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Objective: To evaluate the prognostic accuracy of qSOFA for predicting in-hospital mortality among patients with suspected infection presenting to the ED of a public tertiary hospital in Brazil.Methods: We performed a retrospective cohort study of consecutive adult patients (age ≥ 18 years) with suspected infection who presented to an academic tertiary ED in Porto Alegre (Southern Brazil) during an 18-month period. The qSOFA was calculated by using information collected at triage and patients were followed throughout hospitalization for the primary outcome of in-hospital mortality. Sensitivity, specificity, positive and negative likelihood ratios, and diagnostic odds ratios with corresponding 95% CIs were calculated for the qSOFA and qSOFA65.Results: A total of 7523 ED visits of patients with suspected infection in which an intravenous antibiotic was administered within 24 h were included, which resulted in 908 in-hospital deaths (12.1%). There were 690 (9.2%) patients whose triage qSOFA was ≥2 points. When such cutoff was used, the sensitivity for in-hospital death was 24.6% (95% CI 21.8 to 27.4%) and the specificity was 92.9% (95% CI 92.3% to 93.5%). The sensitivity increased to 67.4% (95% CI 64.2% to 70.3%) when a cutoff of ≥1 was tested, but the specificity decreased to 55.3% (95% CI 54.1% to 56.5%). Using a cutoff of ≥2, the qSOFA65 had a sensitivity of 51.0% (95% CI 47.7% to 54.3%) and a specificity of 75.7% (95% CI 74.6% to 76.7%).Conclusions: The qSOFA score yielded very low sensitivity in predicting in-hospital mortality. Emergency physicians or ED triage nurses in low-to-middle income countries should not be using qSOFA or qSOFA65 as "rule-out" screening tools in the initial evaluation of patients with suspected infection. [ABSTRACT FROM AUTHOR]

Here we report the application of a conjugated copolymer based on thiophene and quinoxaline units, namely poly[2,3-bis-(3-octyloxyphenyl)quinoxaline-5,8-diyl-alt-thiophene-2,5-diyl] (TQ1), to nanoparticle organic photovoltaics (NP-OPVs). TQ1 exhibits more desirable material properties for NP-OPV fabrication and operation, particularly a high glass transition temperature (T g ) and amorphous nature, compared to the commonly applied semicrystalline polymer poly(3-hexylthiophene) (P3HT). This study reports the optimisation of TQ1:PC 71 BM (phenyl C 71 butyric acid methyl ester) NP-OPV device performance by the application of mild thermal annealing treatments in the range of the T g (sub-T g and post-T g ), both in the active layer drying stage and post-cathode deposition annealing stage of device fabrication, and an in-depth study of the effect of these treatments on nanoparticle film morphology. In addition, we report a type of morphological evolution in nanoparticle films for OPV active layers that has not previously been observed, that of PC 71 BM nano-pathway formation between dispersed PC 71 BM-rich nanoparticle cores, which have the benefit of making the bulk film more conducive to charge percolation and extraction. [ABSTRACT FROM AUTHOR]

The Centrality of Pain Scale (COPS) is a recently developed patient-centered, 10-item self-report measure designed to assess how central, or dominating, in their lives individuals with chronic pain perceive pain to be. The COPS underwent initial development and validation previously; preliminary results suggested that the measure had excellent psychometric properties and that COPS scores were associated with important clinical factors. The purpose of the present study was to examine the psychometric properties of the COPS in a sample of individuals with mixed chronic pain diagnoses (N = 178) being treated at a U.S. Veterans Affairs Medical Center. Principal components analysis of COPS items revealed a single factor, and all items loaded highly. The COPS had high internal consistency (Cronbach's alpha = .902) and was significantly correlated with other measures of pain, mental health, psychological factors associated with pain, and chronic pain coping styles, suggesting convergent and divergent validity. Hierarchical linear regression analyses indicated that COPS score was independently associated with both pain severity and interference. Future research should evaluate the generalizability of the COPS in different samples, its responsiveness to treatment, and the extent to which pain centrality may be a focus of nonpharmacologic interventions for chronic pain. Perspective We conducted psychometric testing of the COPS, a recently developed patient-centered self-report measure designed to examine how central or dominating pain is to a person's life. Study results indicated a reliable and valid measure, which was significantly associated with pain severity and interference, even after controlling for demographic and clinical factors. [ABSTRACT FROM AUTHOR]

