A Survey of Speech-language Pathologists: Long-term Speech Therapy Needs for Patients within Three Neurological Conditions

Forty-seven speech-language pathologists (SLPs) completed a written survey designed to obtain their opinions regarding the speech-language pathology needs of patients presenting with communication deficits following traumatic brain injury, cerebrovascular accident and cerebral palsy. Results indicated that over one-half of the SLPs in the study cited the most common reason that speech therapy is stopped is due to lack of insurance coverage, not because the patient reached maximum improvement. After discharge from services, 78-92% of SLPs affirmed that their patients would have benefitted from ongoing speech-language treatment if insurance limitations were not a consideration. In many instances, therapy was recommended for several years up to lifetime follow-up. Study results demonstrate that a common reason for termination of therapy was due to insurance limits, The implications of this pilot study for life care planners pertain to consulting with SLPs regarding what the evaluation and long term speech-language pathology needs may be for patients with these three neurological disorders, without considering insurance limits

Obtención de ladrillos cara vista a partir de cenizas volantes de la Central Térmica del Narcea (Asturias)

Fly ash, from the Coal Power Plant of Narcea (Asturias), has been used to determine its possible use as a raw material in the bare face red-brown brick manufacture. The correct mould of a ceramic material demands a paste with an adequate plasticity. So, the optimum compositions of humidity, lubricant (talc) and binder (white dextrin) have been investigated. The samples were made by compressing paste into a mould using varying values of pressure and boiling temperature once the cooling speed had been established. Finally, the cooked pieces were submitted to trials demanded by the Basic Construction Norm, to see if they met the required specifications concerning Water Absorption, Suction, Contraction, Resistance to Freezing, Efflorescence and Compressive Strength.Se caracterizan las cenizas volantes de la Central Térmica del Narcea (Asturias) para determinar su utilización como materia prima en la obtención de ladrillos cara vista. El moldeo correcto de una pieza cerámica exige trabajar una pasta con una adecuada plasticidad, para ello se investiga cuál ha de ser la composición óptima de la misma, en cuanto a: humedad, cantidad de lubricante (talco) y de ligante (dextrina blanca). El conformado de las piezas o ladrillos se realiza por prensado, utilizando distintos valores de presión, así como la temperatura de cocción, una vez establecida la velocidad de enfriamiento. Finalmente, las piezas cocidas se someten a los ensayos exigidos por la Norma Básica de Edificación, para ver si cumplen las especificaciones requeridas en cuanto a: Absorción de agua. Succión, Contracción, Heladicidad, Eflorescencia y Resistencia a la compresión

Ecosystem services of tropical dry forests : insights from longterm ecological and social research on the Pacific coast of Mexico

In the search for an integrated understanding of the relationships among productive activities, human well-being, and ecosystem functioning, we evaluated the services delivered by a tropical dry forest (TDF) ecosystem in the Chamela Region, on the Pacific Coast of Mexico. We synthesized information gathered for the past two decades as part of a long-term ecosystem research study and included social data collected in the past four years using the Millennium Ecosystem Assessment (MA) conceptual framework as a guide. Here we identify the four nested spatial scales at which information has been obtained and emphasize one of them through a basin conceptual model. We then articulate the biophysical and socio-economic constraints and drivers determining the delivery of ecosystem services in the Region. We describe the nine most important services, the stakeholders who benefit from those services, and their degree of awareness of such services. We characterize spatial and temporal patterns of the services&rsquo; delivery as well as trade-offs among services and stakeholders. Finally, we contrast three alternative future scenarios on the delivery of ecosystem services and human well-being. Biophysical and socioeconomic features of the study site strongly influence human&minus;ecosystem interactions, the ecosystem services delivered, the possible future trajectories of the ecosystem, and the effect on human well-being. We discuss future research approaches that will set the basis for an integrated understanding of human&minus;ecosystem interactions and for constructing sustainable management strategies for the TDF.<br /

