Paediatric hand function assessment practices of occupational therapists in South Africa

Introduction: South African occupational therapists' assessment practices of children's hand function are unknown, although the treatment thereof is an integral part of the paediatric scope of practice and clientele. Hand function assessment frameworks and instruments are available, but a lack of contextually relevant, comprehensive standardised instruments was identified. The study aimed to investigate occupational therapists' current paediatric hand function assessment practices and their preferences towards future practice. Methods: A quantitative, cross-sectional study design using convenient and snowball sampling was employed. An EvaSysco survey system, custom-developed online questionnaire, was used to collect information. Results: In total, 194 HPCSA-registered occupational therapists participated. All the participants currently rely on informal observations. Although not exclusively designed for hand function, standardised developmental tests were often used. Limited familiarity with and use of t he available published hand function assessment instrument was reported. Future assessment preferences supported a standardised, comprehensive hand function assessment instrument for different age groups and paedi atric conditions. Conclusion: This study provides baseline evidence of current and preferred paediatric hand fu net ion assessment practices used by occupational therapists. The need for training to use the available published instruments was highlighted. Recommendations towards the refinement of existing or the development of a standardised, contextually relevant instrument for paediatric practice in South Africa are offered. Implications for practice This article offers a deeper understanding of available paediatric hand function assessment frameworks, assessment instruments, and practices of occupational therapists. It provides an outline of existing methods therapist use and offersclear directives for how the South African OT would prefer to assess hand function in eh ildren. Emphasis is placed on the need for a contextually relevant instrument and future research in refining existing instruments or developing a new instrument is proposed. Additionally, practitioners provided practical suggestions to guide the development of a contextually relevant instrument for potential use in future instrument development research

Cognitive flexibility training has direct and near transfer effects, but no far transfer effects, preschoolers

The current project studied the direct, near transfer, and far transfer effects of cognitive flexibility training in two experiments with 117 3-year-olds. In both Experiments 1 and 2, children performed three Dimensional Change Card Sorting (DCCS) tasks in a pre-training/training/post-training design. The training consisted of giving corrective feedback in the training DCCS task. In Experiment 2, in addition, three other executive control tasks were administered during pre-training and post-training. Results showed a direct effect of feedback in the training DCCS task and transfer of this effect to the post-training DCCS task after 1 week with different sorting rules and different stimuli. These findings show that preschoolers learned to switch sorting rules in the context of the DCCS task, independent of the specific sorting rules, and that this effect is not transient. No support was found for transfer to the other executive control tasks. A possible explanation is that the feedback mainly improved rule switching, an ability that is specifically required for performing a cognitive flexibility task but not the other executive control tasks

Development and Preliminary Evaluation of the Reaction to Unacceptable Behavior Inventory

__Background__ Monitoring the implementation of new interventions, as in this study Nonviolent Resistance (NVR) for the use in residential youth care settings, is mandatory in order to evaluate, adjust and refine the implementation process where necessary. Objective As there is no instrument for such monitoring of NVR available, the authors developed a new questionnaire, named Reaction to Unacceptable Behavior Inventory, (in short: RUBI). __Method__ This questionnaire was completed by staff of four different residential settings in the Netherlands, at different stages of the NVR implementation process. The staff members reported on the practice of their colleagues. __Results__ The results are promising, as they show good reliability, inter-item correlations and other psychometric features for the included items. Furthermore, the results show that the RUBI seems to discriminate between trained and untrained teams, defending its use in future implementation processes and implementation research. __Conclusions__ The RUBI is the first attempt to create an instrument which can be used for monitoring change during implementation of NVR, and for evaluating the degree of difference or compatibility between NVR and existing practice before implementation. Longitudinal research is needed to strengthen the documentation of validity and reliability of the RUBI in different settings, countries, and cultures. This should also be extended to the final and follow-up stages of implementation. In the future, redundant and insensitive items should be removed and standards for interpreting scale scores should be developed

