Basale Stimulation bei Patienten im Wachkoma und Minimally Conscious State : Begründung für die Durchführung durch die Ergotherapie

Objective: Basal stimulation is a therapy concept used by occupational therapists for patients in vegetative state and minimally conscious state, although the concept was invented for nursing care. The aim of this article is to assess to what extent basal stimulation is effective in patients in vegetative state or minimally conscious state. Furthermore should be reasoned why occupational therapists also use basal stimulation within their interventions. Method: A systematical literature research was performed to examine the effectiveness of basal stimulation. Caseworks were coded by use of the enablement skills from the Canadian model of client-centered enablement to establish the reasoning for the use of basal stimulation by occupational therapists. Results: A review which studies the efficacy of basal stimulation was included. The main statement of this review is, that no literature exists at this stage, which confirms the efficacy of basal stimulation in critically ill patients. Four Caseworks, which describe the approach with basal stimulation in patients in vegetative state or minimally conscious state, were coded. The codes show a tendency which enablement skills can be linked with basal stimulation most frequent. Conclusion: The effectiveness of basal stimulation in patients in vegetative state and minimally conscious state is not confirmed by evidence. Further research in this field is highly recommended. This article presents a comprehensible reasoning for the use of basal stimulation by occupational therapists.Basale Stimulation wird bei Patienten im Wachkoma und Minimally Conscious State von Ergotherapeuten als Therapiekonzept genutzt, obschon es sich dabei um ein Konzept aus dem Bereich der Pflege handelt. Das Ziel der Arbeit besteht darin deutlich zu machen, inwiefern die basale Stimulation eine Wirkung bei Patienten im Wachkoma oder Minimally Conscious State zeigt. Zudem wird begründet, weshalb die basale Stimulation auch von Ergotherapeuten angewendet werden sollte. Eine systematische Literaturrecherche wurde durchgeführt, um die Wirksamkeit der basalen Stimulation zu untersuchen. Fallberichte wurden mithilfe der Enablement Skills aus dem Canadian Model of Client-Centered Enablement kodiert, um die Begründung für die ergotherapeutische Anwendung der basalen Stimulation herzuleiten. Ein Review zur Wirksamkeit der basalen Stimulation wurde inkludiert. Darin wird ausgesagt, dass die Wirksamkeit der basalen Stimulation zur Pflege kritisch Kranker von der vorliegenden Literatur zum gegenwärtigen Zeitpunkt nicht bestätigt wird. Vier Fallberichte zu der Arbeit mit basaler Stimulation bei Patienten im Wachkoma oder MCS wurden kodiert. Aus der Kodierung ergab sich eine Tendenz, welche Enablement Skills am häufigsten mit basaler Stimulation in Verbindung gebracht werden können. Die Wirksamkeit der basalen Stimulation bei Patienten im Wachkoma und Minimally Conscious State ist nicht evidenzbasiert bestätigt. Weitere Forschung auf diesem Gebiet wird dringend empfohlen. Diese Arbeit liefert eine nachvollziehbare Begründung für die ergotherapeutische Anwendung der basalen Stimulation.Basal stimulation is a therapy concept used by occupational therapists for patients in vegetative state and minimally conscious state, although the concept was invented for nursing care. The aim of this article is to assess to what extent basal stimulation is effective in patients in vegetative state or minimally conscious state. Furthermore should be reasoned why occupational therapists also use basal stimulation within their interventions. A systematical literature research was performed to examine the effectiveness of basal stimulation. Caseworks were coded by use of the enablement skills from the Canadian model of client-centered enablement to establish the reasoning for the use of basal stimulation by occupational therapists. A review which studies the efficacy of basal stimulation was included. The main statement of this review is, that no literature exists at this stage, which confirms the efficacy of basal stimulation in critically ill patients. Four Caseworks, which describe the approach with basal stimulation in patients in vegetative state or minimally conscious state, were coded. The codes show a tendency which enablement skills can be linked with basal stimulation most frequent. The effectiveness of basal stimulation in patients in vegetative state and minimally conscious state is not confirmed by evidence. Further research in this field is highly recommended. This article presents a comprehensible reasoning for the use of basal stimulation by occupational therapists

ALMA CO(3-2) Observations of Star-Forming Filaments in a Gas-Poor Dwarf Spheroidal Galaxy

