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Purpose: Chronic idiopathic urinary retention (CIUR) in young women is poorly understood and a probable etiology is established only in around 40%, most commonly a primary disorder of external urethral sphincter relaxation, sometimes referred to as Fowler's syndrome. A high prevalence of psychological and functional comorbidities is reported, however these have been poorly characterized. Materials and Methods: Women consecutively referred for the assessment and management of CIUR were evaluated cross-sectionally for 13 psychological/behavioral domains using a structured clinical interview: depression, anxiety, post-traumatic stress disorder (PTSD), other psychiatric history, functional neurological disorder, other functional syndromes, childhood and adult trauma, personality disorder, and self-harm (ever/current). Results: A total of 91 women (mean age [SD]: 34 [11] years) were evaluated. Women with Fowler's syndrome (n = 69) were younger (mean age [SD]: 32 [9] vs 40 [13] years) than women without Fowler's syndrome and reported shorter mean duration of urinary symptoms (mean [SD]: 5 [6] vs 10 [9]). A high prevalence of psychiatric and psychological comorbidities was reported (97%) including current depression (77%), current anxiety (78%), and PTSD (32%). A high prevalence of functional neurological disorder (56%) and other functional symptoms (65%) was also reported. Self-harm was reported in (14%) and personality disorder in 16%. Childhood trauma was reported in 35% of women. Conclusions: Young women with CIUR report a high burden of psychiatric disorders, affective symptoms, trauma, PTSD, self-harm, and functional neurological disorder, particularly in those with Fowler's syndrome. These factors can undermine the engagement with health care professionals and affect management and should therefore be addressed during the urological assessment. [ABSTRACT FROM AUTHOR]

Optimization of machine learning architectures is essential in determining the efficacy and the applicability of any neural architecture to real world problems. In this work a generalized Newton’s method (GNM) is presented as a powerful approach to learning in deep neural networks (DNN). This technique was compared to two popular approaches, namely the stochastic gradient descent (SGD) and the Adam algorithm, in two popular classification tasks. The performance of the proposed approach confirmed it as an attractive alternative to state-of-the-art first order solutions. Due to the good results presented in the case of shallow DNN, in the last part of the article an hybrid optimization method is presented. This method consists in combining two optimization algorithms, i.e. GNM and Adam or GNM and SGD, during the training phase within the layers of the neural network. This configuration aims to benefit from the strengths of both first-and second-order algorithms. In this case a convolutional neural network is considered and its parameters are updated with a different optimization algorithm. Also in this case, the hybrid approach returns the best performance with respect to the first order algorithms. [ABSTRACT FROM AUTHOR]

Background and purposeRestorative therapies have the potential to improve function and reduce disability after stroke with a wide therapeutic window. The current study evaluated GSK249320, a monoclonal antibody that blocks the axon outgrowth inhibition molecule myelin-associated glycoprotein and also protects oligodendrocytes.MethodsPatients with mild-moderate stroke were randomized to intravenous GSK249320 (1, 5, or 15 mg/kg per infusion, in escalating cohorts of 8-9 subjects) versus placebo (n=17). Infusion 1 was 24 to 72 hours after stroke; infusion 2 was 9 ± 1 days later. The primary objective evaluated safety and tolerability, and the secondary objectives evaluated immunogenicity, pharmacokinetics, biomarkers, neurophysiology, and motor function.ResultsBaseline (n=42) characteristics were similar across treatment groups. No safety concerns were found based on adverse events, examination, vital signs, ECG, nerve conduction tests, brain imaging, motor function testing, and laboratory studies. Two of the 25 subjects dosed with GSK249320 developed transient antidrug antibodies after infusion 1. The pharmacokinetics profile was as expected for an IgG1 type monoclonal antibody. Serum levels of the biomarker S100β did not differ between groups. Global outcome measures were similar across groups. Modality-specific end points could be consistently measured in the first few days after stroke, and one of these, gait velocity, demonstrated a trend toward improvement with GSK249320 compared with placebo.ConclusionsGSK249320 was generally well tolerated. No major safety issues were identified in this first study of a monoclonal antibody to modulate the neurobiology of brain repair after stroke. Future studies might explore the efficacy of GSK249320 as a restorative therapy for stroke. Clinical Trial Registration- URL: http://www.clinicaltrials.gov. Unique Identifier: NCT00833989.

