The missed missing hole

At times in clinical neurology, the identification of a subtle clinical or radiological sign can lead to prompt diagnosis of a very rare or difficult case. We report on a patient who presented with untreatable headache and unilateral ptosis. Computed tomography (CT) scan of the head did not reveal any structural cause. Magnetic resonance angiogram showed absence of left internal carotid artery, which was eventually confirmed by a catheter angiography. Reviewing the case, it emerged that a feature on the initial CT scan "bone window" would have confirmed the diagnosis, had it been searched for: the underdeveloped carotid canal, which is a consequence and a marker of internal carotid artery agenesis.

The relationship between social support and functional capacity in elderly persons with cognitive alterations

The objective of this study was to identify the relationship between social support and the functional capacity of elderly persons with cognitive alterations. It is a descriptive, cross-sectional and quantitative study. The subjects were 101 elderly persons registered in Family Health Centers whose performance in the Mini-Exam for Mental Status was below a certain specified level in a previous study. The Medical Outcomes Study questionnaire, Katz Index and Pfeffer Questionnaire were applied. The dimensions of material, affective, emotional, informational and positive social interaction support resulted in an average final score of 74.32 points, indicating a better level of material and affective support in relation to the other dimensions of support. There was a statistically significant correlation between emotional support and the Katz Index. Knowledge about this relationship favors the development of a nursing care pathway for the elderly which is capable of maintaining their functional capacity and ensuring satisfactory social relations.

Molecular chemistry and the missing mass problem in planetary nebulae

Context. Detections of molecular lines, mainly from H-2 and CO, reveal molecular material in planetary nebulae. Observations of a variety of molecules suggest that the molecular composition in these objects differs from that found in interstellar clouds or in circumstellar envelopes. The success of the models, which are mostly devoted to explain molecular densities in specific planetary nebulae, is still partial however. Aims. The present study aims at identifying the influence of stellar and nebular properties on the molecular composition of planetary nebulae by means of chemical models. A comparison of theoretical results with those derived from the observations may provide clues to the conditions that favor the presence of a particular molecule. Methods. A self-consistent photoionization numerical code was adapted to simulate cold molecular regions beyond the ionized zone. The code was used to obtain a grid of models and the resulting column densities are compared with those inferred from observations. Results. Our models show that the inclusion of an incident flux of X-rays is required to explain the molecular composition derived for planetary nebulae. We also obtain a more accurate relation for the N(CO)/N(H-2) ratio in these objects. Molecular masses obtained by previous works in the literature were then recalculated, showing that these masses can be underestimated by up to three orders of magnitude. We conclude that the problem of the missing mass in planetary nebulae can be solved by a more accurate calculation of the molecular mass.

What is Missing for Traditional Design-Centric Engineering Education to Better Prepare Newly Graduated Engineers for the Global Era?

This paper presents an analysis of the capacity of design centric methodologies to prepare engineering students to succeed in the market. Gaps are brainstormed and analyzed with reference to their importance. Reasons that may lead the newly graduated engineers not to succeed right from the beginning of their professional lives have also been evaluated. A comparison among the two subjects above was prepared, reviewed and analyzed. The influence of multidisciplinary, multicultural and complex environmental influences created in the current global business era is taken into account. The industry requirements in terms of what they expect to 'receive' from their engineers are evaluated and compared to the remaining of the study above. An innovative approach to current engineering education that utilizes traditional design-centric methodologies is then proposed, aggregating new disciplines to supplement the traditional engineering education. The solution encompasses the inclusion of disciplines from Human Sciences and Emotional Intelligence fields willing to better prepare the engineer of tomorrow to work in a multidisciplinary, globalized, complex and team working environment. A pilot implementation of such an approach is reviewed and conclusions are drawn from this educational project.

