Huitzilpoxtli : primer cuento de la revolución mexicana

Fil: Lamb, Ruth S.. Scripps College (Claremont, California

Progressive Supranuclear Palsy and Corticobasal Degeneration: Pathophysiology and Treatment Options

There are currently no disease-modifying treatments for progressive supranuclear palsy (PSP) or corticobasal degeneration (CBD), and no approved pharmacological or therapeutic treatments that are effective in controlling their symptoms. The use of most pharmacological treatment options are based on experience in other disorders or from non-randomized historical controls, case series, or expert opinion. Levodopa may provide some improvement in symptoms of Parkinsonism (specifically bradykinesia and rigidity) in PSP and CBD; however, evidence is conflicting and where present, benefits are often negligible and short lived. In fact, “poor” response to levodopa forms part of the NINDS-SPSP criteria for the diagnosis of PSP and consensus criteria for the diagnosis of CBD (Lang Mov Disord. 20 Suppl 1:S83–91, 2005; Litvan et al. Neurology. 48:119–25, 1997; Armstrong et al. Neurology. 80(5):496–503, 2013). There is some evidence that intrasalivery gland botulinum toxin is useful in managing problematic sialorrhea and that intramuscular botulinum toxin and baclofen are helpful in reducing dystonia, including blepharospasm. Benzodiazepines may also be useful in managing dystonia. Myoclonus may be managed using levetiracetam and benzodiazepines. Pharmacological agents licensed for Alzheimer’s disease (such as acetylcholinesterase inhibitors and N-Methyl-D-aspartate receptor antagonists) have been used off-label in PSP, CBD, and other tauopathies with the aim of improving cognition; however, there is limited evidence that they are effective and risk of adverse effects may outweigh benefits. The use of atypical antipsychotics for behavioural symptoms is not recommended in the elderly or those with demetia associated conditions and most antipsychotics will worsen Parkinsonism. Antidepressants may be useful for behavioral symptoms and depression but are often poorly tolerated due to adverse effects. In the absence of an effective drug treatment to target the underlying cause of CBD and PSP, management should focus on optimizing quality of life, relieving symptoms and assisting patients with their activities of daily living (ADL). Patients should be managed by a multidisciplinary team consisting of neurologists, physiotherapists (PT), occupational therapists (OT), speech and language therapists (SALT), dieticians, ophthalmologists, psychologists, and palliative care specialists

Complexity in the lives of looked after children and their families in Scotland: 2003 to 2016

This research sought to answer the question: Has child protection in Scotland become more complex over time, and if so, how? To do this we examined changes in complexity in: 1) Society. 2) The Children’s Hearings System and associated legislation and practice. 3) The lives of looked after children aged under three years and their families. To do this we developed a method to measure changes in complexity in the lives of looked children, and used it to assess complexity in the first three years of the lives of children born in 2003 compared to those born in 2013. Results: Changing complexity in looked after children’s lives: Increases: a) Extent of family fragmentation - separation of children from their parents and siblings. This was directly linked to changes in child protection practice resulting in more children aged under three years being removed from their parents’ care. b) Residence with child who is not a sibling. c) Number of changes in Compulsory Supervision Orders (CSOs). Contributory factors were increases in numbers of children with permanence plans, supervised contact with parents and earlier age of being taken into care. d) Number of problems faced by parents, especially criminality. But, the frequencies of many individual parental problems were high over time suggesting a stable population of high risk parents with multiple serious problems. Each of the following parental problems were present in over 50% of the families studied: victim of abuse; perpetrator of abuse; abused drugs; committed an offence; mental illness; inappropriate relationships; difficult childhood; unemployed; and/or was in a volatile relationship. e) Presence of legal representatives in Hearings and number of relevant persons - both are directly linked to changes in legislation. f) Over the past two decades in Scotland in general (i.e. not specifically amongst families of looked after children), complexity resulting from ethnic diversity and drug and alcohol abuse have increased. Decreases: a)SIMD (Scottish Index of Multiple Deprivation) at birth – the first residence of children born in 2003 had lower SIMD than those born in 2013. This change reflects the increase over time in the number of children who went directly from hospital after birth into foster care, since foster carers tended to live in more affluent areas than did birth parents. b) Number of changes of co-residents experienced by child. This again was linked to the increased practice of placing children with foster carers from birth. No changes: a) Sibling group size b)Rates of parental separation c) Rates of problems in extended family d) Rates of problems for family in community e) Number of places of residence f) Number of concurrent residences g) Number of changes of key worker h) Number of child problems i) Number of organisations working with family. We found that inter-agency complexity has, in general, not increased over the time. We also found that many of these types of complexity have remained consistently high (e.g. over 40% of families had problems in their community and extended family, over 70% of parents separated in the first three years of their child’s life, and a fifth of children were premature or had low birth weights). Frequencies of complex Children’s Hearings-related events from 2003-04 to 2015-16: Increase of 19% - Child Protection Orders; increase of 87% - Pre-Hearing Panels/ Business meetings; increase of 115% - Appeals; increase of 137% - Interim Compulsory Supervision Orders/ Warrants; increase of 191% - Non Disclosure Orders; decrease of 0.2% - Hearing held; decrease of 2% - children with CSOs; decrease of 8% - applications for proof concluded. In addition, there was an 88% increase in the number of pieces of legislation related to the Hearings System between 1998 and 2017. Conclusion: This research has provided evidence to answer conclusively that: Yes - child protection in Scotland has become more complex over time. There are multiple factors that affect the care and protection of children which have become more complex, in particular the extent of problems faced by parents. Legislation and practice changes to protect looked after children have also added complexity to the lives of vulnerable families both directly through their involvement in legal processes and indirectly through increased family fragmentation through interventions to take children into care. This increased complexity in child protection has implications for all those working within the Hearings System, especially for the training of Children’s Panel Members and professionals, and in their decision making to protect vulnerable children. Importantly, it has implications for those families who find themselves involved in an increasingly complex legal system

