A model to differentiate WAD patients and people with abnormal pain behaviour based on biomechanical and self-reported tests

[EN] The prevalence of malingering among individuals presenting whiplash-related symptoms is significant and leads to a huge economic loss due to fraudulent injury claims. Various strategies have been proposed to detect malingering and symptoms exaggeration. However, most of them have been not consistently validated and tested to determine their accuracy in detecting feigned whiplash. This study merges two different approaches to detect whiplash malingering (the mechanical approach and the qualitative analysis of the symptomatology) to obtain a malingering detection model based on a wider range of indices, both biomechanical and self-reported. A sample of 46 malingerers and 59 genuine clinical patients was tested using a kinematic test and a self-report questionnaire asking about the presence of rare and impossible symptoms. The collected measures were used to train and validate a linear discriminant analysis (LDA) classification model. Results showed that malingerers were discriminated from genuine clinical patients based on a greater proportion of rare symptoms vs. possible self-reported symptoms and slower but more repeatable neck motions in the biomechanical test. The fivefold cross-validation of the LDA model yielded an area under the curve (AUC) of 0.84, with a sensitivity of 77.8% and a specificity of 84.7%.Open access funding provided by Universita degli Studi di Padova within the CRUI-CARE Agreement. This work was supported by funding from the European Union's Horizon 2020 research and innovation program under grant agreement No 777090Monaro, M.; De Rosario Martínez, H.; Baydal Bertomeu, JM.; Bernal-Lafuente, M.; Masiero, S.; Macía-Calvo, M.; Cantele, F.... (2021). A model to differentiate WAD patients and people with abnormal pain behaviour based on Biomechanical and self-reported tests. International Journal of Legal Medicine. 135(4):1637-1646. https://doi.org/10.1007/s00414-021-02572-5163716461354Cassidy JD, Leth-Petersen S, Rotger GP (2018) What happens when compensation for whiplash claims is made more generous? J Risk Insur 85:635–662Previtera, AM (2004) Il colpo di frusta cervicale. Diagnosi, biomeccanica e trattamento. Grafica MA. RO, Copiano (PV)Noll-Hussong M (2017) Whiplash Syndrome Reloaded: Digital Echoes of Whiplash Syndrome in the European Internet Search Engine Context. JMIR Public Heal Surveill 3:e15. https://doi.org/10.2196/publichealth.7054Janitzek T (2007) Reining in Whiplash: Better Protection for Europe’s Car Occupants. Corporate Authors: European Transport Safety CouncilSpitzer WO, Skovron ML, Salmi LR, Cassidy JD, Duranceau J, Suissa S, Zeiss E (1995) Scientific monograph of the Quebec Task Force on Whiplash-Associated Disorders: redefining “whiplash” and its management., Spine (Phila. Pa. 1976). 20 1S-73S. http://www.ncbi.nlm.nih.gov/pubmed/7604354Binder A (2007) The diagnosis and treatment of nonspecific neck pain and whiplash. Eura Medicophys 43:79Ferrara SD, Ananian V, Baccino E, Banczerowski P, Bordignon D, Boscolo-Berto R, Domenici R, Quevedo JG, Graw M, Hell W (2016) Whiplash-Associated Disorders. Int J Legal Med 130:13–22Hartling L, Brison RJ, Ardern C, Pickett W (1976) Prognostic value of the Quebec classification of whiplash-associated disorders, Spine (Phila. Pa 26(2001):36–41Broos J, Meijer R (2016) Simulation Method for Whiplash Injury Prediction Using an Active Human Model, in: Proc. IRCOBI Conf.Cassidy JD, Carroll LJ, Côté P, Lemstra M, Berglund A, Nygren Å (2000) Effect of Eliminating Compensation for Pain and Suffering on the Outcome of Insurance Claims for Whiplash Injury. N Engl J Med 342:1179–1186. https://doi.org/10.1056/NEJM200004203421606Pearce JMS (1999) A critical appraisal of the chronic whiplash syndrome. J Neurol Neurosurg Psychiatry 66(3):273–276. https://doi.org/10.1136/jnnp.66.3.273Schmand B, Lindeboom J, Schagen S, Heijt R, Koene T, Hamburger HL (1998) Cognitive complaints in patients after whiplash injury: the impact of malingering. J Neurol Neurosurg Psychiatry 64:339–343Larrabee GJ (1990) Cautions in the use of neuropsychological evaluation in legal settings. Neuropsychology 4:239–247. https://doi.org/10.1037/0894-4105.4.4.239Cornell DG, Hawk GL (1989) Clinical presentation of malingerers diagnosed by experienced forensic psychologists. Law Hum Behav 13:375–383. https://doi.org/10.1007/BF01056409Berry DTR, Baer RA, Harris MJ (1991) Detection of malingering on the MMPI: A meta-analysis. Clin Psychol Rev 11:585–598. https://doi.org/10.1016/0272-7358(91)90005-FRogers R, Correa AA (2008) Determinations of Malingering: Evolution from Case-Based Methods to Detection Strategies, Psychiatry. Psychol Law 15:213–223. https://doi.org/10.1080/13218710802014501Rogers R, Shuman DW (2005) Malingering and deception in criminal evaluations, Fundam. In: Rogers R, Shuman DW (eds) Fundamentals of forensic practice: mental health and criminal law, pp 21–55. https://doi.org/10.1007/b106925Smith GP, Burger GK (1997) Detection of malingering: validation of the Structured Inventory of Malingered Symptomatology (SIMS). J Am Acad Psychiatry Law Online 25:183–189Sartori G, Forti S, Birbaumer N, Flor H (2003) A brief and unobtrusive instrument to detect simulation and exaggeration in patients with whiplash syndrome. Neurosci