The Atomic-Level Structure of Cementitious Calcium Aluminate Silicate Hydrate Determined by NMR

We review our recent paper which resolves the long-standing dilemma of the location and nature of the six-fold coordinated aluminum in calcium aluminate silicate hydrate (C-A-S-H) samples. First principles calculations predict that at high Ca:Si and H2O ratios, aluminum is incorporated into the bridging sites of the linear silicate chains and that the stable coordination number is six. We confirm this hypothesis experimentally by one- and two-dimensional dynamic nuclear polarization enhanced 27 Al and 29 Si solid-state NMR experiments in which we correlate the distinctive six-fold coordinated aluminum NMR signal at 5 ppm to 29 Si NMR signals from silicates in C-A-S-H

Life-threatening hypophosphataemia in a cirrhotic patient with jaundice

We report the case of a 51-year-old patient with a history of liver cirrhosis, who presented with jaundice (total bilirubin 50 mg/dl [855 µmol/l], direct bilirubin 20 mg/dl [342 µmol/l]) and life-threatening hypophosphataemia (serum phosphate 0.5 mg/dl [0.16 mmol/l]), accompanied by inappropriate phosphaturia. The patient also manifested hypouricaemia (serum uric acid 1.7 mg/dl [101 µmol/l]) with renal uric acid wasting and renal glycosuria. This generalized proximal tubular defect may occasionally be seen in deeply jaundiced patients. Therefore, serum phosphate levels should be closely monitored in these patients

THE EFFECTS OF ENHANCED SENSORI-MOTOR REHABILITATION ON INDICES OF FUNCTIONAL PERFORMANCE IN PATIENTS UNDERGOING TOTAL KNEE REPLACEMENT

The primary aim of this thesis addressed a knowledge gap regarding whether sensori-motor training (SMT) stimuli implemented early post-surgery are capable of targeting persisting sensori-motor and neuromuscular deficits in TKR patients’ performance. Therefore, the effects of early enhanced sensori-motor training (ESMET) on self-reported and objective measures of physical function, sensori-motor, neuromuscular, and musculoskeletal performance capabilities of patients undergoing total knee replacement (TKR) were investigated. In order to assess the effects of SMT on patients’ functional mobility and sensori-motor function, as well as indirectly investigating the mechanism underpinning any observed effects, relevant outcome measures used in the literature were reviewed for their clinimetric properties. Indices of functional performance, as reflected by the Timed Up and Go Test (as primary outcome), balance-related performance, sensori-motor performance, neuromuscular performance, muscle size and knee ROM, as well as patient-reported measures (PROMs), were selected on the basis of their clinimetric utility to best reflect the outcome of the SMT intervention. A clinical survey of Greek physiotherapists’ perspectives revealed that contemporary usual care management of TKR-related rehabilitation incorporated in the majority of cases home-based exercises with emphasis on knee ROM and muscle strengthening (Moutzouri et al, 2016b). A first systematic review including studies with IIc-IV level of evidence (Moutzouri et al, 2016c), revealed that patients undergoing TKR surgery experience persisting deficits in static and dynamic balance and incidence of falls remain within the pre-surgery levels. In parallel, a second systematic review evaluating preliminary effects of contemporary functional physiotherapy programmes being augmented by SMT in TKR clinical population, revealed statistically significant greater effects for balance performance but not for functional capabilities. However, the number of studies that had met inclusion criteria was small (n = 5) and the nature of their designs, which had been as pilot studies in the majority of cases, precluded conclusive findings. Following preliminary investigations of reproducibility of measurement and related clinimetric characteristics of outcomes, the main aspect of the thesis reported on the findings of a novel randomised control trial (Moutzouri et al,2017), in which the effects of a newly formulated time-matched sensori-motor exercise training programme [ESMET] was compared with those from a functional exercise training programme [FET] (representing the control condition and usual care practice, and which have been characterised by the findings of the aforementioned clinical survey) during rehabilitation following TKR. Participants (n= 52) were allocated to 12-week programmes of rehabilitation, initiated in the second week post-surgery, and assessed at pre-surgery (0 weeks), 8 weeks post-surgery, and at 14 weeks post-surgery on outcomes which included indices of self-reported and objective measures of physical function, sensori-motor, neuromuscular, and musculoskeletal performance capabilities. The findings revealed significant advantages for the new sensori-motor focused rehabilitation on several outcomes (relative effect size range at 14 weeks post-surgery ~ 0.5 to 2.1), including a significant group by time interaction (F(1.7,82.5)GG = 11.0; p <0.005) for the study’s primary outcome (Timed Up and Go Test), favouring ESMET over FET by ~ 35 %. However, the study’ findings need to be interpreted with caution due to the single-blind nature of the study. Key words: total knee replacement; knee osteoarthritis, Rehabilitation; Balance; sensori-motor trainin

