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Abstract Introduction Hand grip strength (HGS) is an important measure in a physiotherapy assessment and for this purpose it is necessary to have valid and reliable instruments to measure it. In this study we aimed at investigating the reliability, validity, and agreement of the new hand-held dynamometer NOD (OT-Bioelettronica, To-Italy) compared to Jamar® hydraulic dynamometer (JD), the gold standard. Methods Fifty healthy subjects were selected; 9 trials for the dominant hand and 9 trials for the non-dominant hand were administrated to each of them: 3 trials of HGS with the JD in rung #3, 3 trials with the JD-adapted-grip (like the NOD one), and 3 trials with NOD. To verify the reliability of NOD, the Intraclass Correlation Coefficient (ICC 3,1) was calculated with a mixed effects model with the addition of adjustment variables (age, gender, dominant / non-dominant limb, trials). The model used single HGS measurements to estimate variance components, so reflecting both degree of correspondence and agreement among devices. To assess concurrent validity NOD was compared to the “gold standard” JD, in terms of ICCs and through Pearson correlation. The agreement between the methods of measurement was calculated with the Limits of Agreement (LoA) and the plots of Bland–Altman. Results All ICCs show high inter-reliability; the results are very similar for both dynamometers. The value of the adjusted ICC of NOD was 0.90. For validity, Pearson correlations of NOD towards JD and JD-adapted-grip were high (r = 0.87 and 0.88). However, the LoA and the plots of Bland–Altman demonstrated that there is no agreement between NOD and JD and between NOD and JD-adapted-grip, with NOD showing lower mean scores than JD. Conclusions NOD is a reliable and valid instrument for HGS. However, even if it cannot be considered interchangeable with JD because there is no agreement between them in free-living adults, NOD is easier to carry than other dynamometers, it has a Bluetooth® connection with a free App and it is a multi-purpose tool that should be considered both in daily practice and in clinical settings.

In the evolving field of artificial intelligence, fine-tuning diffusion models is crucial for generating contextually coherent digital characters across various media. This paper examines four advanced fine-tuning techniques: Low-Rank Adaptation (LoRA), DreamBooth, Hypernetworks, and Textual Inversion. Each technique enhances the specificity and consistency of character generation, expanding the applications of diffusion models in digital content creation. LoRA efficiently adapts models to new tasks with minimal adjustments, making it ideal for environments with limited computational resources. It excels in low VRAM contexts due to its targeted fine-tuning of low-rank matrices within cross-attention layers, enabling faster training and efficient parameter tweaking. DreamBooth generates highly detailed, subject-specific images but is computationally intensive and suited for robust hardware environments. Hypernetworks introduce auxiliary networks that dynamically adjust the model’s behavior, allowing for flexibility during inference and on-the-fly model switching. This adaptability, however, can result in slightly lower image quality. Textual Inversion embeds new concepts directly into the model’s embedding space, allowing for rapid adaptation to novel styles or concepts, but is less effective for precise character generation. This analysis shows that LoRA is the most efficient for producing high-quality outputs with minimal computational overhead. In contrast, DreamBooth excels in high-fidelity images at the cost of longer training. Hypernetworks provide adaptability with some tradeoffs in quality, while Textual Inversion serves as a lightweight option for style integration. These techniques collectively enhance the creative capabilities of diffusion models, delivering high-quality, contextually relevant outputs.

