Unfulfilled rehabilitation needs and dissatisfaction with care 12 months after a stroke : an explorative observational study

BACKGROUND: People who have suffered a stroke commonly report unfulfilled need for rehabilitation. Using a model of patient satisfaction, we examined characteristics in individuals that at 3 months after stroke predicted, or at 12 months were associated with unmet need for rehabilitation or dissatisfaction with health care services at 12 months after stroke. METHODS: The participants (n = 175) received care at the stroke units at the Karolinska University Hospital, Sweden. The dependent variables "unfulfilled needs for rehabilitation" and "dissatisfaction with care" were collected using a questionnaire. Stroke severity, domains of the Stroke Impact Scale (SIS), the Sense of Coherence scale (SOC) and socio demographic factors were used as independent variables in four logistic regression analyses. RESULTS: Unfulfilled needs for rehabilitation at 12 months were predicted by strength (SIS) (odds ratio (OR) 7.05) at three months, and associated with hand function (SIS) (OR 4.38) and poor self-rated recovery (SIS) (OR 2.46) at 12 months. Dissatisfaction with care was predicted by SOC (OR 4.18) and participation (SIS) (OR 3.78), and associated with SOC (OR 3.63) and strength (SIS) (OR 3.08). CONCLUSIONS: Thirty-three percent of the participants reported unmet needs for rehabilitation and fourteen percent were dissatisfied with the care received. In order to attend to rehabilitation needs when they arise, rehabilitation services may need to be more flexible in terms of when rehabilitation is provided. Long term services with scheduled re-assessments and with more emphasis on understanding the experiences of both the patients and their social networks might better be able to provide services that attend to patients' needs and aid peoples' reorientation; this would apply particularly to those with poor coping capacity.

The influence of visual inter-hemispheric connections on spiking, assembly and LFP activities, and their phase relationship during figure-ground stimulation

Desde os descobrimentos pioneiros de Hubel e Wiesel acumulou-se uma vasta literatura descrevendo as respostas neuronais do córtex visual primário (V1) a diferentes estímulos visuais. Estes estímulos consistem principalmente em barras em movimento, pontos ou grades, que são úteis para explorar as respostas dentro do campo receptivo clássico (CRF do inglês classical receptive field) a características básicas dos estímulos visuais como a orientação, direção de movimento, contraste, entre outras. Entretanto, nas últimas duas décadas, tornou-se cada vez mais evidente que a atividade de neurônios em V1 pode ser modulada por estímulos fora do CRF. Desta forma, áreas visuais primárias poderiam estar envolvidas em funções visuais mais complexas como, por exemplo, a separação de um objeto ou figura do seu fundo (segregação figura-fundo) e assume-se que as conexões intrínsecas de longo alcance em V1, assim como as conexões de áreas visuais superiores, estão ativamente envolvidas neste processo. Sua possível função foi inferida a partir da análise das variações das respostas induzidas por um estímulo localizado fora do CRF de neurônios individuais. Mesmo sendo muito provável que estas conexões tenham também um impacto tanto na atividade conjunta de neurônios envolvidos no processamento da figura quanto no potencial de campo, estas questões permanecem pouco estudadas. Visando examinar a modulação do contexto visual nessas atividades, coletamos potenciais de ação e potenciais de campo em paralelo de até 48 eletrodos implantados na área visual primária de gatos anestesiados. Estimulamos com grades compostas e cenas naturais, focando-nos na atividade de neurônios cujo CRF estava situado na figura. Da mesma forma, visando examinar a influência das conexões laterais, o sinal proveniente da área visual isotópica e contralateral foi removido através da desativação reversível por resfriamento. Fizemos isso devido a: i) as conexões laterais intrínsecas não podem ser facilmente manipuladas sem afetar diretamente os sinais que estão sendo medidos, ii) as conexões inter-hemisféricas compartilham as principais características anatômicas com a rede lateral intrínseca e podem ser vistas como uma continuação funcional das mesmas entre os dois hemisférios e iii) o resfriamento desativa as conexões de forma causal e reversível, silenciando temporariamente seu sinal, permitindo conclusões diretas a respeito da sua contribuição. Nossos resultados demonstram que o mecanismo de segmentação figurafundo se reflete nas taxas de disparo de neurônios individuais, assim como na potência do potencial de campo e na relação entre sua fase e os padrões de disparo produzidos pela população. Além disso, as conexões laterais inter-hemisféricas modulam estas variáveis dependendo da estimulação feita fora do CRF. Observamos também uma influência deste circuito lateral na coerência entre potenciais de campo entre eletrodos distantes. Em conclusão, nossos resultados dão suporte à ideia de um mecanismo complexo de segmentação figura-fundo atuando desde as áreas visuais primárias em diferentes escalas de frequência. Esse mecanismo parece envolver grupos de neurônios ativos sincronicamente e dependentes da fase do potencial de campo. Nossos resultados também são compatíveis com a hipótese que conexões laterais de longo alcance também fazem parte deste mecanismo