Management of dyslipidemias with fibrates, alone and in combination with statins: role of delayed-release fenofibric acid

Cardiovascular disease (CVD) represents the leading cause of mortality worldwide. Lifestyle modifications, along with low-density lipoprotein cholesterol (LDL-C) reduction, remain the highest priorities in CVD risk management. Among lipid-lowering agents, statins are most effective in LDL-C reduction and have demonstrated incremental benefits in CVD risk reduction. However, in light of the residual CVD risk, even after LDL-C targets are achieved, there is an unmet clinical need for additional measures. Fibrates are well known for their beneficial effects in triglycerides, high-density lipoprotein cholesterol (HDL-C), and LDL-C subspecies modulation. Fenofibrate is the most commonly used fibric acid derivative, exerts beneficial effects in several lipid and nonlipid parameters, and is considered the most suitable fibrate to combine with a statin. However, in clinical practice this combination raises concerns about safety. ABT-335 (fenofibric acid, Trilipix®) is the newest formulation designed to overcome the drawbacks of older fibrates, particularly in terms of pharmacokinetic properties. It has been extensively evaluated both as monotherapy and in combination with atorvastatin, rosuvastatin, and simvastatin in a large number of patients with mixed dyslipidemia for up to 2 years and appears to be a safe and effective option in the management of dyslipidemia

Add-on-Statin Extended Release Nicotinic Acid/Laropiprant but Not the Switch to High-Dose Rosuvastatin Lowers Blood Pressure: An Open-Label Randomized Study

Introduction. Nicotinic acid (NA) and statins have been associated with reductions in blood pressure (BP). Patients and Methods. We recruited 68 normotensive and hypertensive dyslipidemic patients who were treated with a conventional statin dose and had not achieved lipid targets. Patients were randomized to switch to high-dose rosuvastatin (40 mg/day) or to add-on current statin treatment with extended release (ER) NA/laropiprant (1000/20 mg/day for the first 4 weeks followed by 2000/40 mg/day for the next 8 weeks) for 3 months. Results. Switching to rosuvastatin 40 mg/day was not associated with significant BP alterations. In contrast, the addition of ER-NA/laropiprant to current statin treatment resulted in a 7% reduction of systolic BP (from 134 ± 12 to 125 ± 10 mmHg, P < .001 versus baseline and P = .01 versus rosuvastatin group) and a 5% reduction of diastolic BP (from 81 ± 9 to 77 ± 6 mmHg, P = .009 versus baseline and P = .01 versus rosuvastatin group). These reductions were significant only in the subgroup of hypertensives and were independent of the hypolipidemic effects of ER-NA/laropiprant. Conclusions. Contrary to the switch to high-dose rosuvastatin, the addition of ER-NA/laropiprant to statin treatment was associated with significant reductions in both systolic and diastolic BP

Γνώσεις και στάσεις των εκπαιδευτικών για τη Διαταραχή Ελλειμματικής Προσοχής Υπερκινητικότητας: Συσχέτιση με τη λειτουργία ψυχοπαιδαγωγικής υπηρεσίας εντός του σχολείου.