This article introduces a novel approach to remote laboratory instruction, specifically designed for teaching three-dimensional modeling using Blender software. The lab uses virtual machines to provide students with the necessary computational power to carry out the course activities, along with the correct version of the software. The flipped remote lab approach combines the elements of flipped classroom and peer assessment, making it suitable for face-to-face, totally online, or hybrid classes. Prior to each of the two lectures, students begin to practice by replicating the instructor's demonstrations in a set of concise tutorials. Upon completion of the assigned tasks, students carry out self-assessments of their own modeling, in addition to assessing two models created by their peers. A rubric comprising three questions facilitates the assessment process and allows providing feedback on each response. During the subsequent lecture, students work together with the instructor to address challenges encountered in their modeling, exploring also the advanced aspects of software usage that time constraints preclude in a traditional setting. The analysis of the flipped remote lab results reveals that student responses in peer-assessment activities are relevant to the posed questions. Moreover, the students who realized the models demonstrated a comparable level of rigor in self-assessment as their mates who reviewed their works. While students express a high degree of appreciation for the laboratory activities, a notable concern is the highlighted heavy workload. Increasing the allocated time for task completion can help mitigate the workload impact. The article concludes with insights gained from the implementation of the flipped remote lab approach.

BackgroundThe increase in average life expectancy, aging, and the rise in the number of people living with dementia contribute to growing interest from the scientific community. As the disease progresses, people with dementia may need help with most daily activities and need to be supervised by their carer to ensure their safety. With the help of technology, health care provides new means of self-managing health that support active aging, allowing older people and people with dementia to live independently in their homes for a longer period of time. Although some systematic reviews have revealed some of the impacts of using digital interventions in this area, a broad systematic review that examines the overall results of the effect of this intervention type is mandatory. ObjectiveThe aim of this review is to further investigate and understand the acceptability and barriers to using technology to monitor and manage health conditions of people living with dementia and their caregivers. MethodsA review of systematic reviews on acceptability factors and barriers for people with dementia and caregivers was carried out. Interventions that assessed acceptability factors and barriers to the use of technology by people with dementia or their carers were included. Each potentially relevant systematic review was assessed in full text by a member of a team of external experts. ResultsThe analysis of the results will be presented in the form of a detailed table of the characteristics of the reviews included. It will also describe the technologies used and factors of acceptability and barriers to their use. The search and preliminary analysis were carried out between May 5, 2023, and August 1, 2024. ConclusionsThis review will play an important role as a comprehensive, evidence-based summary of the barriers and facilitators to the use of digital interventions. This review may help to establish effective policy and clinical guideline recommendations.

Este artigo, fruto de pesquisa de mestrado profissional, busca responder à seguinte pergunta: Como as professoras de bebês e crianças bem pequenas registram as propostas pedagógicas no dia a dia. O objetivo geral é verificar como e se o registro reflexivo qualifica a prática pedagógica das professoras de educação infantil. O universo do estudo é uma Escola Municipal de Educação Básica da cidade de São Bernardo do Campo/SP. Os instrumentos de produção de dados são os registros realizados por duas educadoras da creche e entrevistas semiestruturadas com as mesmas docentes. Os dados indicam que as professoras de educação infantil registram suas práticas, porém se tornam eficazes à medida que há um processo formativo reflexivo. O papel da coordenadora pedagógica é fundante nesse processo, pois suas devolutivas qualificam as práticas da escrita cotidiana.

“Comunicazione Digitale XR” is a project that exploits the EON-XR platform to enrich Information Technology education by incorporating interactive 360-degree visuals and 3D models to complement traditional teaching methods. This study probes the efficacy of Extended Reality (XR) technologies in augmenting educational experiences through the integration of gamification techniques within the curriculum. The evaluation, involving twenty-six students, delved into factors such as engagement levels, comprehension of material, and the contributory role of XR in exam readiness. Data collection was conducted using electronic log files, which provided detailed quantitative metrics on student interactions, and a post-intervention survey that assessed changes in comprehension and engagement. Additionally, qualitative data was gathered through semi-structured interviews. Quantitative data from surveys and log files were analyzed using descriptive statistics, while qualitative data from interviews were subjected to thematic analysis. This investigation has demonstrated substantial enhancements in student comprehension and engagement with the educational content facilitated by XR technologies. These findings underscore the potential of XR to augment the educational paradigm and improve students’ preparedness for academic evaluations.