Sensitization Toward Organ Donation Among Medical Students in Spanish Regions With More Than 50 Donors Per Million Population

The awareness of organ donation among health professionals is important at the time of transplant promotion. In this sense, the training and awareness of the professionals in training is fundamental

When urban modernisation entails service delivery co-production: a glance from Medellin

International audienceThrough the example of Ciudadela Nuevo Occidente, a large social housing district in Medellín, this article describes a process that primarily involves co-learning and micro-negotiations that help produce the cognitive alignment necessary to the management of services. The hypothesis put forward in this article is that the frictions caused by the residents' difficulties in adapting to the socioeconomic , cultural and cognitive frameworks of their new environment, imposed by urban modernisation running processes, engender forms of service co-production that ultimately strengthen the utility's capacity to extend and adapt its delivery model while enhancing the quality of services

The Gaia-ESO Survey : The analysis of high-resolution UVES spectra of FGK-type stars

Date of Acceptance: 01/09/2014Context. The ongoing Gaia-ESO Public Spectroscopic Survey is using FLAMES at the VLT to obtain high-quality medium-resolution Giraffe spectra for about 105 stars and high-resolution UVES spectra for about 5000 stars. With UVES, the Survey has already observed 1447 FGK-type stars. Aims. These UVES spectra are analyzed in parallel by several state-of-the-art methodologies. Our aim is to present how these analyses were implemented, to discuss their results, and to describe how a final recommended parameter scale is defined. We also discuss the precision (method-to-method dispersion) and accuracy (biases with respect to the reference values) of the final parameters. These results are part of the Gaia-ESO second internal release and will be part of its first public release of advanced data products. Methods. The final parameter scale is tied to the scale defined by the Gaia benchmark stars, a set of stars with fundamental atmospheric parameters. In addition, a set of open and globular clusters is used to evaluate the physical soundness of the results. Each of the implemented methodologies is judged against the benchmark stars to define weights in three different regions of the parameter space. The final recommended results are the weighted medians of those from the individual methods. Results. The recommended results successfully reproduce the atmospheric parameters of the benchmark stars and the expected Teff-log g relation of the calibrating clusters. Atmospheric parameters and abundances have been determined for 1301 FGK-type stars observed with UVES. The median of the method-to-method dispersion of the atmospheric parameters is 55 K for Teff, 0.13 dex for log g and 0.07 dex for [Fe/H]. Systematic biases are estimated to be between 50-100 K for Teff, 0.10-0.25 dex for log g and 0.05-0.10 dex for [Fe/H]. Abundances for 24 elements were derived: C, N, O, Na, Mg, Al, Si, Ca, Sc, Ti, V, Cr, Mn, Fe, Co, Ni, Cu, Zn, Y, Zr, Mo, Ba, Nd, and Eu. The typical method-to-method dispersion of the abundances varies between 0.10 and 0.20 dex. Conclusions. The Gaia-ESO sample of high-resolution spectra of FGK-type stars will be among the largest of its kind analyzed in a homogeneous way. The extensive list of elemental abundances derived in these stars will enable significant advances in the areas of stellar evolution and Milky Way formation and evolution.Peer reviewe

The health and economic burden of bloodstream infections caused by antimicrobial-susceptible and non-susceptible Enterobacteriaceae and <i>Staphylococcus aureus</i> in European hospitals, 2010 and 2011:a multicentre retrospective cohort study

