318 research outputs found
Uneven focal shoe deterioration in Tourette syndrome.
A 31-year-old single man (AB) sought neuropsychiatric consultation for treatment-resistant motor and vocal tics. He described himself expressing a total of 24 different tics, mainly facial twitches (eye blinking, raising eyebrows, mouth opening, lips licking, stereotyped grimacing) and inappropriate utterances (grunting, throat clearing, sniffing), since the age of 7. There appeared to be no family history of tic disorder. He reported occasional utterance of swear words in contextually inappropriate situations (coprolalia), and the urge to copy other people’s movements (echopraxia). Other tic-associated symptoms included self-injurious behaviours and forced touching of objects. A.B. met both DSM-IV-tr and ICD-10 criteria for Tourette syndrome, and also DSM-IV-tr criteria for attention deficit hyperactivity disorder (combined type) in childhood
The World Starts With Me: using intervention mapping for the systematic adaptation and transfer of school-based sexuality education from Uganda to Indonesia
Evidence-based health promotion programmes, including HIV/AIDS prevention and sexuality education programmes, are often transferred to other cultures, priority groups and implementation settings. Challenges in this process include the identification of retaining core elements that relate to the programme’s effectiveness while making changes that enhances acceptance in the new context and for the new priority group. This paper describes the use of a systematic approach to programme adaptation using a case study as an example. Intervention Mapping, a protocol for the development of evidence-based behaviour change interventions, was used to adapt the comprehensive school-based sexuality education programme ‘The World Starts With Me’. The programme was developed for a priority population in Uganda and adapted to a programme for Indonesian secondary school students. The approach helped to systematically address the complexity and challenges of programme adaptation and to find a balance between preservation of essential programme elements (i.e. logic models) that may be crucial to the programme’s effectiveness, including key objectives and theoretical behaviour change methods, and the adaptation of the programme to be acceptable to the new priority group and the programme implementers
Behavioral Sequence Analysis Reveals a Novel Role for ß2* Nicotinic Receptors in Exploration
Nicotinic acetylcholine receptors (nAChRs) are widely expressed throughout the
central nervous system and modulate neuronal function in most mammalian brain
structures. The contribution of defined nAChR subunits to a specific behavior is
thus difficult to assess. Mice deleted for ß2-containing nAChRs
(ß2−/−) have been shown to be hyperactive in an
open-field paradigm, without determining the origin of this hyperactivity. We
here develop a quantitative description of mouse behavior in the open field
based upon first order Markov and variable length Markov chain analysis focusing
on the time-organized sequence that behaviors are composed of. This description
reveals that this hyperactivity is the consequence of the absence of specific
inactive states or “stops”. These stops are associated with
a scanning of the environment in wild-type mice (WT), and they affect the way
that animals organize their sequence of behaviors when compared with stops
without scanning. They characterize a specific “decision
moment” that is reduced in ß2−/− mutant
mice, suggesting an important role of ß2-nAChRs in the strategy used
by animals to explore an environment and collect information in order to
organize their behavior. This integrated analysis of the displacement of an
animal in a simple environment offers new insights, specifically into the
contribution of nAChRs to higher brain functions and more generally into the
principles that organize sequences of behaviors in animals
Esophageal Cancer Related Gene-4 Is a Choroid Plexus-Derived Injury Response Gene: Evidence for a Biphasic Response in Early and Late Brain Injury
By virtue of its ability to regulate the composition of cerebrospinal fluid (CSF), the choroid plexus (CP) is ideally suited to instigate a rapid response to traumatic brain injury (TBI) by producing growth regulatory proteins. For example, Esophageal Cancer Related Gene-4 (Ecrg4) is a tumor suppressor gene that encodes a hormone-like peptide called augurin that is present in large concentrations in CP epithelia (CPe). Because augurin is thought to regulate senescence, neuroprogenitor cell growth and differentiation in the CNS, we evaluated the kinetics of Ecrg4 expression and augurin immunoreactivity in CPe after CNS injury. Adult rats were injured with a penetrating cortical lesion and alterations in augurin immunoreactivity were examined by immunohistochemistry. Ecrg4 gene expression was characterized by in situ hybridization. Cell surface augurin was identified histologically by confocal microscopy and biochemically by sub-cellular fractionation. Both Ecrg4 gene expression and augurin protein levels were decreased 24–72 hrs post-injury but restored to uninjured levels by day 7 post-injury. Protein staining in the supraoptic nucleus of the hypothalamus, used as a control brain region, did not show a decrease of auguin immunoreactivity. Ecrg4 gene expression localized to CPe cells, and augurin protein to the CPe ventricular face. Extracellular cell surface tethering of 14 kDa augurin was confirmed by cell surface fractionation of primary human CPe cells in vitro while a 6–8 kDa fragment of augurin was detected in conditioned media, indicating release from the cell surface by proteolytic processing. In rat CSF however, 14 kDa augurin was detected. We hypothesize the initial release and proteolytic processing of augurin participates in the activation phase of injury while sustained Ecrg4 down-regulation is dysinhibitory during the proliferative phase. Accordingly, augurin would play a constitutive inhibitory function in normal CNS while down regulation of Ecrg4 gene expression in injury, like in cancer, dysinhibits proliferation
Exploring factors that influence the spread and sustainability of a dysphagia innovation: an instrumental case study
Background: Swallowing difficulties challenge patient safety due to the increased risk of malnutrition, dehydration
and aspiration pneumonia. A theoretically driven study was undertaken to examine the spread and sustainability of
a locally developed innovation that involved using the Inter-Professional Dysphagia Framework to structure
education for the workforce. A conceptual framework with 3 spread strategies (hierarchical control, participatory
adaptation and facilitated evolution) was blended with a processual approach to sustaining organisational change.