Amyotrophic lateral sclerosis (ALS) is a lethal disease affecting motoneurons. In familial ALS, patients bear mutations in the superoxide dismutase gene (SOD1). We transplanted human bone marrow mesenchymal stem cells (hMSCs) into the lumbar spinal cord of asymptomatic SOD1G93A mice, an experimental model of ALS. hMSCs were found in the spinal cord 10 weeks after, sometimes close to motoneurons and were rarely GFAP- or MAP2-positive. In females, where progression is slower than in males, astrogliosis and microglial activation were reduced and motoneuron counts with the optical fractionator were higher following transplantation. Motor tests (Rotarod, Paw Grip Endurance, neurological examination) were significantly improved in transplanted males. Therefore hMSCs are a good candidate for ALS cell therapy: they can survive and migrate after transplantation in the lumbar spinal cord, where they prevent astrogliosis and microglial activation and delay ALS-related decrease in the number of motoneurons, thus resulting in amelioration of the motor performance.

Esta resenha traz uma análise descritiva e crítica sobre o livro "Olhar Atento: Como Incentivar os Alunos a Aprender por Meio da Observação", de Shari Tishman, uma obra que convida educadores a redescobrirem a profundidade do ato de observar. Tishman mostra que a observação cuidadosa é um processo que envolve intensas atividades cognitivas que estimulam pensamento crítico e criatividade e são fundamentais não apenas para a aprendizagem acadêmica, mas para a formação de seres humanos atentos e empáticos. Além disso, propõe estratégias concretas para desenvolver, em sala de aula, essa prática que ela considera essencial para a aprendizagem significativa.

Peripheral nerve damage often leads to the onset of neuropathic pain (NeuP). This condition afflicts millions of people, significantly burdening healthcare systems and putting strain on families’ financial well-being. Here, we will focus on the role of peripheral sensory neurons, specifically the Dorsal Root Ganglia neurons (DRG neurons) in the development of NeuP. After axotomy, DRG neurons activate regenerative signals of axons-soma communication to promote a gene program that activates an axonal branching and elongation processes. The results of a neuronal morphological cytoskeleton change are not always associated with functional recovery. Moreover, any axonal miss-targeting may contribute to NeuP development. In this review, we will explore the epidemiology of NeuP and its molecular causes at the level of the peripheral nervous system and the target organs, with major focus on the neuronal cross-talk between intrinsic and extrinsic factors. Specifically, we will describe how failures in the neuronal regenerative program can exacerbate NeuP.

We report the case of a young male patient who presented to our emergency department complaining of a transient headache and a feeling of motor impairment in his right lower limb, both of which completely resolved spontaneously. After a few minutes of his arrival, he developed a locked-in sensation with anxiety and agitation, followed by a rapid onset of left facio-brachio-crural hemisyndrome. Contrast-enhanced CT of the brain and neck showed the occlusion of the proximal-intermediate basilar artery. Acute basilar artery occlusion (BAO) is a rare life-threatening stroke that requires prompt diagnosis and appropriate treatment to avoid rapid fatal complications (coma and death). The prognosis is poor, with long-lasting sequelae in the survivors. The diagnosis is often difficult since BAO accounts for only 1% of all strokes, and the prodromal symptoms are often very mild, transient, and non-specific, such as nausea, dizziness, headache, confusion, and vertigo. In the presence of convulsion-like symptoms or an unexplained altered level of consciousness, emergency physicians should always consider BAO in the differential diagnosis.