Lett 342:53–56. https://doi.org/10.1016/S0304-3940(03)00233-7Sobel JB, Sollenberger P, Robinson R, Polatin PB, Gatchel RJ (2000) Cervical nonorganic signs: a new clinical tool to assess abnormal illness behavior in neck pain patients: a pilot study. Arch Phys Med Rehabil 81:170–175Murphy DR, Hurwitz EL (2011) Application of a diagnosis-based clinical decision guide in patients with neck pain. Chiropr Man Therap 19:19. https://doi.org/10.1186/2045-709X-19-19Mendelson G, Mendelson D (2004) Malingering pain in the medicolegal context. Clin J Pain 20:423–432Fishbain DA, Cole B, Cutler RB, Lewis J, Rosomoff HL, Rosomoff RS (2003) A structured evidence-based review on the meaning of nonorganic physical signs: Waddell signs. Pain Med 4:141–181Capilla Ramírez P, González Ordi H (2009) A Protocol for detection of malingered pain symptomatology in clinical practice: case studies, TRAUMA-SPAIN. 20:255–263Capilla Ramírez P, González Ordi H (2012) Simulaciónenpatología dolorosa crónica del raquis cervical (cervicalgia/esguince cervical). Rev. Española Med. Leg. 38:76–84. https://doi.org/10.1016/j.reml.2012.03.003Vernon H, Tran S, Soave D, Moreton J (2010) Simulated malingering in the testing of cervical muscle isometric strength. J Back Musculoskelet Rehabil 23:117–127Endo K, Suzuki H, Yamamoto K (1976) Consciously postural sway and cervical vertigo after whiplash injury, Spine (Phila. Pa 33(2008):E539–E542Baydal-Bertomeu JM, Page ÁF, Belda-Lois JM, Garrido-Jaén D, Prat JM (2011) Neck motion patterns in whiplash-associated disorders: Quantifying variability and spontaneity of movement. Clin Biomech 26:29–34. https://doi.org/10.1016/j.clinbiomech.2010.08.008Baydal-Bertomeu J-M, García-Mas M-A, Poveda R, Belda J-M, Garrido-Jaén D, Vivas M-J, Vera P, López J (2007) Determination of simulation patterns of cervical pain from kinematical parameters of movement. Challenges Assist Technol AAATE 07(20):429–433Oddsdottir GL, Kristjansson E, Gislason MK (2015) Sincerity of effort versus feigned movement control of the cervical spine in patients with whiplash-associated disorders and asymptomatic persons: a case–control study. Physiother Theory Pract 31:403–409G. Sartori, A. Zangrossi, G. Orrù, M. Monaro 2017 Detection of Malingering in Psychic Damage Ascertainment, in: P5 Med. Justice, Springer, Cham, pp. 330–341. https://doi.org/10.1007/978-3-319-67092-8_21Vrij A, Fisher R, Mann S, Leal S (2008) A cognitive load approach to lie detection. J Investig Psychol Offender Profiling 5:39–43S Agosta G Sartori 2013 The autobiographical IAT: a review Front Psychol 4. https://doi.org/10.3389/fpsyg.2013.00519Sartori G, Agosta S, Gnoato F (2007) High accuracy detection of malingered whiplash syndrome. International Whiplash Trauma Congress, Miami, FLS Zago E Piacquadio M Monaro G Orrù E Sampaolo T Difonzo A Toncini E Heinzl 2019The Detection of Malingered Amnesia: An Approach Involving Multiple Strategies in a Mock CrimeFront Psychiatry 10. https://doi.org/10.3389/fpsyt.2019.00424G. Sartori, A. Zangrossi, M. Monaro, Deception Detection With Behavioral Methods, in: J.P. Rosenfeld (Ed.), Detect. Concealed Inf. Decept., Elsevier, 2018: pp. 215–241. https://doi.org/10.1016/B978-0-12-812729-2.00010-0De Rosario H, Vivas MJ, Sinovas MI, Page Á (2018) Relationship between neck motion and self-reported pain in patients with whiplash associated disorders during the acute phase. Musculoskelet Sci Pract 38:23–29. https://doi.org/10.1016/j.msksp.2018.09.004Landis JR, Koch GG (1977) The Measurement of Observer Agreement for Categorical Data. Biometrics 33:159. https://doi.org/10.2307/2529310Hosmer DW, Lemeshow S (2000) Applied Logistic Regression, John Wiley & Sons Inc, Hoboken, NJ. USA. https://doi.org/10.1002/0471722146H. De Rosario, phia: Post-Hoc Interaction Analysis, (2013). https://cran.r-project.org/web/packages/phia/index.html. Accessed 17 Sept 2020R Core Team (2020) R: a language and environment for statistical computing. http://www.r-project.org/. Accessed 17 Sept 2020Sing T, Sander O, Beerenwinkel N, Lengauer T (2005) ROCR: visualizing classifier performance in R. Bioinformatics 21:3940–3941. https://doi.org/10.1093/bioinformatics/bti623W.N. Venables, B.D. Ripley, Modern Applied Statistics with S, Fourth, Springer, New York, 2002. http://www.stats.ox.ac.uk/pub/MASS4/M. Gamer, J. Lemon, I. Fellows, P. Singh, Various Coefficients of Interrater Reliability and Agreement, (2019). https://cran.r-project.org/package=irr. Accessed 17 Sept 2020M Monaro A Toncini S Ferracuti G Tessari MG Vaccaro P Fazio De G Pigato T Meneghel C Scarpazza G Sartori 2018The Detection of Malingering: A New Tool to Identify Made-Up Depression Front Psychiatry 9. https://doi.org/10.3389/fpsyt.2018.00249Ferrari R, Kwan O (2001) The no-fault flavor of disability syndromes. Med Hypotheses 56:77–84. https://doi.org/10.1054/mehy.2000.1115Fishbain DA (1994) Secondary gain concept. APS J 3:264–273. https://doi.org/10.1016/S1058-9139(05)80274-8Fishbain DA, Cutler R, Rosomoff HL, Rosomoff RS (1999) Chronic Pain Disability Exaggeration/Malingering and Submaximal Effort Research. Clin J Pain 15:244–274. https://doi.org/10.1097/00002508-199912000-00002Gatchel RJ, Adams L, Polatin PB, Kishino ND (2002) Secondary loss and pain-associated disability: theoretical overview and treatment implications. J Occup Rehabil 12:99–110. https://doi.org/10.1023/A:101501261448