We performed a multicentre retrospective cohort study including 606,649 acute inpatient episodes at 10 European hospitals in 2010 and 2011 to estimate the impact of antimicrobial resistance on hospital mortality, excess length of stay (LOS) and cost. Bloodstream infections (BSI) caused by third-generation cephalosporin-resistant Enterobacteriaceae (3GCRE), meticillin-susceptible (MSSA) and -resistant Staphylococcus aureus (MRSA) increased the daily risk of hospital death (adjusted hazard ratio (HR) = 1.80; 95% confidence interval (CI): 1.34-2.42, HR = 1.81; 95% CI: 1.49-2.20 and HR = 2.42; 95% CI: 1.66-3.51, respectively) and prolonged LOS (9.3 days; 95% CI: 9.2-9.4, 11.5 days; 95% CI: 11.5-11.6 and 13.3 days; 95% CI: 13.2-13.4, respectively). BSI with third-generation cephalosporin-susceptible Enterobacteriaceae (3GCSE) significantly increased LOS (5.9 days; 95% CI: 5.8-5.9) but not hazard of death (1.16; 95% CI: 0.98-1.36). 3GCRE significantly increased the hazard of death (1.63; 95% CI: 1.13-2.35), excess LOS (4.9 days; 95% CI: 1.1-8.7) and cost compared with susceptible strains, whereas meticillin resistance did not. The annual cost of 3GCRE BSI was higher than of MRSA BSI. While BSI with S. aureus had greater impact on mortality, excess LOS and cost than Enterobacteriaceae per infection, the impact of antimicrobial resistance was greater for Enterobacteriaceae

Arm-specific dynamics of chromosome evolution in malaria mosquitoes

<p>Abstract</p> <p>Background</p> <p>The malaria mosquito species of subgenus <it>Cellia </it>have rich inversion polymorphisms that correlate with environmental variables. Polymorphic inversions tend to cluster on the chromosomal arms 2R and 2L but not on X, 3R and 3L in <it>Anopheles gambiae </it>and homologous arms in other species. However, it is unknown whether polymorphic inversions on homologous chromosomal arms of distantly related species from subgenus <it>Cellia </it>nonrandomly share similar sets of genes. It is also unclear if the evolutionary breakage of inversion-poor chromosomal arms is under constraints.</p> <p>Results</p> <p>To gain a better understanding of the arm-specific differences in the rates of genome rearrangements, we compared gene orders and established syntenic relationships among <it>Anopheles gambiae, Anopheles funestus</it>, and <it>Anopheles stephensi</it>. We provided evidence that polymorphic inversions on the 2R arms in these three species nonrandomly captured similar sets of genes. This nonrandom distribution of genes was not only a result of preservation of ancestral gene order but also an outcome of extensive reshuffling of gene orders that created new combinations of homologous genes within independently originated polymorphic inversions. The statistical analysis of distribution of conserved gene orders demonstrated that the autosomal arms differ in their tolerance to generating evolutionary breakpoints. The fastest evolving 2R autosomal arm was enriched with gene blocks conserved between only a pair of species. In contrast, all identified syntenic blocks were preserved on the slowly evolving 3R arm of <it>An. gambiae </it>and on the homologous arms of <it>An. funestus </it>and <it>An. stephensi</it>.</p> <p>Conclusions</p> <p>Our results suggest that natural selection favors specific gene combinations within polymorphic inversions when distant species are exposed to similar environmental pressures. This knowledge could be useful for the discovery of genes responsible for an association of inversion polymorphisms with phenotypic variations in multiple species. Our data support the chromosomal arm specificity in rates of gene order disruption during mosquito evolution. We conclude that the distribution of breakpoint regions is evolutionary conserved on slowly evolving arms and tends to be lineage-specific on rapidly evolving arms.</p

Genetic landscape of 6089 inherited retinal dystrophies affected cases in Spain and their therapeutic and extended epidemiological implications

