The Impact of Body-Weight Supported Locomotor Training in a Toddler with GMFCS Level V Cerebral Palsy: A Case Study

BACKGROUND AND PURPOSE: Children with cerebral palsy (CP) in Gross Motor Function Classification System (GMFCS) level V present with decreased gross motor function and trunk control that impacts their functional activities and participation in family activities. Research indicates body-weight supported locomotor training (BWSLT) may improve motor control for children with neuromotor disabilities. The toddler years present a window of opportunity for developmental changes. The purpose of this case study was to explore the impact of a 6-week BWSLT intervention on postural control, gross motor function, and quality of life in a young child with cerebral palsy in GMFCS level V. CASE DESCRIPTION: A 3 year-old male child diagnosed with CP was recruited from a local pediatric home health agency. He presented with spasticity in all four extremities, gross motor delay, truncal ataxia, and decreased head control. The child was dependent for all functional mobility and activities of daily living. The child attended BWSLT sessions 3 times per week for 6 weeks. An experienced pediatric physical therapist and 3 assistants facilitated the gait cycle on the treadmill. Facilitation was decreased when the child demonstrated improved motor control. Throughout the 6 weeks, treadmill speed was systematically increased from 0.7mph to 1.8mph and body-weight support was systematically decreased from 50 to 33%. Total walking time varied between 11 and 26 minutes (in 3-5 minute bouts) and total standing time ranged from 4 to 13 minutes (in 2-5 minute bouts). The child attended 17 of the 18 sessions, missing 1 due to respiratory illness. OUTCOMES: At the initial assessment, the child received a total Gross Motor Function Measure (GMFM-66) score of 20.5, SE = 2.2, 95%CI [16.3, 24.8]. He scored 1/20 on the Segmental Assessment of Trunk Control (SATCo) and his total standardized score was 61.5 on the CPCHILD, an assessment of quality of life for children with CP in GMFCS levels IV and V. After 6-weeks of BWSLT, the child improved his GMFM-66 score by 30% to 26, SE = 2, 95%CI [22.1, 29.9]. He also showed a slight improvement in the SATCo, 2/20, and the CPCHILD, 61.91. His school physical therapist reported he was able to hold his head up more during the day and showed increased endurance with improved lower extremity control with walking in his gait trainer. DISCUSSION: The outcomes of this case study suggest that gross motor function and trunk control may improve through body-weight supported locomotor training in young children with severe CP. The 6 week time frame was chosen based on previous literature, but a longer time frame may have produced greater results. Future research is needed to determine if this type of intervention can improve function across a larger population of toddlers with CP in GMFCS levels V. Additionally, dosage requirements for this population should be explored

Trunk control and gross motor outcomes after body-weight supported treadmill training in young children with severe cerebral palsy: A case series

BACKGROUND AND PURPOSE: Children with cerebral palsy (CP) in Gross Motor Function Classification System (GMFCS) levels IV and V present with decreased gross motor function and trunk control that impacts their functional activities and participation in family activities. Research indicates body-weight supported treadmill training (BWSTT) may improve motor control for children with neuromotor disabilities. The toddler years present a window of opportunity for developmental changes. The purpose of this case series was to explore the impact of a 6-week BWSTT intervention on postural control and gross motor function in 3 young children with cerebral palsy in GMFCS levels IV and V. CASE DESCRIPTION: Three children diagnosed with CP between the ages of 2 to 3 years participated in 6 weeks of BWSTT, 3 times per week. All children displayed decreased trunk control as measured by the Segmental Assessment of Trunk Control (SATCo) and decreased gross motor function as measured by the Gross Motor Function Measure (GMFM-66). One child was dependent for all mobility (GMFCS level V) and 2 children were able to belly crawl for short distances (GMFCS level IV). None of the children were able to walk without assistance. All 3 displayed spasticity in bilateral lower extremities. BWSTT consisted of an experienced pediatric physical therapist and 3 assistants facilitating the gait cycle on the treadmill. Facilitation was decreased when the child demonstrated improved motor control. Treadmill speed was systematically increased (average speed = 1.15mph) and body-weight support was systematically decreased (range: 50 to 33%). Total walking time averaged 20:04 minutes (in 2-10 minute bouts) and total standing time averaged 8:28 minutes (in 2-4 minute bouts). Average attendance was 94%. OUTCOMES: Final scores revealed that all 3 children improved gross motor function and trunk control. Child 1 improved his SATCo score from Level 0 to Level 1, indicating improved head control. His GMFM-66 score increased from 20.5 to 26. The other 2 children showed greater improvements in trunk control. Child 2’s SATCo score increased from Level 2 to Level 3 and his GMFM-66 score increased from 36.8 to 42.4. Child 3 improved on the SATCo from Level 2 to Level 4 and on the GMFM from 31.8 to 40.9. Parents of all 3 children reported increased motivation to walk during physical therapy sessions. DISCUSSION: The outcomes of this case series suggest that gross motor function and trunk control may improve through BWSTT in young children with severe CP. The 6 week time frame was chosen based on previous literature, but a longer time frame may have produced greater results. Parents of all 3 children expressed the desire to continue the intervention. Future research is needed to determine if this type of intervention can improve function across a larger population of toddlers with CP in GMFCS levels IV and V

