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The practice of neuropsychology offers a unique yet multidimensional approach to clinical assessment, with its emphasis on the Bio-Psycho-Social Model. This chapter addresses a variety of issues that are relevant in our field, beginning with a discussion of the recommended model of training in neuropsychology and purposes of neuropsychological assessment. To give the reader a sense of the current context of neuropsychological assessment, we also describe the most typical work settings and specific issues in each, as well as populations seen and instruments used in our field. We then discuss some aspects of the assessment process that neuropsychologists consider, in addition to common challenges of our clinical and research practice, such as the assessment of practice effects, effort, individuals from diverse cultural and linguistic backgrounds, and general validity issues. We end this chapter with a brief discussion of the future of neuropsychological assessment and how technology may play a key role in shaping the activities and settings of our practice.
‘Hey boss, we have a real challenging case tomorrow. She is a 94-year-old lady with carcinoma of the stomach needing a laparoscopic resection for recurrent bleeding. She could move around the house ok six months ago but has lost a lot of weight over the past few months. On a load of medications for hypertension, diabetes and has atrial fibrillation. Family said she took ages waking up from her last GA. The family reckon the last anaesthetist overdosed her but the doctor said he gave her the usual dose at one MAC. I guess you want to use TIVA… what should I read up on tonight?’
This chapter will examine the model of what I term “politically engaged unionism” in the Las Vegas area as a template for labor-community coalitions in the labor movement of the future. Culinary Workers Union Local 226, an affiliate of UNITE HERE, AFL-CIO (“the Culinary Union”) has focused on being a politically connected union able to obtain results with state and local policymakers, and that political and legislative success has been followed by gains at the bargaining table. In this chapter, I argue that the Culinary Union defies previous distinctions between business unionism and social movement unionism, with lessons for the future of the rest of the labor movement.
Due to their excellent properties, aerogel has attracted the attention of the scientific community to use it in the biomedical area as a drug delivery system. This work reports on the synthesis and characterization of ZrO2 aerogels and cryogels obtained by the sol-gel method. The influence of different cetyltrimethylammonium bromide (CTAB) and the type of drying on structural, morphological and texture properties of ZrO2 aerogels and cryogels was investigated. SEM images reveal that a porous interconnected three-dimensional network was formed into aerogels due to supercritical drying. Zirconia aerogel sample has a specific surface area (SBET) larger than zirconia cryogels. Therefore, our results indicate that zirconia aerogel is an adequate material for applications in drug delivery systems.
In this work, the anodization of grade 2 titanium was performed using a HCl-based electrolyte in order to obtain Titania nanostructures. Different glycerol concentrations were added to the HCl electrolyte to study the effect it has on the shape and density of the nanostructures, additionally, anodization time and voltage was also varied. The anodized samples were observed by SEM microscopy and studied by Raman spectroscopy and X-ray diffraction. Raman spectroscopy and XRD showed the formation of the anatase phase of the TiO2. By SEM it was possible to observe several changes in the shape of the structures, by adding glycerol ball-like structures were visible, anodization time did not change the shape of the nanostructures. However, the voltage variation showed a clear control on the shape of the structures, forming nanotubes at higher voltages. It was concluded that a better control of the shape and density of the nanostructures is achieved by adding glycerol, however, in order to overcome the resistance that the electrolyte brings, higher voltages are required.
This article describes a project intended to promote access to electroacoustic music for children and teenagers aged 6 to 15 years in a socially and educationally disadvantaged rural community in Michoacán, Mexico. It explores an educational model of teaching, learning and creation of electroacoustic music through the use of music technology and pedagogy based on constructivism and Paulo Freire’s ideas on education as a practice of freedom. It provides a pedagogical reflection on the processes of learning and appreciation of this new music. The project includes the use of an interactive music system – implemented in MaxMSP using a mobile phone OSC app to control space and its interaction with timbre, pitch and duration – as an aid in the classroom and its implementation in an educational programme with a social impact. The research covered in this article could be taken into account to deliver new music education in rural communities with similar socioeconomic circumstances.
