Plasma acyl-carnitines,bilirubin, tyramine and tetrahydro-21-deoxycortisol in Parkinson's disease and essential tremor. A case control biomarker study

Background and purposeGiven the overlapping clinical manifestations and pathology, the differentiation between essential tremor (ET) and Parkinson's disease (PD) is difficult. Our aims were to examine the plasma metabolomics profiling and their association with motor and non-motor symptoms (NMS) in patients with PD, and to determine differences between de novo PD compared to moderate-advanced PD vs. controls and patients with ET.MethodsPlasma samples were collected from 137 subjects including 35 age matched controls, 29 NOVO-PD, 35 PD and 38 ET patients. PD severity, motor and NMS including cognitive function were assessed using the UPDRS, NMS and PD cognitive rating scales, respectively. Metabolomics analysis was performed by UPLC-ESI-QToF-MS followed by unsupervised multivariate statistics. The area under the curve of the biomarkers according to distribution of their concentrations and the diagnosis of PD (NOVO-PD, advanced PD) vs ET and healthy controls was used as a measurement of diagnostic ability.ResultsSeveral acyl-carnitines, bilirubin, tyramine and tetrahydro-21-deoxycortisol (THS) presented good predictive accuracy (AUC higher than 0.8) for differentiating de novo PD and advanced PD from controls and ET, suggesting an alteration in the lipid oxidation pathway. In multivariate regression analysis, metabolite levels were not significantly associated with motor and NMS severity in PD.ConclusionsDiverse acyl-carnitines, bilirubin, tyramine and some adrenal gland derived metabolites are suggested as potential biomarkers able to distinguish between PD from controls and ET.     

Early visual ERPs are influenced by individual emotional skills

Processing information from faces is crucial to understanding others and to adapting to social life. Many studies have investigated responses to facial emotions to provide a better understanding of the processes and the neural networks involved. Moreover, several studies have revealed abnormalities of emotional face processing and their neural correlates in affective disorders. The aim of this study was to investigate whether early visual event-related potentials (ERPs) are affected by the emotional skills of healthy adults. Unfamiliar faces expressing the six basic emotions were presented to 28 young adults while recording visual ERPs. No specific task was required during the recording. Participants also completed the Social Skills Inventory (SSI) which measures social and emotional skills. The results confirmed that early visual ERPs (P1, N170) are affected by the emotions expressed by a face and also demonstrated that N170 and P2 are correlated to the emotional skills of healthy subjects. While N170 is sensitive to the subject’s emotional sensitivity and expressivity, P2 is modulated by the ability of the subjects to control their emotions. We therefore suggest that N170 and P2 could be used as individual markers to assess strengths and weaknesses in emotional areas and could provide information for further investigations of affective disorders.     

General principles to consider when designing a clinical communication assessment program

ObjectivesAssessment of clinical communication helps teachers in healthcare education determine whether their learners have acquired sufficient skills to meet the demands of clinical practice. The aim of this paper is to give input to educators when planning how to incorporate assessment into clinical communication teaching by building on the authors’ experience and current literature.MethodsA summary of the relevant literature within healthcare education is discussed, focusing on what and where to assess, how to implement assessment and how to choose appropriate methodology.ResultsEstablishing a coherent approach to teaching, training, and assessment, including assessing communication in the clinical context, is discussed. Key features of how to implement assessment are presented including: establishing a system with both formative and summative approaches, providing feedback that enhances learning and establishing a multi-source and longitudinal assessment program.ConclusionsThe implementation of a reliable, valid, credible, feasible assessment method with specific educational relevance is essential for clinical communication teaching.Practice implicationsAll assessment methods have strengths and limitations. Since assessment drives learning, assessment should be aligned with the purpose of the teaching program. Combining the use of different assessment formats, multiple observations, and independent measurements in different settings is advised.     

Preliminary findings of a randomized clinical trial of a virtual training program for applied behavior analysis technicians

As the demand for applied behavior analysis (ABA) services for children with an autism spectrum disorder continues to grow, it is critical to develop efficient, effective, and widely accessible procedures for training technicians to implement ABA interventions. One approach would be to develop efficacious training programs that could be delivered over the Internet via a virtual private network (VPN). In the current study, we developed a 40-h virtual training program in which participants completed e-learning modules and also received behavioral skills training over a VPN to implement behavior reduction and skill acquisition protocols in both discrete-trail and play-based formats. This virtual training program was evaluated in a randomized-clinical trial (RCT) using direct-observation measures on the implementation of discrete-trial training and play-based procedures as the primary dependent variables (which were also collected via a VPN). Participants in the treatment group showed robust and statistically significant improvement in their implementation of behavior reduction and acquisition programs under both discrete-trial and play-based formats, and they rated the training as highly socially acceptable. These preliminary results from an ongoing RCT suggest that this effective, convenient, and socially acceptable virtual training program has the potential to extend access to ABA services to families in rural and other underserved areas or populations.     

Exploring the efficacy of behavioral skills training to teach basic behavior analytic techniques to oral care providers

Performing oral care procedures with children with autism who exhibit noncompliance can be challenging for oral care professionals. Previous research has elucidated a number of effective behavior analytic procedures for increasing compliance, but some procedures are likely to be too time consuming and expensive for community-based oral care providers to adopt. The purpose of this study was to use Behavioral Skills Training to teach dental hygiene students and staff to implement basic function-based behavior analytic strategies to reduce noncompliance and increase their success in performing oral care exams and cleanings in vivo. All participants rapidly acquired the techniques and used them effectively during exams and cleanings following BST, and skills generalized to their completion of an X-ray procedure with several children with autism. The number of steps attempted in all procedures increased relative to baseline for all participants.     

追加反馈对护生沟通能力的影响

目的:探讨临床教学中追加反馈对护生沟通技能效果的影响。方法:随机抽取某院实习的护理专业2007级本科生56名,分为实验1组(28人)和实验2组(28人)。实验1组采用结果反馈(KR),反馈内容为沟通错误的信息;实验2组采用表现反馈,反馈内容为沟通错误及正确沟通的信息。结果:两组在沟通技能整个阶段成绩有显著性差别(P0.01)。结论:学习和实践过程中追加反馈的类型和内容对护生沟通技能的把握和运用有影响,表现反馈较结果反馈能够明显提高护生沟通技能。     

Improving therapeutic outcomes in autism spectrum disorders: Enhancing social communication and sensory processing through the use of interactive robots

For children with autism spectrum disorders (ASDs), social robots are increasingly utilized as therapeutic tools in order to enhance social skills and communication. Robots have been shown to generate a number of social and behavioral benefits in children with ASD including heightened engagement, increased attention, and decreased social anxiety. Although social robots appear to be effective social reinforcement tools in assistive therapies, the perceptual mechanism underlying these benefits remains unknown. To date, social robot studies have primarily relied on expertise in fields such as engineering and clinical psychology, with measures of social robot efficacy principally limited to qualitative observational assessments of children's interactions with robots. In this review, we examine a range of socially interactive robots that currently have the most widespread use as well as the utility of these robots and their therapeutic effects. In addition, given that social interactions rely on audiovisual communication, we discuss how enhanced sensory processing and integration of robotic social cues may underlie the perceptual and behavioral benefits that social robots confer. Although overall multisensory processing (including audiovisual integration) is impaired in individuals with ASD, social robot interactions may provide therapeutic benefits by allowing audiovisual social cues to be experienced through a simplified version of a human interaction. By applying systems neuroscience tools to identify, analyze, and extend the multisensory perceptual substrates that may underlie the therapeutic benefits of social robots, future studies have the potential to strengthen the clinical utility of social robots for individuals with ASD.