit de Atención con o sin Hiperactividad, Autismo, Síndrome de Down y Discalculia. Como aporte primordial de este Trabajo Fin de Master (TFM), se intenta trazar una línea de criterios que permitan la evaluación objetiva de este tópico, con miras a ofrecer un enfoque práctico y reciente sobre ésta temática, mostrando de forma esquematizada las pautas existentes y sirviendo de síntesis orientativa para el diseño accesible de las TIC con la finalidad de promover un soporte real a personas con los tipo de discapacidad cognitiva en los que se ha enfocado esta investigación. Logrando obtener como resultado principal de este estudio, 36 pautas generales que agrupan las coincidencias del grupo de discapacidades estudiadas y que han sido distribuidas en categorías: texto, navegación y generales, para su mejor interpretación y manejo de la Accesibilidad en las TIC´S para Personas con Discapacidad Cognitiva.---ABSTRACT---This research presents the results of a systematic review from collecting, reading and analysis of different bibliographic sources within a heterogeneous group consisting of 175 studies that form the basis of current literature document "Accessibility User Cognitive Research" (W3C , 2015th) of the W3C. This bibliographic database is composed of scientific publications based on books, articles, lectures and specialized Web sites, in which is enhanced as a particular object of analysis, the inquiry into the search for accessibility guidelines for Web technologies to support integration of people with cognitive disabilities. As part of this research process, the current situation has been collected and described, particularly the challenges in the use of information and communications technology (ICT) in relation to people with learning disabilities or cognitive disabilities, such as Dyslexia, aphasia, nonverbal learning disorder, aging-Dementia, Attention Deficit Disorders with or without hyperactivity, autism, Down syndrome and dyscalculia. As primary contribution of this Master's Thesis (TFM), it tries to draw a line of criteria to allow an objective assessment of this topic, in order to provide a practical and recent focus on this theme, showing schematically existing guidelines and serving as guidance for accessible design of ICT in order to promote a real support to people with cognitive disabilities where this research has focused on. Managing to obtain the main result of this study, 36 general guidelines that group the set of disabilities studied and have been distributed in categories: text, navigation and general, for better interpretation and management of ICTs for Accessibility people with cognitive disabilities.