Purpose Childhood abuse has been associated with age of menarche in some studies, but not all, and few have assessed the independent associations of sexual and physical abuse with early menarche. We examined the association between childhood abuse and early menarche among pregnant women in Lima, Peru. Methods Multinomial logistic regression procedures were used to estimate odds ratios (OR) and 95% confidence intervals (CIs) for early menarche (≤11 years) in relation to any physical or sexual childhood abuse, physical abuse only, sexual abuse only, and both physical and sexual abuse in a cohort of 1,499 pregnant (first trimester) women. Results Approximately 69% of participants reported experiencing physical or sexual abuse in childhood. The frequencies of physical abuse only, sexual abuse only, and both physical and sexual abuse were 37.4%, 7.7%, and 24.5%, respectively. Compared with women who reported no childhood abuse, those who reported any childhood abuse had a 1.38-fold increased odds of early menarche (95% CI, 1.01–1.87). Compared with no abuse, the odds of early menarche was 1.60-fold among women with childhood sexual abuse only (OR, 1.60; 95% CI, .93–2.74) and 1.56-fold for those with both physical and sexual abuse (OR, 1.56; 95% CI, 1.07–2.25) during childhood. Isolated physical abuse was weakly associated with early menarche (OR, 1.23; 95% CI, .87–1.74). There was no clear evidence of association of childhood abuse with late menarche (≥15 years). Conclusions Childhood abuse, particularly joint physical and sexual abuse, is associated with early menarche. Our findings add to an expanding body of studies documenting the enduring adverse health consequences of childhood abuse. [ABSTRACT FROM AUTHOR]

To reduce the consumption of freshwater in the laundry industry, a new trend of closing the water cycle has resulted in the reuse/recycling of water. In this study, the performance of a full-scale submerged aerobic membrane bioreactor (9 m 3 ) used to treat/reuse industrial laundry wastewater was examined over a period of 288 days. The turbidity and total solids (TS) were reduced by 99%, and the chemical oxygen demand (COD) effluent removal efficiencies were between 70% and 99%. The levels of COD removed by the membrane were significantly greater than the levels of biodegraded COD. This enabled the bioreactor to sustain COD levels that were below 100 mg/L, even during periods of low wastewater biodegradation due to bioreactor sludge. An economic evaluation of the membrane bioreactor (MBR) system showed a savings of 1.13 € per 1 m 3 of water. The payback period for this system is approximately 6 years. The energy and maintenance costs represent only 5% of the total cost of the MBR system. [ABSTRACT FROM AUTHOR]

Abstract: The objective was to evaluate the metabolic and vascular effects of lifestyle interventions involving a healthy diet and either a moderate- or a high-intensity exercise regimen in nondiabetic subjects with metabolic syndrome. The effects of these interventions on flow-mediated vasodilation (FMD) and risk profiles were compared with a standard low-fat diet and engaging in daily walking (standard of care). Seventy-five healthy adults with metabolic syndrome (30-55 years old) were randomized to a 10 000-steps-a-day exercise program, a 3-times-a-week fitness (>75% peak VO2) program, or a 1-hour-walking-a-day program for 12 weeks. The first 2 interventions were combined with an accessible healthy, no-sugar diet; and the third was combined with a tailored low-fat diet. The outcomes, including FMD and risk factors, were examined at 12 weeks and at 1-year reassessment. Significant increase in FMD (mean difference = 1.51%, 95% confidence interval = 1.05%-3.017%, P = .0007) and decrease in arterial pressure (mean difference = 19.3 ± 2.3/−12.6 ± 1.8 mm Hg, P = .0001) were observed in all groups. However, the FMD changed most favorably in the high-intensity, low-sugar group (mean difference = 1.56%, 95% confidence interval = 0.1%-3.02%, P = .036). Significant improvements in body mass index, waist, insulin-like growth factor–1, homeostasis model assessment of insulin resistance, insulin, glucose, urinary albumin excretion, and lipid profiles occurred in all groups. Metabolic syndrome was resolved in 64%. One year later, weight loss (−9.1 ± 2.3 kg, P = .0001) and arterial pressure decrease (−18.5 ± 2.3/−12.3 ± 2.1 mm Hg, P = .0001) were maintained. Practical, health-centered diet combined with high-intensity exercise is associated with enhanced vascular protection. These data suggest that more intense exercise combined with a low-sugar diet modulates endothelium-dependent vasodilation. [Copyright &y& Elsevier]

