Developing a provisional definition of flare in patients with established gout

Objective Various nonvalidated criteria for disease flare have been used in studies of gout. Our objective was to develop empirical definitions for a gout flare from patient-reported features. Methods Possible elements for flare criteria were previously reported. Data were collected from 210 gout patients at 8 international sites to evaluate potential gout flare criteria against the gold standard of an expert rheumatologist definition. Flare definitions based on the presence of the number of criteria independently associated with the flare and classification and regression tree approaches were developed. Results The mean +/- SD age of the study participants was 56.2 +/- 15 years, 207 of them (98%) were men, and 54 of them (26%) had flares of gout. The presence of any patient-reported warm joint, any patient-reported swollen joint, patient-reported pain at rest score of >3 (010 scale), and patient-reported flare were independently associated with the study gold standard. The greatest discriminating power was noted for the presence of 3 or more of the above 4 criteria (sensitivity 91% and specificity 82%). Requiring all 4 criteria provided the highest specificity (96%) and positive predictive value (85%). A classification tree identified pain at rest with a score of >3, followed by patient self-reported flare, as the rule associated with the gold standard (sensitivity 83% and specificity 90%). Conclusion We propose definitions for a disease flare based on self-reported items in patients previously diagnosed as having gout. Patient-reported flare, joint pain at rest, warm joints, and swollen joints were most strongly associated with presence of a gout flare. These provisional definitions will next be validated in clinical trials.

Guidelines for the Development of Comprehensive Care Centers for Congenital Adrenal Hyperplasia: Guidance from the CARES Foundation Initiative

Patients with rare and complex diseases such as congenital adrenal hyperplasia (CAH) often receive fragmented and inadequate care unless efforts are coordinated among providers. Translating the concepts of the medical home and comprehensive health care for individuals with CAH offers many benefits for the affected individuals and their families. This manuscript represents the recommendations of a 1.5 day meeting held in September 2009 to discuss the ideal goals for comprehensive care centers for newborns, infants, children, adolescents, and adults with CAH. Participants included pediatric endocrinologists, internal medicine and reproductive endocrinologists, pediatric urologists, pediatric surgeons, psychologists, and pediatric endocrine nurse educators. One unique aspect of this meeting was the active participation of individuals personally affected by CAH as patients or parents of patients. Representatives of Health Research and Services Administration (HRSA), New York-Mid-Atlantic Consortium for Genetics and Newborn Screening Services (NYMAC), and National Newborn Screening and Genetics Resource Center (NNSGRC) also participated. Thus, this document should serve as a "roadmap" for the development phases of comprehensive care centers (CCC) for individuals and families affected by CAH.

Saúde Coletiva em debate: reflexões acerca de um campo em construção

O campo da saúde se apresenta como espaço de produção de conhecimento e práticas em transformação, que procura explicar a saúde para melhor intervir num contexto ampliado de vida. Buscamos explorar a trajetória histórico-político-conceitual da constituição do campo da Saúde Coletiva no Brasil, apoiando-nos em uma metodologia que utiliza elementos analíticos da própria reflexão que o estudo traz. Por meio das bases de dados teórico-conceituais, desenvolvemos uma análise para compreendermos o campo a partir de um olhar crítico sobre a cientificização das áreas de conhecimento. Considerando a singularidade de um campo em transformação, compreendemos sua conformação enquanto um campo de saberes e práticas militantes para a construção de novos paradigmas, a fim de explicar a saúde do povo brasileiro e nela intervir.

Configuração de posições em uma comunidade epistêmica e sua relação com o sentido da aprendizagem em redes interorganizacionais: estudo de caso no campo da biotecnologia

Na literatura sobre redes interorganizacionais, parte das abordagens de pesquisa afirma que tal tipo de ambiente favorece as condições para a aprendizagem por meio da combinação de capacidade de diferentes membros. Igualmente, existem correntes de estudo que apontam haver ressalvas relacionadas às próprias características dos membros. Esta aparente contradição instigou um questionamento: como a configuração de posições de membros de redes interorganizacionais afeta o sentido que a aprendizagem adquire para os próprios membros? Utilizando-se referências conceituais da área de aprendizagem em redes interorganizacionais, o estudo apresenta os resultados da análise de um caso empírico de uma comunidade epistêmica (rede de cooperação científica formalmente instituída) brasileira no campo da biotecnologia. Adotou-se como método de pesquisa a triangulação de técnicas quantitativas e qualitativas. Inicialmente, utilizou-se a análise quantitativa sociométrica evidenciando a posição do membro de acordo com a centralidade para a aprendizagem e a produção acadêmica. Após essa identificação, foram aplicadas entrevistas semiestruturadas aos membros localizados em diferentes posições, fossem elas de alto valor agregado (membros com alta centralidade) ou marginais (membros com baixa centralidade). A partir de um referencial de análise qualitativo com foco nos conceitos de práticas e gêneros discursivos, foi possível delinear diferentes sentidos sobre a aprendizagem decorrida de acordo com a posição dos membros. A partir dos resultados, evidenciou-se a relação da posição ocupada pelo membro da rede o sentido dado à aprendizagem. Apesar das limitações associadas à pesquisa sobre um caso único que dificulta a possível generalização dos resultados, o estudo abre possibilidades de aprofundar novas pesquisas sobre a relação entre as características dos membros e sua posição com a aprendizagem em redes interorganizacionais.