Attitudes of mental health professionals towards persons with schizophrenia: a transcultural comparison between Switzerland and Brazil

Background: Stigmatization is an important issue in the treatment and course of schizophrenia. The maintenance of stigmatizing attitudes may be related to socio-cultural factors. Objectives: To compare stigmatizing attitudes of mental health professionals in the culturally diverse countries Brazil and Switzerland. Methods: We analyzed data of two broad stigmatization surveys from Switzerland and Brazil by focusing on the social distance and attitudes of mental health professionals towards the acceptance of side effects of psychopharmacological treatment. Results: Swiss mental health professionals showed significantly higher levels of social distance than their Brazilian counterparts. There was also a weak effect of age as well as an interaction effect between origin and age. With respect to the acceptance of side effects, the effect of origin was rather weak. With the exception of drug dependence, Swiss professionals' acceptance of long-lasting side effects was significantly higher than for their counterparts in Brazil. Discussion: The strong association between origin and social distance may be related to the socio-cultural background of the mental health professionals. In comparison with Switzerland, Brazil is very heterogeneous in terms of ethnicity and socio-economic structure. The distinct acceptance of side effects may additionally be related to the more sophisticated medicaments (i.e. new generation of antipsychotic drugs) commonly used in Switzerland. Hengartner MP, et al. / Rev Psiq Clin. 2012;39(4):115-21

Wh plus missing-E-T signature from gaugino pair production at the LHC

In SUSY models with heavy squarks and gaugino mass unification, the gaugino pair production reaction pp -> (W) over tilde (+/-)(1)(Z) over tilde (2) dominates gluino pair production for m (g) over tilde less than or similar to 1 TeV at LHC with root s = 14 TeV (LHC14). For this mass range, the two-body decays (W) over tilde (1) -> W (Z) over tilde (1) and (Z) over tilde (2) -> h (Z) over tilde (1) are expected to dominate the chargino and neutralino branching fractions. By searching for lb (b) over tilde + is not an element of(T) events from (W) over tilde (+/-)(1)Z(2) production, we show that LHC14 with 100 fb(-1) of integrated luminosity becomes sensitive to chargino masses in the range m((W) over tilde1) similar to 450-550 GeV corresponding to m (g) over tilde similar to 1.5-2 TeV in models with gaugino mass unification. For 10(3) fb(-1), LHC14 is sensitive to the Wh channel for m((W) over tilde1) similar to 300-800 GeV, corresponding to m (g) over tilde similar to 1-2.8 TeV, which is comparable to the reach for gluino pair production followed by cascade decays. The Wh + is not an element of(T) search channel opens up a new complementary avenue for SUSY searches at LHC, and serves to point to SUSYas the origin of any new physics discovered via multijet and multilepton + is not an element of(T) channels.

Is missing maxillary lateral incisor in complete cleft lip and palate a product of genetics or local environment?

Objective: To test the null hypothesis: Subjects with isolated complete unilateral cleft lip and palate (UCLP) show no differences in overall frequency of tooth agenesis (hypodontia), comparing a subsample with cleft-side maxillary lateral incisor (MxI2) agenesis to a subsample without cleftside MxI2 agenesis. Findings could clarify the origins of cleft-side MxI2 agenesis. Materials and Methods: Tooth agenesis was identified from dental radiographs of 141 subjects with UCLP. The UCLP cohort was segregated into four categories according to the status and location of MxI2 in the region of the unilateral cleft: group M: subjects with one tooth, located on the mesial side of the alveolar cleft; group D: subjects with one tooth, located on the distal side of the alveolar cleft; group MD: subjects with two teeth present, one mesial and one distal to the cleft; and group ABS: subjects with lateral incisor absent (agenesis) in the cleft area. Results: The null hypothesis was rejected. Among UCLP subjects, there was a twofold increase (P < .0008) in overall frequency of tooth agenesis outside the cleft region in a subsample with cleftside MxI2 agenesis (ABS), compared to a subsample presenting with no agenesis of the cleft-side MxI2 (M+D+MD). Conclusions: Cleft-side MxI2 agenesis in CLP subjects appears to be largely a genetically controlled anomaly associated with cleft development, rather than a collateral environmental consequence of the adjacent cleft defect, since increased hypodontia involving multiple missing teeth observed remote from a cleft clearly has a significant genetic basis. (Angle Orthod. 2012;82:959-963.)

