International classification of functioning, disability and health core sets for children and youth with cerebral palsy: a consensus meeting

AIM: The objective of this article is to report on the Core Sets developed for children and youth aged 0 to 18 years, with cerebral palsy (CP) based on the pediatric International Classification of Functioning, Disability and Health (ICF) by the World Health Organization (WHO).METHOD: A formal decision-making and consensus process integrating evidence gathered from preparatory studies was followed. Preparatory studies included: a systematic literature review; an international expert survey; a qualitative study of children and youth with CP and their caregivers; and a clinical study. Relevant ICF categories were identified in a formal consensus process by international experts from different backgrounds. Twenty-six international experts chosen by WHO region with expertise in CP attended the consensus meeting.RESULTS: Overall, five ICF Core Sets were developed: a Comprehensive Core Set (135 ICF categories); a Common Brief (25 ICF categories); and three age-specific Core Sets: under 6 years (31 ICF categories), from 6 to &lt;14 years (35 ICF categories) and from 14 to 18 years (37 ICF categories).INTERPRETATION: These ICF Core Sets for children and youth with CP are the first ICF-based tools developed for this population. The ICF Core Sets for children and youth with CP can be applied in clinical practice, research, teaching and administration. The application of the ICF Core Sets to this population will standardize the functional assessments of CP worldwide.<br/

Left atrial trajectory impairment in hypertrophic cardiomyopathy disclosed by geometric morphometrics and parallel transport

The analysis of full Left Atrium (LA) deformation and whole LA deformational trajectory in time has been poorly investigated and, to the best of our knowledge, seldom discussed in patients with Hypertrophic Cardiomyopathy. Therefore, we considered 22 patients with Hypertrophic Cardiomyopathy (HCM) and 46 healthy subjects, investigated them by three-dimensional Speckle Tracking Echocardiography, and studied the derived landmark clouds via Geometric Morphometrics with Parallel Transport. Trajectory shape and trajectory size were different in Controls versus HCM and their classification powers had high AUC (Area Under the Receiving Operator Characteristic Curve) and accuracy. The two trajectories were much different at the transition between LA conduit and booster pump functions. Full shape and deformation analyses with trajectory analysis enabled a straightforward perception of pathophysiological consequences of HCM condition on LA functioning. It might be worthwhile to apply these techniques to look for novel pathophysiological approaches that may better define atrio-ventricular interaction

Content validity of the comprehensive ICF core set for children with cerebral palsy aged 0-6 years: Iranian occupational therapists perspective

Objectives Comprehensive ICF Core Set of cerebral palsy (CP) includes a set of functions of children with CP has been created recently. This study determined the content validity of this version based on Iranian Occupational Therapists� perspectives to explore whether the ICF Core Sets for CP include the areas of function of CP in Occupational Therapy practice. Materials & Methods This qualitative study conducted from Feb 2015 to Apr 2016 in Tehran, Iran. Experts were the academic staffs selected through convenience sampling. Content validity of comprehensive ICF-Core Set of CP with 135 ICF categories was done by them. Delphi survey was used for generating consensus on the final version. Participants were 50 clinical Occupational Therapists invited via email from across Iran. An agreement of 75 was considered as the cut-off for inclusion of each code-category. Results About 60 of the code�categories of comprehensive version of ICF Core Set of CP were approved by Occupational Therapists. In the final version, 82 code-categories were listed that included 21 code-categories for Body Functions, 40 for Activity/Participation, and 21 for Environmental Factors. Conclusion The validity of the Iranian ICF Core Set for children with CP aged 0�6 yr was supported by Iranian Occupational Therapists. It could be the basis for evaluation of this population in Occupational Therapy. © 2018, Iranian Child Neurology Society. All rights reserved

