Study protocol for a hybrid 1 effectiveness-implementation trial of Brief Skills Training in Affective and Interpersonal Regulation (Brief STAIR) and web-administered STAIR (webSTAIR) for posttraumatic stress disorder in integrated primary care.

BACKGROUND: Posttraumatic stress disorder (PTSD) disproportionally affects low-income, racial and ethnic minoritized communities, where prevalence is high, yet access to evidence-based treatments (EBTs) is low. As such, there is a need to identify effective, feasible, and scalable interventions for PTSD. Stepped care approaches that include brief, low-intensity treatments are one approach to improving access yet have not been developed for adults with PTSD. Our study aims to test the effectiveness of a step one PTSD treatment in primary care while gathering information on implementation to maximize sustainability in the setting. METHODS: This study will be conducted in integrated primary care in the largest safety net hospital in New England using a hybrid type 1 effectiveness-implementation design. Eligible trial participants are adult primary care patients who meet full or subthreshold criteria for PTSD. Interventions include Brief clinician-administered Skills Training in Affective and Interpersonal Regulation (Brief STAIR) versus web-administered STAIR (webSTAIR) during a 15-week active treatment period. Participants complete assessments at baseline (pre-treatment), 15 weeks (post-treatment), and 9 months (follow-up) post-randomization. We will assess feasibility and acceptability post-trial using surveys and interviews with patients, study therapists, and other key informants, and will assess the preliminary effectiveness of interventions in terms of PTSD symptom change and functioning. CONCLUSION: This study will provide evidence for the feasibility, acceptability, and preliminary effectiveness of brief, low-intensity interventions in safety net integrated primary care, with the aim of including these interventions in a future stepped care approach to PTSD treatment. CLINICAL TRIAL NUMBER: NCT04937504

A Survey of Universal Design at Museums: Current Industry Practice and Perceptions

Background: Museums are key educational and cultural resources in the community, yet many are not accessible to visitors with disabilities. Universal design promotes products and environments usable to the greatest extent possible by all people, regardless of ability. This study explores current industry practice and perceptions of accessibility and universal design in a small sample of American museums. Suggestions for how occupational therapists can help museums go above and beyond ADA guidelines are provided. Method: An 17-item cross-sectional survey was used to collect data. Twenty-five museum associations assisted with recruitment. A descriptive numerical summary and qualitative analysis were used to summarize the results. Results: Sixty respondents participated in the survey. Accommodations for visitors with visual impairment and physical barriers created by historical buildings were identified as both challenges and successes by the respondents. Confusion between ADA standards and universal design was evident in several responses. Conclusion: The most frequently reported accessibility rating was good. Staff training and community-based partnerships are important, but often overlooked practices for improving accessibility. Local agencies who serve people with disabilities are underused resources in the community. There is a potential role for occupational therapists to assist museums with staff training, recruiting people with disabilities, and establishing community partnerships. Additional research is warranted

Memória e Cotidiano em Porecatu/PR

O presente paper é fruto do projeto de pesquisa, extensão e ensino Memória Coletiva e Patrimônio Cultural em Porecatu, registrado na Pró- reitoria de Extensão da Universidade Estadual de Londrina. Tem como objetivo inventariar, compreender, registrar e preservar bens materiais e simbólicos significativos para os moradores de uma cidade de pequeno porte na região norteparanaense, por meio de um trabalho de antropólogos, historiadores e arquitetos. Sensibilizando grupos de moradores de diversos perfis socioculturais com ações como memórias de famílias; memórias e politica; trabalho e memórias; gênero feminino e memórias; festa, lazer e memórias; educação patrimonial; bens materiais e memórias; fotografias e memórias -, com o apoio das secretarias de cultura e educação do município-, busca reconstituir a história local por intermédio das experiências e das concepções de seus moradores no passado e no presente. O estudo ancora-se em um caminho teórico que trata de cidade, memória e patrimônio cultural. Os dados são coletados por meio de técnicas de pesquisa qualitativa, característicos da etnografia. O envolvimento com diferentes grupos de moradores da cidade- ao ouvir e registrar seus depoimentos, bem como vivenciar seu cotidiano- tem permitido reconstituir o passado por meio das memórias, assim como compreender como moradores no presente vivenciam o cotidiano e (re) significam a cidade. Porecatu é uma cidade nascida com a expansão da agricultura do café no norteparanaense e a aquisição de terras por intermédio de iniciativas individuais. A formação da Usina Central do Paraná impulsionou o processo migratório para a Porecatu, bem como moldou a paisagem urbana e rural da cidade. As diferentes memórias e vivências cotidianas são reveladoras de grupos de elite e ao mesmo tempo de grupos de classes populares, responsáveis pela construção da cidade, e modos de vida, marcadores de seu perfil sociocultural- de sua história- sintonizados com aspectos da sociedade mundial