Scalable Jet-Based Fabrication of PEI-Hydrogel Particles for CO₂ Capture

The capture, regeneration, and conversion of CO2 from ambient air and flue gas streams are critical aspects of mitigating global warming. Solid sorbents for CO2 absorption are very promising as they have high mass transfer areas without energy input and reduce emissions and minimize corrosion as compared to liquid sorbents. However, precisely tunable solid CO2 sorbents are difficult to produce. Here, we demonstrate the high-throughput production of hydrogel-based CO2-absorbing particles via liquid jetting. By wrapping a liquid jet consisting of an aqueous solution of cross-linkable branched polyethylenimine (PEI) with a layer of suspension containing hydrophobic silica nanoparticles, monodisperse droplets with a silica nanoparticle coating layer was formed in the air. A stable Pickering emulsion containing PEI droplets was obtained after these ejected droplets were collected in a heated oil bath. The droplets turn into mm-sized particles after thermal curing in the bath. The diameter, PEI content, and silica content of the particles were systematically varied, and their CO2 absorption was measured as a function of time. Steam regeneration of the particles enabled cyclic testing, revealing a CO2 absorption capacity of 6.5 ± 0.5 mol kg−1 solid PEI in pure CO2 environments and 0.7 ± 0.3 mol kg−1 solid PEI for direct air capture. Several thousands of particles were produced per second at a rate of around 0.5 kg per hour, with a single nozzle. This process can be further scaled by parallelization. The complete toolbox for the design, fabrication, testing, and regeneration of functional hydrogel particles provides a powerful route toward novel solid sorbents for regenerative CO2 capture.</p

Evaluation of the 2015 ATA Guidelines in Patients with Distant Metastatic Differentiated Thyroid Cancer

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Evaluation of the 2015 ATA Guidelines in Patients With Distant Metastatic Differentiated Thyroid Cancer

CONTEXT: Current American Thyroid Association (ATA) Management Guidelines for the treatment of differentiated thyroid cancer (DTC) stratify patients to decide on additional radioiodine (RAI) therapy after surgery, and to predict recurring/persisting disease. However, studies evaluating the detection of distant metastases and how these guidelines perform in patients with distant metastases are scarce. OBJECTIVE: To evaluate the 2015 ATA Guidelines in DTC patients with respect to 1) the detection of distant metastases, and 2) the accuracy of its Risk Stratification System in patients with distant metastases. PATIENTS AND MAIN OUTCOME MEASURES: We retrospectively included 83 DTC patients who were diagnosed with distant metastases around the time of initial therapy, and a control population of 472 patients (312 low-risk, 160 intermediate-risk) who did not have a routine indication for RAI therapy. We used the control group to assess the percentage of distant metastases that would have been missed if no RAI therapy was given. RESULTS: Two hundred forty-six patients had no routine indication for RAI therapy of which 4 (1.6%) had distant metastases. Furthermore, among the 83 patients with distant metastases, 14 patients (17%) had excellent response, while 55 (67%) had structural disease after a median follow-up of 62 months. None of the 14 patients that achieved an excellent response had a recurrence. CONCLUSIONS: In patients without a routine indication for RAI therapy according to the 2015 ATA Guidelines, distant metastases would initially have been missed in 1.6% of the patients. Furthermore, in patients with distant metastases upon diagnosis, the 2015 ATA Guidelines are an excellent predictor of both persistent disease and recurrence

Preferences of patients, clinicians, and healthy controls for the management of a Bethesda III thyroid nodule