Three-Dimensional Modelling of Honeybee Venom Allergenic Proteases: Relation to Allergenicity

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Adaptation to climate change in megacities of Latin America: Regional Learning Network of the research project ClimateAdaptationSantiago (CAS)

The main objective of this publication is to document the current state of urban climate change adaptation practice in Latin America. It is a summary of the three workshops of the Regional Learning Network that was set up under the ClimateAdaptationSantiago project (CAS), encompassing six large Latin American cities (Bogotá, Buenos Aires, Lima, Mexico City, São Paulo and Santiago). It aims to synthesize information on the manifestations and impacts of climate change in those Latin American cities that participated in the network, and above all, governance in the form of concrete actions. The publication is based on information obtained from the participants in the three workshops, but also includes additional scientific input and reflections by the editors. All of this information makes a major contribution to highlighting the different paths these six cities are pursuing in response to climate change. To that end, the publication discusses the various courses of action on climate change adaptation, with the aim of learning from these cases and highlighting practical examples.

Distribuição espaço-temporal de macroinvertebrados aquáticos do médio Rio Xingu, Altamira - PA

O presente estudo objetivou avaliar a estrutura da assembléia de macroinvertebrados bentônicos no médio rio Xingu, estimando a produção secundária anual. Dois ambientes no setor do médio rio Xingu foram estudados, um lêntico (lago da Ilha Grande) e o canal principal. No lago foram realizadas coletas nos habitats marginal e profundo, utilizando amostrador tipo core e uma draga Ekiman-Birge; já nos habitats de corredeira e remanso no canal principal, os organismos foram coletados com uma rede tipo surber e core. As coletas ocorerram durante 12 meses abrangendo o período de cheia (janeiro a maio) e da seca (junho a dezembro) local. Foram coletados um total de 23.432 indivíduos da macrofauna bentônica, referentes a 43 táxons, 8 classes e 4 filos. Os insetos e gastrópodes corresponderam, respectivamente, a 47% e 36% do total de exemplares capturados. A maior diversidade de táxons foi registrada para os ambientes de corredeiras. O ambiente de remanso do rio por sua vez foi muito similar em riqueza de espécies, ao ambiente marginal do lago. A densidade média no período de seca foi de 1.605,75 ind.m^-2, e no período da cheia de 894,43 ind.m^-2. Leptophlebiidae, Hydropsychidae e Chironomidae, com 29,0%, 21,4% e 13,1%, respectivamente contribuíram com a maior abundância no ambiente de rio. Já para o lago, os Chironomidae (34,6%) Oligochaeta (23,2%), Chaoboridade (14,7%) e Nematoda (14,5%) contribuíram com a maior proporção da densidade. As diferenças encontradas nas assembléias de macroinvertebrados entre habitats foram relacionadas a diferenças de oxigênio dissolvido e nutrientes. Os ambientes de corredeira foram os mais diferenciados de todos os habitats estudados.

Ancient Dispersal of the Human Fungal Pathogen Cryptococcus gattii from the Amazon Rainforest

Over the past two decades, several fungal outbreaks have occurred, including the high-profile 'Vancouver Island' and 'Pacific Northwest' outbreaks, caused by Cryptococcus gattii, which has affected hundreds of otherwise healthy humans and animals. Over the same time period, C. gattii was the cause of several additional case clusters at localities outside of the tropical and subtropical climate zones where the species normally occurs. In every case, the causative agent belongs to a previously rare genotype of C. gattii called AFLP6/VGII, but the origin of the outbreak clades remains enigmatic. Here we used phylogenetic and recombination analyses, based on AFLP and multiple MLST datasets, and coalescence gene genealogy to demonstrate that these outbreaks have arisen from a highly-recombining C. gattii population in the native rainforest of Northern Brazil. Thus the modern virulent C. gattii AFLP6/VGII outbreak lineages derived from mating events in South America and then dispersed to temperate regions where they cause serious infections in humans and animals.