First Ex-Vivo Validation of a Radioguided Surgery Technique with beta- Radiation

Purpose: A radio-guided surgery technique with beta- -emitting radio-tracers was suggested to overcome the effect of the large penetration of gamma radiation. The feasibility studies in the case of brain tumors and abdominal neuro-endocrine tumors were based on simulations starting from PET images with several underlying assumptions. This paper reports, as proof-of-principle of this technique, an ex-vivo test on a meningioma patient. This test allowed to validate the whole chain, from the evaluation of the SUV of the tumor, to the assumptions on the bio-distribution and the signal detection. Methods: A patient affected by meningioma was administered 300 MBq of 90Y-DOTATOC. Several samples extracted from the meningioma and the nearby Dura Mater were analyzed with a beta- probe designed specifically for this radio-guided surgery technique. The observed signals were compared both with the evaluation from the histology and with the Monte Carlo simulation. Results: we obtained a large signal on the bulk tumor (105 cps) and a significant signal on residuals of $\sim$0.2 ml (28 cps). We also show that simulations predict correctly the observed yields and this allows us to estimate that the healthy tissues would return negligible signals (~1 cps). This test also demonstrated that the exposure of the medical staff is negligible and that among the biological wastes only urine has a significant activity. Conclusions: This proof-of-principle test on a patient assessed that the technique is feasible with negligible background to medical personnel and confirmed that the expectations obtained with Monte Carlo simulations starting from diagnostic PET images are correct.Comment: 17 pages, 4 Figs, Accepted by Physica Medic

Reclutamiento de la merluza argentina, Merluccius hubbsi, del stock patagónico: una revisión de las principales características que afectan el potencial reproductivo y la supervivencia durante las primeras etapas de la vida

Understanding the causes that generate variability of recruitment in marine populations constitutes one of the greatest challenges in fishery science. Our predictive capacity to explain these variations is relatively low, due to the interaction of exogenous and endogenous factors, which vary across time and space within populations. In order to gain information on recruitment fluctuations of the Argentine hake (Merluccius hubbsi) from Patagonian stock, we reviewed the results obtained analyzing the reproductive ecology, trophic and energetic dynamics during different stages of development of this species, and its relationship with environmental variables. We observed that the reproductive potential is strongly influenced by characteristics of the parental stock, particularly females, in terms of their size, age and condition. This feature, called ‘maternal effect’, suggests that the spawning stock biomass, commonly used as an index of productivity in fishery assessment, is a poor predictor of recruitment. We also observed that survival during hake early life is affected by the spatial coincidence with the North Patagonian Frontal System, characterized by a high concentration of nutrients, high productivity, and food availability. Physical conditions and larval density in the nursery area affected the nutritional state and mortality of hake, mainly by competition for food or predation. It was observed that the transition of juveniles from pelagic to demersal habitat occurs over a longer period than previously recognized for this species, stressing the importance of using acoustic information to complement data from bottom trawls. This is one of the main topics to be further developed in order to estimate new recruitment indices for Argentine hake, along with other research items proposed to improve stock assessment.Comprender las causas que generan la variabilidad del reclutamiento en las poblaciones marinas constituye uno de los mayores desafíos de la ciencia pesquera. Nuestra capacidad predictiva para explicar estas variaciones es relativamente baja, debido a la interacción de factores exógenos y endógenos, que varían en el tiempo y el espacio dentro de las poblaciones. Con el fin de obtener información sobre las fluctuaciones en el reclutamiento de la merluza argentina (Merluccius hubbsi) del stock patagónico, revisamos los resultados obtenidos analizando la ecología reproductiva, la dinámica trófica y energética durante las diferentes etapas de desarrollo de esta especie y su relación con variables ambientales. Observamos que el potencial reproductivo está fuertemente influenciado por las características parentales, particularmente de las hembras, en cuanto a su tamaño, edad y condición. Esta característica, denominada “efecto materno”, sugiere que la biomasa de la población reproductora, comúnmente utilizada como índice de productividad en la evaluación de pesquerías, es un predictor deficiente del reclutamiento. También observamos que la supervivencia durante los primeros años de vida de la merluza se ve afectada por la coincidencia espacial con el Sistema Frontal Norpatagónico, caracterizado por una alta concentración de nutrientes, alta productividad y disponibilidad de alimento. Las condiciones físicas y la densidad larvaria en la zona de crianza afectaron el estado nutricional y la mortalidad de la merluza, principalmente por competencia por alimento o depredación. Se observó que la transición del hábitat pelágico al demersal en los juveniles se produce durante un período más extenso que el reconocido anteriormente para esta especie, lo que destaca la importancia de utilizar los registros acústicos para complementar la información de las redes de arrastre de fondo. Este es uno de los principales temas a desarrollar para estimar nuevos índices de reclutamiento de merluza argentina, junto con otras líneas de investigación propuestas para mejorar la evaluación del stock

