The overlooked outcome measure for spinal cord injury: use of assistive devices

Although several outcome measures are used to assess various areas of interest regarding spinal cord injuries (SCIs), little is known about the frequency of their use, and the ways in which they transform shared knowledge into implemented practices. Herein, 800 professionals from the International Spinal Cord Society, especially trained for caring in patients with SCI, were invited to respond to an Internet survey collecting information on the use of standardized measures in daily clinical practices. We asked both clinicians and researchers with different areas of interest about their use of functional outcome measures, and, in particular, which scales they habitually use to assess various aspects of clinical practice and rehabilitation. We selected a set of rating scales, which were validated for measuring SCIs (http://www.scireproject.com/outcome-measures). The results show that the areas of interest assessed by most of the participants were neurological status, upper limb, lower limb gait, pain, spasticity, self-care, and daily living. The most widely used rating scales were the spinal cord independence measure, the functional independence measure and the International Standards for Neurological Classification of Spinal Cord Injury. Instead, the majority of respondents did not evaluate the use of assistive technology. Despite the availability of several outcome scales, the practice of evaluating SCIs with standardized measures for assistive technologies and wheelchair mobility is still not widespread, even though it is a high priority in the rehabilitation of SCI patients. The results emphasize the need for a more thorough knowledge and use of outcome scales, thus improving the quality of assistive device evaluation

Analysis of thermal field within an urban canyon with variable thermophysical characteristics of the building's walls.

In a typical urban configuration, a microclimatic analysis has been carried out. Using a CFD method, a N-S oriented urban street canyon, with a given H/W ratio, has been examined. The standard k–ε turbulence model has been used to simulate a three-dimensional flow field and to calculate the thermo-fluid dynamics parameters that characterize the street canyon. In this study has been analyzed the thermal flow field when the walls of the building change the properties of solar radiation absorption, in particular for α=0.2 and α=0.8. Solar radiation considered is that of 21/07 in Milan in two different hours: at 11:00 a.m. and at 02:00 p.m. The study shows the importance of the thermophysical properties of a wall, in the development of the thermal field and flow field. This is a very important topic, in terms of improvement of well-being and the quality of the air within the cities, through the choice of materials and colors of the facades of buildings.

Mirizzi Syndrome: From Ultrasound Diagnosis to Surgery—A Case Report

The Mirizzi syndrome is a rare disorder that usually presents with jaundice and cholangitis; its lack of recognition in the diagnostic path could have serious consequences for the patient undergoing cholecystectomy. Here we describe the clinical case of a jaundiced patient from the ultrasound suspect of Mirizzi syndrome to the surgical treatment

An essay on revisionism in the Italian Communist Party

"1679"--handwritten on coverIncludes bibliographical reference

Strong coupling between excitons in organic semiconductors and Bloch Surface Waves

We report on the strong coupling between the Bloch surface wave supported by an inorganic multilayer structure and $J$-aggregate excitons in an organic semiconductor. The dispersion curves of the resulting polariton modes are investigated by means of angle-resolved attenuated total reflection as well as photoluminescence experiments. The measured Rabi splitting is 290 meV. These results are in good agreement with those obtained from our theoretical model

Long-term effects of automated mechanical peripheral stimulation on gait patterns of patients with Parkinson's disease

New treatments based on peripheral stimulation of the sensory–motor system have been inspiring new rehabilitation approaches in Parkinson’s disease (PD), especially to reduce gait impairment, levodopa washout effects, and the incidence of falls. The aim of this study was to evaluate the change in gait and the clinical status of PD patients after six sessions of a treatment based on automated mechanical peripheral stimulation (AMPS). Eighteen patients with PD and 15 age-matched healthy individuals (control group) participated in this study. A dedicated medical device delivered the AMPS. PD patients were treated with AMPS six times once every 4 days. All PD patients were treated in the off-levodopa phase and were evaluated with gait analysis before and after the first intervention (acute phase), after the sixth intervention, 48 h after the sixth intervention, and 10 days after the end of the treatment. To compare the differences among the AMPS interventions (pre, 6 AMPS, and 10 days) in terms of clinical scales, a t-test was used (α≤0.05). In addition, to compare the differences among the AMPS interventions (pre, post, 6 AMPS, 48 h and 10 days), the gait spatiotemporal parameters were analyzed using the Friedman test and the Bonferroni post-hoc test (α≤0.05). Also, for comparisons between the PD group and the control group, the gait spatiotemporal parameters were analyzed using the Mann–Whitney test and the Bonferroni post-hoc test (α≤0.05). The results of the study indicate that the AMPS treatment has a positive effect on bradykinesia because it improves walking velocity, has a positive effect on the step and stride length, and has a positive effect on walking stability, measured by the increase in stride length. These results are consistent with the improvements measured with clinical scales. These findings indicate that AMPS treatment seems to generate a more stable walking pattern in PD patients, reducing the well-known gait impairment that is typical of PD; regular repetition every 4 days of AMPS treatment appears to be able to improve gait parameters, to restore rhythmicity, and to reduce the risk of falls, with benefits maintained up to 10 days after the last treatment. The trial was registered online at ClinicalTrials.gov (number identifier: NCT0181528)