Εισαγωγή: Η Διαταραχή Ελλειμματικής Προσοχής και Υπερκινητικότητας (ΔΕΠΥ) είναι μια νευροαναπτυξιακή διαταραχή πολυπαραγοντικής αιτιολογίας που συνήθως διαγιγνώσκεται με την είσοδο του παιδιού στο δημοτικό σχολείο, καθώς οι αυξημένες απαιτήσεις για προσαρμογή σε ένα δομημένο πλαίσιο με σαφείς κανόνες καθιστούν τα συμπτώματα της ΔΕΠΥ (απροσεξία, υπερκινητκότητα και παρορμητικότητα) πιο εμφανή και δυσλειτουργικά. Προκειμένου οι εκπαιδευτικοί να ανταποκριθούν στις ανάγκες ενός μαθητή με ΔΕΠΥ πρέπει να έχουν ακριβή πληροφόρηση για τη διαταραχή. Διεθνείς και ελάχιστες ελληνικές μελέτες μέχρι σήμερα που έχουν διερευνήσει τις γνώσεις και τις πεποιθήσεις των εκπαιδευτικών για τη ΔΕΠΥ έχουν επισημάνει ελλείψεις και εσφαλμένες αντιλήψεις, ειδικά όσον αφορά στην αιτιοπαθογένεια της διαταραχής και την αντιμετώπισή της. Παρά το αυξημένο επιστημονικό ενδιαφέρον για τη ΔΕΠΥ και τις ειδικές εκπαιδευτικές ανάγκες των μαθητών που εμφανίζουν τη διαταραχή δεν υπάρχουν έρευνες που να διερευνούν εάν οι γνώσεις και αντιλήψεις των εκπαιδευτικών διαφοροποιούνται ανάλογα με τη λειτουργία ή μη ψυχοπαιδαγωγικής υπηρεσίας εντός της σχολικής μονάδας. Σκοπός: Η παρούσα εργασία αποσκοπεί να μελετήσει εάν η λειτουργία ή μη ψυχοπαιδαγωγικής υπηρεσίας εντός του σχολείου επηρεάζει το επίπεδο γνώσης και τις πεποιθήσεις των εκπαιδευτικών για τη ΔΕΠΥ και πώς αυτές σχετίζονται με τα δημογραφικά στοιχεία (φύλο, ηλικία) και τη διδακτική εμπειρία (χρόνος προϋπηρεσίας, διδασκαλία μαθητή/-ων με ΔΕΠΥ, επιμόρφωση για τη ΔΕΠΥ) του εκπαιδευτικού. Στην έρευνα συμμετείχαν συνολικά 181 εκπαιδευτικοί Α/βαθμιας γενικής εκπαίδευσης του Νομού Αττικής που εργάζονταν σε δημόσια σχολεία, χωρίς ψυχοπαιδαγωγική υπηρεσία (Ν=101) και σε ιδιωτικά σχολεία με ψυχοπαιδαγωγική υπηρεσία εντός της σχολικής μονάδας (Ν=80). Η συλλογή δεδομένων έγινε τη χρονική περίοδο Δεκέμβριος 2018-Φεβρουάριος 2019, μέσω συμπλήρωσης του Ερωτηματολογίου Γνώσης για τη ΔΕΠΥ (ADHD-KQ, Giannopoulou και συν., 2017) καθώς και του Ερωτηματολογίου Πεποιθήσεων για τη ΔΕΠΥ το οποίο κατασκευάστηκε για τους σκοπούς της παρούσας έρευνας. Η αξιοπιστία εσωτερικής συνοχής της συνολικής κλίμακας ADHD-KQ και της συνολικής κλίμακας των Πεποιθήσεων ήταν ικανοποιητική (Cronbach&apos;s alpha 0.86 και 0.87 αντίστοιχα). Αποτελέσματα: Όσον αφορά στις πεποιθήσεις σχετικά με τη βασιμότητα της διάγνωσης ΔΕΠΥ (υφίσταται ως διαταραχή και δεν είναι απόρροια της εσκεμμένης συμπεριφοράς του παιδιού ή της ανεπαρκούς διαπαιδαγώγησης/μέριμνας των γονιών) δεν βρέθηκε στατιστικώς σημαντική διαφορά μεταξύ δύο ομάδων εκπαιδευτικών. Παρομοίως, όσον αφορά στη συνολική γνώση για τη ΔΕΠΥ, αλλά και στις γνώσεις που αφορούν επιμέρους τομείς δεν διαπιστώθηκε στατιστικώς σημαντική διαφορά μεταξύ των εκπαιδευτικών ανάλογα με τη λειτουργία ή μη ψυχοπαιδαγωγικής υπηρεσίας εντός της σχολικής μονάδας. Το γενικότερο επίπεδο γνώσεων των εκπαιδευτικών γύρω από τη ΔΕΠΥ φάνηκε να είναι χαμηλό έως μέτριο, με εξαίρεση τη συμπτωματολογία, καθώς το ποσοστό των σωστών απαντήσεων κυμαινόταν από το18.2% και έφτανε μέχρι το 97.8 %. Η πολυπαραγοντική γραμμική παλινδρόμηση) έχοντας σαν εξαρτημένη μεταβλητή τη συνολική βαθμολογία των γνώσεων και σαν ανεξάρτητες τα δημογραφικά και εργασιακά στοιχεία των συμμετεχόντων ανέδειξε την παρακολούθηση εκπαιδευτικών προγραμμάτων για τη ΔΕΠΥ ως τον μόνο σημαντικό προβλεπτικό παράγοντα του επιπέδου των γνώσεων των εκπαιδευτικών. Η δε πολυπαραγοντική γραμμική παλινδρόμηση έχοντας σαν εξαρτημένη μεταβλητή τη συνολική βαθμολογία των πεποιθήσεων και σαν ανεξάρτητες τη συνολική βαθμολογία γνώσεων για τη ΔΕΠΥ, τα δημογραφικά και εργασιακά στοιχεία των συμμετεχόντων ανέδειξε το επίπεδο της γνώσης για τη ΔΕΠΥ ως τον ισχυρότερο προβλεπτικό παράγοντας της βαθμολογίας των πεποιθήσεων. Συγκεκριμένα, όσο υψηλότερη γνώση είχαν οι εκπαιδευτικοί τόσο λιγότερες λανθασμένες πεποιθήσεις είχαν και κατ’ επέκταση θετικότερη στάση απέναντι στους μαθητές με ΔΕΠΥ. Η παρακολούθηση εκπαιδευτικών προγραμμάτων για τη ΔΕΠΥ βρέθηκε, επίσης, να σχετίζεται με μια θετικότερη στάση. Συμπεράσματα: Κρίνεται απαραίτητο να ληφθούν μέτρα για την ορθή ενημέρωση των εκπαιδευτικών σχετικά με την αιτιοπαθογένεια, τα βασικά γνωστικά ελλείμματα που σχετίζονται με τη ΔΕΠΥ και την επίδρασή τους στη μάθηση και στη συμπεριφορά, την εφαρμογή ειδικών διδακτικών προσεγγίσεων για τους μαθητές με ΔΕΠΥ, τα οφέλη και τους περιορισμούς των διαθέσιμων θεραπευτικών παρεμβάσεων συμπεριλαμβανομένης της