We report ALMA observations of $^{12}$CO(3-2) and $^{13}$CO(3-2) in the gas-poor dwarf galaxy NGC 5253. These 0.3"(5.5 pc) resolution images reveal small, dense molecular gas clouds that are located in kinematically distinct, extended filaments. Some of the filaments appear to be falling into the galaxy and may be fueling its current star formation. The most intense CO(3-2) emission comes from the central $\sim$100 pc region centered on the luminous radio-infrared HII region known as the supernebula. The CO(3-2) clumps within the starburst region are anti-correlated with H$\alpha$ on $\sim$5 pc scales, but are well-correlated with radio free-free emission. Cloud D1, which enshrouds the supernebula, has a high $^{12}$CO/$^{13}$CO ratio, as does another cloud within the central 100 pc starburst region, possibly because the clouds are hot. CO(3-2) emission alone does not allow determination of cloud masses as molecular gas temperature and column density are degenerate at the observed brightness, unless combined with other lines such as $^{13}$CO.Comment: 7 pages, 5 figures, Accepted to Ap

Die automatisierte Bewertung von Dopamin-Transporter-SPECT basierend auf künstlicher Intelligenz

Bei der DAT-SPECT (dopamine transporter single photon emission computer tomography, [englisch]) handelt es sich um nuklearmedizinisches diagnostisches Verfahren, welches unter anderem bei dem klinischen Bild des Parkinsonismus Anwendung findet. Es bietet eine in vivo-Einschätzung über die Integrität dopaminerger Synapsen und unterliegt einer gewissen Interrater-Variabilität. Künstliche Intelligenz (KI) hat in den vergangenen Jahren in vielen Bereichen des Alltags Einzug gehalten. In der Medizin gibt es bereits jetzt Algorithmen, die die menschliche Beurteilung in ihrer Leistungsfähigkeit übertreffen. Hier ist besonders das Teilgebiet des tiefen Lernens in den Fokus gerückt. Ziel des Projektes war die Erprobung eines Ansatzes, mit dieser Methodik DAT-SPECT-Dateien automatisiert zu klassifizieren. Es wurden retrospektiv aus einem Datensatz von 1679 DAT-SPECT-Aufnahmen nach diagnostischer Bewertung durch klinisch tätiges ärztliches Personal 442 Einzeldateien ausgewählt und binär klassifiziert. Anschließend wurde eine KI-Umgebung basierend auf Google Tensorflow® aufgesetzt. Es wurden verschiedene Kombinationen aus Fraktionen eines faltenden künstlichen neuronalen Netzwerkes, Durchlaufraten und verschiedenen Trainingsdatensätzen angewandt. Diese wurden danach mit unbekannten Daten einem Testprozess unterzogen. Es wurden Genauigkeiten von bis zu 90%, Sensitivitäten und Spezifitäten von jeweils bis zu 100% erreicht. Die positiven und negativen Prädiktionswerte lagen ebenfalls je bei bis zu 100%. Allerdings zeigten die Ergebnisse starke Schwankungen je nach benutzter Trainings- und Testkombination. Tendenziell schien eine höhere Netzwerkfraktion mit höherer Laufrate bessere Resultate zu erbringen. Insgesamt illustriert die vorliegende Arbeit eine Möglichkeit, DAT-SPECT-Dateien automatisiert zu beurteilen. Auch wenn sowohl in der wissenschaftlichen Literatur wie auch in diesem Projekt teils beeindruckende Ergebnisse erzielt wurden, stellt die eingeschränkte Nachvollziehbarkeit sowie die bislang fehlende klinische Korrelation automatisierter Klassifikationen eine Herausforderung dar. Auch ergeben sich in diesem Kontext in Anbetracht der Verwendung sensibler Daten juristische wie ethische Fragestellungen, deren Bedeutung mit der zunehmenden Digitalisierung des Gesundheitssystems wachsen wird

Quality communication with parents

This literature review looks at quality communication between the parents of children with special needs and school personnel. Advantages and problems with communication will be discussed. Also, discussions will focus on the use of communication between educators and parents of children with special needs over the past five decades. The influence of public laws on communication between these groups will be examined. In addition, the advantages and problems involved in this communication will be drawn from the literature and guidelines will be identified that are needed for effective communication between educators and parents of children with special needs. Lastly, conclusions and recommendations will be shared concerning how to develop a more effective communication system between these two groups