A bone of contention: A dynamic ultrasound assessment of the role of the radial head in the arthrokinematics of the proximal radioulnar joint

INTRODUCTION: The arthrokinematics of the proximal radioulnar joint (PRUJ) are believed to follow the convex-concave rule, meaning that when the convex radial head articulates with the concave radial notch on the ulna, rolling and gliding occur in opposite directions during forearm pronation and supination. Previous research using helical computerized tomography (CT) identified that the sequence of joint actions is in contrast with this rule, which would indicate a posterior glide of the radius on the ulna during pronation movement and the converse during supination. OBJECTIVES: The aims of this study are to determine the arthrokinematics of the PRUJ while being assessed via ultrasound (US) imaging and to assess the impact the direction of joint mobilization has on active and passive range of motion (ROM) during forearm supination and pronation at the PRUJ. METHODS: A convenience sample of 53 healthy individuals were recruited. The arthrokinematics of the PRUJ were observed via US cine-loops. A linear US transducer was applied in the transverse plane and placed over the radial head during all testing conditions. A metronome standardized the rate of forearm pronation and supination at 1Hz (60 bpm) during US cine-loops acquisition. Radial head motion was assessed in two different elbow positions during US and joint range of motion assessment. The elbow was flexed to 90° with a neutral forearm position and fully extended with a neutral forearm position. The glenohumeral joint was stabilized during all testing conditions. A repeated measures design randomizing joint mobilization direction to the radial head was utilized to assess forearm pronation and supination via inclinometer data measured in degrees. Joint glides were applied to the radial head according to the convex-concave rule to facilitate forearm supination and pronation. An anteromedial glide to facilitate forearm supination and a posterolateral glide to facilitate forearm pronation. A metronome standardized the rate of joint mobilization at a rate 2Hz (120 bpm). A bubble inclinometer assessed active and passive PRUJ ROM at the wrist during all testing conditions. RESULTS:US imaging cine-loops showed the radial head rolled anteromedially during pronation and posterolaterally during supination, with no translation/gliding evident. Multivariate analysis revealed that the direction of joint mobilization had a significant impact on ROM F(1,47.0)= 6.964, p=.011, partial η2 =.129), with anterior mobilization increasing pronation and posterior mobilization increasing supination. Supination ROM was significantly increased F1(1, 47.0) = 78.03, p CONCLUSION: Our findings are in conflict with the convex-concave rule, which is frequently used by physical therapists to improve joint motion. Should we now reconsider applying this rule to improve joint ROM at the PRUJ

Process, outcome and experience of transition from child to adult mental healthcare : multiperspective study

Background Many adolescents with mental health problems experience transition of care from child and adolescent mental health services (CAMHS) to adult mental health services (AMHS). Aims As part of the TRACK study we evaluated the process, outcomes and user and carer experience of transition from CAMHS to AMHS. Method We identified a cohort of service users crossing the CAMHS/AMHS boundary over 1 year across six mental health trusts in England. We tracked their journey to determine predictors of optimal transition and conducted qualitative interviews with a subsample of users, their carers and clinicians on how transition was experienced. Results Of 154 individuals who crossed the transition boundary in 1 year, 90 were actual referrals (i.e. they made a transition to AMHS), and 64 were potential referrals (i.e. were either not referred to AMHS or not accepted by AMHS). Individuals with a history of severe mental illness, being on medication or having been admitted were more likely to make a transition than those with neurodevelopmental disorders, emotional/neurotic disorders and emerging personality disorder. Optimal transition, defined as adequate transition planning, good information transfer across teams, joint working between teams and continuity of care following transition, was experienced by less than 5% of those who made a transition. Following transition, most service users stayed engaged with AMHS and reported improvement in their mental health. Conclusions For the vast majority of service users, transition from CAMHS to AMHS is poorly planned, poorly executed and poorly experienced. The transition process accentuates pre-existing barriers between CAMHS and AMH