Intravitreal methotrexate in type B lymphoblastic leukemia—Case Report

Leukemia is a common neoplasia that, in its progress, can have ocular involvement due to direct infiltration or secondary to hematological alterations typical of the disease. These findings are consistent with an involvement of the central nervous system and are thus related to the prognosis. Despite the existing systemic therapies, there needs to be more literature that shows the treatment in the ocular involvement of this disease. A case report of a child with ocular involvement due to treatment-refractory acute lymphoblastic leukemia, successfully managed with intravitreal methotrexate, is presented

The application of the World Health Organization - International Classification of Functioning, Disability and Health in outcomes assessment in hip and knee arthroplasty rehabilitation

© 2014 Dr. Maria Jenelyn AlviarWith the rising rates in hip and knee arthroplasty procedures, the demand for and utilisation of rehabilitation services are also expected to rise. The challenge in arthroplasty rehabilitation is meeting the growing demands and at the same time optimising rehabilitation outcomes. Outcomes assessment therefore assumes greater importance with the need to establish whether the goals of effectiveness and efficiency are met. Currently, outcomes assessment in arthroplasty rehabilitation is beset with problems. These vary from conceptual to measurement issues and continue to impede the progress in this field. The introduction of the International Classification of Functioning, Disability and Health (ICF) in 2001is envisioned to have a role in outcomes assessment in clinical and research contexts. This is a 2-phase thesis that investigated the clinical applicability and feasibility of the ICF in outcomes assessment in persons with osteoarthritis (OA) undergoing hip and knee arthroplasty. In phase I (preliminary phase), the ICF was used as a reference framework in examining the content of outcome measures used in hip and knee arthroplasty rehabilitation. The majority of the 112 outcome measures used in arthroplasty rehabilitation assess at the level of body structures and body functions, and activity at the individual level. Frequently-used multidimensional site- and condition-specific patient-reported outcome instruments fail to capture participation and environment. Additionally, critical appraisal of the metric attributes of 28 generic and specific instruments show that most patient-reported outcome instruments used in this area lack the necessary requisites of an evaluative tool, which are agreement and responsiveness to clinical change. In phase II, the ICF comprehensive OA core set was investigated for its potential as a starting point in the development of a clinical measure of functioning in the population of interest. In 316 persons with OA undergoing hip and knee arthroplasty, the ICF comprehensive OA core set categories are relevant in describing the functioning of this population. Further, the results of the Rasch analysis of this core set support the unidimensionality of the body functions component, and activity and participation component after the removal of some items, and collapsing the response options. The findings of moderate to strong correlations with other measures purporting to assess similar constructs also provide evidence to the external construct validity of the core set. However, further studies are needed to determine whether targeting can be improved in this population, particularly during the pre-operative stage and during the sub-acute care stage (rehabilitation) following surgery

Multimodal Dynamics of Extended Communication

Language is a multimodal performance of remarkable coordination. Previous research has found this coordination responds to word-level variables as well as sentence-level variables. Coordination at the longer time scales of the discourse-level, however, is less studied. Bridging the rapidly changing multimodal behaviors of language to its diverse discursive contexts and pragmatic intentions is fundamental for our understanding of language use in social contexts. This dissertation takes initial steps in this direction by studying the dynamic organization and coordination of body movement and prosody over the extended time scales of diverse performances. Chapter 2 explores the dynamics and multimodal patterns that speakers produce in the context of an academic talk. We analyze the organization and coordination of body movement, prosody, and PowerPoint slide transitions. Results show weak regularities in the coordination and organization of the modalities as a result of the shared discursive context, but also highlight the role of individual constraints in shaping the multimodal behaviors of speakers. Chapter 3 contrasts the multimodal multiscale coordination of the movements and sounds of solo music performances and speech monologues. Results evidence different coordination patterns depending on performance goals, with higher local sound-movement synchrony and stronger multiscale coordination for speech compared to music. Coordination also varies across the discursive contexts analyzed, but not across instruments of interpretation. Chapter 4 studies the effects that the limitations of videoconferencing have on interpersonal and multimodal coordination. The continuous perturbations introduced by videoconferencing reduce interpersonal coordination during remote conversations in ways consistent with the reduction of signal quality as compared to in-person interactions. Multimodal coordination, which is not mediated by the Zoom’s audiovisual signals, is maintained, while speech convergence is reduced, and movement convergence is disrupted. Chapter 5 outlines a proposal to connect the multimodal coordination patterns of language use to the pragmatic goals of social interactions. I argue that the context sensitivity and rapid adaptability of multimodal coordination are consistent with the characteristics of synergies. I propose the multimodal patterns of language result from metastable multimodal synergies that simultaneously provide stability for pragmatic goals while also dynamically adapting to ever-changing constraints and goals of conversations

Multimodal Dynamics of Extended Communication

Language is a multimodal performance of remarkable coordination. Previous research has found this coordination responds to word-level variables as well as sentence-level variables. Coordination at the longer time scales of the discourse-level, however, is less studied. Bridging the rapidly changing multimodal behaviors of language to its diverse discursive contexts and pragmatic intentions is fundamental for our understanding of language use in social contexts. This dissertation takes initial steps in this direction by studying the dynamic organization and coordination of body movement and prosody over the extended time scales of diverse performances. Chapter 2 explores the dynamics and multimodal patterns that speakers produce in the context of an academic talk. We analyze the organization and coordination of body movement, prosody, and PowerPoint slide transitions. Results show weak regularities in the coordination and organization of the modalities as a result of the shared discursive context, but also highlight the role of individual constraints in shaping the multimodal behaviors of speakers. Chapter 3 contrasts the multimodal multiscale coordination of the movements and sounds of solo music performances and speech monologues. Results evidence different coordination patterns depending on performance goals, with higher local sound-movement synchrony and stronger multiscale coordination for speech compared to music. Coordination also varies across the discursive contexts analyzed, but not across instruments of interpretation. Chapter 4 studies the effects that the limitations of videoconferencing have on interpersonal and multimodal coordination. The continuous perturbations introduced by videoconferencing reduce interpersonal coordination during remote conversations in ways consistent with the reduction of signal quality as compared to in-person interactions. Multimodal coordination, which is not mediated by the Zoom’s audiovisual signals, is maintained, while speech convergence is reduced, and movement convergence is disrupted. Chapter 5 outlines a proposal to connect the multimodal coordination patterns of language use to the pragmatic goals of social interactions. I argue that the context sensitivity and rapid adaptability of multimodal coordination are consistent with the characteristics of synergies. I propose the multimodal patterns of language result from metastable multimodal synergies that simultaneously provide stability for pragmatic goals while also dynamically adapting to ever-changing constraints and goals of conversations