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

Movement Restriction Implications on Potential Welfare Slaughter for Texas High Plains Feedlots

Foot and mouth disease (FMD) is regarded as one of the greatest biological threats to the U.S. livestock industry because of its potential to cause catastrophic economic damages and massive livestock depopulation. Current U.S. contingency plans call for "stamping out" of FMD. An integral component of a "stamping out" policy is movement restrictions. The main purpose for movement restrictions is to stop the spread of disease, but they also disrupt the agribusiness sector. Welfare slaughter, the depopulation of healthy quarantined animals, is a possibility if movement restrictions are kept in place for prolonged periods of time. Many studies have analyzed the economic consequences of alternative mitigation strategies, but generally these studies have ignored the costs that might arise because of movement restrictions affecting uninfected premises located within the quarantine zone. Ultimately this study seeks to improve preparedness in the event of a FMD outbreak. It does this by developing information for those formulating plans on the costs associated with movement restrictions regarding quarantined, uninfected large feedlots located in the Texas High Plains Region. To accomplish this objective two strategies were compared: an unrestricted feed strategy, where feed is allowed to be brought onto uninfected premises and finished cattle are sold; and a welfare slaughter strategy, where feed isn't allowed to be brought onto the uninfected premises so animals are depopulated. In addition, seasonal differences in total costs were examined. This study expanded on the High Plains Study conducted by M. Ward, L. Highfield, P. Vongseng, and M. Garner by using their epidemiological data combined with a cost accounting framework to estimate the total cost of each strategy. This study examined direct disease management costs (indemnity payments, feed costs, marketing costs, surveillance costs, cleaning and disinfecting costs, appraisal cost, euthanasia costs, and disposal costs). Overall, the unrestricted feed strategy was less expensive than the welfare slaughter strategy, costing on average $22.6 million compared to$48.5 million, respectively. Disease outbreak timing did impact the overall cost of both strategies. The results suggest the policy makers should strongly consider creating movement policies that address feed supply and finished cattle movement for uninfected large feedlots in prolonged quarantine zones; as such policies appear to reduce outbreak related costs for stakeholder and the U.S. government

Adherence among Italian paediatricians to the Italian guidelines for the management of fever in children: a cross sectional survey

BACKGROUND: Italian guidelines for the management of fever in children (IFG) have been published in 2009 and thereafter disseminated in all country. A survey was conducted before their publication and three years later to investigate their impact on knowledge and behaviors of paediatricians. METHODS: A questionnaire was administered to convenient samples of paediatricians in 2009 and in 2012, eliciting information about fever definition, methods of temperature measurement, and antipyretic use. Differences in responses between 2009 and 2012 and between paediatricians who were or were not aware of the IFG were evaluated. RESULTS: The responses rates were 74% (480/648) in 2009 and 69% (300/434) in 2012. In 2012 168/300 (56%) of participants were aware of the IFG. The proportion of paediatricians who correctly would never suggest the use of physical methods increased from 18.7% to 36.4% (P < 0.001). In 2009 11% of paediatricians declared that the use of antipyretic drugs depends on patient discomfort and did not use a temperature cut off. In 2012 this percentage reached 45.3% (P < 0.001). Alternate use of antipyretics decreased from 27.0% to 11.3% (P < 0.001). Use of rectal administration of antipyretics in absence of vomiting decreased from 43.8% in 2009 to 25.3% in 2012 (P < 0.001). In general, improvements were more striking in paediatricians who were aware of the IFG than in those who were not aware of them. CONCLUSIONS: Behaviours of Italian paediatricians improved over time. However, some wrong attitudes need to be further discouraged, including use of physical methods and misuse of rectal administration. Further strategy to disseminate the IFG could be needed