Abstract: Neurosurgery has been used to treat depression since 1935, when open surgery was first used to isolate relatively large areas of the limbic system from the rest of the brain. Soon thereafter, more selective leucotomies were performed based on a growing knowledge of the role played by brain limbic circuitry in processing the emotions. Subsequent discovery of the effectiveness in depression of both electroconvulsive therapy and various pharmacotherapies raised serious doubts about “psychosurgical” treatments, but the introduction of stereotactic techniques revived interest in the selective-lesion, neurobiology-based approach. However, neurosurgery has only come to be regarded as an appropriate treatment of severe depression since Benabid introduced the frequency-dependent chronic electric stimulation technique. Because of its nondestructive nature, this procedure will undoubtedly be favored in the future. One can anticipate that, eventually, frequency-dependent chronic electric stimulation will be complemented by newer techniques such as microdialysis and reverse dialysis, with concomitant functional magnetic resonance imaging and/or positron emission tomography scanning, and the use of chemodes for microinfusion or for in situ insertion of reactivated-stem cells. To optimize success, these modern methods will require a new taxonomy of “depressions” based on up-to-date neurobiological criteria. [Copyright &y& Elsevier]

In June 2010, a severe outbreak of 13 cases of post–cataract surgery endophthalmitis caused by multidrug-resistant Pseudomonas aeruginosa occurred. Pulse-field gel electrophoresis in eye isolates found 95% genetic similarity; however, extensive environmental and carriage investigation revealed no source of infection. [ABSTRACT FROM AUTHOR]

In June 2010, a severe outbreak of 13 cases of post–cataract surgery endophthalmitis caused by multidrug-resistant Pseudomonas aeruginosa occurred. Pulse-field gel electrophoresis in eye isolates found 95% genetic similarity; however, extensive environmental and carriage investigation revealed no source of infection. [Copyright &y& Elsevier]

The aim of this review was to identify and, particularly, to classify all the numerous environmental factors that play a significant role in the environment-dependent body weight dysregulation. The main environmental obesogenic factors are related to build environment such as city plan, transport and school, inactivity, TV and screen-related immobility, smart-phone, video games; they are followed by agroalimentary factors such as imbalanced ingredients, pollutants, speed eating, portion size, sweet drinks, nibbling and junk foods supported by publicity, sociocultural and ethnic factors beside the global environmental changes and seasonal light/dark photoperiod. Beside the analytical examination of the obesogenic factors it is mentioned the cumulative effect that tends to coexist in the same population and thus magnify their pathogenic consequences. In addition, more than one obesogenic factors are present in the same population because they are the expression of another underlying common cause - poverty; such a recognition leads towards socio-economic considerations and consequently towards 'political' solutions that are beyond our scientific approach. The mechanism of action of the environmental influence includes the serotonergic system and insulin resistance. More recently, it was shown an environment dependent powerful microbiotic implication. Since obesity is influenced by genetically transmitted changes modulated by environment and lifestyle risk factors it is important to understand the genomic mechanism that allows these interactions. It was shown that obesity-predisposing gene variants that interact with environmental exposures use the DNA methylation epigenetic mechanism. [ABSTRACT FROM AUTHOR]

Important advances are afoot in the field of neurosurgery—particularly in the realms of deep brain stimulation (DBS), deep brain manipulation (DBM), and the newly introduced refinement “closed-loop” deep brain stimulation (CLDBS). Use of closed-loop technology will make both DBS and DBM more precise as procedures and will broaden their indications. CLDBS utilizes as feedback a variety of sources of electrophysiological and neurochemical afferent information about the function of the brain structures to be treated or studied. The efferent actions will be either electric, i.e. the classic excitatory or inhibitory ones, or micro-injection of such things as neural proteins and transmitters, neural grafts, implants of pluripotent stem cells or mesenchymal stem cells, and some variants of gene therapy. The pathologies to be treated, beside Parkinson's disease and movement disorders, include repair of neural tissues, neurodegenerative pathologies, psychiatric and behavioral dysfunctions, i.e. schizophrenia in its various guises, bipolar disorders, obesity, anorexia, drug addiction, and alcoholism. The possibility of using these new modalities to treat a number of cognitive dysfunctions is also under consideration. Because the DBS-CLDBS technology brings about a cross-fertilization between scientific investigation and surgical practice, it will also contribute to an enhanced understanding of brain function. [ABSTRACT FROM AUTHOR]