Structural and functional stabilization of protein entities: state-of-the-art

Within the context of biomedicine and pharmaceutical sciences, the issue of (therapeutic) protein stabilization assumes particular relevance. Stabilization of protein and protein-like molecules translates into preservation of both structure and functionality during storage and/or targeting, and such stabilization is mostly attained through establishment of a thermodynamic equilibrium with the (micro)environment. The basic thermodynamic principles that govern protein structural transitions and the interactions of the protein molecule with its (micro)environment are, therefore, tackled in a systematic fashion. Highlights are given to the major classes of (bio)therapeutic molecules, viz. enzymes, recombinant proteins, (macro)peptides, (monoclonal) antibodies and bacteriophages. Modification of the microenvironment of the biomolecule via multipoint covalent attachment onto a solid surface followed by hydrophilic polymer co-immobilization, or physical containment within nanocarriers, are some of the (latest) strategies discussed aiming at full structural and functional stabilization of said biomolecules.Financial support to Victor M. Balcao, via an Invited Research Scientist fellowship (FAPESP Ref. No. 2011/51077-8), and project funding (FAPESP Ref. No. 2013/03181-6, Project PneumoPhageKill) by Fundacao de Amparo a Pesquisa do Estado de Sao Paulo (FAPESP, Sao Paulo, Brazil), is hereby gratefully acknowledged. The authors are also grateful to Claudio M. Barroso (BSc.), Graphic Designer at University of Sorocaba (UNISO), for computer-designing the schemes/drawings integrating this review paper