AbstractHyperthyroidism is considered the most common endocrinopathy in middle-aged and old cats. The increased level of thyroid hormones influences many organs, including the heart. Cardiac functional and structural abnormalities in cats with hyperthyroidism have indeed been previously described. Nonetheless, myocardial vasculature has not been subjected to analysis. Also, no comparison with hypertrophic cardiomyopathy has been previously described. Although it has been shown that clinical alterations resolve after the treatment of hyperthyroidism, no detailed data have been published on the cardiac pathological or histopathological image of field cases of hyperthyroid cats that received pharmacological treatment. The aim of this study was to evaluate the cardiac pathological changes in feline hyperthyroidism and to compare them to alterations present in cardiac hypertrophy due to hypertrophic cardiomyopathy in cats. The study was conducted on 40 feline hearts divided into three groups: 17 hearts from cats suffering from hyperthyroidism, 13 hearts from cats suffering from idiopathic hypertrophic cardiomyopathy and 10 hearts from cats without cardiac or thyroid disease. A detailed pathological and histopathological examination was performed. Cats with hyperthyroidism showed no ventricular wall hypertrophy in contrast to cats with hypertrophic cardiomyopathy. Nonetheless, histological alterations were similarly advanced in both diseases. Moreover, in hyperthyroid cats more prominent vascular alterations were noted. In contrast to hypertrophic cardiomyopathy, the histological changes in hyperthyroid cats involved all ventricular walls and not mainly the left ventricle. Our study showed that despite normal cardiac wall thickness, cats with hyperthyroidism show severe structural changes in the myocardium.

The growing field of nanotechnology impacts many research areas, such as engineering, electronics, energy, environment, biology, and medicine [...]

Contribution: This article shows that peer instruction can be applied synchronously and effectively to a distance learning course, using the learning platform Moodle together with a videoconferencing tool. Background: Due to the COVID-19 pandemic, all global education has been shifted from face-to-face to distance learning. While the debate on the effectiveness of active learning alternatives to the traditional lectures was still going on, the teachers found themselves facing a further difficulty: how to engage the students in a totally online learning process, where personal contact is completely lacking. The authors found the answer in the online application of peer instruction. Intended Outcomes: The use of online peer instruction (OPI) is expected to engage all the students attending the online lectures in an active learning process, improving their understanding of the topics covered at the same time. Application Design: The use of Moodle has made it possible to bring the peer instruction method online. The appropriate setup of Moodle's Choice and Workshop activities was sufficient to manage the whole process from a technical standpoint, with the teacher managing the communication aspect, via the videoconferencing tool used to give the lectures. Findings: The application of OPI engaged all the students in the online lectures and proved to be effective in improving students' understanding of the topics covered.

A 91-year-old man presented at our emergency room complaining of sialorrhea and facial edema, especially around his lips and palpebral region. The symptoms started in the morning and got worse over two hours. He had a history of hypertension and hypokinetic ischemic cardiomyopathy treated with ramipril, doxazosin, aspirin, furosemide, amiodarone, ranolazine, atorvastatin, and pantoprazole. He referred an allergy to clopidogrel. He did not introduce any novel medications or foods. His vital signs were BP 150/70, HR 57 bpm, sO2 97% in room ambient, RR 18/min, and BT 36.4 °C. He presented a severe edema of the tongue with tirage and cornage. He was immediately treated IV with hydrocortisone 1 g chlorpheniramine maleate 10 mg, and icatibant 30 mg SC and he was intubated through the nose.

Objective A shared consensus on the safety about physical agent modalities (PAMs) practice in physiotherapy and rehabilitation is lacking. We aimed to develop evidence-informed and consensus-based statements about the safety of PAMs.Study design and setting A RAND-modified Delphi Rounds’ survey was used to reach a consensus. We established a steering committee of the Italian Association of Physiotherapy (Associazione Italiana di Fisioterapia) to identify areas and questions for developing statements about the safety of the most commonly used PAMs in physiotherapy and rehabilitation. We invited 28 National Scientific and Technical Societies, including forensics and lay members, as a multidisciplinary and multiprofessional panel of experts to evaluate the nine proposed statements and formulate additional inputs. The level of agreement was measured using a 9-point Likert scale, with consensus in the Delphi Rounds assessed using the rating proportion with a threshold of 75%.Results Overall, 17 (61%) out of 28 scientific and technical societies participated, involving their most representative members. The panel of experts mainly consisted of clinicians (88%) with expertise in musculoskeletal (47%), pelvic floor (24%), neurological (18%) and lymphatic (6%) disorders with a median experience of 30 years (IQR=17–36). Two Delphi rounds were necessary to reach a consensus. The final approved criteria list comprised nine statements about the safety of nine PAMs (ie, electrical stimulation neuromodulation, extracorporeal shock wave therapy, laser therapy, electromagnetic therapy, diathermy, hot thermal agents, cryotherapy and therapeutic ultrasound) in adult patients with a general note about populations subgroups.Conclusions The resulting consensus-based statements inform patients, healthcare professionals and policy-makers regarding the safe application of PAMs in physiotherapy and rehabilitation practice. Future research is needed to extend this consensus on paediatric and frail populations, such as immunocompromised patients.