Glioblastoma multiforme (GBM) is the most common and lethal primary malignancy of the central nervous system. Modern treatments using surgery and/or chemotherapy and/or radiotherapy are improving survival of patients, but prognosis is still very poor, depending inter alia on the patients’ individual genomic traits. Most GBMs are primary; however, secondary GBMs have a better prognosis. Aberrant gene expression and copy number alterations make it possible to identify four subtypes: classical, mesenchymal, proneural, and neural. More and more biomarkers continue to be identified in GBM patients. Such biomarkers are related with varying degrees of specificity to one or more of GBM’s subtypes and, in many instances, may provide useful information about prognosis. Biomarkers fall into either the imaging or molecular category. Molecular biomarkers are identified by use of such platforms as genomics, proteomics, and metabolomics. In the future, biomarkers, either individually or in some combination, will more reliably identify the pathogenic type of GBM and determine choice of therapy. [ABSTRACT FROM AUTHOR]

Abstract: Personalized medicine (PM) in neurosurgery is possible today thanks to newly accessible imaging technologies, and to genomic, proteomic and epigenetic biomarkers capable of providing clinically useful information about individual patients. PM is becoming increasingly indispensable in neurosurgery because this specialty offers a wide range of therapeutic options such as surgery and/or radiotherapy and/or chemotherapy. Moreover, the effectiveness of these procedures varies from one patient to another, depending inter alia on the patients’ individual genomic traits. A prime example is glioblastoma multiforme, which exhibits at least five genomic biomarkers related to distinct therapeutic and prognostic outcomes. At least one of these biomarkers, the ω-6 methylguanine-DNA methyltransferase promoter of methylation status, has already been used in clinical trials. New functional imaging techniques allow the surgeon to circumvent crucial brain areas whose location may vary among patients, thus allowing the safe and complete excision of an adjacent tumor. Functional imaging, together with an increasing number of genomic and other ''omic'' biomarkers, has also given rise to an improved classification based on molecular signatures of tumors like glioblastoma multiforme that will facilitate the correspondence between type of glioma and choice of biologically tailored-to-patient therapy. [Copyright &y& Elsevier]

Abstract: Intractable pain may require neurosurgical intervention. This review provides a critical update of neurosurgical techniques available to treat this condition. Neurosurgery can affect pain''s pathways from the receptor up to the “centers” of its reception and perception, either by destroying or by stimulating them. Early in neurosurgery''s development, and still today, ablative procedures are able to suppress or alleviate pain. However, in most cases, such ablations have only remained effective for a few months or, at best, a few years. This is why, from the 1960s on, a better understanding of the mechanism of pain inspired development of electrical and chemical neuromodulation procedures at every level of the nociceptive system (peripheral nerve, cord, thalamic, periventricular/aqueductal gray, and cortical centers). The encouraging outcomes that resulted are attracting increasing attention and interest among clinicians. The indications for undertaking an ablative vs a neurostimulative procedure, as well as selection of the anatomical target, depend largely on whether pain is nociceptive or neuropathic, given that most of these indications overlap to some extent. In addition, because the published outcomes are not based on universal criteria, it is difficult for the attending physician to select the type of procedure most suitable to the pain problem. This brief review surveys the various neurosurgical procedures together with their corresponding indications in the hope that the information provided will help practitioners choose (1) the type of neurosurgical therapy most appropriate to their patients'' needs and (2) the neurosurgical group best equipped to implement that choice. [Copyright &y& Elsevier]

Abstract: The concurrent background level of metabolic activity may control state of vigilance, promoting wakefulness (and hunger) when it is low, or sleep (and satiety) when it is high. In a series of experiments, we have shown that sleep is dependent on feeding, but only because of the metabolic consequences of food ingestion. These consequences are sensed by glioneuronal populations (at least in the rostromedial hypothalamus), which probably respond to channel-bound adenosine triphosphate/diphosphate turnover (ischymetric monitoring) rather than to the binding of such downstream molecules as adenosine and cytochrome c oxidase. This basic signal is communicated to the vigilance-controlling centers by a cascade of peptidic and nonpeptidic messengers—messengers that promote wakefulness and hunger, possibly via a hypometabolic action (as in the case of neuropeptide Y or hypocretins), or somnolence and satiety, possibly via a hypermetabolic action (as in the case of leptin or certain serotonergic agents). [Copyright &y& Elsevier]