Genome-wide association analysis of dementia and its clinical endophenotypes reveal novel loci associated with Alzheimer's disease and three causality networks : The GR@ACE project

Introduction: Large variability among Alzheimer's disease (AD) cases might impact genetic discoveries and complicate dissection of underlying biological pathways. Methods: Genome Research at Fundacio ACE (GR@ACE) is a genome-wide study of dementia and its clinical endophenotypes, defined based on AD's clinical certainty and vascular burden. We assessed the impact of known AD loci across endophenotypes to generate loci categories. We incorporated gene coexpression data and conducted pathway analysis per category. Finally, to evaluate the effect of heterogeneity in genetic studies, GR@ACE series were meta-analyzed with additional genome-wide association study data sets. Results: We classified known AD loci into three categories, which might reflect the disease clinical heterogeneity. Vascular processes were only detected as a causal mechanism in probable AD. The meta-analysis strategy revealed the ANKRD31-rs4704171 and NDUFAF6-rs10098778 and confirmed SCIMP-rs7225151 and CD33-rs3865444. Discussion: The regulation of vasculature is a prominent causal component of probable AD. GR@ACE meta-analysis revealed novel AD genetic signals, strongly driven by the presence of clinical heterogeneity in the AD series

Effectiveness of an intervention for improving drug prescription in primary care patients with multimorbidity and polypharmacy:Study protocol of a cluster randomized clinical trial (Multi-PAP project)

This study was funded by the Fondo de Investigaciones Sanitarias ISCIII (Grant Numbers PI15/00276, PI15/00572, PI15/00996), REDISSEC (Project Numbers RD12/0001/0012, RD16/0001/0005), and the European Regional Development Fund ("A way to build Europe").Background: Multimorbidity is associated with negative effects both on people's health and on healthcare systems. A key problem linked to multimorbidity is polypharmacy, which in turn is associated with increased risk of partly preventable adverse effects, including mortality. The Ariadne principles describe a model of care based on a thorough assessment of diseases, treatments (and potential interactions), clinical status, context and preferences of patients with multimorbidity, with the aim of prioritizing and sharing realistic treatment goals that guide an individualized management. The aim of this study is to evaluate the effectiveness of a complex intervention that implements the Ariadne principles in a population of young-old patients with multimorbidity and polypharmacy. The intervention seeks to improve the appropriateness of prescribing in primary care (PC), as measured by the medication appropriateness index (MAI) score at 6 and 12months, as compared with usual care. Methods/Design: Design:pragmatic cluster randomized clinical trial. Unit of randomization: family physician (FP). Unit of analysis: patient. Scope: PC health centres in three autonomous communities: Aragon, Madrid, and Andalusia (Spain). Population: patients aged 65-74years with multimorbidity (≥3 chronic diseases) and polypharmacy (≥5 drugs prescribed in ≥3months). Sample size: n=400 (200 per study arm). Intervention: complex intervention based on the implementation of the Ariadne principles with two components: (1) FP training and (2) FP-patient interview. Outcomes: MAI score, health services use, quality of life (Euroqol 5D-5L), pharmacotherapy and adherence to treatment (Morisky-Green, Haynes-Sackett), and clinical and socio-demographic variables. Statistical analysis: primary outcome is the difference in MAI score between T0 and T1 and corresponding 95% confidence interval. Adjustment for confounding factors will be performed by multilevel analysis. All analyses will be carried out in accordance with the intention-to-treat principle. Discussion: It is essential to provide evidence concerning interventions on PC patients with polypharmacy and multimorbidity, conducted in the context of routine clinical practice, and involving young-old patients with significant potential for preventing negative health outcomes. Trial registration: Clinicaltrials.gov, NCT02866799Publisher PDFPeer reviewe

Multiancestry analysis of the HLA locus in Alzheimer’s and Parkinson’s diseases uncovers a shared adaptive immune response mediated by HLA-DRB1*04 subtypes

Across multiancestry groups, we analyzed Human Leukocyte Antigen (HLA) associations in over 176,000 individuals with Parkinson’s disease (PD) and Alzheimer’s disease (AD) versus controls. We demonstrate that the two diseases share the same protective association at the HLA locus. HLA-specific fine-mapping showed that hierarchical protective effects of HLA-DRB1*04 subtypes best accounted for the association, strongest with HLA-DRB1*04:04 and HLA-DRB1*04:07, and intermediary with HLA-DRB1*04:01 and HLA-DRB1*04:03. The same signal was associated with decreased neurofibrillary tangles in postmortem brains and was associated with reduced tau levels in cerebrospinal fluid and to a lower extent with increased Aβ42. Protective HLA-DRB1*04 subtypes strongly bound the aggregation-prone tau PHF6 sequence, however only when acetylated at a lysine (K311), a common posttranslational modification central to tau aggregation. An HLA-DRB1*04-mediated adaptive immune response decreases PD and AD risks, potentially by acting against tau, offering the possibility of therapeutic avenues

