A new scale for the assessment of performance and capacity of hand function in children with hemiplegic cerebral palsy: reliability and validity studies.

BACKGROUND: In hemiplegic children, the recognition of the activity limitation pattern and the possibility of grading its severity are relevant for clinicians while planning interventions, monitoring results, predicting outcomes. OBJECTIVE: Aim of the study is to examine the reliability and validity of Besta Scale, an instrument used to measure in hemiplegic children from 18 months to 12 years of age both grasp on request (capacity) and spontaneous use of upper limb (performance) in bimanual play activities and in ADL. DESIGN: Psychometric analysis of reliability and of validity of the Besta scale was performed. SETTING: Outpatient study sample METHODS: Reliability study: A sample of 39 patients was enrolled. The administration of Besta scale was video-recorded in a standardized manner. All videos were scored by 20 independent raters on subsequent viewing. 3 raters randomly selected from the 20-raters group rescored the same video two years later for intra-rater reliability. Intra and inter-rater reliability were calculated using Intraclass Correlation Coefficient (ICC) and Kendall's coefficient (K), respectively. Internal consistency reliability was assessed using Alpha's Chronbach coefficient. Validity study: a sample of 105 children was assessed 5 times (at t0 and 2, 3, 6 and 12 months later) by 20 independent raters. Each patient underwent at the same time to QUEST and Besta scale administration and assessment. Criterion validity was calculated using rho-Pearson coefficient. RESULTS: Reliability study: The inter-rater reliability calculated with Kendall's coefficient resulted moderate K=0.47. The intra-rater (or test-retest) reliability for 3 raters was excellent (ICC=0.927). The Cronbach's alpha for internal consistency was 0.972. Validity study: Besta scale showed a good criterion validity compared to QUEST increasing by age and severity of impairment. Rho Pearson's correlation coefficient r was 0.81 (P<0.0001). Limitations. Besta scales in infants finds hard to distinguish between mild to moderately impaired hand function. CONCLUSIONS: Besta scale scoring system is a valid and reliable tool, utilizable in a clinical setting to monitor evolution of unimanual and bimanual manipulation and to distinguish hand's capacity from performance.

Annual variation of (7)Be soil inventory in a semiarid region of central Argentina.

Reliable information on environmental radionuclides atmospheric entrance, and their distribution along the soil profile, is a necessary condition for using these soil and sediment tracers to investigate key environmental processes. To address this need, (7)Be content in rainwater and the wet deposition in a semiarid region at San Luis Province, Argentina, were studied. Following these researches, in the same region, we have assessed the (7)Be content along a soil profile, during 2.5 years from September 2009 to January 2012. As expected, the specific activity values in soil samples in the wet period (November-April) were higher than in the dry period (May-October). During the investigated period (2009 - beginning 2012) and for all sampled points, the maximum value of the (7)Be specific activity (Bq kg(-1)) was measured at the surface level. A typical decreasing exponential function of (7)Be areal activity (Bq m(-2)) with soil mass depth (kg m(-2)) was found and the key distribution parameters were determined for each month. The minimum value of areal activity was 51 Bq m(-2) in August, and the maximum was 438 Bq m(-2) in February. The relaxation mass depth ranges from 2.9 kg m(-2) in March to 1.3 kg m(-2) in August. (7)Be wet deposition can explain in a very significant proportion the (7)Be inventory in soil. During the period of winds in the region (September and October), the (7)Be content in soil was greater than the expected contribution from wet deposition, situation that is compatible with a higher relative contribution of dry deposition at this period of the year.

Using (222)Rn as a tracer of geodynamical processes in underground environments.

Radon levels in two old mines in San Luis, Argentina, were measured and analyzed, with the aim to assess the potential use of this radioactive noble gas as a tracer of geological processes in underground environments. La Carolina gold mine and Los Cóndores tungsten mine are today used as tourism mines. CR-39 nuclear track detectors were used for this purpose. Measurements were performed during both winter and summer seasons. The findings show that in these environments, significant radon concentrations are subject to large seasonal fluctuations, due to the strong dependence on natural ventilation with the outside temperature variations. For both mines, higher concentration values of (222)Rn were observed in summer than in winter; with an extreme ratio of 2.5 times between summer and winter seasons for Los Cóndores mine. The pattern of radon transport inside La Carolina mine revealed, contrary to what was believed, that this mine behaves as a system with two entrances located at different levels. However, this feature can only be observed in the winter season, when there is a marked difference between the inside and outside temperatures of the mine. In the case of Los Cóndores mine, the radon concentration pattern distribution is principally established by air current due to chimney-effect in summer and winter seasons. In both cases, the analyses of radon pattern distribution appear as a good method to trace air currents, and then localize unknown ducts, fissures or secondary tunnels in subterranean environments.