Caregiver perspectives on body-weight supported treadmill training as an intervention for young children with cerebral palsy

PURPOSE/HYPOTHESIS: Children with cerebral palsy (CP) in Gross Motor Function Classification System (GMFCS) levels IV and V present with challenges that impact their functional activities and participation in family activities. The purpose of this study was to examine caregivers’ perspectives on body-weight supported treadmill training (BWSTT) as an intervention for their young children with CP. NUMBER OF SUBJECTS: Participants included 4 caregivers of children with CP in GMFCS levels IV (n = 2) and V (n = 2) who previously participated in 6 weeks of BWSTT. MATERIALS/METHODS: Three children diagnosed with CP in GMFCS levels IV and V between the ages of 2 to 3 years participated in 6 weeks of BWSTT, 3 times per week. The type of CP varied for each child: 1 had spastic diplegia, 1 had spastic triplegia and 1 had spastic quadriplegia. The caregivers of the children were asked to participate in face to face interviews after the intervention ended. Four caregivers (1 parent of each child, plus an additional parent of 1 of the children) participated in one-on-one semi-structured interviews using open-ended questions. Interviews were audio recorded and transcribed. Analysis of the interviews was conducted through open coding to identify categories by the principal investigator. A secondary investigator coded 50% of the transcripts to triangulate the coding for trustworthiness. The two investigators then discussed the codes and categories until an agreement was reached to identify the emergent themes and an overarching theme. RESULTS: The principal investigator and 3-4 research assistants were able to perform BWSTT with all 3 young children without adverse effects. Attendance varied between 16 to 18 sessions, with an average participation rate of 94%. Careful triangulation of the interview data led to the identification of 3 common themes and 1 overarching theme based on caregiver perceptions of the BWSTT program. The themes identified were: 1) Caregiving (support system, physical and emotional strain, routines), 2) Future outlook (optimism, facing challenges, fears/worries), and 3) Importance of therapies (traditional physical therapy, BWSTT intervention, and other therapies as more important than physical therapy). The overarching theme that emerged was: Acceptance of the journey. CONCLUSIONS: The caregivers reported that after the BWSTT intervention, their children improved in motivation to walk, and also with head and trunk control. Caregivers of the children all expressed the desire to continue the program and stated that they would participate again if given the chance. They also emphasized the importance of other therapies to address issues such as feeding and communication. CLINICAL RELEVANCE: Caregivers are likely to take time out of their busy schedules to pursue physical therapy treatments that they view as effective in improving their child’s gross motor function. Although physical therapy is perceived as vital to their child’s progress, it is a small part of the overall journey for these families

Trunk control and gross motor outcomes after body weight supported treadmill training in young children with severe cerebral palsy: a non-experimental case series

OBJECTIVE: To explore the impact of a body weight supported treadmill training (BWSTT) intervention on postural control and gross motor function in three young children with cerebral palsy (CP) classified as Gross Motor Function Classification System (GMFCS) levels IV or V. METHOD: Children (N = 3) between the ages of 2-3 years who were diagnosed with CP classified as GMFCS levels IV and V participated in BWSTT three times per week. The Segmental Assessment of Trunk Control (SATCo) and the gross motor function measure (GMFM-66) were assessed before and after the 6-week intervention. RESULTS: Final testing revealed that all participants improved on the SATCo and GMFM. CONCLUSION: BWSTT is a viable intervention that may improve trunk control and gross motor outcomes in young children with severe CP. Further research is needed to explore the impact of BWSTT for young children classified as GMFCS levels IV and V

Use and availability of medicinal resources in Ouro Verde de Goiás, Goiás State, Brazil