φαρμακευτικής αγωγής, καθώς η αύξηση γνώσεων από τη συμμετοχή τους σε πρόγραμμα επιμόρφωσης για η ΔΕΠΥ θα επιφέρει αλλαγή στη στάση τους απέναντι στους μαθητές με τη διαταραχή.Introduction: Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder of multifactorial aetiology that is usually diagnosed when a child enters primary school, as the increased requirements for adapting to a given structure makes symptoms (inattention, hyperactivity and impulsivity) more obvious and dysfunctional. In order for teachers to meet the needs of a student with ADHD, they must have accurate information about the disorder. International and a few Greek studies up to date that have examined teachers&apos; knowledge and beliefs relating to ADHD have highlighted gaps in knowledge and misconceptions, especially regarding the aetiology of the disorder and its management. Despite the increased scientific interest in ADHD and the special educational needs of students presenting with the disorder, there are no studies examining whether teachers&apos; knowledge and perceptions of ADHD vary according to whether a psycho-pedagogical service operates within the school unit. Purpose: The present study aims to investigate whether or not the operation of a psychopedagogical service within the school impacts on the level of teachers’ ADHD knowledge and beliefs about the disorder and how these relate to teacher’s demographic characteristics (gender, age) and teaching experience (in-service years, experience of teaching student/-s with ADHD, attendance of ADHD seminars). A total of 181 primary school teachers of the Prefecture of Attica who worked in public schools, without a psycho-pedagogical service (N = 101) and in private schools with a psycho-pedagogical service within the school unit (N = 80) participated in the study. Data collection was carried out during December 2018-February 2019, through the completion of self-report ADHD Knowledge Questionnaire (ADHD-KQ, Giannopoulou et al., 2017) and the Beliefs about ADHD Questionnaire, which was developed for the purpose of the present study. The internal reliability of the overall ADHD-KQ scale and the overall Beliefs scale was satisfactory (Cronbach&apos;s alpha 0.86 for the overall and 0.87 respectively). Results: Regarding the teachers’ beliefs relating to legitimacy of the ADHD diagnosis (the disorder exists and is not just a result of child’s intentional behaviour or parental inadequate child rearing practices/parental care) no statistically significant difference was found between the two groups of teachers. Likewise, no statistically significant difference was found in the overall level of ADHD knowledge, but also in knowledge in specific domains, depending on the operation or non-operation of a psychopedagogical service within the school unit. The teacher’s ADHD knowledge overall was low to moderate, with the exception to the symptoms domain, as the percentage of correct answers ranged from 18.2% to 97.8%. The multiple linear regression analysis, using the total ADHD-KQ score as the dependent outcome variable and demographic characteristics and work experience as independent variables indicated that the teacher’s attendance of seminars focusing on ADHD was the only significant predictor of the level of their ADHD knowledge. The multiple linear regression analysis using the total beliefs score as the dependent variable and as the total ADHD-KQ score, gender, age, years of teaching experience, attendance of ADHD seminar/-s, having taught a student with ADHD, indicated the level of ADHD knowledge the strongest predictor of the beliefs total score; higher levels of ADHD knowledge were related to fewer misconceptions about the disorder and consequently to more positive attitudes towards students with ADHD. The attendance of ADHD training seminars was also found to be associated with a more positive attitude. Conclusions: It is necessary to take measures to properly inform teachers about the etiology, the main cognitive deficits associated with ADHD and their effect on learning and behavior, the implementation of special teaching approaches for students with ADHD, the benefits and the limitations of the available therapeutic interventions including medication, as the increase in knowledge from their participation in a training programme on ADHD will bring about a change in their attitude towards students with the disorder