Cross-cultural translation and application of the Lieberman–Brian inclusion rating scale for PE in German-speaking countries

Overcoming participation barriers of students with disabilities in physical education is of great importance and an internationally recognized goal. Research highlights that students with disabilities have mixed feelings about their inclusion experiences in physical education. Physical education teachers often do not feel prepared to appropriately support all students. In Germanspeaking countries in particular, there is a strong tradition of segregation, with varying interpretations of inclusion. In this light, an instrument to reliably assess the inclusive potential of physical education is needed, thereby providing data on the efficacy of teachers’ practices. Such an assessment scale would be important to identify barriers to inclusive physical education while providing teachers with data that could potentially enhance the learning environment. The purpose of this study was to outline initial insights into the cross-cultural translation process of the Lieberman/Brian Inclusion Rating Scale for PE in German-speaking countries. The translation process followed suggestions for transcultural validation. Expert review was provided to check content and face validity. Major item challenges centered around paraeducators, gym management, and conceptual differences regarding physical education

Evaluating automated longitudinal tumor measurements for glioblastoma response assessment.

Automated tumor segmentation tools for glioblastoma show promising performance. To apply these tools for automated response assessment, longitudinal segmentation, and tumor measurement, consistency is critical. This study aimed to determine whether BraTumIA and HD-GLIO are suited for this task. We evaluated two segmentation tools with respect to automated response assessment on the single-center retrospective LUMIERE dataset with 80 patients and a total of 502 post-operative time points. Volumetry and automated bi-dimensional measurements were compared with expert measurements following the Response Assessment in Neuro-Oncology (RANO) guidelines. The longitudinal trend agreement between the expert and methods was evaluated, and the RANO progression thresholds were tested against the expert-derived time-to-progression (TTP). The TTP and overall survival (OS) correlation was used to check the progression thresholds. We evaluated the automated detection and influence of non-measurable lesions. The tumor volume trend agreement calculated between segmentation volumes and the expert bi-dimensional measurements was high (HD-GLIO: 81.1%, BraTumIA: 79.7%). BraTumIA achieved the closest match to the expert TTP using the recommended RANO progression threshold. HD-GLIO-derived tumor volumes reached the highest correlation between TTP and OS (0.55). Both tools failed at an accurate lesion count across time. Manual false-positive removal and restricting to a maximum number of measurable lesions had no beneficial effect. Expert supervision and manual corrections are still necessary when applying the tested automated segmentation tools for automated response assessment. The longitudinal consistency of current segmentation tools needs further improvement. Validation of volumetric and bi-dimensional progression thresholds with multi-center studies is required to move toward volumetry-based response assessment

Definitive-intent radiotherapy for sinonasal carcinoma in cats: a multicenter retrospective assessment

Treatment of epithelial sinonasal tumors in cats is not commonly reported. Palliative radiation protocols have been described more often than definitive-intent protocols. In this multi-institutional retrospective study, we included 27 cats treated with single-modality radiotherapy. Cats were irradiated using 10 daily fractions of 4.2Gy. Three cats (11.1%) experienced a complete clinical response and 17 (63%) had a partial clinical response. Stable clinical disease was noted in three cats (11.1%). Four cats (14.8%) showed progression within 3 months following treatment. The median time to progression for all cases was 269 days (95% CI: 225;314). The proportion of cats free of progression at 1 and 2 years was 24% (95%CI: 22%;26%) and 5% (95%CI: 5%;6%), respectively. None of the prognostic factors evaluated were predictive of outcome (anemia, tumor volume at the time of staging, modified Adams stage, intracranial involvement, facial deformity, epistaxis, inappetence or weight loss). Median overall survival (OS) for all deaths was 452 days (95%CI: 334;571). The proportion of cats alive at 1 and 2 years was 57% (95%CI: 37%;77%) and 27% (95%CI: 25%;29%), respectively. Surprisingly, cats with epistaxis had a longer median OS of 828 days (95%CI: 356;1301) compared to 296 days (95%CI: 85;508) in cats without epistaxis, (p=0.04, Breslow). Radiation therapy used as a single modality for the treatment of feline sinonasal carcinoma improved clinical signs and was well tolerated

