Trunk Recovery Scale: a new tool to measure posture control in patients with severe acquired brain injury. A study of the psychometric properties.

BACKGROUND: Posture control appears deeply impaired in patients with severe Acquired Brain Injury (ABI). One of the main goals of neurorehabilitation specialists is to try to assess this neural function in a standardized manner. However, the tests available to evaluate posture control recovery after brain damage were developed for patients with focal neurological signs. We therefore developed a new test, the Trunk Recovery Scale (TRS). AIM: To evaluate the inter-rater reliability, internal consistency, external validity, and sensitivity of TRS in patients with ABI. DESIGN: Validation study. SETTING: We examined 59 patients hospitalized after a brain injury in the Intensive and the Extensive Rehabilitation Units of our hospital. POPULATION: Patients with diagnosis of severe ABI with the capacity to respond to simple verbal orders and with a Level of Cognitive Functioning Scale (LCF scale) ≥ 4. METHODS: Three raters independently assessed 20 subjects. One of the raters also assessed 39 additional subjects using TRS, Trunk Control Test (TCT), and Functional Independence Measure (FIM), and repeated the evaluation after 30 days. RESULTS: The Inter-rater reliability was generally high (ICC=0,97 and 0,92 for total score and different subscales). Weighted Kappa values indicated "substantial agreement" except for items 2, 7, and 12. Internal consistency was good: Cronbach's coefficients were 0.900 and 0.910 for different subscales, and the elimination of one item at a time did not substantially improve the internal consistency. External validity was excellent (Spearman rank correlations =0.943 and 0.849 for TCT and FIM). Sensitivity was good. CONCLUSIONS: Our data confirm that TRS reliably assesses posture control in patients with severe ABI. However, as the sample size of internal consistency and validity was limited, the results may be overestimated. We therefore propose that this study be considered the first in a series of similar studies. This series should include a Rasch Analysis, which would further evaluate the suitability of keeping or removing items with less consistency and would define the mathematical properties of different subscales and the total score. CLINICAL REHABILITATION IMPACT: Our data confirm that TRS detects subtle but potentially meaningful motor changes in patients and can therefore allow clinicians to document treatment effectiveness and define treatment objectives.

Atomic and electronic structure of ultrathin fluoride barrier layers at the oxide/Si interface.

A SrF(2) ultrathin barrier layer on Si(001) is used to form a sharp interface and block reactivity and intermixing between the semiconductor and a Yb(2)O(3) overlayer. Yb(2)O(3)/Si(001) and Yb(2)O(3)/SrF(2)/Si(001) interfaces grown in ultra high vacuum by molecular beam epitaxy are studied by photoemission and x-ray absorption fine structure. Without the fluoride interlayer, Yb(2)O(3)/Si(001) presents an interface reacted region formed by SiO(x) and/or silicate compounds, which is about 9 Å thick and increases up to 14-15 Å after annealing at 500-700 °C. A uniform single layer of SrF(2) molecules blocks intermixing and reduces the oxidized Si region to 2.4 Å after deposition and to 3.5 Å after annealing at 500 °C. In both cases we estimate a conduction band offset and a valence band offset of ∼ 1.7 eV and 2.4 eV between the oxide and Si, respectively. X-ray absorption fine structure measurements at the Yb L(III) edge suggest that the Yb oxide films exhibit a significant degree of static disorder with and without the fluoride barrier. Sr K edge measurements indicate that the ultrathin fluoride films are reacted, with the formation of bonds between Si and Sr; the Sr-Sr and Sr-F interatomic distances in the ultrathin fluoride barrier film are relaxed to the bulk value.

Contrast-enhanced sonography in early kidney graft dysfunction.

OBJECTIVES: The aim of this study was a comparison of contrast-enhanced sonography (CEUS) and power Doppler ultrasound (US) findings in renal grafts within 30 days posttransplantation. METHODS: A total of 39 kidney recipients underwent CEUS (SonoVue bolus injection) and US examinations at 5 (T0), 15 (T1), and 30 (T2) days after grafting. The results were correlated with clinical findings and functional evolution. Fourteen patients displayed early acute kidney dysfunction: 10 had acute tubular necrosis (acute tubular necrosis [ATN] group); four acute rejection episodes (ARE group); 25 with normal evolution (as control, C group). Renal biopsies were performed to obtain a diagnosis in the four ATN cases and in all ARE patients. Creatinine and estimated glomerular filtration rate were used as kidney function parameters. CEUS analysis was performed both on cortical and medullary regions while US resistivity indexes (RI) were obtained on main, infrarenal, and arcuate arteries. From an analysis of CEUS time-intensity curves, we computed peak enhancement (PEAK), time to peak (TTP), mean transit time (MTT), regional blood flow (RBF) and volume (RBV), and cortical to medullary ratio of these indies (RATIO). RESULTS: An increased RI was present in the ATN and ARE groups as well as a reduced PEAK and RBF. RATIO-RBV and RATIO-MTT were lower than C among ATN cases, while TTP was higher compared to C in ARE. No statistical difference was evidence for RI between ATN and ARE groups. MTT (T0) was significantly related to creatinine at follow-up (T2). CONCLUSIONS: US and CEUS identified grafts with early dysfunction, but only some CEUS-derived parameters distinguished ATN from ARE, adding prognostic information.

