Fysioterapeuttien kliininen päättely lapsen motorisen kehityksen tukemisessa

kliininen päättely kuuluu olennaisena osana fysioterapeutin työhön. Kliinisessä päättelyssä fysioterapeutti kerää ja prosessoi sekä olemassa olevaa että uutta tietoa ja käyttää sitä asiakkaan terveydentilan, elämäntilanteen ja kuntoutuksen ennusteen arviointiin. Lisäksi fysioterapeutti suunnittelee kerätyn tiedon avulla asiakkaalle yksilöllisesti soveltuvan terapian. Australialainen Ian Edwards on tutkimuksessaan todennut, että fysioterapeutit käyttävät seuraavia kliinisen päättelyn strategioita: diagnostinen päätöksenteko, kertomuksiin liittyvä päätöksenteko, menettelytapoihin liittyvä strategia, vuorovaikutuksellinen päätöksenteko, yhteistoiminnallinen päätöksenteko, eettinen päätöksenteko, ennusteisiin liittyvä päätöksenteko ja päätöksenteko opettamisessa. Istuallaan liikkuminen eli ”peppukiitäminen” voi olla eräs havaittu motorisen kehityksen poikkeavuus noin 1-vuotiaalla lapsella. Lapsi ei ala kontata eikä nousta seisomaan vaan liikkuu mielenkiintoisten kohteiden luokse istuallaan. Tällöin lapsen motorista kehitystä seurataan ja tuetaan esimerkiksi fysioterapeutin vastaanotolla. Opinnäytetyömme tarkoituksena on perehtyä fysioterapeutin kliiniseen päättelyyn terapiatilanteessa, jossa lapsi liikkuu istuallaan. Tarkoituksenamme on myös selvittää, tarvitsevatko istuallaan liikkuvat lapset fysioterapiaa, ja mihin fysioterapeutit perustavat terapian. Olemme haastatelleet kolmea kokenutta, lasten fysioterapian parissa työskentelevää fysioterapeuttia kyseisistä aiheista. Haastattelemamme fysioterapeutit käyttivät kaikkia kliinisen päättelyn strategioita istuallaan liikkuvan lapsen fysioterapiassa. Eniten fysioterapeuteilla oli käytössä diagnostinen sekä menettelytapoihin liittyvä päätöksenteko. Fysioterapeutit vertasivat lapsen kehitystasoa normaaliin motoriseen kehitykseen. Lapsen terapia toteutettiin leikkien, lelujen, laulujen ja lorujen avulla. Vanhempien ohjaaminen koettiin tärkeäksi. Fysioterapeuttien toiminnan perusta oli teoria (esimerkiksi lapsen motorinen kehitys), jonka jälkeen he löysivät pitkästä kokemuksestaan keinot terapian toteuttamiseen. Fysioterapeutit kokivat erilaiset koulutukset sekä moniammatillisen yhteistyön hyödylliseksi. Emme saaneet yksiselitteistä vastausta kysymykseen, tarvitsevatko istuallaan liikkuvat lapset fysioterapiaa. Vanhempien ohjaus näytti haastattelujen perusteella toteutuvan asiantuntijajohtoisesti.

Mesure de l'impact de l'implication des proches aidants de patients hospitalises dans une unité de soins psychiatriques aigus sur eux-mêmes

Le but de cette étude est de mesurer ainsi que de qualifier l'impact de l'implication des proches aidants de patients hospitalisés dans des unités de soins psychiatriques aigus sur eux-mêmes. Le cadre conceptuel utilisé est celui du fardeau des familles de Schene (1990). Il différencie les parties objectives et subjectives du fardeau familial. La récolte de données a été réalisée à l'aide de l'Involvement Evaluation Questionnaire (IEQ). Les résultats de cette étude montrent que les proches aidants souffrent d'un niveau d'inquiétude élevé, 3.8 sur une échelle de Likert à 5 questions, ainsi que d'un niveau de tension à 2.44 sur une échelle de Likert à 5 questions. Des associations ont été trouvées. L'augmentation de la durée du trouble diminue l'inquiétude, avec une valeur ρ de 0.048. Le fait d'être habitué à la situation a également un impact en diminuant la tension, avec une valeur ρ de 0.002. Plus on est « habitué à la situation », avec une valeur ρ de -0.021, moins le proche est inquiet par rapport à la situation du patient. Ainsi que, plus le patient est jeune, plus le proche aidant ressent de tension, avec une valeur ρ de 0.008. Ces résultats, peu généralisables au vu du petit échantillon (n=24), pourraient toutefois impliquer une réflexion approfondie sur l'accueil, la place et le soutien des proches aidants de patients souffrants de troubles psychiatriques hospitalisés dans une unité de soins aigus de la part des infirmières.