A new catechol-functionalized polyamidoamine as an effective SPION stabilizer

A synthetic strategy was established for decorating and stabilizing superparamagnetic iron oxide nanoparticles (SPIONs) with a zwitterionic linear polyamidoamine (PAA). The strategy was successfully tested with a PAA coded ISA23 previously found endowed with interesting biological properties, such as biocompatibility, degradability in aqueous media and stealth-like properties when injected in test animals. A post-synthetic functionalization with catechol-bearing moieties of a preformed PAA was successfully carried out. ISA23 was obtained by polyaddition reactions of methyl-piperazine and 2,2-bis(acrylamidoacetic) acid. It was functionalized using nitrodopamine and 1-ethyl-3-(3-dimethylaminopropyl)carbodiimide as coupling agent, to randomly form amide bonds with 17% of ISA23 carboxylic groups (ISA23-ND). SPIONs were prepared by a thermal decomposition synthesis in 1-octadecene with oleic acid, and then transferred in water by two distinct ligand exchange procedures: i) the direct displacement of oleate molecules from SPION surface by ISA23 in a biphasic (n-hexane/water) environment; ii) the two-step method involving an intermediate small molecule, tetramethylammonium hydroxide, used as a transient transfer agent, which was in turn exchanged with ISA23-ND in a second exchange step occurring in water. The two-step procedure provided a SPION@PAA nanocomposite more stable than that obtained by the one-step procedure in the presence of an applied external magnetic field. ATR-FTIR spectroscopy, \u3b6-potential and thermogravimetric analysis (TGA) showed the presence of the ISA23 on the SPION surface. In particular, TGA showed that the ISA23-ND amount on the NPs accounted for 26% of the overall nanocomposite mass. The nanocomposite size was determined by both TEM (21.1\ub12.9 nm) and DLS measurements (hydrodynamic size 100\ub128 nm). SPION@ISA23-ND were re-suspended after lyophilization reverting to their pristine dimensions. The SPION@ISA23-ND adsorption of BSA in water, considered as the first stage of phagocytosis, was very low, suggesting that ISA23 could impart stealthiness to SPION@ISA23-ND. 1H-NMR relaxivity measurements showed an r2 value of 158 s-1 mmol-1 L (vs 100 s-1 mmol-1L for Endorem\uae) at relevant clinical fields for magnetic resonance imaging (from 0.2 to 1.5 T). SPION@ISA23-ND was tested on HeLa cells and their internalization was visualized by reflectance microscopy. Finally, with the aim of prepare a new dual magneto-optical system, a synthetic procedure to decorate SPION@ISA23-ND with a fluorescent dye was devised, even though the emission intensity of the resultant conjugate was lower than expected, possibly due to luminescence quenching caused by the closeness of emitting moieties to the SPION surface

Distribution of interleukin-1 receptor complex at the synaptic membrane driven by interleukin-1β and NMDA stimulation

Interleukin-1β (IL-1β) is a pro-inflammatory cytokine that contributes to neuronal injury in various degenerative diseases, and is therefore a potential therapeutic target. It exerts its biological effect by activating the interleukin-1 receptor type I (IL-1RI) and recruiting a signalling core complex consisting of the myeloid differentiation primary response protein 88 (MyD88) and the IL-1R accessory protein (IL-1RAcP). This pathway has been clearly described in the peripheral immune system, but only scattered information is available concerning the molecular composition and distribution of its members in neuronal cells. The findings of this study show that IL-1RI and its accessory proteins MyD88 and IL-1RAcP are differently distributed in the hippocampus and in the subcellular compartments of primary hippocampal neurons. In particular, only IL-1RI is enriched at synaptic sites, where it co-localises with, and binds to the GluN2B subunit of NMDA receptors. Furthermore, treatment with NMDA increases IL-1RI interaction with NMDA receptors, as well as the surface expression and localization of IL-1RI at synaptic membranes. IL-1β also increases IL-1RI levels at synaptic sites, without affecting the total amount of the receptor in the plasma membrane. Our results reveal for the first time the existence of a dynamic and functional interaction between NMDA receptor and IL-1RI systems that could provide a molecular basis for IL-1β as a neuromodulator in physiological and pathological events relying on NMDA receptor activation

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

Stevens-Johnson Syndrome and Herpes Simplex Type 1 Infection during Adalimumab Therapy for Crohn&apos;s Disease

Stevens–Johnson syndrome (SJS) is a severe mucocutaneous adverse drug reaction with a relatively high mortality rate. SJS is described during herpes simplex virus type 1 (HSV1) infection and, rarely, even during adalimumab therapy. We report the case of a patient with Crohn’s disease who developed SJS during an HSV1 infection and a contemporaneous anti-TNFα therapy with adalimumab. Remission was achieved with suspension of adalimumab and high doses of intravenous steroids and antivirals. Patients with HSV1 infection and on adalimumab therapy have a combined risk of SJS and should be monitored closely