Temporal evolution of ¹³7Cs⁺, K⁺ and Na⁺ in fruits of South American tropical species.

Concentrations of (137)Cs, K and Na in fruits of lemon (Citrus limon B.) and of K and Na in fruits of coconut (Cocos nucifera L.) trees were measured by both gamma spectrometry and neutron activation analysis, with the aim to understand the behaviour of monovalent inorganic cations in tropical plants as well as the plant ability to store these elements. Similar amounts of K(+) were incorporated by lemon and coconut trees during the growth and ripening processes of its fruits. The K concentration decreased exponentially during the growth of lemons and coconuts, ranging from 13 to 25 g kg(-1) dry weight. The incorporation of Na(+) differed considerably between the plant species studied. The Na concentration increased linearly during the lemon growth period (0.04 to 0.70 g kg(-1) d.w.) and decreased exponentially during the coconut growth period (1.4 to 0.5 g kg(-1) d.w.). Even though radiocaesium is not an essential element to plants, our results have shown that (137)Cs incorporation to vegetable tissues is positively correlated to K distribution within the studied tropical plant species, suggesting that the two elements might be assimilated in a similar way, going through the biological cycle together. A mathematical model was developed from the experimental data allowing simulating the incorporation process of monovalent inorganic cations by the fruits of such tropical species. The agreement between the theoretical approach and the experimental values is satisfactory along fruit development.

Assessment of 7Be content in precipitation in a South American semi-arid environment.

There are two naturally occurring radiogenic isotopes of beryllium, 7Be and ¹°Be. These are produced when cosmic radiation interacts with oxygen and nitrogen in the atmosphere. After production, these radionuclides are input to ecosystems through wet and dry deposition. In recent years 7Be and ¹°Be have proved to be powerful tools for studying dynamic processes that occur on the surface of the earth. We measured the 7Be content in precipitation at a semiarid location in central Argentina. From November 2006 to March 2009, 68 precipitation events were collected. Measured 7Be content ranged from 0.7±0.4 Bq L⁻¹ to 3.2±0.7 Bq L⁻¹, with a mean of 1.7 Bq L⁻¹ ±0.6 Bq L⁻¹. Beryllium-7 content of rainfall did not show clear relationships with amount of rainfall (mm), mean intensity (mm h⁻¹) or duration (h⁻¹), or elapsed time between events (day). The general results indicate that for the typical range of precipitation there was no atmospheric washout and that the reload of the atmosphere is not a relevant factor, but when the amount of precipitation is very high washout may occur. On the other hand, when the 7Be content was measured during single rain events, a high content of this radionuclide was found to be associated with very low rainfall intensity (≈3 mm h⁻¹), this suggests that rain intensity could affect the 7Be content. Using all data, a good linear relationship between 7Be deposition and rain magnitude was obtained (r²=0.82, p<0.0001). Because of this, the slope of this linear regression equation may be applied as a tool for tracing environmental processes that affect the surface of the earth. We can do this by directly estimating erosion/sedimentation processes using 7Be or by estimating the input of ¹°Be in the environment with the aim to evaluate land degradation phenomena.

Variability of 137Cs and 40K soil-to-fruit transfer factor in tropical lemon trees during the fruit development period.

In this investigation we evaluate the soil uptake of (137)Cs and (40)K by tropical plants and their consequent translocation to fruits, by calculating the soil-to-fruit transfer factors defined as F(v) = [concentration of radionuclide in fruit (Bq kg(-1) dry mass)/concentration of radionuclide in soil (Bq kg(-1) dry mass in upper 20 cm)]. In order to obtain F(v) values, the accumulation of these radionuclides in fruits of lemon trees (Citrus limon B.) during the fruit growth was measured. A mathematical model was calibrated from the experimental data allowing simulating the incorporation process of these radionuclides by fruits. Although the fruit incorporates a lot more potassium than cesium, both radionuclides present similar absorption patterns during the entire growth period. F(v) ranged from 0.54 to 1.02 for (40)K and from 0.02 to 0.06 for (137)Cs. Maximum F(v) values are reached at the initial time of fruit growth and decrease as the fruit develops, being lowest at the maturation period. As a result of applying the model a decreasing exponential function is derived for F(v) as time increases. The agreement between the theoretical approach and the experimental values is satisfactory.

The perception of involved professionals towards research feasibility and usefulness: lessons from the Multi-Site Trial on Efficacy of Constraint Induced Movement Therapy in Children with Hemiplegia.