Objective: To analyze the supply of input and procedures, non-invasive and micro-invasive, for dental caries lesions in Primary Care in Brazil, comparing the Brazilian geographic regions in three different periods. Material and Methods: Historical series study based on secondary data extracted from the 1st Cycle (2012), 2nd (2014), and 3rd cycle (2018) of the External Evaluation of the National Program for Access and Quality of Primary Care. The proportions of Oral Health Teams offering non-invasive (fluor) and micro-invasive (sealants) supplies and procedures between Brazilian geographic regions were compared using the Chi-square test, using the Z Test adjusted by the Bonferroni method, and between the years (2012, 2014, and 2018) using the Cochran Q test (p<0.05). The percentage variation between the proportions per cycle was calculated. Results: The availability of inputs of fluor gel in Brazil increased between 2014 (91.6%) and 2018 (94.1%) (p<0.001), but statistically only in the Northeast and North (p<0.001). The offer of the topical fluorine procedure increased between 2012 (78.8%) and 2018 (87.4%) (p<0.001) in Brazil, with the most significant increase in the North (+7.5%) and Northeast (+22.0%). There was greater availability of inputs of sealants in Brazil between 2012 (56.8%) and 2018 (69.5%) (p<0.001) in Brazil, and more significant expansion in the Northeast (+43.4%). There was a greater offer of the sealing procedure in Brazil between 2014 (98.6%) and 2018 (98.5%), compared to 2012 (94.7%) (p<0.001), with more significant expansion in the North (+5.8%). Conclusion: There was an increase in the supply of input and procedures, non-invasive and micro-invasive, in Primary Care in Brazil. Despite maintaining regional inequalities, they were reduced, with greater expansion in the North and Northeast regions between the years evaluated. [ABSTRACT FROM AUTHOR]

This cross-sectional study examined factors associated with occupational stress among 384 dentists working in the private sector in the first year of the COVID-19 pandemic in Brazil. Data were collected from August to October 2020 through an online form. Two outcomes – (1) anxiety and worry and (2) preparation and safety for work during the pandemic – constituted a proxy for occupational stress. The independent variables were grouped according to the explanatory theoretical model into individual, organisational and extra-organisational factors. Associations were tested by bivariate and multivariate logistic regression. Although prepared and confident, dentists felt anxious and worried about providing clinical care. Women, younger respondents and those who received no guidance on safety measures were more likely to report insecurity and unpreparedness. Younger professionals, those who did not participate in decision-making and who only sometimes had an assistant for four -hand work, were more likely to feel anxious and worried. In addition to individual factors, work organisation factors were associated with occupational stress among dentists in the first year of the pandemic. [ABSTRACT FROM AUTHOR]

This study assessed the psychometric properties of a recently developed health-related quality of life (HRQOL) instrument (Vecu et Sante Percue de l'Adolescent -Malade, VSP-AM) in 172 adolescents receiving growth hormone. The VSP-AM was cross-culturally adapted into English and tested for internal consistency (@a=0.78-0.89 subscales, 0.74 Summary Score), construct and criterion validity, and responsiveness. Correlations with other scales demonstrated convergent validity. Adolescents who reported HRQOL as high or low had significantly different scores (all p<0.001). Adolescents receiving growth hormone therapy differed significantly from adolescents with medical, surgical or psychiatric disorders. The VSP-AM shows reliability and validity for HRQOL measurement in adolescents with growth disorders.