Background: Active surveillance is propagated as an alternative for hemithyroidectomy in the management of Bethesda III thyroid nodules. Methods: A cross-sectional survey questioned respondents on their willingness to accept risks related to active surveillance and hemithyroidectomy. Results: In case of active surveillance, respondents (129 patients, 46 clinicians, and 66 healthy controls) were willing to accept a risk of 10%–15% for thyroid cancer and 15% for needing more extensive surgery in the future. Respondents were willing to accept a risk of 22.5%–30% for hypothyroidism after hemithyroidectomy. Patients and controls were willing to accept a higher risk on permanent voice changes compared with clinicians (10% vs. 3%, p < 0.001). Conclusion: Real-life risks associated which active surveillance and hemithyroidectomy for Bethesda III nodules are equivalent or less than the risks people are willing to accept. Clinicians accepted less risk for permanent voice changes

Serum microRNA profiles in athyroid patients on and off levothyroxine therapy

BackgroundLevothyroxine replacement treatment in hypothyroidism is unable to restore physiological thyroxine and triiodothyronine concentrations in serum and tissues completely. Normal serum thyroid stimulating hormone (TSH) concentrations reflect only pituitary euthyroidism and, therefore, novel biomarkers representing tissue-specific thyroid state are needed. MicroRNAs (miRNAs), small non-coding regulatory RNAs, exhibit tissue-specific expression patterns and can be detectable in serum. Previous studies have demonstrated differential expression of (precursors of) miRNAs in tissues under the influence of thyroid hormone.ObjectiveTo study if serum miRNA profiles are changed in different thyroid states.Design and methodsWe studied 13 athyroid patients (6 males) during TSH suppressive therapy and after 4 weeks of thyroid hormone withdrawal. A magnetic bead capture system was used to isolate 384 defined miRNAs from serum. Subsequently, the TaqMan Array Card 3.0 platform was used for profiling after individual target amplification.ResultsMean age of the subjects was 44.0 years (range 20-61 years). Median TSH levels were 88.9 mU/I during levothyroxine withdrawal and 0.006 mU/I during LT4 treatment with a median dosage of 2.1 fag/kg. After normalization to allow inter-sample analysis, a paired analysis did not demonstrate a significant difference in expression of any of the 384 miRNAs analyzed on and off LT4 treatment.ConclusionAlthough we previously showed an up-regulation of pri-miRNAs 133b and 206 in hypothyroid state in skeletal muscle, the present study does not supply evidence that thyroid state also affects serum miRNAs in humans

Impact of Reclassification of Oncocytic and Follicular Thyroid Carcinoma by the 2022 WHO Classification

Background The 2022 WHO Classification categorizes oncocytic (OTC) and follicular thyroid carcinoma (FTC), based on the degree of capsular and vascular invasion, into minimally invasive (MI), encapsulated angio-invasive (EA), and widely invasive tumors (WI). While associations with clinical outcomes have been studied extensively in FTC, robust clinical data are lacking for OTC. We aimed to investigate the impact of the reclassification of OTC and FTC by the 2022 WHO Classification on clinical outcomes.Methods All adult OTC and FTC patients treated at the Erasmus MC (the Netherlands) between 2000 and 2016 were retrospectively included. All tumors were extensively revised by 2 independent pathologists, facilitated by Palga: Dutch Pathology Databank. Kaplan-Meier curves were used to study the association of the 2004 and 2022 WHO Classification with overall survival, disease-specific survival (DSS), recurrence-free survival, and radioactive iodine (RAI)-refractory disease.Results Among 52 OTC and 89 FTC patients, 15 (28.8%) OTC and 34 (38.2%) FTC tumors were reclassified as EAOTC or EAFTC. The 2022 WHO Classification substantially improved risk stratification in both subtypes for DSS, compared to the 2004 edition. Ten-year DSS rates were 100% for MIOTC, 92.9% for EAOTC, and 56.5% for WIOTC, compared to 100% (MIOTC) and 64.2% (WIOTC) following the 2004 WHO Classification. For FTC and RAI-refractory disease, similar trends were observed.Conclusion Classification of OTC and FTC into 3 subcategories as defined by the 2022 WHO Classification substantially improves discrimination between low-, intermediate-, and high-risk patients, especially for DSS and RAI-refractory disease