O objetivo do presente estudo foi realizar um levantamento etnobotânico das plantas medicinais usadas por comunidades rurais e urbanas no município de Ouro Verde de Goiás, situado na mesorregião do mato grosso goiano; eleger espécies nativas do bioma Cerrado potenciais para estudos farmacológicos com base na concordância de uso popular corrigida (CUPc); e avaliar se o conhecimento botânico e o cultivo de espécies medicinais em quintais podem ser afetados por classes de idade, gênero, escolaridade, local de nascimento e procedência rural/urbana do informante pelos testes Kruskal-Wallis (H) e Qui-quadrado (c 2). Foram selecionados 84 informantes por meio de amostragens aleatórias, sendo efetuadas entrevistas estruturadas. As fontes disponíveis de recursos medicinais foram: quintais, áreas antrópicas, matas de galeria e remanescentes de florestas estacionais. Foram registradas 98 espécies distribuídas em 45 famílias destacando-se em número as exóticas cultivadas. Nos quintais, foram catalogadas 78 espécies cultivadas, sendo 39,7% para remédios, e demais associações com a alimentação (39,7%) e a ornamentação (20,5%). Vinte espécies são adquiridas pelo extrativismo na vegetação do entorno, sendo todas nativas do bioma Cerrado, com exceção de Senna occidentalis, que é invasora. Duas espécies de florestas estacionais (Forsteronia refracta e Celtis iguanaea) apresentaram a CUPc > 50%, evidenciando consensos de uso popular. Verificou-se que 41% dos informantes da zona rural recorrem ao extrativismo na vegetação nativa, procura que é consideravelmente maior em relação aos informantes da zona urbana (16,7%). A quantidade de espécies citadas foi significativamente maior entre os informantes que tinham quintal. O número de espécies citadas e a presença de quintal independem do grau de escolaridade, gênero, local de nascimento, idade e zona de procedência rural ou urbana do informante.The goal of this study was to conduct an ethnobotanical survey of the medicinal plants used by rural and urban communities in the town of Ouro Verde de Goiás, situated in the mato grosso goiano meso-region of the state of Goiás; to pinpoint species native to the Cerrado biome with potential for pharmacological studies based on corrected popular use concordance (CUPc); and to determine if ethnobotanical knowledge of medicinal plants from backyards differed by age, gender, education, place of birth and rural versus urban setting of the informant. Statistical tests applied were Kruskal-Wallis (H) and Qui-square (c 2). Eighty-four informants were selected by random sampling and interviews were structured. The available sources of medicinal plants were: backyards, disturbed areas, gallery forests and deciduous dry forests. Ninetyeight species, distributed in 45 botanical families, were found, with cultivated exotics outnumbering native plants. In backyards, 78 species were cultivated, of which 39.7% were cited exclusively as medicinal, the remaining also being reported as food (39.7%) or ornamentals (20.5%). Twenty species were gathered from the surrounding vegetation, all of which are native to the Cerrado biome, except for Senna occidentalis which is weedy. Two species that occur in deciduous dry forest (Forsteronia refracta and Celtis iguanaea) had high CUPc (> 50%), showing consensus of popular use. Forty-one percent of rural area informants reported gathering medicinal plants from native vegetation, which is significantly more than those in urban areas (16.7%). The number of species cited by informants with cultivated backyards was significantly greater than those that did not. The number of medicinal plants cited by informants and the presence of a backyard did not differ significantly among informants from different classes of gender, education, place of birth and rural versus urban dwelling

Perceptions of Task Interdependence in Software Development: An Industrial Case Study

Context: Task interdependence is a work design factor that expresses the mutual dependency between tasks that compose a whole work. In software development, task interdependencies are created by the technical dependencies between the components of the software system and by how the development tasks are allocated to individuals in a teamwork context. Despite its importance for individual and team effectiveness, we still do not have studies about how software engineers perceive task interdependence in practice. Goal: To understand the perceptions of software engineers about the interdependence in their work and how these perceptions interact with other human and technical factors in the development process. Method: We performed an exploratory qualitative case study of a single software development team in a Brazilian software company that developed solutions for the financial market. We interviewed all 10 team members and used standard coding techniques from qualitative research to code, categorize, and synthesize data. Results: Individuals are consistent in their understanding of task interdependence and how it happens in practice. However, there are asymmetries between the individual perceptions in an interdependence relationship, which seem to exacerbate expressed feelings of anxiety and dissatisfaction. Conclusion: Our results suggest that the perception of task interdependence in software development is often not symmetrical with potential negative effects on emotional states that are related to motivation and satisfaction in the workplace.Comment: 11 page