Cuerpos no identificados en el contexto Mexicano

The discovery of clandestine graves has become a recurring fact during the last ten years in Mexico, estimating that there could be more than 2000 scattered throughout the country (Guillen et al., 2018). Less well known, reported and attended to are the mass graves, located in municipal or state census, which house bodies of unidentified people and of which there is no official census. It is estimated that there are some 26,000 unidentified bodies (SEGOB, 2019a) and annually, in Mexico City alone, almost 500 are destined for the cemetery mass grave. Comprehensive projects in forensic science are required to mitigate the high percentage of unidentified bodies that coordinate the correct burial of bodies and their search in mass graves. The current humanitarian crisis and the complexity of the context make it necessary to consider the overlaps between cases of the disappeared and unidentified bodies, between search and identification.El hallazgo de fosas clandestinas se ha convertido en un hecho recurrente durante los últimos diez años en México, estimándose que podrían existir más de 2000 repartidas por todo el país (Guillen et al., 2018). Menos conocidas, reportadas y atendidas son las fosas comunes, localizadas en panteones municipales o estatales, que albergan cuerpos de personas no identificados y de las cuales no hay un censo oficial. Se estima que existen unos 26000 cuerpos en calidad de no identificados (SEGOB, 2019a) y anualmente, tan solo en la Ciudad de México, son destinados a la fosa común cementerial casi 500. Se requieren proyectos integrales en ciencia forense, que mitiguen el alto porcentaje de cuerpos sin identificar, que coordinen la correcta inhumación de cuerpos y su registro en fosas comunes. La crisis humanitaria vigente y la complejidad del contexto precisan considerar las imbricaciones entre casos de desaparecidos y cuerpos no identificados, entre búsqueda e identificación

Quality of life in amputed diabetic patients under 60 years old at Hospital Pasteur, Uruguay. In the period of August - September 2018

Carolina Fortuna: Estudiante de Medicina, Ciclo de Metodologia Cientifica II, Facultad de Medicina, Universidad de la Repùblica, Uruguay. La contribución de la realización del trabajo fue equivalente a los demás estudiantes.-- Ignacio Giaudrone: Estudiante de Medicina, Ciclo de Metodologia Cientifica II, Facultad de Medicina, Universidad de la Repùblica, Uruguay. La contribución de la realización del trabajo fue equivalente a los demás estudiantes.-- Álvaro Saucedo: Estudiante de Medicina, Ciclo de Metodologia Cientifica II, Facultad de Medicina, Universidad de la Repùblica, Uruguay. La contribución de la realización del trabajo fue equivalente a los demás estudiantes.-- Roberto Scòpice: Estudiante de Medicina, Ciclo de Metodologia Cientifica II, Facultad de Medicina, Universidad de la Repùblica, Uruguay. La contribución de la realización del trabajo fue equivalente a los demás estudiantes.-- Lucia Silva: Estudiante de Medicina, Ciclo de Metodologia Cientifica II, Facultad de Medicina, Universidad de la Repùblica, Uruguay. La contribución de la realización del trabajo fue equivalente a los demás estudiantes.-- José Silveira: Estudiante de Medicina, Ciclo de Metodologia Cientifica II, Facultad de Medicina, Universidad de la Repùblica, Uruguay. La contribución de la realización del trabajo fue equivalente a los demás estudiantes.-- Marcelo Diamant: Docente supervisor. Departamento de Cirugía Vascular de la Facultad de Medicina, Universidad de la República, Montevideo, Uruguay.-- Laura Pradines: Docente supervisor. Departamento de Cirugía Vascular de la Facultad de Medicina, Universidad de la República, Montevideo, Uruguay. Contacto: Marcelo Diamant. Departamento de Cirugía Vascular, Facultad de Medicina. Gral. Flores 2125, 11800. Montevideo, Uruguay. Tel:(598)2924 3414 ext. 3403. Email: [email protected] estudio presenta como objetivo valorar el impacto en la calidad de vida en una muestra de pacientes portadores de amputaciones de pie diabético asistidos en la Unidad de Pie Diabético del Hospital Pasteur, Montevideo en un periodo comprendido entre agosto y septiembre de 2018. Se aplicó el cuestionario DQOL que determina la calidad de vida a 54 pacientes. También se indagó sobre las amputaciones y sobre los ámbitos socio-económico, cultural y familiar. Los resultados mostraron mayor participación del sexo masculino (74,1%). El 33% de los pacientes padecían diabetes Tipo 1 y 66% Tipo 2. La edad media del diagnóstico fue a los 41,5 años. Las amputaciones menores incluyen la amputación digital (74%), en el caso de las amputaciones mayores se destacan las amputaciones de pierna (85,7%). Se pudo determinar que la calidad de vida en pacientes con pie diabético fue regular. Se observaron diferencias en la calidad de vida en los pacientes con diabetes Tipo 1 respecto a los pacientes Tipo 2, concomitantemente, mayor afectación de la calidad de vida en el grupo con amputación mayor en relación a amputación menor. No se observó diferencia en la calidad de vida entre pacientes con una amputación respecto a los que presentan amputación bilateral. Se encontró un deterioro en la calidad de vida en los pacientes con mayor tiempo transcurrido entre el diagnóstico de diabetes y la primera amputación.The study aims to assess the impact on quality of life in a sample of patients with diabetic foot amputations assisted in the Diabetic Foot Unit of the Pasteur Hospital, Montevideo between August and September 2018. The DQOL questionnaire was applied that determines quality of life in 54 patients. They also inquired about amputations and about the socio-economic, cultural and family spheres. The results showed a greater participation of the male sex (74.1%). 33% of the patients had Type 1 diabetes and 66% Type 2. The mean age at diagnosis was 41.5 years. Minor amputations included toe amputation (74%), in the case of major amputations, leg amputations stand out (85.7%). It was possible to determine that the quality of life in patients with diabetic foot was regular. Differences in quality of life were observed in patients with Type 1 diabetes compared to Type 2 patients, concomitantly, greater impairment of quality of life in the group with major amputation in relation to minor amputation. There was no difference in quality of life between patients with one amputation compared to those with two. A deterioration in the quality of life was found in patients with the longest time elapsed between the diagnosis of diabetes and the first amputation