Muscular dystrophies due to heterozygous pathogenic variants in LMNA gene cover a broad spectrum of clinical presentations and severity with an age of onset ranging from the neonatal period to adulthood. The natural history of these conditions is not well defined, particularly in patients with congenital or early onset who arguably present with the highest disease burden. Thus the definition of natural history endpoints along with clinically revelant outcome measures is essential to establishing both clinical care planning and clinical trial readiness for this patient group. We designed a large international cross-sectional retrospective natural history study of patients with genetically proven muscle laminopathy who presented with symptoms before two years of age intending to identify and characterize an optimal clinical trial cohort with pertinent motor, cardiac and respiratory endpoints. Quantitative statistics were used to evaluate associations between LMNA variants and distinct clinical events. The study included 151 patients (median age at symptom onset 0.9 years, range: 0.0-2.0). Age of onset and age of death were significantly lower in patients who never acquired independent ambulation compared to patients who achieved independent ambulation. Most of the patients acquired independent ambulation (n = 101, 66.9%), and subsequently lost this ability (n = 86; 85%). The age of ambulation acquisition (median: 1.2 years, range: 0.8-4.0) and age of ambulation loss (median: 7 years, range: 1.2-38.0) were significantly associated with the age of the first respiratory interventions and the first cardiac symptoms. Respiratory and gastrointestinal interventions occurred during first decade while cardiac interventions occurred later. Genotype-phenotype analysis showed that the most common mutation, p.Arg249Trp (20%), was significantly associated with a more severe disease course. This retrospective natural history study of early onset LMNA-related muscular dystrophy confirms the progressive nature of the disorder, initially involving motor symptoms prior to onset of other symptoms (respiratory, orthopaedic, cardiac and gastrointestinal). The study also identifies subgroups of patients with a range of long-term outcomes. Ambulatory status was an important mean of stratification along with the presence or absence of the p.Arg249Trp mutation. These categorizations will be important for future clinical trial cohorts. Finally, this study furthers our understanding of the progression of early onset LMNA-related muscular dystrophy and provides important insights into the anticipatory care needs of LMNA-related respiratory and cardiac manifestations.

Muscular dystrophies due to heterozygous pathogenic variants in LMNA gene cover a broad spectrum of clinical presentations and severity with an age of onset ranging from the neonatal period to adulthood. The natural history of these conditions is not well defined, particularly in patients with congenital or early onset who arguably present with the highest disease burden. Thus the definition of natural history endpoints along with clinically revelant outcome measures is essential to establishing both clinical care planning and clinical trial readiness for this patient group. We designed a large international cross-sectional retrospective natural history study of patients with genetically proven muscle laminopathy who presented with symptoms before two years of age intending to identify and characterize an optimal clinical trial cohort with pertinent motor, cardiac and respiratory endpoints. Quantitative statistics were used to evaluate associations between LMNA variants and distinct clinical events. The study included 151 patients (median age at symptom onset 0.9 years, range: 0.0-2.0). Age of onset and age of death were significantly lower in patients who never acquired independent ambulation compared to patients who achieved independent ambulation. Most of the patients acquired independent ambulation (n = 101, 66.9%), and subsequently lost this ability (n = 86; 85%). The age of ambulation acquisition (median: 1.2 years, range: 0.8-4.0) and age of ambulation loss (median: 7 years, range: 1.2-38.0) were significantly associated with the age of the first respiratory interventions and the first cardiac symptoms. Respiratory and gastrointestinal interventions occurred during first decade while cardiac interventions occurred later. Genotype-phenotype analysis showed that the most common mutation, p.Arg249Trp (20%), was significantly associated with a more severe disease course. This retrospective natural history study of early onset LMNA-related muscular dystrophy confirms the progressive nature of the disorder, initially involving motor symptoms prior to onset of other symptoms (respiratory, orthopaedic, cardiac and gastrointestinal). The study also identifies subgroups of patients with a range of long-term outcomes. Ambulatory status was an important mean of stratification along with the presence or absence of the p.Arg249Trp mutation. These categorizations will be important for future clinical trial cohorts. Finally, this study furthers our understanding of the progression of early onset LMNA-related muscular dystrophy and provides important insights into the anticipatory care needs of LMNA-related respiratory and cardiac manifestations.