The genomes of two key bumblebee species with primitive eusocial organization

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Impacts of interruption of the Agulhas leakage on the tropical Atlantic in coupled ocean-atmosphere simulations

In this paper we use a coupled ocean-atmosphere model to investigate the impact of the interruption of Agulhas leakage of Indian ocean water on the tropical Atlantic, a region where strong coupled ocean-atmosphere interactions occur. The effect of a shut down of leakage of Indian ocean water is isolated from the effect of a collapse of the MOC. In our experiments, the ocean model is forced with boundary conditions in the southeastern corner of the domain that correspond to no interocean exchange of Indian ocean water into the Atlantic. The southern boundary condition is taken from the Levitus data and ensures an MOC in the Atlantic. Within this configuration, instead of warm and salty Indian ocean water temperature (cold) and salinity (fresh) anomalies of southern ocean origin propagate into the South Atlantic and eventually reach the equatorial region, mainly in the thermocline. This set up mimics the closure of the ""warm water path"" in favor of the ""cold water path"". As part of the atmospheric response, there is a northward shift of the intertropical convergence zone (ITCZ). The changes in trade winds lead to reduced Ekman pumping in the equatorial region. This leads to a freshening and warming of the surface waters along the equator. Especially in the Cold Tongue region, the cold and fresh subsurface anomalies do not reach the surface due to the reduced upwelling. The anomaly signals are transported by the equatorial undercurrent and spread away from the equator within the thermocline. Part of the anomaly eventually reaches the Tropical North Atlantic, where it affects the Guinea Dome. Surprisingly, the main effect at the surface is small on the equator and relatively large at the Guinea Dome. In the atmosphere, the northward shift of the ITCZ is associated with a band of negative precipitation anomalies and higher salinities over the Tropical South Atlantic. An important implication of these results is that the modified water characteristics due to a shut down of the Agulhas leakage remain largely unaffected when crossing the equatorial Atlantic and therefore can affect the deepwater formation in the North Atlantic. This supports the hypothesis that the Agulhas leakage is an important source region for climate change and decadal variability of the Atlantic.

Impact of biannual rossby waves on the Indian Ocean Dipole

Topex/Poseidon sea surface height anomalies during 1993-2002 are decomposed using 2-D finite impulse response filters which showed biannual Rossby waves (BRWs) in the equatorial Indian Ocean (peak at 1.5 degrees S) and in the southern tropical Indian Ocean (peak at 10.5 degrees S) during Indian Ocean Dipole (IOD) years. Anomalous downwelling BRWs in the equatorial Indian Ocean triggered by the wind stress curl-induced Ekman pumping near the eastern boundary started propagating westward from the eastern boundary in July/August 1993 and 1996, i.e., more than one year prior to the formation of the IOD events of 1994 and 1997 respectively. These strong downwelling signals reach the western equatorial Indian Ocean during the peak dipole time.

Changes in the intermediate water mass formation rates in the global ocean for the Last Glacial Maximum, mid-Holocene and pre-industrial climates

The paleoclimate version of the National Center for Atmospheric Research Community Climate System Model version 3 (NCAR-CCSM3) is used to analyze changes in the water formation rates in the Atlantic, Pacific, and Indian Oceans for the Last Glacial Maximum (LGM), mid-Holocene (MH) and pre-industrial (PI) control climate. During the MH, CCSM3 exhibits a north-south asymmetric response of intermediate water subduction changes in the Atlantic Ocean, with a reduction of 2 Sv in the North Atlantic and an increase of 2 Sv in the South Atlantic relative to PI. During the LGM, there is increased formation of intermediate water and a more stagnant deep ocean in the North Pacific. The production of North Atlantic Deep Water (NADW) is significantly weakened. The NADW is replaced in large extent by enhanced Antarctic Intermediate Water (AAIW), Glacial North Atlantic Intermediate Water (GNAIW), and also by an intensified of Antarctic Bottom Water (AABW), with the latter being a response to the enhanced salinity and ice formation around Antarctica. Most of the LGM intermediate/mode water is formed at 27.4 < sigma(theta) < 29.0 kg/m(3), while for the MH and PI most of the subduction transport occurs at 26.5 < sigma(theta) < 27.4 kg/m(3). The simulated LGM Southern Hemisphere winds are more intense by 0.2-0.4 dyne/cm(2). Consequently, increased Ekman transport drives the production of intermediate water (low salinity) at a larger rate and at higher densities when compared to the other climatic periods.