We investigated whether Tagalog-speaking children incrementally interpret the first noun as the agent, even if verbal and nominal markers for assigning thematic roles are given early in Tagalog sentences. We asked five- and seven-year-old children and adult controls to select which of two pictures of reversible actions matched the sentence they heard, while their looks to the pictures were tracked. Accuracy and eye-tracking data showed that agent-initial sentences were easier to comprehend than patient-initial sentences, but the effect of word order was modulated by voice. Moreover, our eye-tracking data provided evidence that, by the first noun phrase, seven-year-old children looked more to the target in the agent-initial compared to the patient-initial conditions, but this word order advantage was no longer observed by the second noun phrase. The findings support language processing and acquisition models which emphasize the role of frequency in developing heuristic strategies (e.g., Chang, Dell, & Bock, 2006).
Rotavirus (RV) is the main cause of acute gastroenteritis (AGE) in young children. The San Luis province of Argentina introduced RV vaccination in May 2013. We estimate vaccine impact (RVI) using real-world data. Data on all-cause AGE cases and AGE-related hospitalisations for San Luis and the adjacent Mendoza province (control group) were obtained and analysed by interrupted time-series methods. Regardless of the model used for counterfactual predictions, we estimated a reduction in the number of all-cause AGE cases of 20–25% and a reduction in AGE-related hospitalisations of 55–60%. The vaccine impact was similar for each age group considered (<1 year, <2 years and <5 years). RV vaccination was estimated to have reduced direct medical costs in the province by about 4.5 million pesos from May 2013 to December 2014. Similar to previous studies, we found a higher impact of RV vaccination in preventing severe all-cause AGE cases requiring hospitalisation than in preventing all-cases AGE cases presenting for medical care. An assessment of the economic value of RV vaccination could take other benefits into account in addition to the avoided medical costs and the costs of vaccination.
New dietary-based concepts are needed for treatment and effective prevention of overweight and obesity. The primary objective was to investigate if reduction in appetite is associated with improved weight loss maintenance. This cohort study was nested within the European Commission project Satiety Innovation (SATIN). Participants achieving ≥8% weight loss during an initial 8-week low-energy formula diet were included in a 12-week randomised double-blind parallel weight loss maintenance intervention. The intervention included food products designed to reduce appetite or matching controls along with instructions to follow national dietary guidelines. Appetite was assessed by ad libitum energy intake and self-reported appetite evaluations using visual analogue scales during standardised appetite probe days. These were evaluated at the first day of the maintenance period compared with baseline (acute effects after a single exposure of intervention products) and post-maintenance compared with baseline (sustained effects after repeated exposures of intervention products) regardless of randomisation. A total of 181 participants (forty-seven men and 134 women) completed the study. Sustained reduction in 24-h energy intake was associated with improved weight loss maintenance (R 0·37; P = 0·001), whereas the association was not found acutely (P = 0·91). Suppression in self-reported appetite was associated with improved weight loss maintenance both acutely (R −0·32; P = 0·033) and sustained (R −0·33; P = 0·042). Reduction in appetite seems to be associated with improved body weight management, making appetite-reducing food products an interesting strategy for dietary-based concepts.
The aim of this study was to translate, culturally adapt, and psychometrically evaluate the Brazilian version of the “End-of-Life Professional Caregiver Survey” (BR-EPCS).
This is an observational cross-sectional study. The sample was composed of 285 Brazilian healthcare professionals who work or worked in the palliative care area. A minimum number of 280 participants were established, following the recommendation of 10 subjects for each instrument item. The European Organisation for Research and Treatment of Cancer — Quality of Life Group Translation Procedure protocol was used for the translation and the cultural adaptation. For the precise/reliable evaluation of factors measured by the BR-EPCS, Cronbach's alpha (α) and composite reliability coefficients were used. The factorial analyses were made by means of the exploratory structural equation modeling methods and confirmatory factor analysis. We have conducted a multiple linear regression analysis to evaluate the sociodemographic variables' capabilities in the result prediction measured by BR-EPCS factors.
The factorial analysis showed the relevance of two factors: Factor 1 — “Given care effectiveness” (18 items; Cronbach's α = 0.94; Composite Reliability = 0.95) and Factor 2 — “Mourning and ethical and cultural values” (10 items; Cronbach's α = 0.89; Composite Reliability = 0.88). Multiple linear regression analyses revealed that the working time, sex, palliative care training, and its own advance directives are predictors of the constructs assessed by the BR-EPCS.
Significance of results
The BR-EPCS is a reliable, valid, and culturally appropriate tool to identify the educational needs of healthcare professionals who work with palliative care. This instrument can be used for educational and research reasons.
