Exploring reliability of scar rating scales using photographs of burns from children aged up to 15 years.

Assessing burn scars from photographs is a common practice given the growing trend to support health service delivery via electronic media (eg, email, videoconferencing). Scar rating scales, originally designed for in-person assessment, have been used to rate scars from photographic images. Evidence for the reliability of this practice is lacking. Five raters completed three scar rating scales (Patient and Observer Scar Scale, Manchester Scar Scale, modified Vancouver Scar Scale), both in-person and using photographs on 12 participants (seven male, five female) with 18 scar areas (3 × 3 cm). Interrater reliability for the scar parameters of vascularity, color, contour, pliability, and overall opinion achieved intraclass correlation coefficient values of between 0.71 and 0.87 (in-person) and 0.72 and 0.77 (using photographs) for multiple raters. The level of agreement between in-person and photographic assessment was below acceptable levels, which brings into question construct validity when scar rating scales are used in a way for which they were not designed. Reliability estimates in this study were likely reduced by the underrepresentation of scars in the more severe range. This limitation needs to be addressed in future research. Advances are required in the development and refinement of burn scar rating scales, specifically for photographic use, given their routine use in clinical care.

Considerations for occupational therapy assessment for Indigenous children in Australia.

BACKGROUND: To date, the literature specifically relating to occupational therapy assessment of Australian Indigenous children is lacking. This article aims to present occupational therapists with practice guidelines for conducting assessments with primary school-aged Indigenous children in Australia. It highlights key considerations to be made prior to assessment, reviews potentially culturally relevant assessment tools and discusses key principles to guide assessment practice. METHOD: A literature review was carried out with the aim of investigating: (i) Australian Indigenous culture in relation to health and paediatric development; (ii) current practices for assessment with Australian Indigenous children; and (c) paediatric assessment tools and their potential use with Australian Indigenous children. RESULTS: Research relating to specific assessments does highlight some pertinent points about their use with children from non-Western cultures. CONCLUSIONS: Conducting culturally relevant assessment requires a combination of the right tools, an adaptive approach to both understanding and conducting assessments and, above all, an appreciation that each child is unique.

A computational study of the intramolecular deprotonation of a carbon acid in aqueous solution.

Proton transfer reactions are the rate-limiting steps in many biological and synthetic chemical processes, often requiring complex cofactors or catalysts to overcome the generally unfavourable thermodynamic process of carbanion intermediate formation. It has been suggested that quantum tunnelling processes enhance the kinetics of some of these reactions, which when coupled to protein motions may be an important consideration for enzyme catalysis. To obtain a better fundamental and quantitative understanding of these proton transfer mechanisms, a computational analysis of the intramolecular proton transfer from a carbon acid in the small molecule, 4-nitropentanoic acid, in aqueous solution is presented. Potential-energy surfaces from gas-phase, implicit and QM/MM (quantum mechanical/molecular mechanical) explicit solvation quantum chemistry models are compared, and the potential of mean force, for the full reaction coordinate, using umbrella-sampling molecular dynamics is analysed. Semi-classical multidimensional tunnelling corrections are also used to estimate the quantum tunnelling contributions and to understand the origin of the primary deuterium kinetic isotope effects (KIEs). The computational results are found to be in excellent agreement with the KIEs and the energetics obtained experimentally.