BACKGROUND: In the last decades, the world of rehabilitation has been more and more calling for clear evidence to support intervention and numerous research programs have been developed. At stake, relatively little research on opinions and attitude of rehabilitation personnel involved in research conducted in real clinical settings has been carried out. AIM: To explore the opinion of professionals involved in a national clinical trial on research. DESIGN: Multicentre cross-sectional study. SETTING: 19 rehabilitation centres/services (4 research institutes, 15 local rehabilitation services). POPULATION: All professional participating to a multi-centre clinical trial on the effects of Constraint Induced Movement Therapy on children with hemiplegic cerebral palsy. METHODS: A 15-questions questionnaire inquiring feasibility, usefulness, products, costs, judgement and perceptions about clinical research in rehabilitation was administered. RESULTS: Among those working in one of the 19 rehabilitation centres part of the multicentric study, 76 professionals were asked to fill in the questionnaire. 68 professionals answered (89.4% of response rate). More than 75% of the sample thinks that its rehabilitation centre is suited to develop clinical research. Research results useful for the development of their daily activities (new tools for the assessment of children, to demonstrate the efficacy of a new treatment option and to learn a new way of working, and to strengthen the ties within the working team). Research is costly in terms of personal time and effort, but it can modify the rehabilitation praxis (assessment tools, the relationship with colleagues/patients). 98% of the interviewees declared the willingness to participate to other research projects. CONCLUSION AND CLINICAL REHABILITATION IMPACT: This survey highlights the importance of conducting research in local rehabilitation services, not only in terms of generation of new evidences, but also in terms of building networks, sharing experiences and knowledge, connecting with centers of excellence and providing a specific training for research conduction.

Occupational exposure to radon and natural gamma radiation in the La Carolina, a former gold mine in San Luis Province, Argentina.

Radon and gamma radiation level measurements were carried out inside the La Carolina mine, one of the oldest gold mining camps of southern South America, which is open for touristic visits nowadays. CR-39 track-etch detectors and thermoluminescent dosimeters of natural CaF(2) and LiF TLD-100 were exposed at 14 points along the mine tunnels in order to estimate the mean (222)Rn concentration and the ambient dose equivalent during the summer season (November 2008 to February 2009). The values for the (222)Rn concentration at each monitoring site ranged from 1.8+/-0.1 kBqm(-3) to 6.0+/-0.5 kBqm(-3), with a mean value of 4.8 kBqm(-3), indicating that these measurements exceed in about three times the upper action level recommended by ICRP for workplaces. The correlations between radon and gamma radiation levels inside the mine were also investigated. Effective doses due to (222)Rn and gamma rays inside the mine were determined, resulting in negligible values to tourists. Considering the effective dose to the mine tourist guides, values exceeding 20mSv of internal contribution to the effective doses can be reached, depending on the number of working hours inside the mine.

Short-term seasonal variability in 7Be wet deposition in a semiarid ecosystem of central Argentina.

The (7)Be wet deposition has been intensively investigated in a semiarid region at San Luis Province, Argentina. From November 2006 to May 2008, the (7)Be content in rainwater was determined in 58 individual rain events, randomly comprising more than 50% of all individual precipitations at the sampling period. (7)Be activity concentration in rainwater ranged from 0.7+/-0.3 Bq l(-1) to 3.2+/-0.7 Bq l(-1), with a mean value of 1.7 Bq l(-1) (sd=0.53 Bq l(-1)). No relationship was found between (7)Be content in rainwater and (a) rainfall amount, (b) precipitation intensity and (c) elapsed time between events. (7)Be ground deposition was found to be well correlated with rainfall amount (R=0.92). For the precipitation events considered, the (7)Be depositional fluxes ranged from 1.1 to 120 Bq m(-2), with a mean value of 32.7 Bq m(-2) (sd=29.9 Bq m(-2)). The annual depositional flux was estimated at 1140+/-120 Bq m(-2)y(-1). Assuming the same monthly deposition pattern and that the (7)Be content in soil decreases only through radioactive decay, the seasonal variation of (7)Be areal activity density in soil was estimated. Results of this investigation may contribute to a valuable characterization of (7)Be input in the explored semiarid ecosystem and its potential use as tracer of environmental processes.

The teriparatide in the treatment of severe senile osteoporosis.