Ketamine is a fast-acting N-methyl-D-aspartate (NMDA) receptor antagonist that can be used in a range of clinical scenarios in the pre-hospital setting and emergency department (ED). When compared with other anesthetic agents, ketamine has many unique properties, such as the ability to produce dose-dependent analgesic and anesthetic effects with a wide margin of safety. Ketamine may be used in the ED for sedation, pain management, and acute agitation treatment in the cases of benzodiazepine (BDZ)-resistant alcohol withdrawal syndrome (AWS) and substance use disorder. To highlight the efficacy and safety of ketamine, we reviewed the literature, starting with a description of four different cases of patients who presented to our ED and were treated with ketamine.

Methemoglobinemia (MET) is a life-threatening condition resulting from the development of methemoglobin (MetHb), which binds oxygen irreversibly, causing refractory hypoxia and so-called “functional anemia”. MET can be caused by hereditary or acquired processes. Acquired forms are the most common. Symptoms correlate with the MetHb level and range from cyanosis and dyspnea to dysrhythmias, metabolic acidosis, coma, and cardiac arrest. MetHb levels above 70% are fatal. Methylene blue (MB) is the specific antidote. In all cases, supportive treatment, including intravenous hydration, glucose correction, and oxygen supplementation, must be started immediately. Exchange transfusion has been used successfully to treat MET and may be appropriate in patients for whom MB is ineffective. We report the case of a 54-year-old woman who presented to our emergency department for the acute and sudden development of chest pain, shortness of breath, and severe cyanosis after drinking a significant amount of boiled courgette water. Arterial blood gas analysis revealed a MetHb level of 26%. She was treated immediately with MB, oxygen supplementation, and hydration with normalization of her MetHb in 12 hours. Our recommendation is to always investigate MET in patients with unexplained cyanosis and refractory hypoxia.

La regulación de las inteligencias artificiales (IA) devino un tema clave para las agendas tanto de los estados nación como de los organismos internacionales. En los países de América Latina y, particularmente, en Argentina, estos temas no han pasado desapercibidos y es posible encontrar numerosas iniciativas que se orientan a planificar y regular diferentes aspectos de las IA. Incluso, es posible advertir que estos intentos de regulaciones legales han aumentado luego de atravesar la pandemia. Al respecto, ¿qué políticas públicas sobre IA se han implementado en Argentina? ¿Cuántos proyectos de ley se están tratando en el Congreso de la Nación? ¿Tiene Argentina una estrategia nacional sobre cómo regular las IA? El artículo tiene por objeto relevar y analizar los diferentes antecedentes de regulación de las IA en Argentina desde 2018 hasta finales de 2023, incluyendo tanto las políticas públicas del Poder Ejecutivo como los proyectos de ley presentados en el Congreso de la Nación. El artículo forma parte de una investigación de mayor alcance que analiza las relaciones de co-construcción entre las IA y sus regulaciones, y busca fortalecer la soberanía tecnológica y las políticas públicas en Argentina.