Chemically Resolved Particle Fluxes Over Tropical and Temperate Forests

Chemically resolved submicron (PM1) particlemass fluxes were measured by eddy covariance with a high resolution time-of-flight aerosolmass spectrometer over temperate and tropical forests during the BEARPEX-07 and AMAZE-08 campaigns. Fluxes during AMAZE-08 were small and close to the detection limit (<1 ng m−2 s−1) due to low particle mass concentrations (<1 μg m−3). During BEARPEX-07, concentrations were five times larger, with mean mid-day deposition fluxes of −4.8 ng m−2 s−1 for total nonrefractory PM1 (Vex,PM1 = −1 mm s−1) and emission fluxes of +2.6 ng m−2 s−1 for organic PM1 (Vex,org = +1 mm s−1). Biosphere–atmosphere fluxes of different chemical components are affected by in-canopy chemistry, vertical gradients in gas-particle partitioning due to canopy temperature gradients, emission of primary biological aerosol particles, and wet and dry deposition. As a result of these competing processes, individual chemical components had fluxes of varying magnitude and direction during both campaigns. Oxygenated organic components representing regionally aged aerosol deposited, while components of fresh secondary organic aerosol (SOA) emitted. During BEARPEX-07, rapid incanopy oxidation caused rapid SOA growth on the timescale of biosphere-atmosphere exchange. In-canopy SOA mass yields were 0.5–4%. During AMAZE-08, the net organic aerosol flux was influenced by deposition, in-canopy SOA formation, and thermal shifts in gas-particle partitioning.Wet deposition was estimated to be an order ofmagnitude larger than dry deposition during AMAZE-08. Small shifts in organic aerosol concentrations from anthropogenic sources such as urban pollution or biomass burning alters the balance between flux terms. The semivolatile nature of the Amazonian organic aerosol suggests a feedback in which warmer temperatures will partition SOA to the gas-phase, reducing their light scattering and thus potential to cool the region.

Differential effects of task-specific practice on performance in a simulated penalty kick under high-pressure

Objectives The current study investigated to what extent task-specific practice can help reduce the adverse effects of high-pressure on performance in a simulated penalty kick task. Based on the assumption that practice attenuates the required attentional resources, it was hypothesized that task-specific practice would enhance resilience against high-pressure. Method Participants practiced a simulated penalty kick in which they had to move a lever to the side opposite to the goalkeeper's dive. The goalkeeper moved at different times before ball-contact. Design Before and after task-specific practice, participants were tested on the same task both under low- and high-pressure conditions. Results Before practice, performance of all participants worsened under high-pressure; however, whereas one group of participants merely required more time to correctly respond to the goalkeeper movement and showed a typical logistic relation between the percentage of correct responses and the time available to respond, a second group of participants showed a linear relationship between the percentage of correct responses and the time available to respond. This implies that they tended to make systematic errors for the shortest times available. Practice eliminated the debilitating effects of high-pressure in the former group, whereas in the latter group high-pressure continued to negatively affect performance. Conclusions Task-specific practice increased resilience to high-pressure. However, the effect was a function of how participants responded initially to high-pressure, that is, prior to practice. The results are discussed within the framework of attentional control theory (ACT).

The mere presence of a goalkeeper affects the accuracy of penalty kicks

The keeper-independent strategy, in which a football penalty kicker selects a target location in advance and ignores the goalkeeper's actions during the run-up, has been suggested to be the preferable strategy for taking a penalty kick. The current in-field experiment investigated the question of whether the goalkeeper can indeed be ignored. Ten intermediate-level football players were instructed to adopt a goalkeeper-independent strategy and to perform penalty kicks directed at one of two targets located in the upper corners of the goal under three conditions: without a goalkeeper, in the presence of a goalkeeper (who tried to save the ball), and in the presence of a goalkeeper who was informed by the penalty kickers where they intended to direct the ball. The mere presence of a goalkeeper impaired shot accuracy. The shots were more centralised, that is, biased toward the goalkeeper. The effects were enhanced for the condition in which the penalty kicker knew the goalkeeper was knowledgeable about ball direction. The findings were consistent with the response activation model that holds that aiming at a target can be biased toward salient visual non-targets. The implications for adopting and practising goalkeeper-independent strategies are discussed.