Nursing assessments have been recommended for the daily screening for delirium; however, the utility of individual items have not yet been tested. In a first step in establishing the potential of the electronic Patient Assessment-Acute Care (ePA-AC) as such, the impact of delirium on the functional domains was assessed.
In this prospective observational cohort study, 277 patients were assessed and 118 patients were delirious. The impact of delirium on functional domains of the ePA-AC related to self-initiated activity, nutrition, and elimination was determined with simple logistic regressions.
Patients with delirium were older, sicker, were more commonly sedated during the assessment, stayed longer in the intensive care unit (ICU) and floors, and less commonly discharged home. A general pattern was the loss of abilities and full functioning equivalent to global impairment. For self-initiated mobility, in and out of the bed sizable limitations were noted and substantial inability to transfer caused friction and shearing. Similarly, any exhaustion and fatigue were associated with delirium. For self-initiated grooming and dressing, the impairment was greater in the upper body. Within the nutritional domain, delirium affected self-initiated eating and drinking, the amount of food and fluids, energy and nutrient, as well as parenteral nutrition requirement. In delirious patients, the fluid demand was rather increased than decreased, tube feeding more often required and dysphagia occurred. For the elimination domain, urination was not affected — of note, most patients were catheterized, whereas abilities to initiate or control defecation were affected.
Significance of results
Delirium was associated with sizable impairment in the level of functioning. These impairments could guide supportive interventions for delirious patients and perspectively implement nursing instruments for delirium screening.
In the territory between the Amazon and Orinoco rivers in the late sixteenth century, Sir Walter Raleigh observed natives use arrows with a “poison” so strong that its victims died, not by direct physical injury, but rather by the perishing effect of its poison. Curiosity in this substance by European explorers helped transform curare from an arrow poison to a surgical relaxant. The introduction of muscle relaxants revolutionized anesthetic practice as it allowed for improved surgical conditions, lower levels of volatile anesthetics, and improved tracheal intubation conditions.
In the present investigation, biocomposites were synthesized from a polymeric alginate matrix in which the carrot residue and a natural bentonite (ANat / Bio) or an iron-modified clinoptilolite-type zeolite (ZFe / Bio) were supported. Their properties were evaluated adsorbents in contact with aqueous solutions of methylene blue (MB). In the first hour of contact, 46% removal was obtained for the ZFe / Bio biocomposite and 60% for the ANat / Bio biocomposite; reaching 100% removal for the ZFe / Bio biocomposite and 98% for the ANat / Bio biocomposite after 24 hours. The biocomposites were characterized by Scanning Electron Microscopy (SEM) and Fourier Transformed Infrared Spectroscopy (FTIR).
The aim of the current study was to examine the heterogeneity of functional outcomes in first episode psychosis (FEP) patients and related clinical, neurocognitive and sociodemographic factors using a cluster analytic approach.
A large sample of FEP patients (N = 209) was functionally reassessed 10 years after the first contact with an early intervention service. Multiple baseline, 3-year and 10-year follow-up variables were explored.
The cluster analysis emphasized the existence of six independent clusters of functioning: one cluster was normal overall (42.16%), two clusters showed moderate interpersonal (9.63%) or instrumental (12.65%) deficits, two clusters showed more severe interpersonal (12.05%) or interpersonal and instrumental (13.85%) deficits and there was a significantly overall impaired cluster (9.63%). Cluster comparisons showed that several baseline and follow-up factors were differentially involved in functional outcomes.
The current study demonstrated that distinct clusters of functioning in FEP patients can be identified. The fact that a variety of profiles was observed contributes to a better understanding of the nature of the heterogeneity characterizing FEP patients and has clinical implications for developing individualized treatment plans.
Previous researchers have examined the frequency at which healthy participants obtain one or more low scores on neuropsychological test batteries, proposing five psychometric principles of multivariate base rates: (a) low scores are common, with their frequency contingent on (b) the low score cutoff used, (c) the number of tests administered/interpreted, and (d) the demographic characteristics and (e) intelligence of participants. The current study explored whether these principles applied to high scores as well, using the Delis-Kaplan Executive Function System (D-KEFS).
Multivariate base rates of high scores (≥75th, ≥84th, ≥91st, ≥95th, and ≥98th percentiles) were derived for a three-test, four-test, and full D-KEFS battery, using the adult portion of the normative sample (aged 16–89 years; N = 1050) stratified by education and intelligence. The full D-KEFS battery provides 16 total achievement scores (primary indicators of executive function).