Long-term Results of a Randomized Controlled Trial Analyzing the Role of Systematic Pre-operative Coronary Angiography before Elective Carotid Endarterectomy in Patients with Asymptomatic Coronary Artery Disease

ObjectivesTo evaluate the potential benefit of systematic preoperative coronary-artery angiography followed by selective coronary-artery revascularization on the incidence of myocardial infarction (MI) in patients undergoing carotid endarterectomy (CEA) without a previous history of coronary artery disease (CAD).MethodsWe randomised 426 patients who were candidates for CEA, with no history of CAD, a normal electrocardiogram (ECG), and a normal cardiac ultrasound. In group A (n = 216) all patients underwent coronary angiography before CEA. In group B (n = 210) CEA was performed without coronary angiography. Patients were not blinded for relevant assessments during follow-up. Primary end-point was the occurrence of MI at 3.5 years. The secondary end-point was the overall survival rate. Median length of follow-up was 6.2 years.ResultsIn group A, coronary angiography revealed significant coronary artery stenosis in 68 patients (31.5%). Among them, 66 underwent percutaneous Intervention (PCI) prior to CEA and 2 received combined CEA and coronary-artery bypass grafting (CABG). Postoperatively, no MI was observed in group A, whereas 6 MI occurred in group B, one of which was fatal (p = .01).During the study period, 3 MI occurred in group A (1.4%) and 33 were observed in group B (15.7%), 6 of which were fatal. The Cox model demonstrated a reduced risk of MI for patients in group A receiving coronary angiography (HR,.078; 95% CI, 0.024-0.256; p < .001). In addition, patients with diabetes and patients <70 years presented with an increased risk of MI. Survival analysis at 6 years by Kaplan-Meier estimates was 95.6 ± 3.2% in Group A and 89.7 ± 3.7% in group B (Log Rank = 6.54, p = .01).ConclusionsIn asymptomatic coronary-artery patients, systematic coronary angiography prior to CEA followed by selective PCI or CABG significantly reduces the incidence of late MI and increases long-term survival. (ClinicalTrials.gov number, NCT02260453)

Meaningful health outcomes for paediatric neurodisability: stakeholder prioritisation and appropriateness of patient reported outcome measures

BACKGROUND: Health services are increasingly focused on measuring and monitoring outcomes, particularly those that reflect patients' priorities. To be meaningful, outcomes measured should be valued by patients and carers, be consistent with what health professionals seek to achieve, and be robust in terms of measurement properties. The aim of this study was (i) to seek a shared vision between families and clinicians regarding key aspects of health as outcomes, beyond mortality and morbidity, for children with neurodisability, and (ii) to appraise which multidimensional patient reported outcome measures (PROMs) could be used to assess salient health domains. METHODS: Relevant outcomes were identified from (i) qualitative research with children and young people with neurodisability and parent carers, (ii) Delphi survey with health professionals, and (iii) systematic review of PROMs. The International Classification of Functioning Disability and Health provided a common language to code aspects of health. A subset of stakeholders participated in a prioritisation meeting incorporating a Q-sorting task to discuss and rank aspects of health. RESULTS: A total of 33 pertinent aspects of health were identified. Fifteen stakeholders from the qualitative and Delphi studies participated in the prioritisation meeting: 3 young people, 5 parent carers, and 7 health professionals. Aspects of health that emerged as more important for families and targets for health professionals were: communication, emotional wellbeing, pain, sleep, mobility, self-care, independence, mental health, community and social life, behaviour, toileting and safety. Whilst available PROMs measure many aspects of health in the ICF, no single PROM captures all the key domains prioritised as for children and young people with neurodisability. The paucity of scales for assessing communication was notable. CONCLUSIONS: We propose a core suite of key outcome domains for children with neurodisability that could be used in evaluative research, audit and as health service performance indicators. Future work could appraise domain-specific PROMs for these aspects of health; a single measure assessing the key aspects of health that could be applied across paediatric neurodisability remains to be developed