The osteoporosis is a systemic disease of multicausal etiopathogenesis. A progressive bone loss and qualitative alterations in the macro- and micro-architecture of the remaining bones, resulting in a loss of strength of bones to such an extent that even very modest traumas will cause fractures characterize it. Three forms are defined (i) postmenopausal appearing after the menopause, (ii) senile appearing with advancing age, and (iii) the idiopathic forms. Severe osteoporosis is declared when the patients suffer vertebral or femoral fractures without any trauma during a treatment with anti-reabsorptive medicines of at least 1-year. The treatment of osteoporosis is based on various categories of pharmaca, such as bisphosphonates, selective estrogen receptor modulators (SERMs), diaminobutyric acid (DABA), parathyroid hormone (PTH), estrogens and non-hormonal drugs. The teriparatide, the recombinant human (rh)PTH(1-34), is identical in amino acid sequence until the 34th (N-terminal) amino acid of the endogenous, human PTH. It is produced in E. coli using the recombinant DNA technology. It is a pharmacon having a strong trophic-anabolic action on the bone tissue, assuring both the inhibition of the bone loss, and the formation of new bones of good quality. It acts as a stimulant of the osteoblast functions, and at the same time, increases the absorption of calcium from the intestine, and also the renal reabsorption of calcium, and decreases the excretion of phosphates in the kidney. This study summarizes our own experience with the use of rhPTH(1-34) in the treatment of senile patients with severe osteoporosis. Our sample consisted of 40 elderly women of the mean age of 78+/-5 years, having severe osteoporosis. They displayed a columnar T-score>-3.5 and femoral T-score>-2.5, had been under antireabsorptive treatment since at least 12 months. In particular, 15 patients were treated with Alendronate (70 mg/week), 10 of them with Risedronate (35 mg/week), and 15 of them with Raloxifene (60 mg/day). These patients in our study were treated for 1 year with 20 microg/day of rhPTH (1-34), injected subcutaneously, and supplemented also with a daily dose of 1g of calcium and 800 IU of Vitamin D, per os. At start of this treatment (time t(0)), after 6 months (time t(6)) and after 12 months (time t(12)) patients underwent a bone mineral density (BMD) analysis (Dexa-Lunar-DPX-P) on the lumbar vertebral column, (L1-L4 zone), as well as a femoral BMD. We applied also quality of life (QoL) questionnaire of the European Foundation for Osteoporosis (QUALEFFO), and evaluated also the use of non-steroidal anti-inflammatory drugs (NSAIDs). Our final considerations are that the teriparatide therapy increases significantly the bone mass density, expressed in terms of T-Score, reduces the occurrence of new fractures, improves the QoL, and decreases also the consumption of NSAIDs.

Interleukin-18 (IL-18) and matrix metalloproteinase-9 (MMP-9) in post-menopausal osteoporosis.

This survey covered 60 post-menopausal women with osteoporosis. The patients were divided into three equal groups, and each group was treated with one of the three so-called anti-resorptive drugs, namely alendronate (10 mg/day) risedronate (5 mg/day) and raloxifene (60 mg/day) for 12 months. The Elisa technique was used to measure circulating IL-18 and MMP-9. Lumbar bone mineral density (BMD) levels were determined by using dexa mineralometry (Lunar DPX) at baseline and after 12 months of treatment. The results showed comparable responses of the patients treated with alendronate or risedronate, being a significant increase in BMD, an increase in circulating IL-18, and only slight modifications in circulating MMP-9 levels. After 12 months of treatment with raloxifene, there were minimal, non-significant increases in BMD, slight modifications in IL-18 levels, and a significant reduction in circulating MMP-9 levels. The conclusions can be drawn that all three drugs, albeit through different mechanisms, can be considered valid treatments for post-menopausal osteoporosis. Although measurements of circulating IL-8 and MMP-9 levels allowed us to differentiate the effects of the three drugs used, as of today, they have no real role in the diagnosis and/or follow-up of osteoporosis.

Optimal strategies and complexity: a theoretical analysis of the anti-predatory behavior of the hare.

Predator-prey relationships involving rabbits and hares are widely studied at a long-term population level, while the short-term ethological interactions between one predator and one prey are less well documented. We use a physiologically-based model of hare behavior, developed in the framework of artificial intelligence studies, to analyse its sophisticated anti-predatory behavior. The hares use to stand to the fox in order to inform it that its potential prey is alerted. The behavior of the hare is characterized by specific standing and flushing distances. We show that both hare survival probability and body condition depend on habitat cover, as well as on the ability of the predator to approach-undetected-a prey. We study two anti-predatory strategies, one based on the maximization of the survival probability and the other on the maximization of the body conditions of the hare. Despite the fact that the two strategies are not independent, they are characterized by quite different behavioral patterns. Field estimates of flushing and standing distances are consistent with survival maximization. There exists an optimal anti-predatory strategy, characterized by a flushing distance of 20 m and a standing distance of 30 m, which is optimal in a large set of environmental conditions with a sharp fitness advantage with respect to suboptimal strategies. These results improve our understanding of the anti-predatory behavior of the hare and lend credibility to the optimality approach in the behavioral analysis, showing that even for complex organisms, characterized by a large network of internal constraints and feedback, it is possible to identify simple optimal strategies with a large potential for selection.