W Z plus missing-E-T signal from gaugino pair production at LHC7

LHC searches for supersymmetry currently focus on strongly produced sparticles, which are copiously produced if gluinos and squarks have masses of a few hundred GeV. However, in supersymmetric models with heavy scalars, as favored by the decoupling solution to the SUSY flavor and CP problems, and m((g) over tilde) greater than or similar to 500 GeV as indicated by recent LHC results, chargino-neutralino ((W) over tilde (+/-)(1)(Z) over tilde (2)) production is the dominant cross section for m((W) over tilde1) similar to m((Z) over tilde2) < m(<(g)over tilde>)/3 at LHC with root s = 7 TeV (LHC7). Furthermore, if m((Z) over tilde1) + (m (Z) over tilde) less than or similar to m((Z) over tilde2) less than or similar to m((Z) over tilde1) + m(h), then (Z) over tilde (2) dominantly decays via (Z) over tilde (2) -> (Z) over tilde (1)Z, while (W) over tilde (1) decays via (W) over tilde (1) -> (Z) over tilde W-1. We investigate the LHC7 reach in the W Z + (sic)T channel (for both leptonic and hadronic decays of the W boson) in models with and without the assumption of gaugino mass universality. In the case of the mSUGRA/CMSSM model with heavy squark masses, the LHC7 discovery reach in the W Z+ (sic)T channel becomes competetive with the reach in the canonical (sic)T + jets channel for integrated luminosities similar to 30 fb(-1). We also present the LHC7 reach for a simplified model with arbitrary m((Z) over tilde1) and m((W) over tilde1) similar to m((Z) over tilde2). Here, we find a reach of up to m((W) over tilde1) similar to 200 (250) GeV for 10 (30) fb(-1).

Living Invisible: HTLV-1-Infected Persons and the Lack of Care in Public Health

Introduction: Human T-cell lymphotropic virus type 1 (HTLV-1) infection is intractable and endemic in many countries. Although a few individuals have severe symptoms, most patients remain asymptomatic throughout their lives and their infections may be unknown to many health professionals. HTLV-1 can be considered a neglected public health problem and there are not many studies specifically on patients' needs and emotional experiences. Objective: To better understand how women and men living with HTLV-1 experience the disease and what issues exist in their healthcare processes. Methods: A qualitative study using participant observation and life story interview methods was conducted with 13 symptomatic and asymptomatic patients, at the outpatient clinic of the Emilio Ribas Infectious Diseases Institute, in Sao Paulo, Brazil. Results and Discussion: The interviewees stated that HTLV-1 is a largely unknown infection to society and health professionals. Counseling is rare, but when it occurs, focuses on the low probability of developing HTLV-1 related diseases without adequately addressing the risk of infection transmission or reproductive decisions. The diagnosis of HTLV-1 can remain a stigmatized secret as patients deny their situations. As a consequence, the disease remains invisible and there are potentially negative implications for patient self-care and the identification of infected relatives. This perception seems to be shared by some health professionals who do not appear to understand the importance of preventing new infections. Conclusions: Patients and medical staff referred that the main focus was the illness risk, but not the identification of infected relatives to prevent new infections. This biomedical model of care makes prevention difficult, contributes to the lack of care in public health for HTLV-1, and further perpetuates the infection among populations. Thus, HTLV-1 patients experience an "invisibility" of their complex demands and feel that their rights as citizens are ignored.