La expresión corporal en educación física : propuesta curricular desde la administración educativa

Resumen basado en el de la publicaciónSe analiza la expresión corporal en la Educación Física y se presenta un estudio de caso de un Match de improvisación. La expresión corporal es el instrumento con el cual se producen las variadas formas del arte del movimiento. Es fundamental en el proceso de comunicación y éste debe ser interactivo y dinámico. Se analiza la expresión corporal como medio educativo para la formación integral del alumnado. En el estudio del caso, se muestra cómo se aplica al marco escolar y en qué puede ayudar.AndalucíaBiblioteca de Educación del Ministerio de Educación, Cultura y Deporte; Calle San Agustín 5 -3 Planta; 28014 Madrid; Tel. +34917748000; [email protected]

La orientación deportiva en el marco escolar : propuesta educativa para la educación física en secundaria

Resumen basado en el de la publicaciónSe ofrecen directrices de cómo llevar a cabo trabajos de orientación deportivo en los centros de Educación Secundaria y se contextualiza dentro del marco escolar y su currículum. La orientación es un deporte consistente en una carrera individual cronometrada donde los participantes usan un mapa esencial y una brújula para recorrer en el orden adecuado diferentes puntos de control. Se explican las diversas modalidades de orientación existentes: como actividad en la naturaleza, como deporte competitivo, como actividad de ocio al aire libre y como modo de mantenerse en forma. La orientación guarda relación con el currículo oficial de Educación Física y forma parte del bloque de contenidos de Actividades en el Medio Natural.AndalucíaBiblioteca de Educación del Ministerio de Educación, Cultura y Deporte; Calle San Agustín 5 -3 Planta; 28014 Madrid; Tel. +34917748000; [email protected]

La expresión corporal en educación física : propuesta curricular desde la administración educativa

Resumen basado en el de la publicaciónSe analiza la expresión corporal en la Educación Física y se presenta un estudio de caso de un Match de improvisación. La expresión corporal es el instrumento con el cual se producen las variadas formas del arte del movimiento. Es fundamental en el proceso de comunicación y éste debe ser interactivo y dinámico. Se analiza la expresión corporal como medio educativo para la formación integral del alumnado. En el estudio del caso, se muestra cómo se aplica al marco escolar y en qué puede ayudar.AndalucíaBiblioteca de Educación del Ministerio de Educación, Cultura y Deporte; Calle San Agustín 5 -3 Planta; 28014 Madrid; Tel. +34917748000; [email protected]

La educación para la paz : propuestas educativas desde la educación física escolar

Resumen basado en el de la publicaciónSe presenta una iniciativa en la que se trata de incluir un contenido educativo sobre la paz y valores necesarios para la integración del alumno mediante la Educación Física. Para poder educar a los alumnos mediante la paz, es necesario poner en marcha un plan de convivencia en el centro capaz de inculcar valores éticos y cívicos. La Educación Física se muestra como una de las materias con multitud de actividades orientadas a su consecución. Practicando juegos y deportes se debe hacer hincapié en la utilización del diálogo para la resolución de conflictos, desarrollando así actitudes de compañerismo ante los demás.AndalucíaBiblioteca de Educación del Ministerio de Educación, Cultura y Deporte; Calle San Agustín 5 -3 Planta; 28014 Madrid; Tel. +34917748000; [email protected]

La construcción de materiales en Educación Física : contribuciones educativas de dichos materiales en el proceso educativo

Resumen basado en el de la publicaciónSe presenta una descripción de los materiales de desechos construidos para el aprendizaje en una clase de educación física. En la construcción de materiales se persigue valorar la importancia de reciclar, concienciar al individuo en el respeto del medio ambiente y en un consumo responsable en la vida diaria. Se muestran los pasos a seguir para la construcción de diversos materiales, de papel y cartón o materiales con utensilios de la vida cotidiana. Para su diseño y elaboración, se indican qué orientaciones metodológicas son más oportunas, así como su evaluación en el marco escolar. Se indica también cómo incluir a los alumnos con necesidades específicas de apoyo educativo en este tipo de actividades del aprendizaje.AndalucíaBiblioteca de Educación del Ministerio de Educación, Cultura y Deporte; Calle San Agustín 5 -3 Planta; 28014 Madrid; Tel. +34917748000; [email protected]