Therapeutic strategy in the form of communication in the children with the autism spectrum disorders - narrative review

Autism spectrum disorders (ASD) is a neurodevelopmental disorder influenced by a number of genetic and environmental factors. It is characterized by a broad range of symptoms, particularly in the areas of communication and language, which pose a therapeutic challenge for both parents and therapists.   This article, based on a review of available studies on PubMed, presents therapeutic methods based on functional communication strategies and ways to implement them as a form of treatment for children with the autism spectrum disorders.   The major goals of ASD treatment are socialization and communication skills improvement and current treatments are not based on pharmacological therapies, but on behavioral therapies. Through appropriate speech development and practical communication strategies that are based on techniques like motivating the child to create eye contact with an adult, it is possible to realize the development of proper communication. These strategies are a form of therapy and allow for the improvement of the child's communication on multiple levels and shaping the social attitudes. Incorporating suitable therapeutic communication techniques enables the development and enhancement of social skills in children with autism spectrum disorders. Children with ASD benefit from appropriate communication because it helps them communicate their needs, understand the social norms, and improve their quality of life

Combination of psycho- and pharmacotherapy as a modern method of treatment of Alzheimer's disease.

Introduction: Alzheimer's disease is a degenerative disease of the brain, caused by the deposition of beta-amyloid and tau protein. It is characterized by progressive memory and behavior disorders which, over time, completely prevent the patient from functioning properly in everyday life, performing work and disrupting social contacts. Communication problems arise and patients forget more and more words. Unfortunately, we are not able to completely stop the progression of this disease, but we can only delay its development. To delay the progression of the disease, pharmacotherapy includes acetylcholinesterase inhibitors and NMDA receptor antagonists. Matherials and methods: This article, based on a PubMed review of available research, examines the impact of rivastigmine, donepezil, memantine and psychotherapy on delaying disease progression. Results: A number of studies have investigated the effect of 6-12 milligrams of rivastigmine, 10 milligrams of donepezil and 20 milligrams of memantine on patients' ability to communicate. The results were checked using the MMSE, ADAS or SIB scales and interviews conducted regularly by clinicians. In addition, patients were subjected to various forms of psychotherapy, including reminiscence therapy and cognitive therapy. All groups experienced significantly less deterioration in their functional stage of disease compared to the placebo groups. Conclusions: The best results in the treatment of Alzheimer's disease can be obtained by combining pharmacological therapy with non-pharmacological effects. Thanks to this form of treatment, the progression of the disease is delayed, and patients retain their communication abilities for longer

Biomechanical Changes During a 90º Cut in Collegiate Female Soccer Players With Participation in the 11+

# Background Valgus collapse and high knee abduction moments have been identified as biomechanical risk factors for ACL injury. It is unknown if participation in the 11+, a previously established, dynamic warm-up that emphasizes biomechanical technique and reduces ACL injury rates, reduces components of valgus collapse during a 90º cut. # Hypothesis/Purpose To determine whether participation in the 11+ during a single soccer season reduced peak knee abduction moment and components of valgus collapse during a 90º cut in collegiate female soccer players. # Study Design Prospective cohort study # Methods Forty-six participants completed preseason and postseason motion analysis of a 90º cut. During the season, 31 players completed the 11+ and 15 players completed their typical warm-up (control group). Peak knee abduction moment, components of valgus collapse (hip adduction, internal rotation, and knee abduction angles), and a novel measure of knee valgus collapse were analyzed with repeated-measures ANOVAs to determine differences between preseason and postseason. Smallest detectable change (SDC) and minimal important difference (MID) values were applied to contextualize results. # Results There was a significant main effect of time for non-dominant knee valgus collapse (p=0.03), but decreases in non-dominant knee valgus collapse only exceeded the SDC in the intervention team. # Conclusions Clinically meaningful decreases in knee valgus collapse may indicate a beneficial biomechanical effect of the 11+. Participation in the 11+ may lower ACL injury risk by reducing valgus collapse during a 90º cut. # Level of Evidence 2

Moist Static Energy Budget Analysis of Tropical Cyclone Intensification in High-Resolution Climate Models