Simulated Patient as Co-facilitators: Benefits and Challenges of the Interprofessional Team OSCE (Submission #9350).

Hypothesis: The quality of care for chronic patients depends on the collaborative skills of the healthcare providers.1,2 The literature lacks reports of the use of simulation to teach collaborative skills in non-acute care settings. We posit that simulation offers benefits for supporting the development of collaborative practice in non-acute settings. We explored the benefits and challenges of using an Interprofessional Team - Objective Structured Clinical Examination (IT-OSCE) as a formative assessment tool. IT-OSCE is an intervention which involves an interprofessional team of trainees interacting with a simulated patient (SP) enabling them to practice collaborative skills in non-acute care settings.5 A simulated patient are people trained to portray patients in a simulated scenario for educational purposes.6,7 Since interprofessional education (IPE) ultimately aims to provide collaborative patient-centered care.8,9 We sought to promote patient-centeredness in the learning process. Methods: The IT-OSCE was conducted with four trios of students from different professions. The debriefing was co-facilitated by the SP with a faculty. The participants were final-year students in nursing, physiotherapy and medicine. Our research question focused on the introduction of co-facilitated (SP and faculty) debriefing after an IT-OSCE: 1) What are the benefits and challenges of involving the SP during the debriefing? and 2) To evaluate the IT-OSCE, an exploratory case study was used to provide fine grained data 10, 11. Three focus groups were conducted - two with students (n=6; n=5), one with SPs (n=3) and one with faculty (n=4). Audiotapes were transcribed for thematic analysis performed by three researchers, who found a consensus on the final set of themes. Results: The thematic analysis showed little differentiation between SPs, student and faculty perspectives. The analysis of transcripts revealed more particularly, that the SP's co-facilitation during the debriefing of an IT-OSCE proved to be feasible. It was appreciated by all the participants and appeared to value and to promote patient-centeredness in the learning process. The main challenge consisted in SPs feedback, more particularly in how they could report accurate observations to a students' group rather than individual students. Conclusion: In conclusion, SP methodology using an IT-OSCE seems to be a useful and promising way to train collaborative skills, aligning IPE, simulation-based team training in a non-acute care setting and patient-centeredness. We acknowledge the limitations of the study, especially the small sample and consider the exploration of SP-based IPE in non-acute care settings as strength. Future studies could consider the preparation of SPs and faculty as co-facilitators. References: 1. Borrill CS, Carletta J, Carter AJ, et al. The effectiveness of health care teams in the National Health Service. Aston centre for Health Service Organisational Research. 2001. 2. Reeves S, Lewin S, Espin S, Zwarenstein M. Interprofessional teamwork for health and social care. Oxford: Wiley-Blackwell; 2010. 3. Issenberg S, McGaghie WC, Petrusa ER, Gordon DL, Scalese RJ. Features and uses of high-fidelity medical simulations that lead to effective learning - a BEME systematic review. Medical Teacher. 2005;27(1):10-28. 4. McGaghie W, Petrusa ER, Gordon DL, Scalese RJ. A critical review of simulation-based medical education research: 2003-2009. Medical Education. 2010;44(1):50-63. 5. Simmons B, Egan-Lee E, Wagner SJ, Esdaile M, Baker L, Reeves S. Assessment of interprofessional learning: the design of an interprofessional objective structured clinical examination (iOSCE) approach. Journal of Interprofessional Care. 2011;25(1):73-74. 6. Nestel D, Layat Burn C, Pritchard SA, Glastonbury R, Tabak D. The use of simulated patients in medical education: Guide Supplement 42.1 - Viewpoint. Medical teacher. 2011;33(12):1027-1029. Disclosures: None (C) 2014 by Lippincott Williams & Wilkins, Inc.