COMT Met (158) modulates facial emotion recognition in bipolar I disorder mood episodes

Background: One of the many cognitive deficits reported in bipolar disorder (BD) patients is facial emotion recognition (FER), which has recently been associated with dopaminergic catabolism. Catechol-O-methyltransferase (COMT) is one of the main enzymes involved in the metabolic degradation of dopamine (DA) in the prefrontal cortex (PFC). The COMT gene polymorphism rs4680 (Val(158)Met) Met allele is associated with decreased activity of this enzyme in healthy controls. The objective of this study was to evaluate the influence of Val(158)Met on FER during manic and depressive episodes in BD patients and in healthy controls. Materials and methods: 64 BD type I patients (39 in manic and 25 in depressive episodes) and 75 healthy controls were genotyped for COMT rs4680 and assessed for FER using the Ekman 60 Faces (EK60) and Emotion Hexagon (Hx) tests. Results: Bipolar manic patients carrying the Met allele recognized fewer surprised faces, while depressed patients with the Met allele recognized fewer "angry" and "happy" faces. Healthy homozygous subjects with the Met allele had higher FER scores on the Hx total score, as well as on "disgust" and "angry" faces than other genotypes. Conclusion: This is the first study suggesting that COMT rs4680 modulates FER differently during BD episodes and in healthy controls. This provides evidence that PFC DA is part of the neurobiological mechanisms of social cognition. Further studies on other COMT polymorphisms that include euthymic BD patients are warranted. ClinicalTrials.gov Identifier: NCT00969. (C) 2011 Elsevier B.V. All rights reserved.

Major involvement of mTOR in the PPAR gamma-induced stimulation of adipose tissue lipid uptake and fat accretion

Evidence points to a role of the mammalian target of rapamycin (mTOR) signaling pathway as a regulator of adiposity, yet its involvement as a mediator of the positive actions of peroxisome proliferator-activated receptor (PPAR)gamma agonism on lipemia, fat accretion, lipid uptake, and its major determinant lipoprotein lipase (LPL) remains to be elucidated. Herein we evaluated the plasma lipid profile, triacylglycerol (TAG) secretion rates, and adipose tissue LPL-dependent lipid uptake, LPL expression/activity, and expression profile of other lipid metabolism genes in rats treated with the PPAR gamma agonist rosiglitazone (15 mg/kg/day) in combination or not with the mTOR inhibitor rapamycin (2 mg/kg/day) for 15 days. Rosiglitazone stimulated adipose tissue mTOR complex 1 and AMPK and induced TAG-derived lipid uptake (136%), LPL mRNA/activity (2- to 6-fold), and fat accretion in subcutaneous (but not visceral) white adipose tissue (WAT; 50%) and in brown adipose tissue (BAT; 266%). Chronic mTOR inhibition attenuated the upregulation of lipid uptake, LPL expression/activity, and fat accretion induced by PPAR gamma activation in both subcutaneous WAT and BAT, which resulted in hyperlipidemia. In contrast, rapamycin did not affect most of the other WAT lipogenic genes upregulated by rosiglitazone. Together these findings demonstrate that mTOR is a major regulator of adipose tissue LPL-mediated lipid uptake and a critical mediator of the hypolipidemic and lipogenic actions of PPAR gamma activation.-Blanchard, P-G., W. T. Festuccia, V. P. Houde, P. St-Pierre, S. Brule, V. Turcotte, M. Cote, K. Bellmann, A. Marette, and Y. Deshaies. Major involvement of mTOR in the PPAR gamma-induced stimulation of adipose tissue lipid uptake and fat accretion. J. Lipid Res. 2012. 53: 1117-1125.

CASE-CONTROL STUDY OF AN OUTBREAK OF ACUTE TOXOPLASMOSIS IN AN INDUSTRIAL PLANT IN THE STATE OF SÃO PAULO, BRAZIL

Foodborne diseases represent operational risks in industrial restaurants. We described an outbreak of nine clustered cases of acute illness resembling acute toxoplasmosis in an industrial plant with 2300 employees. These patients and another 36 similar asymptomatic employees were diagnosed with anti-T. gondii IgG titer and avidity by ELISA. We excluded 14 patients based on high IgG avidity and chronic toxoplasmosis: 13 from controls and one from acute disease other than T. gondii infection. We also identified another three asymptomatic employees with T.gondii acute infection and also anti-T. gondii IgM positive as remaining acute cases. Case control study was conducted by interview in 11 acute infections and 20 negative controls. The ingestion of green vegetables, but not meat or water, was observed to be associated with the incidence of acute disease. These data reinforce the importance of sanitation control in industrial restaurants and also demonstrate the need for improvement in quality control regarding vegetables at risk for T. gondii oocyst contamination. We emphasized the accurate diagnosis of indexed cases and the detection of asymptomatic infections to determine the extent of the toxoplasmosis outbreak.