High scores occurred commonly for all batteries. For the three-test battery, 24.1% and 12.4% had 1 or more scores ≥95th percentile and ≥98th percentile, respectively. High scores occurred more often for longer batteries: 61.6%, 72.9%, and 87.8% obtained 1 or more scores ≥84th percentile for the three-test, four-test, and full batteries, respectively. The frequency of high scores increased with more education and higher intelligence.
The principles of multivariate base rates also applied to high D-KEFS scores: high scores were common and contingent on the cutoff used, number of tests administered/interpreted, and education/intelligence of examinees. Base rates of high scores may help clinicians identify true cognitive strengths and detect cognitive deficits in high functioning people.
In this work, the effect of γ-radiation on the decomposition of adenine dissolved in distilled water, saline solutions and artificial seawater was studied. As the composition of the major cations and anions of artificial seawater probably better resembles the composition of seawater on the Earth 4.0 billion years ago, this seawater was named artificial seawater 4.0 Ga. The main finding in this work is that artificial seawater 4.0 Ga demonstrated a better protective effect of adenine against γ-radiation. In addition, artificial seawater 4.0 Ga showed that adenine had no changes in pH after radiation exposure and the minor radiation-chemical yield G. The radiolysis of adenine promoted modifications in Fourier-transform infrared spectra. The deconvolution of some bands demonstrated the formation of a new frequency at 1713 cm−1. High performance liquid chromatography-mass detected a product of decomposition with 151 atomic units. Using the geometry optimization and simulated vibrational spectra it was possible to show that the main species formed are hydroxyl and oxide modified adenine. The data point to the formation of hydroxyl-adenine and adenine Nx-oxide. These products have biological relevance and could be available for chemical evolution.
As the Inca Empire was predominantly agrarian, the integration of local farming communities into a corporate agricultural system constituted a great challenge for the imperial political economy. The authors thus analyse an unusual circular structure in the Altos de Arica region of northern Chile, which resembles an important building—called ‘sunturhuasi’—in the capital, Cusco. They explore this structure using three-dimensional modelling, identifying its probable use in astronomical observations and hence its clear connection with the Inca agricultural calendar, ultimately suggesting that it was central to an imperial built environment related to the political economy of maize production.
This work presents the synthesis and characterization of a pearylated polysiloxane material (PAP) from a polycondensation reaction, followed by functionalization with HClSO3 by an electrophilic substitution reaction. According to the characterization techniques applied, a sulfonated pearylated polysiloxane was also obtained, (SPAP). The purpose of this sulfonated material is to obtain an ionomer able to be applied in hydrogen fuel cells of the proton exchange membrane kind (PEMFC). The reaction to produce the polysiloxane precursor was carried out with the commercial reagents: PhSiCl3, Ph2SiCl2 and Ph3SiCl in anhydrous THF at 75 °C and the SPAP material was obtained by sulfonation of the precursor with chlorosulfonic acid. PAP and SPAP were characterized by 1H, NMR for liquids, 29Si NMR for solids, IR-ATR, SEM, and cyclic voltammetry. The NMR 29Si spectra show that PAP and PAPS contain crosslinking regions due to PhSiCl3, growing chain zones due to Ph2SiCl2 and polymer termination zones due to Ph3SiCl, obtaining a mixture of siloxanes. The analysis by cyclic voltammetry indicates that by integrating the area under the curve of the adsorption peaks of H2, a value of 0.062 mC/cm2 is obtained, a value close to the commercial ionomer of Nafion®.
Scaffolds based on two different geometries were constructed by additive manufacturing: one based on a triply periodic minimal surface, the Schwarz D surface, and the other based on a rectangular geometry with orthogonal through-holes. For construction of the scaffolds, two different materials were used: polylactic acid (PLA) in filament form and alumina in printable paste form. The structure of the resulting scaffolds was characterized via X-ray diffraction and scanning electron microscopy, and cell proliferation was assessed for each geometry and material, using fluorescence microscopy and DNA quantification via NanoDrop. Additive manufacturing allowed us to obtain scaffolds with the assessed materials while guaranteeing the interconnectivity of the pores in each one. The curved surfaces constructed with PLA were more favorable for cell attachment and proliferation of the CHO-K1 cell line.