Enhancement of human adipose-derived stem cell expansion and stability for clinical use

Co-culture techniques associating both dermal fibroblasts and epidermal keratinocytes have shown to have better clinical outcome than keratinocyte culture alone for the treatment of severe burns. Since fat grafting has been shown to improve scar remodelling, new techniques such as cell-therapy-assisted surgical reconstruction with isolated and expanded autologous adipose-derived stem cells (ASCs) would be of benefit to increase graft acceptation. Therefore, integrating ASCs into standardized procedures for cultured skin grafting could be of benefit for the patient if cell quality and quantity could be maintained. The purpose of this study was to evaluate ASC processing from adult tissue with simple isolation (without enzymatic steps), expansion (low density of 325-3,000 cells/cm2) and storage conditions to assure methods to enhance the cellular resistance when transferred back to the patient. Co-culture with cell-banked skin progenitor cells (FE002-SK2) showed an increase of 40-50% ASCs yield at high passages alongside with a better preservation of morphology, proper adipogenic and osteogenic differentiation and efficient biocompatibility with 3D collagen scaffolds. ASCs can be considered as a valuable additional cell source to be delivered in biological bandages to the patient in a need of tissue reconstruction such as burn patients.

Kierrätyspolttoaineen käyttö leijupetikattilan konseptiin

Diplomityö tehtiin Rautjärven kunnassa sijaitsevalle M-real Simpeleen tehtaan voimalaitokselle. Voimalaitoksella on leijupetikattila ja se tuottaa prosessilämmön ja höyryn kartonki- ja paperikoneelle. Vuotuinen energiantuotanto on noin 115 GWh. Diplomityön tavoitteena oli tutkia kierrätyspolttoaineen käyttöä osana voimalaitoksen polttoainekonseptista. Voimalaitoksen biokattila on leijupetikattila, jossa poltetaan tehtaalta tulevaa kuorta ja lietettä sekä tehtaan ulkopuolisia puuperäisiä biopolttoaineita ja turvetta. Yksi työn päätavoitteista oli laatia voimassa olevan ympäristöluvan muutoshakemus, jotta kierrätyspolttoaineen käytölle saataisiin lupa. Suurten polttolaitosten päästöjen tarkkailu- ja raportointivaatimukset ovat uudistuneet viime vuosina paljon. Suurimpia muutosten aiheuttajia ovat Valtioneuvoston asetukset 1017/2002 ja 362/2003. Tässä työssä kuvataan uusien asetusten tuomia vaatimuksia itse kattilalle ja polttoaineen syötölle, jatkuvatoimisille mittalaitteille ja muille suoritettaville mittauksille. Uutena asiana on myös ilmapäästöjen seurantamittaukset ja -tapa, jolla tulokset ilmoitetaan. Mahdollisimman pieniin leijupetikattilamuutoksiin uskotaan pääsevän korvaamalla kierrätyspolttoaine REF1:llä 5 – 10 % turpeesta tai puupolttoaineista.

Little evidence for association between the TGFBR1*6A variant and colorectal cancer: a family-based association study on non-syndromic family members from Australia and Spain.

Genome-wide linkage studies have identified the 9q22 chromosomal region as linked with colorectal cancer (CRC) predisposition. A candidate gene in this region is transforming growth factor beta receptor 1 (TGFBR1). Investigation of TGFBR1 has focused on the common genetic variant rs11466445, a short exonic deletion of nine base pairs which results in truncation of a stretch of nine alanine residues to six alanine residues in the gene product. While the six alanine (*6A) allele has been reported to be associated with increased risk of CRC in some population based study groups this association remains the subject of robust debate. To date, reports have been limited to population-based case-control association studies, or case-control studies of CRC families selecting one affected individual per family. No study has yet taken advantage of all the genetic information provided by multiplex CRC families. Methods: We have tested for an association between rs11466445 and risk of CRC using several family-based statistical tests in a new study group comprising members of non-syndromic high risk CRC families sourced from three familial cancer centres, two in Australia and one in Spain. Results: We report a finding of a nominally significant result using the pedigree-based association test approach (PBAT; p = 0.028), while other family-based tests were non-significant, but with a p-value < 0.10 in each instance. These other tests included the Generalised Disequilibrium Test (GDT; p = 0.085), parent of origin GDT Generalised Disequilibrium Test (GDT-PO; p = 0.081) and empirical Family-Based Association Test (FBAT; p = 0.096, additive model). Related-person case-control testing using the 'More Powerful' Quasi-Likelihood Score Test did not provide any evidence for association (M-QL5; p = 0.41). Conclusions: After conservatively taking into account considerations for multiple hypothesis testing, we find little evidence for an association between the TGFBR1*6A allele and CRC risk in these families. The weak support for an increase in risk in CRC predisposed families is in agreement with recent meta-analyses of case-control studies, which estimate only a modest increase in sporadic CRC risk among 6*A allele carriers.