ESRETNET Study Group, The ERDC Study Group, The Associated Clinical Study Group.Inherited retinal diseases (IRDs), defined by dysfunction or progressive loss of photoreceptors, are disorders characterized by elevated heterogeneity, both at the clinical and genetic levels. Our main goal was to address the genetic landscape of IRD in the largest cohort of Spanish patients reported to date. A retrospective hospital-based cross-sectional study was carried out on 6089 IRD affected individuals (from 4403 unrelated families), referred for genetic testing from all the Spanish autonomous communities. Clinical, demographic and familiar data were collected from each patient, including family pedigree, age of appearance of visual symptoms, presence of any systemic findings and geographical origin. Genetic studies were performed to the 3951 families with available DNA using different molecular techniques. Overall, 53.2% (2100/3951) of the studied families were genetically characterized, and 1549 different likely causative variants in 142 genes were identified. The most common phenotype encountered is retinitis pigmentosa (RP) (55.6% of families, 2447/4403). The most recurrently mutated genes were PRPH2, ABCA4 and RS1 in autosomal dominant (AD), autosomal recessive (AR) and X-linked (XL) NON-RP cases, respectively; RHO, USH2A and RPGR in AD, AR and XL for non-syndromic RP; and USH2A and MYO7A in syndromic IRD. Pathogenic variants c.3386G > T (p.Arg1129Leu) in ABCA4 and c.2276G > T (p.Cys759Phe) in USH2A were the most frequent variants identified. Our study provides the general landscape for IRD in Spain, reporting the largest cohort ever presented. Our results have important implications for genetic diagnosis, counselling and new therapeutic strategies to both the Spanish population and other related populations.This work was supported by the Instituto de Salud Carlos III (ISCIII) of the Spanish Ministry of Health (FIS; PI16/00425 and PI19/00321), Centro de Investigación Biomédica en Red Enfermedades Raras (CIBERER, 06/07/0036), IIS-FJD BioBank (PT13/0010/0012), Comunidad de Madrid (CAM, RAREGenomics Project, B2017/BMD-3721), European Regional Development Fund (FEDER), the Organización Nacional de Ciegos Españoles (ONCE), Fundación Ramón Areces, Fundación Conchita Rábago and the University Chair UAM-IIS-FJD of Genomic Medicine. Irene Perea-Romero is supported by a PhD fellowship from the predoctoral Program from ISCIII (FI17/00192). Ionut F. Iancu is supported by a grant from the Comunidad de Madrid (CAM, PEJ-2017-AI/BMD7256). Marta del Pozo-Valero is supported by a PhD grant from the Fundación Conchita Rábago. Berta Almoguera is supported by a Juan Rodes program from ISCIII (JR17/00020). Pablo Minguez is supported by a Miguel Servet program from ISCIII (CP16/00116). Marta Corton is supported by a Miguel Servet program from ISCIII (CPII17/00006)

Aspectos clínicos y epidemiológicos de los síndromes de Apert y Crouzon en España

Epidemiología y Teratología: Resultados sobre los datos del ECEMCApert and Crouzon syndromes are the most frequent ones among those syndromes with craniosynostosis. We have used data from the Spanish Collaborative Study of Congenital Malformations (ECEMC), to analyze some clinical and epidemiological characteristics of both syndromes. A total of 19 cases of Apert and 21 cases of Crouzon syndromes were identified among 1,914,726 liveborn infants. Their birth prevalence has diminished along the time although the decrease is only statistically significant for Crouzon syndrome. Mean parental ages, and mean differences between the parental ages, are significantly higher in Apert cases than in controls, what is indicating a relationship between paternal age and mutations for this syndrome. The differences between the parental ages of Crouzon cases and controls are not statistically significant. All the cases with Apert syndrome of our series were the first occurrence in the family, while 38.10% of the Crouzon cases were familial. We also observed a significant increasing linear trend in the frequency of infants with Apert syndrome, with the increasing paternal age, which is more noticeable since the age of 35 years. However, this is not observed for Crouzon cases whether sporadic or familial. Regarding the clinical aspects, Apert syndrome is more frequently associated to other defects than Crouzon syndrome. With respect to the affectation of hands in the Apert cases, the most frequent defect was the so-called "mitten hand", wich was present in 50% of our cases. In 28.57% the first finger was separated from the rest that are fused. Interestingly, in one case only the fifth finger was separated for the other four that remain fused.N