The aim was to understand the processes, mechanism and outcomes associated with the spread and sustainability
of this safety initiative.
Methods: An instrumental case study, prospectively tracked a dysphagia innovation for 34 months (April 2011
to January 2014) in a large health care organisation in England. A train-the-trainer intervention (as participatory
adaptation) was deployed on care pathways for stroke and fractured neck of femur. Data were collected at the
organisational and clinical level through interviews (n = 30) and document review. The coding frame combined
the processual approach with the spread mechanisms. Pre-determined outcomes included the number of staff
trained about dysphagia and impact related to changes in practice.
Results: The features and processes associated with hierarchical control and participatory adaptation were
identified. Leadership, critical junctures, temporality and making the innovation routine were aspects of hierarchical
control. Participatory adaptation was evident on the care pathways through stakeholder responses, workload and
resource pressures. Six of the 25 ward based trainers cascaded the dysphagia training. The expected outcomes
were achieved when the top-down mandate (hierarchical control) was supplemented by local engagement and
support (participatory adaptation).
Conclusions: Frameworks for spread and sustainability were combined to create a ‘small theory’ that described
the interventions, the processes and desired outcomes a priori. This novel methodological approach confirmed
what is known about spread and sustainability, highlighted the particularity of change and offered new insights
into the factors associated with hierarchical control and participatory adaptation. The findings illustrate the dualities
of organisational change as universal and context specific; as particular and amendable to theoretical generalisation.
Appreciating these dualities may contribute to understanding why many innovations fail to become routine
Can the outcome of pelvic-floor rehabilitation in patients with fecal incontinence be predicted?
Purpose: Pelvic-floor rehabilitation does not provide the same degree of relief in all fecal incontinent patients. We aimed at studying prospectively the ability of tests to predict the outcome of pelvic-floor rehabilitation in patients with fecal incontinence. Materials and methods: Two hundred fifty consecutive patients (228 women) underwent medical history and a standardized series of tests, including physical examination, anal manometry, pudendal nerve latency testing, anal sensitivity testing, rectal capacity measurement, defecography, endoanal sonography, and endoanal magnetic resonance imaging. Subsequently, patients were referred for pelvic-floor rehabilitation. Outcome of pelvic-floor rehabilitation was quantified by the Vaizey incontinence score. Linear regression analyses were used to identify candidate predictors and to construct a multivariable prediction model for the posttreatment Vaizey score. Results: After pelvic-floor rehabilitation, the mean baseline Vaizey score (18, SD±3) was reduced with 3.2 points (p<0.001). In addition to the baseline Vaizey score, three elements from medical history were significantly associated with the posttreatment Vaizey score (presence of passive incontinence, thin stool consistency, primary repair of a rupture after vaginal delivery at childbed) (R2, 0.18). Th
DAX-1 expression in human breast cancer: comparison with estrogen receptors ER-α, ER-β and androgen receptor status
BACKGROUND: So far there have been no reports on the expression pattern of DAX-1 (dosage-sensitive sex reversal, adrenal hypoplasia critical region, on chromosome X, gene 1) in human breast cells and its relationship to the estrogen receptors, ER-α and ER-β, and the androgen receptor (AR). METHODS: In this study we evaluated, by immunohistochemistry and Western blot analysis, the presence and distribution of DAX-1 in benign breast disease (BBD), in situ carcinoma (CIS), and ductal and lobular breast carcinomas. RESULTS: In BBD and breast carcinomas, DAX-1 was present in both the nuclei and the cytoplasm of epithelial cells, although in infiltrative carcinomas the percentage of nuclear immunoreaction was higher than in CIS. An important relation was observed between DAX-1 and AR expression and between this orphan receptor and nodal status. CONCLUSION: DAX-1 might modify the AR and ER-β intracellular location, and because a direct positive relation between the expression of these three receptors was found it could be assumed that the presence of DAX-1 in neoplastic cells might indicate a possible failure of endocrine therapies
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