Fitossociologia da mata do Morro da Quixaba no território de Fernando de Noronha

O território de Fernando de Noronha localiza-se a 32º 25'30" W de longitude e 3º 50' 10" S de latitude e é composto por 21 ilhas. Este trabalho foi realizado na ilha principal na região do Morro da Quixaba até a Ponta da Sapata, onde a vegetação foi menos perturbada nas últimas décadas. Utilizou-se o método de quadrantes para a amostragem de indivíduos com diâmetro mínimo de 5 cm a 30 cm do solo. A distância entre os pontos foi estabelecida em 10 m. No total foram aplicados 100 pontos de amostragem, em diversas picadas alocadas na área de estudo. Foram encontradas 13 famílias sendo dominantes, Nyctaginaceae, Bignoniaceae, Anacardiaceae, Rubiaceae e Euphorbiaceae. Dentre as 16 espécies encontradas, Guapira sp. ocupou a primeira posição em importância com IVI de 100,67%, seguida de Tabebuia roseoalba (55,14%), Spondias mombin (52,17%), Guettarda sp. (21,72%) Allophylus sp. (17,27%). ____________________________________________________________________________________ ABSTRACTFernando de Noronha territory is located at 32º 25'30" W and 3º 50'10" S and it is composed of 21 islands. We studied the Quixaba Hill winch extends until to Sapata Point, where the vegetation has been relatively undisturbed on the last decades. The method used the point-centered-quarter. Only individuals with, at least, 5 cm diameter above the ground level was sampled. The distance between points was 10 m with points on peackies in the studied area. We obtained 16 species distributed in 13 families with the dominance of Nyctaginaceae, standing out Bignoniaceae, Anacardiaceae, Rubiaceae and Euphorbiaceae. Guapira sp. reached the best IVI (100,67), followed by Tabebuia roseo-alba (55,14), Spondias mombin (52,17), Guettarda sp. (21,72) e Allophylus sp. (17,27)

Characterization of a Plasmodium falciparum mutant that has deleted the majority of the gametocyte-specific Pf11-1 locus

We identified a gametocyte-specific protein of Plasmodium falciparum called Pf11-1 and provide experimental evidence that this molecule is involved in the emergence of gametes of the infected erythrocyte (gametogenesis). A mutant parasite clone, which has deleted over 90% of the PF11-1 gene locus, was an important control to establish the gametocyte-specific expression of the Pf11-1. Molecular analysis of the Pf11-1 deletion indicates that it is presumably due a chromosome breakage with subsequent "healing" by the addition of telomeric heptanucleotides. Moreover, similar DNA rearrangements are observed in most of the laboratory isolates during asexual propagation in vitro

Mutations in UBA3 Confer Resistance to the NEDD8-Activating Enzyme Inhibitor MLN4924 in Human Leukemic Cells

The NEDD8-activating enzyme (NAE) initiates neddylation, the cascade of post-translational NEDD8 conjugation onto target proteins. MLN4924, a selective NAE inhibitor, has displayed preclinical anti-tumor activity in vitro and in vivo, and promising clinical activity has been reported in patients with refractory hematologic malignancies. Here, we sought to understand the mechanisms of resistance to MLN4924. K562 and U937 leukemia cells were exposed over a 6 month period to MLN4924 and populations of resistant cells (R-K562MLN, R-U937MLN) were selected. R-K562MLN and R-U937MLN cells contain I310N and Y352H mutations in the NAE catalytic subunit UBA3, respectively. Biochemical analyses indicate that these mutations increase the enzyme’s affinity for ATP while decreasing its affinity for NEDD8. These mutations effectively contribute to decreased MLN4924 potency in vitro while providing for sufficient NAE function for leukemia cell survival. Finally, R-K562MLN cells showed cross-resistance to other NAE-selective inhibitors, but remained sensitive to a pan-E1 (activating enzyme) inhibitor. Thus, our work provides insight into mechanisms of MLN4924 resistance to facilitate the development of more effective second-generation NAE inhibitors

Down-Modulation of Cockroach (CR) Allergen-specific Th2 Cell Responses Following Subcutaneous German Cockroach Allergen Immunotherapy (SCIT)

Rationale: The responses of T cells to subcutaneous allergen immunotherapy (SCIT) are not fully elucidated. We conducted a functional immunological evaluation of cockroach (CR) allergen-specific CD4+ T cell reactivity in the double-blinded, placebo-controlled, multi-center CRITICAL study. Methods: Participants (8-17 years of age) with mild to moderate, well-controlled asthma received 12 months of maintenance dosing of CR SCIT (n=20) or placebo (n=26). Peripheral blood mononuclear cells (PBMC) were isolated prior to, and after 12 months of therapy. CD4+ T cell responses at baseline and after treatment were assessed using overlapping peptide pools derived from 11 well-defined CR allergens and intracellular cytokine staining for IL-4, IFNg, and IL-10 production. T cell responses were further evaluated in terms of magnitude, cytokine polarization, and allergen immunodominance. Results: Significant down-modulation of the total magnitude of CD4+ T cell responses was observed with SCIT but not placebo, with a significant change between groups (-4.46±0.82 vs. −1.81±0.72, respectively, p = 0.020). Responses were driven by a decrease in IL-4 (-4.87±0.86 vs. −1.09±0.75, p = 0.002) with unaltered IFNg and IL-10 production, reflecting a shift towards a Th1 polarization profile (1.35±0.58 vs. −0.37±0.50, in SCIT and placebo respectively, p = 0.031). The largest effects were observed against the allergens Bla g 5 and Bla g 9, which are dominantly recognized, suggesting that dominant responses are susceptible to modulation. Conclusions: Our results demonstrate a significant down-regulation of CR-specific Th2 cell responses in urban children with asthma who received SCIT, compared with those who received placebo