Study of Cardiac Features in Adults with Down Syndrome

Down Syndrome (DS) has a significant impact on the development of many tissues, most notably in the heart and in the brain. According to the clinical need to better investigate these aspects, the main aim of this study was to make an overview on the cardiac features in adult individuals with DS. The following data of 37 individuals with DS (range: 18-60 years) were collected and analysed: age, gender, height, weight, waist to height ratio (WHER), smoking history and cardiac parameters (heart rate and blood pressure), blood glucose level or glycaemia, cholesterol (total, high-density lipoprotein – HDL - and low-density lipoprotein - LDL - cholesterol) and triglycerides. In addition, their gait pattern were quantified with 3D Gait Analysis. BMI, WHER and cholesterol HDL results were above the upper limits of the recommended range in people with DS; on the contrary, blood pressure, heart rate, glycaemia, cholesterol-LDL and triglycerides were within the recommended range. Comparing males and females in the DS group, the females showed statistically different values for cholesterol-total, and triglycerides values, with lower values in comparison to males. In motor performance, people with DS presented abnormal gait patterns. Some significant correlations were found: age with LDL, WHER with weight and BMI, systolic with diastolic blood pressure, total cholesterol with LDL and triglycerides. Our results showed that adults with DS suffer from a high prevalence of physical disorders, including overweight and obesity, and abnormal cholesterol values, together with abnormal gait pattern

Embodying functionally relevant action sounds in patients with spinal cord injury

Growing evidence indicates that perceptual-motor codes may be associated with and influenced by actual bodily states. Following a spinal cord injury (SCI), for example, individuals exhibit reduced visual sensitivity to biological motion. However, a dearth of direct evidence exists about whether profound alterations in sensorimotor traffic between the body and brain influence audio-motor representations. We tested 20 wheelchair-bound individuals with lower skeletal-level SCI who were unable to feel and move their lower limbs, but have retained upper limb function. In a two-choice, matching-to-sample auditory discrimination task, the participants were asked to determine which of two action sounds matched a sample action sound presented previously. We tested aural discrimination ability using sounds that arose from wheelchair, upper limb, lower limb, and animal actions. Our results indicate that an inability to move the lower limbs did not lead to impairment in the discrimination of lower limb-related action sounds in SCI patients. Importantly, patients with SCI discriminated wheelchair sounds more quickly than individuals with comparable auditory experience (i.e. physical therapists) and inexperienced, able-bodied subjects. Audio-motor associations appear to be modified and enhanced to incorporate external salient tools that now represent extensions of their body schemas

Machine-Learning for Prescription Patterns: Random Forest in the Prediction of Dose and Number of Antipsychotics Prescribed to People with Schizophrenia

Objective: We aimed to predict antipsychotic prescription patterns for people with schizophrenia using machine learning (ML) algorithms.Methods: In a cross-sectional design, a sample of community mental health service users (SUs; n = 368) with a primary diagnosis of schizophrenia was randomly selected. Socio-demographic and clinical features, including the number, total dose, and route of administration of the antipsychotic treatment were recorded. Information about the number and the length of psychiatric hospitalization was retrieved. Ordinary Least Square (OLS) regression and ML algorithms (i.e., random forest [RF], supported vector machine, K-nearest neighborhood, and Naive Bayes) were used to estimate the predictors of total antipsychotic dosage and prescription of antipsychotic polytherapy (APP).Results: The strongest predictor of the total dose was APP. The number of Community Mental Health Centers (CMHC) contacts was the most important predictor of APP and, with APP omitted, of dosage. Treatment with anticholinergics predicted APP, emphasizing the strong correlation between APP and higher antipsychotic dose. RF performed better than OLS regression and the other ML algorithms in predicting both antipsychotic dose (root square mean error = 0.70, R-2 = 0.31) and APP (area under the receiving operator curve = 0.66, true positive rate = 0.41, and true negative rate = 0.78).Conclusion: APP is associated with the prescription of higher total doses of antipsychotics. Frequent attenders at CMHCs, and SUs recently hospitalized are often treated with APP and higher doses of antipsychotics. Future prospective studies incorporating standardized clinical assessments for both psychopathological severity and treatment efficacy are needed to confirm these findings