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Aim  This study investigated the reliability and validity of the Barry–Albright Dystonia Scale (BADS), the Burke–Fahn–Marsden Movement Scale (BFMMS), and the Unified Dystonia Rating Scale (UDRS) in patients with bilateral dystonic cerebral palsy (CP). Method  Three raters independently scored videotapes of 10 patients (five males, five females; mean age 13y 3mo, SD 5y 2mo, range 5–22y). One patient each was classified at levels I–IV in the Gross Motor Function Classification System and six patients were classified at level V. Reliability was measured by (1) intraclass correlation coefficient (ICC) for interrater reliability, (2) standard error of measurement (SEM) and smallest detectable difference (SDD), and (3) Cronbach’s alpha for internal consistency. Validity was assessed by Pearson’s correlations among the three scales used and by content analysis. Results  Moderate to good interrater reliability was found for total scores of the three scales (ICC: BADS=0.87; BFMMS=0.86; UDRS=0.79). However, many subitems showed low reliability, in particular for the UDRS. SEM and SDD were respectively 6.36% and 17.72% for the BADS, 9.88% and 27.39% for the BFMMS, and 8.89% and 24.63% for the UDRS. High internal consistency was found. Pearson’s correlations were high. Content validity showed insufficient accordance with the new CP definition and classification. Interpretation  Our results support the internal consistency and concurrent validity of the scales; however, taking into consideration the limitations in reliability, including the large SDD values and the content validity, further research on methods of assessment of dystonia is warranted.

Cerebral palsy is the most frequent cause of severe physical disability in childhood. Dyskinetic cerebral palsy (DCP) is the second most common type of cerebral palsy after spastic forms. DCP is typically caused by non-progressive lesions to the basal ganglia or thalamus, or both, and is characterised by abnormal postures or movements associated with impaired tone regulation or movement coordination. In DCP, two major movement disorders, dystonia and choreoathetosis, are present together most of the time. Dystonia is often more pronounced and severe than choreoathetosis, with a major effect on daily activity, quality of life, and societal participation. The pathophysiology of both movement disorders is largely unknown. Some emerging hypotheses are an imbalance between indirect and direct basal ganglia pathways, disturbed sensory processing, and impaired plasticity in the basal ganglia. Rehabilitation strategies are typically multidisciplinary. Use of oral drugs to provide symptomatic relief of the movement disorders is limited by adverse effects and the scarcity of evidence that the drugs are effective. Neuromodulation interventions, such as intrathecal baclofen and deep brain stimulation, are promising options.

Background Limited research exists to guide clinical decisions about trialling, selecting, implementing and evaluating eye-gaze control technology. This paper reports on the outcomes of a Delphi study that was conducted to build international stakeholder consensus to inform decision making about trialling and implementing eye-gaze control technology with people with cerebral palsy. Methods A three-round online Delphi survey was conducted. In Round 1, 126 stakeholders responded to questions identified through an international stakeholder Advisory Panel and systematic reviews. In Round 2, 63 respondents rated the importance of 200 statements generated by in Round 1. In Round 3, 41 respondents rated the importance of the 105 highest ranked statements retained from Round 2. Results Stakeholders achieved consensus on 94 of the original 200 statements. These statements related to person factors, support networks, the environment, and technical aspects to consider during assessment, trial, implementation and follow-up. Findings reinforced the importance of an individualised approach and that information gathered from the user, their support network and professionals are central when measuring outcomes. Information required to support an application for funding was obtained. Conclusion This Delphi study has identified issues which are unique to eye-gaze control technology and will enhance its implementation with people with cerebral palsy.

Background: The Dyskinesia Impairment Scale (DIS) is a new assessment scale for dystonia and choreoathetosis in children and youth with dyskinetic cerebral palsy. Today, the Burke–Fahn–Marsden Dystonia Rating Scale (BFM) is mostly used to assess dystonia in children with inherited dystonia. The aim of this study was to assess reliability and validity of the DIS in children and youth with inherited or idiopathic dystonia. Methods: Reliability was measured by (1) the intraclass correlation coefficients (ICCs) for inter-rater and test-retest reliability, as well as (2) standard error of measurement (SEM) and minimal detectable difference (MDD). For concurrent validity of the DIS-dystonia subscale, the BFM was administered. Results: In total, 11 males and 9 females (median age 16 years and 7 months, range 6 to 24 years) were included. For inter-rater reliability, the ICCs for the DIS total score and the dystonia and choreoathetosis subscale scores were 0.83, 0.87, and 0.71, respectively. For test-retest reliability, the ICCs for the DIS total score and the dystonia and choreoathetosis subscale scores were 0.95, 0.88, and 0.93, respectively. The SEM and MDD for the total DIS were 3.98% and 11.04%, respectively. The Spearman correlation coefficient between the dystonia subscale and the BFM was 0.88 (p < 0.01). Conclusions: Good to excellent inter-rater, test-retest reliability, and validity were found for the total DIS and the dystonia subscale. The choreoathetosis subscale showed moderate inter-rater reliability and excellent test-retest reliability. The DIS may be a promising tool to assess dystonia and choreoathetosis in children and young adults with inherited or idiopathic dystonia.