Tropical cyclone intensification processes are explored in six high-resolution climate models. The analysis framework employs process-oriented diagnostics that focus on how convection, moisture, clouds, and related processes are coupled. These diagnostics include budgets of column moist static energy and the spatial variance of column moist static energy, where the column integral is performed between fixed pressure levels. The latter allows for the quantification of the different feedback processes responsible for the amplification of moist static energy anomalies associated with the organization of convection and cyclone spinup, including surface flux feedbacks and cloud-radiative feedbacks. Tropical cyclones (TCs) are tracked in the climate model simulations and the analysis is applied along the individual tracks and composited over many TCs. Two methods of compositing are employed: a composite over all TC snapshots in a given intensity range, and a composite over all TC snapshots at the same stage in the TC life cycle (same time relative to the time of lifetime maximum intensity for each storm). The radiative feedback contributes to TC development in all models, especially in storms of weaker intensity or earlier stages of development. Notably, the surface flux feedback is stronger in models that simulate more intense TCs. This indicates that the representation of the interaction between spatially varying surface fluxes and the developing TC is responsible for at least part of the intermodel spread in TC simulation

Azimuthally Averaged Wind and Thermodynamic Structures of Tropical Cyclones in Global Climate Models and Their Sensitivity to Horizontal Resolution

Characteristics of tropical cyclones (TCs) in global climate models (GCMs) are known to be influenced by details of the model configurations, including horizontal resolution and parameterization schemes. Understanding model-to-model differences in TC characteristics is a prerequisite for reducing uncertainty in future TC activity projections by GCMs. This study performs a process-level examination of TC structures in eight GCM simulations that span a range of horizontal resolutions from 1° to 0.25°. A recently developed set of process-oriented diagnostics is used to examine the azimuthally averaged wind and thermodynamic structures of the GCM-simulated TCs. Results indicate that the inner-core wind structures of simulated TCs are more strongly constrained by the horizontal resolutions of the models than are the thermodynamic structures of those TCs. As expected, the structures of TC circulations become more realistic with smaller horizontal grid spacing, such that the radii of maximum wind (RMW) become smaller, and the maximum vertical velocities occur off the center. However, the RMWs are still too large, especially at higher intensities, and there are rising motions occurring at the storm centers, inconsistently with observations. The distributions of precipitation, moisture, and radiative and surface turbulent heat fluxes around TCs are diverse, even across models with similar horizontal resolutions. At the same horizontal resolution, models that produce greater rainfall in the inner-core regions tend to simulate stronger TCs. When TCs are weak, the radial gradient of net column radiative flux convergence is comparable to that of surface turbulent heat fluxes, emphasizing the importance of cloud–radiative feedbacks during the early developmental phases of TCs

Hurricanes and Climate: The U.S. CLIVAR Working Group on Hurricanes

While a quantitative climate theory of tropical cyclone formation remains elusive, considerable progress has been made recently in our ability to simulate tropical cyclone climatologies and to understand the relationship between climate and tropical cyclone formation. Climate models are now able to simulate a realistic rate of global tropical cyclone formation, although simulation of the Atlantic tropical cyclone climatology remains challenging unless horizontal resolutions finer than 50 km are employed. This article summarizes published research from the idealized experiments of the Hurricane Working Group of U.S. Climate and Ocean: Variability, Predictability and Change (CLIVAR). This work, combined with results from other model simulations, has strengthened relationships between tropical cyclone formation rates and climate variables such as midtropospheric vertical velocity, with decreased climatological vertical velocities leading to decreased tropical cyclone formation. Systematic differences are shown between experiments in which only sea surface temperature is increased compared with experiments where only atmospheric carbon dioxide is increased. Experiments where only carbon dioxide is increased are more likely to demonstrate a decrease in tropical cyclone numbers, similar to the decreases simulated by many climate models for a future, warmer climate. Experiments where the two effects are combined also show decreases in numbers, but these tend to be less for models that demonstrate a strong tropical cyclone response to increased sea surface temperatures. Further experiments are proposed that may improve our understanding of the relationship between climate and tropical cyclone formation, including experiments with two-way interaction between the ocean and the atmosphere and variations in atmospheric aerosols

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised