Defining ecological strategies in neuroprosthetics.

Neurological disorders disrupt the equilibrium within the brain and spinal cord ecosystems. Ecology reuses, recycles, and reduces to help maintain the balance across ecosystems. Likewise, neuroprosthetics can help the brain help itself with ecoprosthetic designs that integrate the principles of the "three 'R's."

Mood disorders in eating disorder patients: Prevalence and chronology of ONSET.

OBJECTIVES: In a clinical population, we estimated the frequency of mood disorders among 271 patients suffering from Anorexia Nervosa (AN) and Bulimia Nervosa (BN) in comparison to a control group matched for age and gender. METHOD: The frequency of mood disorders was measured using the Mini International Neuropsychiatric Interview (MINI), DSM-IV version. RESULTS: Mood disorders were more frequent among eating disorder (ED) patients than among controls, with a global prevalence of the order of 80% for each ED group. The majority of the mood disorders comorbid with ED were depressive disorders (MDD and dysthymia). The relative chronology of onset of these disorders was equivocal, because mood disorders in some cases preceded and in others followed the onset of the eating disorders. LIMITATIONS: Our sample was characterized by patients with severe ED and high comorbidities, and thus do not represent the entire population of AN or BN. This also may have resulted in an overestimation of prevalence. CONCLUSION: Mood disorders appear significantly more frequently in patients seeking care for ED than in controls. These results have implications for the assessment and treatment of ED patients, and for the aetio-pathogenesis of these disorders.

Evolutionary dynamics of collective action in spatially structured populations.

Many models proposed to study the evolution of collective action rely on a formalism that represents social interactions as n-player games between individuals adopting discrete actions such as cooperate and defect. Despite the importance of spatial structure in biological collective action, the analysis of n-player games games in spatially structured populations has so far proved elusive. We address this problem by considering mixed strategies and by integrating discrete-action n-player games into the direct fitness approach of social evolution theory. This allows to conveniently identify convergence stable strategies and to capture the effect of population structure by a single structure coefficient, namely, the pairwise (scaled) relatedness among interacting individuals. As an application, we use our mathematical framework to investigate collective action problems associated with the provision of three different kinds of collective goods, paradigmatic of a vast array of helping traits in nature: "public goods" (both providers and shirkers can use the good, e.g., alarm calls), "club goods" (only providers can use the good, e.g., participation in collective hunting), and "charity goods" (only shirkers can use the good, e.g., altruistic sacrifice). We show that relatedness promotes the evolution of collective action in different ways depending on the kind of collective good and its economies of scale. Our findings highlight the importance of explicitly accounting for relatedness, the kind of collective good, and the economies of scale in theoretical and empirical studies of the evolution of collective action.

Multi-institutional validation of the prognostic value of Ki-67 labeling index in patients treated with radical prostatectomy.

OBJECTIVE: Several smaller single-center studies have reported a prognostic role for Ki-67 labeling index in prostate cancer. Our aim was to test whether Ki-67 is an independent prognostic marker of biochemical recurrence (BCR) in a large international cohort of patients treated with radical prostatectomy (RP). METHODS: Ki-67 immunohistochemical staining on prostatectomy specimens from 3,123 patients who underwent RP for prostate cancer was retrospectively performed. Univariable and multivariable Cox regression models were used to assess the association of Ki-67 status with BCR. RESULTS: Ki-67 positive status was observed in 762 (24.4 %) patients and was associated with lymph node involvement (LNI) (p = 0.039). Six hundred and twenty-one (19.9 %) patients experienced BCR. The estimated 3-year biochemical-free survivals were 85 % for patients with negative Ki-67 status and 82.1 % for patients with positive Ki-67 status (log-rank test, p = 0.014). In multivariable analysis that adjusted for the effects of age, preoperative PSA, RP Gleason sum, seminal vesicle invasion, extracapsular extension, positive surgical margins, lymphovascular invasion, and LNI, Ki-67 was significantly associated with BCR (HR = 1.19; p = 0.019). Subgroup analysis revealed that Ki-67 is associated with BCR in patients without LNI (p = 0.004), those with RP Gleason sum 7 (p = 0.015), and those with negative surgical margins (p = 0.047). CONCLUSION: We confirmed Ki-67 as an independent predictor of BCR after RP. Ki-67 could be particularly informative in patients with favorable pathologic characteristics to help in the clinical decision-making regarding adjuvant therapy and optimized follow-up scheduling.

Estudo clínico e videofluoroscópico da disfagia na fase subaguda do acidente vascular encefálico

OBJETIVO: Correlacionar, em pacientes portadores de acidente vascular encefálico (AVE) na fase subaguda, as alterações clínicas da deglutição com as observadas na videofluoroscopia. MATERIAIS E MÉTODOS: De 37 portadores de AVE subagudo confirmado por exame de imagem, 26 pacientes de ambos os sexos, com idade média de 59,69 anos, foram avaliados clínica e videofluoroscopicamente. Consideramos como variáveis para pareamento estatístico os parâmetros clínicos indicativos de penetração/aspiração e sua confirmação na videofluoroscopia. RESULTADOS: Identificamos disfagia em 19 (73%) dos 26 pacientes que fizeram videofluoroscopia; dez (38,46%) apresentaram penetração/aspiração de líquidos. Os dados resultantes mostraram não existir correlação (p < 0,05) entre a presença de disfagia e/ou disartria e a presença de penetração/aspiração de líquidos na videofluoroscopia. Houve correlação entre a presença de penetração/aspiração de líquidos observados na videofluoroscopia com os seguintes parâmetros clínicos: estado dos dentes (p = 0,047), mobilidade (p = 0,019) e sensibilidade da face (p = 0,039) e mobilidade da língua (p = 0,012). CONCLUSÃO: Não foi possível definir a presença de penetração/aspiração de líquidos nas vias aéreas por dados epidemiológicos do AVE. A existência de mau estado de preservação dos dentes, alterações na mobilidade da face e da língua e na sensibilidade da face mostrou risco aumentado de penetração/aspiração para líquidos. Permanece importante a indicação da videofluoroscopia para melhor avaliação dos quadros de disfagia após AVE.

A prospective, randomized, triple-blind comparison of articaine and bupivacaine for maxillary infiltrations

Objectives: To compare the clinical anesthetic efficacy of 0.5% bupivacaine and 4% articaine (both with 1:200.000 adrenaline) for anterior maxillary infiltration in healthy volunteers. Material and methods: A triple-blind split-mouth randomized clinical trial was carried out in 20 volunteers. A supraperiosteal buccal injection of 0.9 ml of either solution at the apex of the lateral incisor was done in 2 appointments separated 2 weeks apart. The following outcome variables were measured: latency time, anesthetic efficacy (dental pulp, keratinized gingiva, alveolar mucosa and upper lip mucosa and tissue) and the duration of anesthetic effect. Hemodynamic parameters were monitored during the procedure. Results: Latency time recorded was similar for both anesthetic solutions (p>0.05). No statistically significant differences were found in terms of anesthetic efficacy for dental pulp, keratinized gingiva or alveolar mucosa. Articaine had a significant higher proportion of successful anesthesia at 10 minutes after infiltration in lip mucosa and lip skin (p=0.039). The duration of anesthesia was 336 minutes for bupivacaine and 167 minutes for articaine. (p<0.001). No significant hemodynamic alterations were noted during the procedure. Conclusions: Articaine and bupivacaine exhibited similar anesthetic efficacy for maxillary infiltrations. The duration of anesthesia was longer with the bupivacaine solution, but lip anesthesia was better with articaine

Early versus delayed application of Thomas splints in patients with isolated femur shaft fractures: The benefits quantified.

AIMS: To investigate and quantify the clinical benefits of early versus delayed application of Thomas splints in patients with isolated femur shaft fractures. MATERIALS AND METHODS: Level IV retrospective clinical and radiological analysis of patients presenting from January to December 2012 at a Level 1 Trauma Unit. All skeletally mature patients with isolated femur shaft fractures independently of their mechanism of injury were included. Exclusion criteria were: ipsilateral fracture of the lower limb, neck and supracondylar femur fractures, periprosthetic and incomplete fractures. Their clinical records were analysed for blood transfusion requirements, pulmonary complications, surgery time, duration of hospital stay and analgesic requirements. RESULTS: A total of 106 patients met our inclusion criteria. There were 74 males and 32 females. Fifty seven (54%) patients were in the 'early splinted' group and 49 patients (46%) were in the 'delayed splinted' group (P>0.05). The need for blood transfusion was significantly reduced in the 'early splinted' group (P=0.04). There was a significantly higher rate of pulmonary complications in the 'delayed splinted' group (P=0.008). All other parameters were similar between the two groups. CONCLUSION: The early application of Thomas splints for isolated femur fractures in non-polytraumatised patients has a clinically and statistically significant benefit of reducing the need for blood transfusions and the incidence of pulmonary complications.

Attitudes and burden in relatives of patients with schizophrenia in a middle income country

BACKGROUND: Most studies of family attitudes and burden have been conducted in developed countries. Thus it is important to test the generalizability of this research in other contexts where social conditions and extended family involvement may be different. The aim of this study was to assess the relationship between the attitudes of caregivers and the burden they experience in such a context, namely Arica, a town located in the northernmost region of Chile, close to the border with Peru and Bolivia. METHODS: We assessed attitudes towards schizophrenia (including affective, cognitive and behavioural components) and burden (including subjective distress, rejection and competence) in 41 main caregivers of patients with schizophrenia, all of whom were users of Public Mental Health Services in Arica. RESULTS: Attitude measures differed significantly according to socio-demographic variables, with parents (mainly mothers) exhibiting a more negative attitude towards the environment than the rest of the family (t = 4.04; p = 0.000).This was also the case for caregivers with a low educational level (t = 3.27; p < 0.003), for the oldest caregivers (r = 0.546; p = 0.000) and for those who had spent more time with the patient (r = 0.377; p = 0.015). Although attitudes had significant association with burden, their explanatory power was modest (R2 = .104, F = 4,55; p = .039). CONCLUSIONS: Similar to finding developed countries, the current study revealed a positive and significant relationship between the attitudes of caregivers and their burden. These findings emphasize the need to support the families of patients with schizophrenia in this social context.

« En fonction de la prise de Méthadone® maternelle peut-on prévoir l'outcome et l'adaptation néonatale, ainsi que la survenue d'un sevrage néonatal, sa durée et le développement à court terme de l'enfant ? »

Objectif : Abstract Le but de cette étude consiste à étudier un éventuel lien entre le dosage du traitement de substitution par la Méthadone® pendant la grossesse et les issues obstétricales (rupture prématurée des membranes, menace d'accouchement prématuré), ainsi que néonatales (telles que le retard de croissance intrautérin, l'adaptation néonatale, le sevrage néonatal aux opiacés et l'hypoglycémie néonatale). Nous évaluerons également le développement psychomoteur de l'enfant à court terme (jusqu'à 18 mois de vie) via l'échelle de Griffiths. Méthode : Il s'agit d'une étude rétrospective sur 50 femmes enceintes sous Méthadone® suivies au CHUV et ayant accouché entre les années 2000 et 2010, ainsi que sur leurs enfants suivis par l'Unité du Développement du CHUV et évalués moyennant l'échelle du développement psychomoteur appelée Griffiths (il s'agit de 26 enfants entre 6-9 mois et 20 entre 18-19 mois). Pour ce faire, nous avons parcouru les différentes archives du CHUV (informatiques et papiers) dans un premier temps. Ces données ont été ensuite saisies dans un tableau Excel avant d'être analysées via STATA. Résumé des résultats : En fonction du dosage de la Méthadone®, 27% (dose plus faible) à 47 % (dose plus élevée) des femmes de notre collectif accouchent prématurément (p = 0.139). 48 % de leurs nouveau-nés présentent un retard de croissance intra-utérin (RCIU). Ce risque est d'autant plus élevé que la Méthadone est faiblement dosée (p = 0.073). Inversement au RCIU, le risque d'hypoglycémie néonatale croît avec la dose maternelle de Méthadone® (p = 0.148). La survenue du syndrome de sevrage néonatal aux opiacés ainsi que sa durée sont significativement plus importantes lorsque le dosage maternel de Méthadone est élevé (p = 0.022 ; p = 0.0118) ou lors de la prise concomitante de benzodiazépines (p = 0.004 ; p = 0.0129). La prise d'autres substances illicites a elle aussi tendance à prolonger le sevrage (p = 0.065). Entre 6-9 mois de vie, il y a plus de microcéphalie (périmètre crânien inférieur au P10) lorsque les enfants reçoivent une dose plus faible in utéro (p = 0.005). Le développement psychomoteur est quant à lui plus favorable lorsque le traitement de substitution est fortement dosé (p = 0.039) et que l'enfant vit chez sa mère biologique (p = 0.050) ou bénéficie d'un contact maternel régulier (p = 0.008). L'effet du dosage de la Méthadone® (p = 0.683) et du lieu de vie (p = 0.211) sur le développement psychomoteur ont néanmoins tendance à s'estomper entre 18-19 mois de vie. Conclusions : Bien qu'un traitement de substitution par la Méthadone hautement dosé augmente la survenue et la durée du syndrome de sevrage néonatal aux opiacés, il y a maintenant des indices pour un meilleur outcome de l'enfant lorsque la substitution est importante (moins de RCIU, de microcéphalie et un développement psychomoteur plus favorable). A propos de l'issue néonatale, tous les enfants nés de mères toxicodépendantes semblent être à risque d'hypoglycémie néonatale. Implications pratiques : Il serait désormais préférable d'augmenter les doses de substitution des futures mères toxicomanes d'autant plus lorsque celles-ci le réclament et tous leurs enfants devraient bénéficier d'une alimentation précoce et de contrôles glycémiques, même s'ils sont eutrophiques.

Moderate-Vigorous physical activity across Body Mass Index in females: moderating effect of endocannabinoids and temperament

Background: Endocannabinoids and temperament traits have been linked to both physical activity and body mass index (BMI) however no study has explored how these factors interact in females. The aims of this cross-sectional study were to 1) examine differences among distinct BMI groups on daytime physical activity and time spent in moderate-vigorous physical activity (MVPA), temperament traits and plasma endocannabinoid concentrations; and 2) explore the association and interaction between MVPA, temperament, endocannabinoids and BMI. Methods: Physical activity was measured with the wrist-worn accelerometer Actiwatch AW7, in a sample of 189 female participants (43 morbid obese, 30 obese, and 116 healthy-weight controls). The Temperament and Character Inventory-Revised questionnaire was used to assess personality traits. BMI was calculated by bioelectrical impedance analysis via the TANITA digital scale. Blood analyses were conducted to measure levels of endocannabinoids and endocannabinoid-related compounds. Path-analysis was performed to examine the association between predictive variables and MVPA. Results: Obese groups showed lower MVPA and dysfunctional temperament traits compared to healthy-weight controls. Plasma concentrations of 2-arachidonoylglyceryl (2-AG) were greater in obese groups. Path-analysis identified a direct effect between greater MVPA and low BMI (b = −0.13, p = .039) and high MVPA levels were associated with elevated anandamide (AEA) levels (b = 0.16, p = .049) and N-oleylethanolamide (OEA) levels (b = 0.22, p = .004), as well as high Novelty seeking (b = 0.18, p<.001) and low Harm avoidance (b = −0.16, p<.001). Conclusions: Obese individuals showed a distinct temperament profile and circulating endocannabinoids compared to controls. Temperament and endocannabinoids may act as moderators of the low MVPA in obesity.

SIMULTANEOUS DETERMINATION OF PROTOCATECHUIC ALDEHYDE AND PROTOCATECHUIC ACID USING THE LOCALIZED SURFACE PLASMON RESONANCE PEAK OF SILVER NANOPARTICLES AND CHEMOMETRIC METHODS

A simple and sensitive spectrophotometric method is proposed for the simultaneous determination of protocatechuic acid and protocatechuic aldehyde. The method is based on the difference in the kinetic rates of the reactions of analytes with [Ag(NH3)2]+ in the presence of polyvinylpyrrolidone to produce silver nanoparticles. The data obtained were processed by chemometric methods using principal component analysis artificial neural network and partial least squares. Excellent linearity was obtained in the concentration ranges of 1.23-58.56 µg mL-1 and 0.08-30.39 µg mL-1 for PAC and PAH, respectively. The limits of detection for PAC and PAH were 0.039 and 0.025 µg mL-1, respectively.

L'Univers

1903/08/05 (Numéro 12930).

JOHTAMISOPIT KUNTAORGANISAATIOSSA – diskursiivinen tutkimus sosiaali- ja terveystoimesta 1980-luvulta 2000-luvulle

