Spelling treatment for an individual with dysgraphia: Analysis of generalisation to untrained words

Background: Despite the fact that spelling impairments are common following left hemisphere injury, only a limited number of studies have examined effects of treatments for acquired spelling disorders. In general, following spelling treatment, individuals with spelling impairments related to the orthographic output lexicon have demonstrated improvements restricted to trained words, whereas individuals with impairments of the graphemic buffer demonstrate spelling improvements for both trained and untrained items. Aims: This study was designed to examine patterns of spelling generalisation following treatment in an individual whose spelling impairment related to disruption affecting at least these two stages in the spelling process. Methods & Procedures: Assessment of spelling abilities in one gentleman, NM, with severe agraphia indicated impairment related to the orthographic output lexicon and graphemic buffer stages of spelling. In a single subject experimental treatment design, we employed a copy and recall treatment for two sets of words trained sequentially, and examined generalisation of training improvements to untrained words with similar beginning or ending spellings and nonwords. Outcomes & Results: NM improved spelling of two sets of trained words. He also demonstrated generalised improvements in spelling some untrained whole words. Generalisation was greater for parts of untrained words that were similar in spelling to trained words, and was also greater for the beginnings compared to the endings of words. Conclusions: We contend that the pattern of spelling generalisation observed in NM implicates improvements affecting two stages of spelling. Greater improvements when spelling beginning or ending parts of untrained words with similar spellings to trained words implicates changes mediated by the orthographic output lexicon. Improvements for some untrained words and an advantage to beginning over ending spellings suggests strengthening of the graphemic buffer. These spelling improvements also led to a functional impact on NM's use of spelling in daily activities.     

Efficient national surveillance for health-care-associated infections

BackgroundThe detection of novel health-care-associated infections as early as possible is an important public health priority. However, no evidence base exists to guide the design of efficient and reliable surveillance systems. Here we address this issue in the context of a novel pathogen spreading primarily between hospitals through the movement of patients.MethodsUsing hospital admission data from the year 2007, we modelled the spread of a pathogen among a network of hospitals connected by patient movements using a hospital-based susceptible-infectious model. We compared the existing surveillance system in Scotland with a gold standard (a putative optimal selection algorithm) to determine its efficiency and to see whether it is beneficial to alter the number and choice of hospitals in which to concentrate surveillance effort.FindingsWe validated our model by demonstrating that it accurately predicted the risk of meticillin-resistant cases of Staphylococcus aureus bacteraemia in hospitals in Scotland in 2007. Furthermore, the model predicted that relying solely on the 29 (out of 182) sentinel hospitals that currently contribute most of the national surveillance effort results in an average detection time (time until first appearance of the pathogen in a hospital) of 117 days. This detection time could be reduced to 87 days by optimal selection of the same number of hospitals. Alternatively, the same detection time (117 days) can be achieved with just 22 optimally selected hospitals. Increasing the number of sentinel hospitals to 38 (teaching and general hospitals) reduced detection time by 43 days; a decrease to seven sentinel hospitals (all teaching hospitals) increased detection time substantially to 268 days.InterpretationOur results show that the present surveillance system used in Scotland is not optimal in detecting novel pathogens compared with a gold standard. However, efficiency gains are possible by better choice of sentinel hospitals, or by increasing the number of hospitals involved in surveillance. Similar studies could be used elsewhere to inform the design and implementation of efficient national, hospital-based surveillance systems that achieve rapid detection of novel health-care-associated infections for minimum effort.FundingThis research received funding from the European Union Seventh Framework Programme (FP7-HEALTH-2011-single-stage): Evolution and Transfer of Antibiotic Resistance (EvoTAR).     