Clearing the undergrowth: detection and quantification of low level impurities using 19F NMR

A new 19F NMR method, ODYSSEUS, allows low level impurities to be detected without interference from 13C satellites.</p

Implications of Neuroplasticity to the Philosophical Debate of Free Will and Determinism

Neuroplasticity, the capacity of the brain to induce changes in response to environmental stimuli, entails a continuous rearrangement of the neural network through a complex interaction between genetics and environment. Within this process, the plastic brain uses its internal representations to predict future conditions and proactively proceed to actions. It can be said that plasticity demands a rethinking of the concept of determinism as the process of coming-to-be is directly related to modifications produced by experience. Pure determinism and complete randomness are the two ends of a spectrum of positions relevant to the debate of the existence of free will. However, none conceptually supports free decision-making. How brain activity and the conscious experience of volition are related to one another has been a matter of significant research, with a plethora of findings indicating that early brain signals precede the self-reported time of the decision to act. The meaning of these findings, however, has been debated at both a theoretical and empirical level and the controversy is still ongoing. Consciousness is intertwined with free will along the dimension of time as it would otherwise be purposeless, taking place right at the next moment. Electrical activity of the brain is a measure of neurophysiological function and contributes to the understanding of processes that underlie high-order cognitive functions. A multidisciplinary approach in the study of free will could be designed in a way that philosophical concepts are connected to neural correlates by psychologically functionalizing them in terms of cognitive abilities. Such abilities are at the margins of conscious and nonconscious sensory information and are closely linked to brain processes of executive functions like attentional control and working memory