Julkisen sektorin johtamista on uudistettu viime vuosikymmeninä uuden julkisjohtamisen suuntauksen kautta. Tässä keskeistä ovat olleet markkinamekanismin sekä yksityissektorin johtamisoppien soveltaminen julkiselle sektorille. Tämän tutkimuksen tarkoituksena on tuottaa tietoa johtamisoppien soveltamisesta kuntaorganisaation sosiaalija terveystoimessa. Mielenkiinnon kohteena ovat kysymykset, miten johtamisopit ovat tulleet kuntaorganisaatioon ja miten ne ovat levinneet, rakentuneet sekä rakentaneet kontekstiaan tarkasteluajanjaksolla 1985 - 2007. Tutkimuksen lähestymistapa on diskurssianalyyttinen ja nojaa epistemologialtaan tulkinnallisesta tieteen filosofiasta nousseeseen sosiaaliseen konstruktivismiin. Oppien leviämistä tarkastellaan tässä tutkimuksessa translaationa, kääntämisprosessina, jossa opin johtoportaaseen tullut ensimmäinen versio tulkitaan ja käännetään organisaation kielelle ja käytännöiksi. Oppien rakentumista kontekstissaan käsitteellistetään sedimentoitumisen käsitteen kautta, mikä auttaa ymmärtämään uusien ja vanhojen oppien elementtien kerrostumista lähes muuttumattomista syvärakenteista nopeasti muuttuviin pintarakenteisiin. Tutkimuksen kohdeorganisaationa on suomalainen, keskikokoinen kuntaorganisaatio. Aineistona on käytetty kirjallisia dokumentteja ja haastatteluja. Johtamisoppeja kuntaorganisaatioon välittäviä tahoja ovat olleet konsulttiyritykset, yliopistot, kuntien johtoportaan verkostot, uudet johtajat sekä koulutuspäivät. Organisaation valmius uuden johtamisopin omaksumiseen on yhteydessä organisaatioon, johtoon, tarjolla oleviin oppeihin sekä toimintaympäristöön liittyviin tekijöihin Levitäkseen organisaatiossa oppi tarvitsee johdon tasolta kannattajan, joka markkinoi sitä muulle virkamies- ja luottamushenkilöjohdolle. Kun oppi saavuttaa johdon enemmistön tuen, käynnistyy sen kääntämisprosessi johdon puheesta henkilöstön puheen ja käytäntöjen tasolle. Uudet johtamisopit kyseenalaistavat vanhoja ”totuuksia” ja samalla ne määrittävät, mikä on tärkeää ja mikä jää huomiotta. Uudet opit eivät syrjäytä kokonaan vanhoja, vaan opit sedimentoituvat: vanhojen oppien diskursiivisia elementtejä jää pois ja uusien oppien elementtejä tulee mukaan johtamispuheeseen. Johtamisopit rakentavat kontekstiaan sekä puheen, käytäntöjen että organisaatiorakenteiden tasolla, mutta joihinkin syvärakenteisiin ne eivät ole pystyneet vaikuttamaan tai vaikuttavat äärimmäisen hitaasti. Asiakaslähtöisyys muun muassa on ollut useimpien johtamisoppien diskursiivinen elementti, mutta se on jäänyt toistuvasti kuntaorganisaation sosiaali- ja terveystoimessa organisaatiolähtöisen palvelujen järjestämistavan ja talouden kautta tapahtuvan tuloksellisuuden arvioinnin varjoon. Diskurssit muutoksesta ja sen välttämättömyydestä, tehokkuudesta sekä julkisen rinnastaminen yksityiseen näyttäytyivät tässä tutkimuksessa metatason diskursseina, jotka oikeuttavat yksityiseltä sektorilta lähtöisin olevien johtamisdiskurssien soveltamisen muutoksen ja tehokkuuden aikaansaamiseksi julkiselle sektorille. Kuntien sosiaali- ja terveystoimen tuloksellisuuden ja tehokkuuden arviointi on kapeutunut liikkeenjohdon peruslähtökohdista nousevaksi talouden kautta tapahtuvaksi arvioinniksi. Tässä julkisen toiminnan omiin arvolähtökohtiin ja teoriataustaan pohjautuvien toiminnan tulosten ja saavutettujen hyvinvointivaikutusten arviointi sekä näistä kertovien mittarien kehittäminen yhdessä talouden mittarien kanssa on marginaaliin jäänyttä, mutta nousevaa puhetta.

Precipitação efetiva em fragmento secundário da Mata Atlântica

O presente trabalho foi conduzido na Estação Experimental de Treinamento e Educação Ambiental Mata do Paraíso, localizada no município de Viçosa, MG, e teve como objetivo avaliar a precipitação efetiva de um trecho mais recente de regeneração da mata natural secundária, no período compreendido entre setembro de 2002 e maio de 2003. Para isso, demarcaram-se três parcelas dentro da Mata do Paraíso, onde foram registradas 30 coletas da precipitação, em aberto e interna, e de escoamento pelo tronco, durante o período de 05/09/2002 a 07/05/2003, constituídas de um ou mais eventos de chuva. O estudo revelou precipitação efetiva de 849,6 mm, precipitação interna de 831,7 mm, escoamento pelo tronco de 17,9 mm e perda por interceptação de 189,9 mm, o que correspondeu, respectivamente, a 81,7%, 80,0%, 1,7% e 18,3% da precipitação em aberto, que foi igual a 1.039,5 mm.