Primary leptomeningeal oligodendrogliomatosis

Primary leptomeningeal oligodendrogliomas (PLOs) are rare intracranial malignancies where tumors grow in the subarachnoid space without an obvious connection to the brain or spinal cord parenchyma. Adding to the three previously reported cases of PLO with no parenchymal involvement we report a fourth case of the same in this paper in a 50-year-old woman presenting with unrelenting headaches. CT scan of her head revealed hydrocephalus and MRI revealed diffuse enhancement of her leptomeninges throughout her brain and spine, prominent over the basilar region. Biopsy obtained using a frameless stereotactic biopsy showed sharply defined cell borders, clear cytoplasm, and rounded nuclei consistent with an oligodendroglioma. Our case suggests that PLO can mimic diffuse forms of granulomatous meningitis and should be suspected in patients that clinically and radiographically present like granulomatous meningitis but without blood or CSF markers for the same

Prevalence of sleep disorders in adults with down syndrome: a comparative study of subjective, actigraphic and polygraphic findings

STUDY OBJECTIVES:Sleep problems are often undetected in adults with Down syndrome (DS). Our objective was to determine the prevalence of sleep disorders in adults with DS through self-reported and objective sleep measures. METHODS:We performed a community-based cross-sectional study of 54 adults with DS not referred for sleep disorders. Two polysomnography (PSG) sleep studies were performed. Sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI); daytime sleepiness was evaluated using the Epworth Sleepiness Scale (ESS) and the risk for the sleep apnea syndrome (OSA) was identified using the Berlin Questionnaire (BQ). Participants' sleep/wake pattern was assessed from sleep diaries and by wrist actigraphy. PSQI, ESS, and PSG measures were compared with 35 sex-, age-, and body mass index-matched patients in the control groups. RESULTS:In PSG measures, adults with DS showed lower sleep efficiency (69 ± 17.7 versus 81.6 ± 11; P < .001), less rapid eye movement sleep (9.4 ± 5.8 versus 19.4 ± 5.1; P < .001), a higher prevalence of OSA (78% versus 14%; P < .001), and a higher apnea-hypopnea index (23.5 ± 24.5 versus 3.8 ± 10.5; P < .001) than patients in the control group. In the DS group, the questionnaires (mean PSQI 3.7 ± 2.9; mean ESS 6.3 ± 4.5 and mean BQ 1 ± 0) did not reflect the sleep disturbances detected on the PSG. Actigraphy data recorded daytime sleep that was not self-reported (118.2 ± 104.2 minutes). CONCLUSIONS:Adults with DS show severe sleep disruption and a high prevalence of OSA, undetected by self-reported sleep measures. Actigraphy, PSG, and validated simplified devices for screening OSA should be routinely recommended for this population because treatment of sleep disorders can contribute to healthy aging