Design of surface properties of PET films: effect of fluorinated block copolymers.

This paper demonstrates that the addition of fluorinated block copolymers to PET solutions can be used to prepare PET films with controlled surface morphology, porosity and chemical composition, by exploiting the phenomenon known as breath figures (BF) formation during a spin-coating procedure. Surface features, such as number, depth and diameter of pores and chemical composition, can be tuned by varying the experimental conditions: relative humidity, solution composition and amount of the fluorinated block copolymer added to the PET solutions (in the range of 0.5-10 wt% with respect to PET). BF patterns are more evident at relatively high concentrations of PET (3 wt%) and content of fluorinated block copolymer (10 wt% with respect to PET) in the solution. According to the obtained results, the fluorinated block copolymer seems to play a role in different steps of the mechanism of BF formation. XPS measurements showed a surface composition much richer in fluorinated segments than expected from bulk composition. The combined surface roughness and surface segregation of fluorinated segments have only a limited effect on the macroscopic wettability of the surfaces.

CATRAM: An Apparatus for the Optical Characterization of Advanced Transparent Materials.

At the Transparent Materials Laboratory of the Italian Agency for Energy, New Technologies and Environment, the characterization of advanced transparent materials (CATRAM) facility permits the optical characteristics of transparent advanced materials to be evaluated, a procedure for which spectrophotometers are not adequate. The CATRAM facility is based mainly on a large-diameter integrating sphere to perform transmittance, reflectance, and absorptance measurements. We describe the measurement procedures and verify the reliability of the facility by comparing the results obtained for several samples with those from other laboratories. Furthermore, some system implementations for improvement of accuracy are discussed.

Proposal for ellipsometer configurations allowing phase-sensitive detection.

We propose ellipsometer configurations where, by conveniently modulating either the input or the output polarization, one can determine the ellipsometric parameters, D and psi, purely from phase measurements on two harmonic components of the signal from a single detector. Such phase measurements are less sensitive to noise than the conventional amplitude measurements, and the proposed modulation techniques can allow the achievement of frequencies up to tens of megahertz. Thus a very good time resolution is achieved.

In situ monitoring of film deposition with an ellipsometer based on a four-detector photopolarimeter.

Ellipsometry is a sensitive and noninvasive technique for the characterization of thin films. A recently developed ellipsometer, based on the four-detector photopolarimeter, was arranged outside a UHV chemical vapor deposition chamber for the in situ monitoring of film growth processes. The instrument showed a sensitivity in the submonolayer range when used to follow the growth of germanium thin films deposited on silicon substrates. As the main instrument drawback is represented by the need to have precise alignment, an effective positioning procedure was developed to obtain a positioning error smaller than 0.1°.

Characterization of some suitable deflecting liquids in photothermal deflection spectroscopy.

Generally CCl(4) is used in photothermal deflection spectroscopy as the deflecting medium. We looked for alternative deflecting liquids. This Letter reports the main features of some suitable liquids.

[Maxillofacial lesions in road accidents]. / Lesioni maxillo-facciali da trauma stradale.

Authors have compared the cases of maxillo-facial fractures that have been admitted in the Maxillo-Facial department during a six months period before and after the mandatory use of helmets; that is from January through June in the years 1986 and 1987. A decrease in the number of injured (- 13.3%) and also a rate change was noted: the motorcycle drivers lost a 20.1%, while the adults who drove the motorbikes increased; a raise was found in the bicycle too (+ 8.7%). The lesions of the mandibular increased from 36.7% to 46.1% due to the protection offered to the maxilla by the helmets.

[Mandibular fractures in street accidents. Etiopathogenetic findings in 680 cases]. / Le fratture mandibolari da incidenti stradali: osservazioni etiopatogenetiche su 680 casi.

The authors have studied 680 cases of mandibular fractures by traffic accident that have been observed during a 10 years period in the department of Maxillo-Facial Surgery of the Florence University. Some interesting results have been found: male are more often injured than female (about 70% of all cases) during their second and third decades of life. Among the means of transport authors have found that the motorcycles (motorbikes included) and cars are more often involved, both with an equal number of cases; but the motorcycles are to be considered more dangerous because they are around in a smaller number.