Pregabalin in the treatment of inferior alveolar nerve paraesthesia following overfilling of endodontic sealer

A case of orofacial pain and inferior alveolar nerve (IAN) paraesthesia after extrusion of endodontic sealer within the mandibular canal treated with prednisone and pregabalin is described. A 36-year-old woman underwent root canal treatment of the mandibular second right premolar tooth. Post-operative panoramic radiograph revealed the presence of radiopaque canal sealer in the mandibular canal. Damage to IAN consecutive to extrusion of endodontic sealer was diagnosed. Non-surgical management was decided, including: 1 mg/kg/day prednisone 2 times/day, once-daily regimen, and 150 mg/day pregabalin, two doses per day, monitoring the progress with periodic follow-up visits. Six weeks after the incident the signs and symptoms were gone. The complete resolution of paraesthesia and the control of pain achieved suggest that a non-surgical approach, combining prednisone and the GABA analogue pregabalin, is a good option in the management of the IAN damage subsequent to endodontic sealer extrusion

O efeito da granulometria na decrepitação durante a decomposição térmica de calcários e carvão

The use of fluidized bed combustors to burn coal is largely studied to permit the addition of limestone to capture SO2. The particle size for coal and limestone is an important parameter in this process. Thermogravimetry (TG) is used to elucidate the combustion and sulfation processes, but the experimental parameters must be evaluated to be representative in fluidized bed combustors. In the present study the effect of particle size is analyzed in the calcination of limestones and the combustion of coal through the thermogravimetric curve for limestone and derivative thermogravimetric curve for coal. Small peaks representing mass losses between 400 and 500 ºC are observed due to the jumping of particles out of the crucible. This effect, recognized as decrepitation is observed for mid-sized particles provoked by the release of water vapor trapped within their lattice.

A poluição gerada por máquinas de combustão interna movidas à diesel - a questão dos particulados. Estratégias atuais para a redução e controle das emissões e tendências futuras

The exhaust emissions of vehicles greatly contribute to environmental pollution. Diesel engines are extremely fuel-efficient. However, the exhaust compounds emitted by diesel engines are both a health hazard and a nuisance to the public. This paper gives an overview of the emission control of particulates from diesel exhaust compounds. The worldwide emission standards are summarized. Possible devices for reducing diesel pollutants are discussed. It is clear that after-treatment devices are necessary. Catalytic converters that collect particulates from diesel exhaust and promote the catalytic burn-off are examined. Finally, recent trends in diesel particulate emission control by novel catalysts are presented.

The effects of real time control of welding parameters on weld quality in plasma arc keyhole welding

