Agreement between physicians and parents in rating functional ability of children with juvenile idiopathic arthritis

<p>Abstract</p> <p>Objective</p> <p>To investigate concordance between physicians and parents in rating the degree of functional ability of children with juvenile idiopathic arthritis (JIA).</p> <p>Methods</p> <p>The attending physician and a parent were asked to rate independently the level of physical functioning of 155 patients with disease duration ≥ 5 years on a 6-point scale ranging from 1 = no disability (i.e. the child can do without difficulty all activities that children of his/her age can do) to 6 = severe disability (i.e. all activities are difficult for the child). At study visit, measures of JIA activity and damage were assessed. Agreement was evaluated with weighted kappa (<0.40 = poor agreement; 0.41–0.60 = moderate agreement; 0.61–0.80 = substantial agreement; >0.80 excellent agreement). Physician/parent evaluations were divided in 3 groups: 1) concordance; 2) parent over-rating = parent assessment over-rated relative to physician assessment; 3) physician over-rating = physician assessment over-rated relative to parent assessment. Factors affecting concordance/discordance were evaluated by means of Kruskal-Wallis or Chi-square/Fisher exact test.</p> <p>Results</p> <p>Concordance, parent over-rating and physician over-rating were observed in 107 (69%), 29 (18.7%) and 19 (12.3%) evaluations, respectively. Kappa value was 0.69. Parent over-rating was associated with greater intensity of pain (p = 0.01) and higher Childhood Health Assessment Questionnaire (C-HAQ) score (p = 0.004), whereas physician over-rating was associated with more severe joint disease (p = 0.04 to <0.001), higher C-reactive protein (p = 0.03) higher frequency of Steinbrocker functional class = II (p < 0.001), and greater articular damage, as measured with the Juvenile Arthritis Damage Index (p < 0.001).</p> <p>Conclusion</p> <p>Physicians and parents revealed fair concordance in rating functional ability of children with JIA. Parent over-rating was associated with greater child's pain and worse C-HAQ score, whereas physician over-rating was associated with greater severity of joint inflammation and damage.</p

In-channel wood-related hazards at bridges: A review : In-channel wood-related hazards at bridges: A review

In‐channel wood is a key component in fluvial ecosystems; however, transport of in‐channel wood during floods can create hazards in urbanized areas. Among the mainproblems is wood accumulation at bridges, which reduces flow openings, causesblockage and inundation of nearby areas and, eventually, results in structures collaps-ing. Increasing awareness of the importance of the ecological role of wood in riverscalls for a compromise between the preservation of river ecosystems and manage-ment strategies for the prevention of wood‐related hazards. In recent years, knowl-edge related to in‐channel wood dynamics and hazards has notably increased, and asignificant body of valuable information can be found in an extensive number of stud-ies. This review provides a comprehensive summary of the most relevant advancesregarding in‐channel wood‐bridge interactions. We review the factors controllingwood accumulation formation and summarize the different approaches used to ana-lyse this process, namely, physical and numerical modelling. Finally, we conclude byhighlighting the most important knowledge gaps, addressing particularlyunderresearched fields and stressing the remaining challenge

An integrated artificial vision framework for assisting visually impaired users

We present a conceptual framework inspired by biological vision which integrates low-level vision functionalities oriented to actions \u2013 typical of the so-called \u201cwhere\u201d dorsal pathway \u2013 with identification and recognition capabilities \u2013 common to the \u201cwhat\u201d ventral pathway. Although they proceed independently, these complementary vision models may provide a deeper scene understanding and a more efficient computational framework. In this work, we refer specifically to a set of video analysis modules, which include semantic annotations of the scene and 3D environment interpretation. We discuss and qualitatively evaluate possible connections and integrations between different functionalities, grounding our analysis on a set of specific use cases, depicting visually impaired users finding their way in unfamiliar environments

The Impact of the SARS-CoV-2 Outbreak on the Psychological Flexibility and Behaviour of Cancelling Medical Appointments of Italian Patients with Pre-Existing Medical Condition: The \u201cImpACT-COVID-19 for Patients\u201d Multi-Centre Observational Study

Psychological distress imposed by the SARS-CoV-2 outbreak particularly affects patients with pre-existing medical conditions, and the progression of their diseases. Patients who fail to keep scheduled medical appointments experience a negative impact on care. The aim of this study is to investigate the psychosocial factors contributing to the cancellation of medical appointments during the pandemic by patients with pre-existing health conditions. Data were collected in eleven Italian hospitals during the last week of lockdown, and one month later. In order to assess the emotional impact of the SARS-CoV-2 outbreak and the subject's degree of psychological flexibility, we developed an ad hoc questionnaire (ImpACT), referring to the Acceptance and Commitment Therapy (ACT) model. The Impact of Event Scale-Revised (IES-R), the Depression, Anxiety and Stress Scale (DASS) and the Cognitive Fusion Questionnaire (CFQ) were also used. Pervasive dysfunctional use of experiential avoidance behaviours (used with the function to avoid thought, emotions, sensations), feelings of loneliness and high post-traumatic stress scores were found to correlate with the fear of COVID-19, increasing the likelihood of cancelling medical appointments. Responding promptly to the information and psychological needs of patients who cancel medical appointments can have positive effects in terms of psychological and physical health