Nonlinear modulational instability of wavepackets is one of the mechanisms responsible for the formation of large-amplitude water waves. Here, mechanically generated waves in a three-dimensional basin and numerical simulations of nonlinear waves have been compared in order to assess the ability of numerical models to describe the evolution of weakly nonlinear waves and predict the probability of occurrence of extreme waves within a variety of random directional wave fields. Numerical simulations have been performed following two different approaches: numerical integration of a modified nonlinear Schrödinger equation and numerical integration of the potential Euler equations based on a higher-order spectral method. Whereas the first makes a narrow-banded approximation (both in frequency and direction), the latter is free from bandwidth constraints. Both models assume weakly nonlinear waves. On the whole, it has been found that the statistical properties of numerically simulated wave fields are in good quantitative agreement with laboratory observations. Moreover, this study shows that the modified nonlinear Schrödinger equation can also provide consistent results outside its narrow-banded domain of validity.

In a multicenter, controlled trial, patients undergoing transplantation of a liver from a donor after circulatory death were randomly assigned to receive the liver after hypothermic oxygenated machine perfusion or conventional static cold storage. Hypothermic perfusion led to a lower risk of post-transplantation nonanastomotic biliary strictures.

The intrarenal resistive index is often measured to assess allograft status, but its value is unclear. This study showed that the resistive index, measured at predefined times after transplantation, reflects recipient factors but not intrinsic characteristics of the allograft. In many renal-transplantation centers, measurement of the intrarenal resistive index by means of Doppler ultrasonography is routinely used to evaluate renal allografts. 1 , 2 The resistive index is derived from the pulsatile flow-velocity waveform. In native kidneys, a higher resistive index, as compared with a lower resistive index, is a significant predictor of progressive renal dysfunction and adverse cardiovascular events. 3 – 9 A previous cross-sectional study linked an increased intrarenal resistive index after kidney transplantation with an increased risk of graft loss or recipient death. 10 Although these data suggest that the intrarenal resistive index reflects the intrinsic state of the allograft, it . . .

We present an experimental and numerical investigation on the statistical properties of the surface elevation in crossing sea conditions. Experiments are performed in a very large wave basin (70 m × 50 m × 3 m) and numerical results are obtained using a higher order method for solving the Euler equations. Both experimental and numerical results indicate that the number of extreme events depends on the angle between the two interacting systems. This outcome is supported by recent theoretical investigations which have highlighted that the instability of wave packets may be triggered by the nonlinear interactions between coexisting, non‐collinear wave systems. Key Points Occurrence of extreme waves depends on the angle between crossing wave fronts Crossing seas triggers the formation of extreme waves Experimental and numerical verification of wave instability in crossing seas

A wave basin experiment has been performed in the MARINTEK laboratories, in one of the largest existing three-dimensional wave tanks in the world. The aim of the experiment is to investigate the effects of directional energy distribution on the statistical properties of surface gravity waves. Different degrees of directionality have been considered, starting from long-crested waves up to directional distributions with a spread of ±30° at the spectral peak. Particular attention is given to the tails of the distribution function of the surface elevation, wave heights and wave crests. Comparison with a simplified model based on second-order theory is reported. The results show that for long-crested, steep and narrow-banded waves, the second-order theory underestimates the probability of occurrence of large waves. As directional effects are included, the departure from second-order theory becomes less accentuated and the surface elevation is characterized by weak deviations from Gaussian statistics.

Traditionally, the directional distribution of ocean waves has been regarded as unimodal, with energy concentrated mainly on the wind direction. However, numerical experiments and field measurements have already demonstrated that the energy of short waves tends to be accumulated along two off‐wind directions, generating a bimodal directional distribution. Here, numerical simulations of the potential Euler equations are used to investigate the temporal evolution of initially unimodal directional wave spectra. Because this approach does not include external forcing such as wind and breaking dissipation, spectral changes are only driven by nonlinear interactions. The simulations show that the wave energy spreads outward from the spectral peak, following two characteristic directions. As a result, the directional distribution develops a bimodal form as the wavefield evolves. Although bimodal properties are more pronounced in the high wave number part of the spectrum, in agreement with previous field measurements, the simulations also show that directional bimodality characterizes the spectral peak.