Bioelectrical impedance with different equations versus deuterium oxide dilution method for the inference of body composition in healthy older persons

There is no consensus regarding the accuracy of bioimpedance for the determination of body composition in older persons. This study aimed to compare the assessment of lean body mass of healthy older volunteers obtained by the deuterium dilution method (reference) with those obtained by two frequently used bioelectrical impedance formulas and one formula specifically developed for a Latin-American population. A cross-sectional study. Twenty one volunteers were studied, 12 women, with mean age 72 +/- 6.7 years. Urban community, Ribeiro Preto, Brazil. Fat free mass was determined, simultaneously, by the deuterium dilution method and bioelectrical impedance; results were compared. In bioelectrical impedance, body composition was calculated by the formulas of Deuremberg, Lukaski and Bolonchuck and Valencia et al. Lean body mass of the studied volunteers, as determined by bioelectrical impedance was 37.8 +/- 9.2 kg by the application of the Lukaski e Bolonchuk formula, 37.4 +/- 9.3 kg (Deuremberg) and 43.2 +/- 8.9 kg (Valencia et. al.). The results were significantly correlated to those obtained by the deuterium dilution method (41.6 +/- 9.3 Kg), with r=0.963, 0.932 and 0.971, respectively. Lean body mass obtained by the Valencia formula was the most accurate. In this study, lean body mass of older persons obtained by the bioelectrical impedance method showed good correlation with the values obtained by the deuterium dilution method. The formula of Valencia et al., developed for a Latin-American population, showed the best accuracy.

Relationship between function, strength and electromyography of upper extremities of persons with tetraplegia

Study design: Cross-sectional. Objective: To analyze the relationships between functional tests, arm strength and root mean square of surface electromyography (EMG). Setting: Sao Paulo, Brazil. Methods: Twenty-four individuals with chronic tetraplegia participated. Upper extremity motor score (UEMS), functional independence measure (FIM) motor score, spinal cord independence measure III and capabilities of upper extremity (CUE) were performed. Muscle strength of the right elbow flexors-extensors was assessed using dynamometry and manual muscle test (MMT) and EMG of right biceps and triceps brachii were performed. Spearman's rank correlation coefficients and Mann-Whitney's U-test were used. Results: Functional tests and UEMS correlated strongly among them. UEMS highly correlated with triceps dynamometry and EMG. The dynamometry showed a very high correlation with MMT on the extensor group and a moderate correlation with flexor group. Triceps EMG showed moderate correlation with FIM and CUE. High correlations between triceps EMG and elbow extensors dynamometry and MMT were observed. A significant better performance on functional tests was observed on lower ASIA motor levels. The low-tetraplegia group showed a significant higher score on triceps EMG and dynamometry. Conclusion: Arm strength and EMG seem to be related to functional capabilities and independence in chronic tetraplegia. Spinal Cord (2012) 50, 28-32; doi:10.1038/sc.2011.95; published online 30 August 2011

Effectiveness of the polysaccharide pneumococcal vaccine among HIV-infected persons in Brazil: a case control study

Abstract Background Polysaccharide pneumococcal vaccine is recommended for use in HIV-infected adults in Brazil but there is uncertainty about its effectiveness in this patient population. The main objective of this study was to assess the effectiveness of the 23-valent polysaccharide pneumococcal vaccine against invasive pneumococcal infection among HIV-infected adult patients in São Paulo, Brazil. Methods A case-control study of 79 cases and 242 controls matched on CD4+ cell count and health care setting was conducted. Among HIV-infected adults in São Paulo, Brazil, with and without S. pneumoniae recovered from a normally sterile site; prior receipt of 23 valent polysaccharide pneumococcal vaccine was determined by review of medical records and patient interview. Results After adjustment for confounding factors, the point estimate for the effectiveness of 23 valent polysaccharide vaccine among HIV-infected adults against all invasive pneumococcal infection was 18% (95% CI: <0 to 62%). Conclusion We were unable to demonstrate a statistically significant protective effect of 23 valent polysaccharide against invasive pneumococcal infection vaccine among HIV-infected adults in Brazil. While the vaccine is relatively inexpensive and safe, its effectiveness among HIV-infected adults in Brazil is uncertain.