Coberturas de ácido hialurónico en el tratamiento de quemaduras: revisión sistemática

OBJETIVO Evaluar la efectividad del ácido hialurónico en la cicatrización de quemaduras de espesor parcial. MÉTODO Revisión sistemática de ensayos clínicos randomizados acerca de la utilización de ácido hialurónico en el tratamiento tópico de quemaduras de piel, basada en las recomendaciones del Cochrane Handbook for Systematic Reviews of Interventions. RESULTADOS Fueron recuperados de los ensayos clínicos randomizados que analizaron 143 pacientes portadores de quemaduras de espesor parcial y/o espesor parcial profundo, comparando la aplicación de Ácido Hialurónico al 0,2%, asociado con la Sulfadiazina de Plata al 1% 5g/cm2, versus Sulfadiazina de Plata al 1% 5g/cm2 aislada, para el resultado de una cicatrización completa. CONCLUSIÓN Esta revisión subraya la necesidad de nuevos ensayos clínicos randomizados bien planteados para el establecimiento de la relevancia terapéutica del ácido hialurónico en lo que se refiere a la cicatrización de quemaduras de espesor parcial o espesor parcial profundo.OBJETIVO Avaliar a efetividade do ácido hialurônico na cicatrização de queimaduras de espessura parcial. MÉTODO Revisão sistemática de ensaios clínicos randomizados sobre a utilização de ácido hialurônico no tratamento tópico de queimaduras de pele, baseada nas recomendações do Cochrane Handbook for Systematic Reviews of Interventions. RESULTADOS Foram recuperados dois ensaios clínicos randomizados que analisaram 143 pacientes portadores de queimaduras de espessura parcial e/ou espessura parcial profunda, comparando a aplicação de Ácido Hialurônico 0,2% associado à Sulfadiazina de Prata 1% 5g/cm2, versus Sulfadiazina de Prata 1% 5g/cm2 isolada, para o desfecho cicatrização completa. CONCLUSÃO Esta revisão enfatiza a necessidade de novos ensaios clínicos randomizados bem delineados para estabelecimento da relevância terapêutica do ácido hialurônico no que tange à cicatrização de queimaduras de espessura parcial ou espessura parcial profunda.OBJECTIVE To evaluate the effectiveness of hyaluronic acid in the healing of partial thickness burns. METHOD Systematic review of randomized controlled trials on the use of hyaluronic acid for the topical treatment of skin burns, based on recommendations of the Cochrane Handbook for Systematic Reviews of Interventions. RESULTS Two randomized controlled trials that analyzed 143 patients with partial thickness burns and/or deep partial thickness burns were selected. They compared the application of hyaluronic acid 0.2% associated to silver sulfadiazine 1% 5g/cm2 versus silver sulfadiazine 1% 5g/cm2 alone for the outcome of complete healing. CONCLUSION This review emphasizes the need for new well-designed randomized controlled trials to establish the therapeutic relevance of hyaluronic acid with respect to the healing of burns of partial thickness or deep partial thickness

Influence of Physicochemical Characteristics and Stability of Gold and Silver Nanoparticles on Biological Effects and Translocation across an Intestinal Barrier—A Case Study from In Vitro to In Silico

A better understanding of their interaction with cell-based tissue is a fundamental prerequisite towards the safe production and application of engineered nanomaterials. Quantitative experimental data on the correlation between physicochemical characteristics and the interaction and transport of engineered nanomaterials across biological barriers, in particular, is still scarce, thus hampering the development of effective predictive non-testing strategies. Against this background, the presented study investigated the translocation of gold and silver nanoparticles across the gastrointestinal barrier along with related biological effects using an in vitro 3D-triple co-culture cell model. Standardized in vitro assays and quantitative polymerase chain reaction showed no significant influence of the applied nanoparticles on both cell viability and generation of reactive oxygen species. Transmission electron microscopy indicated an intact cell barrier during the translocation study. Single particle ICP-MS revealed a time-dependent increase of translocated nanoparticles independent of their size, shape, surface charge, and stability in cell culture medium. This quantitative data provided the experimental basis for the successful mathematical description of the nanoparticle transport kinetics using a non-linear mixed effects modeling approach. The results of this study may serve as a basis for the development of predictive tools for improved risk assessment of engineered nanomaterials in the future