Joints intended for welding frequently show variations in geometry and position, for which it is unfortunately not possible to apply a single set of operating parameters to ensure constant quality. The cause of this difficulty lies in a number of factors, including inaccurate joint preparation and joint fit up, tack welds, as well as thermal distortion of the workpiece. In plasma arc keyhole welding of butt joints, deviations in the gap width may cause weld defects such as an incomplete weld bead, excessive penetration and burn through. Manual adjustment of welding parameters to compensate for variations in the gap width is very difficult, and unsatisfactory weld quality is often obtained. In this study a control system for plasma arc keyhole welding has been developed and used to study the effects of the real time control of welding parameters on gap tolerance during welding of austenitic stainless steel AISI 304L. The welding tests demonstrated the beneficial effect of real time control on weld quality. Compared with welding using constant parameters, the maximum tolerable gap width with an acceptable weld quality was 47% higher when using the real time controlled parameters for a plate thickness of 5 mm. In addition, burn through occurred with significantly larger gap widths when parameters were controlled in real time. Increased gap tolerance enables joints to be prepared and fit up less accurately, saving time and preparation costs for welding. In addition to the control system, a novel technique for back face monitoring is described in this study. The test results showed that the technique could be successfully applied for penetration monitoring when welding non magnetic materials. The results also imply that it is possible to measure the dimensions of the plasma efflux or weld root, and use this information in a feedback control system and, thus, maintain the required weld quality.

Aspectos químicos, biológicos e etnofarmacológicos do gênero Cassia

Species of Cassia are widely distributed in tropical and subtropical regions throughout the world, and have been extensively investigated chemically and pharmacologically.They are known to be a rich source of phenolic derivatives, most of them with important biological and pharmacological properties. Some Asian, African and Indian tribes use these species as a laxative, purgative, antimicrobial, antipyretic, antiviral and anti-inflammatory agent. Among a number of other classes of secondary metabolites, such as anthracene derivatives, antraquinones, steroids and stilbenoids, biologically active piperidine alkaloids are an especially important bioactive class of compounds that showed to be restricted to a small group of Cassia species. In this paper we present an overview of the chemical, biological and ethnopharmacological data on Cassia piblished in the literature.

Funciones y uso de metáforas en el diseño de entornos e-learning

El objeto de esta comunicación es presentar un estudio exploratorio sobre las funciones y tipologías de metáfora estructurales presentes en productos de e-learning, para estudiar con más detalle dos ejemplos: Geolearning y Activewolds. Estos servirán para realizar un ejercicio de identificación de los elementos audiovisuales presentes en la interface, el tratamiento de las dimensiones espacio y tiempo; el uso de 'avatares' y de las posibilidades de navegación e interacción dentro de los dos sistemas. La teoría de la muldimodalidad (Kress i van Leeuwen) es el marco teórico que conduce la reflexión sobre la representación, orientación y organización de la comunicación. Desde la misma perspectiva teórica, el trabajo de Burn y Parker nos indica pautas metodológicas para el análisis de los productos

Peutz-Jeghers syndrome: a systematic review and recommendations for management

Peutz¿Jeghers syndrome (PJS, MIM175200) is an autosomal dominant condition defined by the development of characteristic polyps throughout the gastrointestinal tract and mucocutaneous pigmentation. The majority of patients that meet the clinical diagnostic criteria have a causative mutation in the STK11 gene, which is located at 19p13.3. The cancer risks in this condition are substantial, particularly for breast and gastrointestinal cancer, although ascertainment and publication bias may have led to overestimates in some publications. Current surveillance protocols are controversial and not evidence-based, due to the relative rarity of the condition. Initially, endoscopies are more likely to be done to detect polyps that may be a risk for future intussusception or obstruction rather than cancers, but surveillance for the various cancers for which these patients are susceptible is an important part of their later management. This review assesses the current literature on the clinical features and management of the condition, genotype¿phenotype studies, and suggested guidelines for surveillance and management of individuals with PJS. The proposed guidelines contained in this article have been produced as a consensus statement on behalf of a group of European experts who met in Mallorca in 2007 and who have produced guidelines on the clinical management of Lynch syndrome and familial adenomatous polyposis.

Constituintes químicos das flores de Pterogyne nitens (Caesalpinioideae)

The phytochemical investigation of the flowers of Pterogyne nitens (Caesalpinioideae) resulted in the isolation and identification of nine phenolic derivatives, quercetin 3-O-sophoroside, taxifolin, astilbin, ourateacatechin, caffeic, ferulic, sinapic, chlorogenic and gallic acid, besides two guanidine alkaloids, pterogynine, pterogynidine. This is the first time these compounds have been reported in P. nitens flowers. As this is a monospecific genus, these secondary metabolites may have taxonomical significance. Their structures were assigned on the basis of spectroscopic analyses, including two-dimensional NMR techniques.