Comprehension and expression of affective sentences in traumatic brain injury

The comprehension and production of affective prosody and facial expression was investigated in subjects with traumatic brain injury and matched normal subjects. Performance on tasks designed to assess the ability to recognise affect in congruous, neutral, and ambiguous sentences and the ability to portray emotions in affectively neutral sentences revealed significant impairments for the subjects with traumatic brain injury. Analysis of correct responses to ambiguous sentences found increased reliance of brain-injured subjects on verbal compared to paralinguistic cues in interpreting the emotion of the sentence. The clinical implications of the findings relative to counselling, compensation strategies, and direct intervention for patients with traumatic brain injury are discussed.     

Iliotibial band avulsion fracture: a case report with differential diagnosis

Avulsion injuries of the knee are common sequelae of significant trauma given the number of ligamentous and tendinous insertions around the joint. Commonly discussed avulsion fractures of the lateral knee include the Segond fracture of the lateral tibial plateau and the arcuate complex avulsion fracture of the fibular styloid process. A less common avulsion fracture is the iliotibial (IT) band avulsion fracture involving the anterolateral corner of the tibia (Gerdy’s tubercle). It is crucial to identify IT band avulsion fractures because of the frequent associated internal derangements of the knee. This case report describes the imaging of an acute IT band avulsion fracture and compares these findings with other lateral knee avulsion fractures.     

Anti-thymocyte Globulin for the Treatment of Acute Cellular Rejection Following Liver Transplantation

Introduction  

Acute cellular rejection (ACR) post-liver transplantation (LT) can usually be reversed with pulse dose steroids. Anti-thymocyte globulin (ATG) is used to treat steroid-resistant rejection (SRR).     

Fructose-1,6-bisphosphate inhibits in vitro and ex vivo platelet aggregation induced by ADP and ameliorates coagulation alterations in experimental sepsis in rats

Sepsis is a systemic response to an infection that leads to a generalized inflammatory reaction. There is an intimate relationship between procoagulant and proinflammatory activities, and coagulation abnormalities are common in septic patients. Pharmaceutical studies have focused to the development of substances that act on coagulation abnormalities and on the link between coagulation and inflammation. Fructose-1,6-bisphosphate (FBP) is a high-energy glycolitic metabolite that in the past two decades has been shown therapeutic effects in great number of pathological situations, including sepsis. The aims of this study were to assess the effects of FBP on platelet aggregation in vitro and ex vivo in healthy and septic rats and evaluate the use of FBP as a treatment for thrombocytopenia and coagulation abnormalities in abdominal sepsis in rat. FBP inhibited platelet aggregation (P < 0.001) in vitro in healthy rats from the smallest dose tested, 2.5 mM, in a dose-dependent manner. The mean effective dose calculated was 10.6 mM. The highest dose tested, 40 mM, completely inhibited platelet aggregation (P < 0.001) induced by ADP. Platelet aggregation in plasma from septic rats was inhibited only with higher doses of FBP, starting from 20 mM (P < 0.001). The calculated mean effective dose was 19.3 mM. Ex vivo platelet aggregation in septic rats was significantly lower (P < 0.05) than healthy rats and the treatment with FBP, at the dose of 2 g/kg, diminished the platelet aggregation at the extension of 27% (P < 0.001), suggesting that FBP is a potent platelet aggregation inhibitor in vivo. Moreover, treatment with FBP 2 g/kg prevented thrombocytopenia (P < 0.001), prolongation of prothrombin and partial thromboplastin time (P < 0.001), but not fibrinogen, in septic rats. The most important findings in this study are that FBP is a potent platelet aggregation inhibitor, in vitro and ex vivo. It presents protective effects on coagulation abnormalities, which can represent a treatment against DIC. The mechanisms for these effects remain under investigation.     

Short- and long-term costs of laparoscopic colectomy are significantly less than open colectomy

Background  

The financial impact of laparoscopic colectomy remains poorly defined. We report the short-term costs of laparoscopic colectomy (LC) as compared with open colectomy (OC) in a high-volume tertiary care hospital, and are the first to incorporate the costs of late, colectomy-related complications in an analysis of long-term costs.