Search

Background: Pediatric illnesses not only impose physical challenges on affected children, but also profoundly impact their emotional well-being. Understanding how parents respond to their children’s psychological distress during medical experiences is crucial for enhancing the overall support provided to these families. Aim: This study evaluated the internal structure of the Parental Response Styles Questionnaire (PRSQ), designed to differentiate parental responses to psychological distress in children with pediatric illnesses. Methods: A sample of 701 parents of children with medical issues responded to the PRSQ, reporting their different emotional expressions and responses to their children’s expressions of distress during the medical experience. Results: Factor analysis confirmed, in three of the five subsamples, an internal scale structure consisting of four factors: apathy and dysphoria, irritability and rejection, overprotectiveness, and perceived maladjustment. The invariance analyses revealed that congenital heart disease and neurological disorders are more similar in function to each other than pediatric cancer. Parents of children with neurological disorders exhibited a notably insecure pattern of parental responsiveness. Conclusions: In pediatric contexts, parental responses to their children’s emotional distress are significant factors in the process of adaptation. These responses can be measured, differentiated, and, ideally, managed by nurses and other healthcare professionals. The Parental Response Styles Questionnaire (PRSQ) is a promising tool for assessing parental reactions during their children’s treatment, and its structure appears to be particularly robust across diagnoses such as pediatric cancer, congenital heart disease, and neurological disorders.

Abstract Cervical cancer, despite being preventable through primary and secondary prevention strategies, remains one of the leading causes of morbidity and mortality among women in Brazil. This study aimed to analyze the temporal, spatial, and space-time patterns of cervical cancer mortality in Brazil. An ecological study was conducted using temporal, spatial, and space-time analysis techniques, using death certificates with cervical cancer as the underlying cause or associated condition among females in Brazil from 2000 to 2021. Death certificate and population data were provided by the Department of Health Informatics of the Unified Health System (DATASUS) and the Brazilian Institute of Geography and Statistics (IBGE), respectively. A total of 123,306 deaths associated with cervical cancer among women were registered during the study period. A rising trend in mortality was detected since 2014 onwards, after 14 years of decline. Particularly, an increase in mortality was observed among the younger age groups, and in the North and Northeast regions regardless of age. Heterogeneity in the spatial distribution of cervical cancer mortality was observed, with high mortality clusters around the country, but mostly concentrated in the North and Northeast regions. These findings suggest a need and an opportunity to develop efficient and effective health policies targeting those regions and groups of women at higher risk which in turn will allow for fast and significant reductions in cervical cancer mortality in Brazil.

Summary: The vascular repair, a pivotal element of the spinal cord (SC) injury response, has been notably neglected in zebrafish research. Here, we detail the extraction and dissection of whole-mount zebrafish SCs and the optimized whole-mount immunofluorescence staining and clearing protocols for the visualization of SC structures, such as the vascular network. Additional downstream applications of these samples, from gelatin embedding to cryosectioning and tissue staining, can be done after clearing reversion and are also described in this work.For complete details on the use and execution of this protocol, please refer to Ribeiro et al.1 : Publisher’s note: Undertaking any experimental protocol requires adherence to local institutional guidelines for laboratory safety and ethics.

A number of challenges hinder artificial intelligence (AI) models from effective clinical translation. Foremost among these challenges is the lack of generalizability, which is defined as the ability of a model to perform well on datasets that have different characteristics from the training data. We recently investigated the development of an AI pipeline on digital images of the cervix, utilizing a multi-heterogeneous dataset of 9,462 women (17,013 images) and a multi-stage model selection and optimization approach, to generate a diagnostic classifier able to classify images of the cervix into "normal", "indeterminate" and "precancer/cancer" (denoted as "precancer+") categories. In this work, we investigate the performance of this multiclass classifier on external data not utilized in training and internal validation, to assess the generalizability of the classifier when moving to new settings. We assessed both the classification performance and repeatability of our classifier model across the two axes of heterogeneity present in our dataset: image capture device and geography, utilizing both out-of-the-box inference and retraining with external data. Our results demonstrate that device-level heterogeneity affects our model performance more than geography-level heterogeneity. Classification performance of our model is strong on images from a new geography without retraining, while incremental retraining with inclusion of images from a new device progressively improves classification performance on that device up to a point of saturation. Repeatability of our model is relatively unaffected by data heterogeneity and remains strong throughout. Our work supports the need for optimized retraining approaches that address data heterogeneity (e.g., when moving to a new device) to facilitate effective use of AI models in new settings.

The Level of Personality Functioning Scale-Self-Report (LPFS-SR) operationalizes Criterion A of the DSM-5 Alternative Model for Personality Disorders. The current study aimed 1) to examine the internal consistency of the Portuguese version of the LPFS-SR in a community sample and a clinical sample, 2) to compare non-clinical participants (N = 282, Mage = 48.01, SD = 10.87) with two samples of clinical participants, one composed of patients with a personality disorder diagnosis (PD sample, n = 40, Mage = 46.18, SD = 13.59) and the other of patients with other psychiatric diagnoses (OD sample, n = 148, Mage = 49.49, SD = 11.88), with respect to LPFS-SR dimensions and total score, 3) to examine the capacity of the LPFS-SR to discriminate between samples through the ROC curve analyses, and 4) to examine the factor structure of the Portuguese version of the LPFS-SR. The Portuguese version of the LPFS-SR revealed adequate internal consistency results, akin to the original data, in the community and clinical samples. The community sample differed significantly from both clinical samples in all the LPFS-SR dimensions and total score. The ROC curve analysis indicated an optimal cut-off for the total score of 272.00, corresponding to a sensitivity of 75% and a specificity of 89%, in the PD vs. community samples. The LPFS-SR total score discriminative capacity between the PD and OD samples was lower, albeit also significant (area-under-the-curve of .63; p = .027; 95% CI: .52-.74). The current study provided evidence of the LPFS-SR's unidimensionality in both community and clinical samples. Although this study has limitations, its findings contribute to a deeper understanding of the LPFS-SR construct, as well as to its cross-cultural validation.

O ensino da natação possui relevância para a saúde e a segurança de crianças, porém sua prática ainda possui muitas controvérsias em relação a profundidade da piscina, fator que expõe o nadador a alterações posturais e emocionais. Desta forma, o objetivo do artigo foi investigar através de uma revisão sistemática qual a relação entre a profundidade das piscinas e a aprendizagem da natação infantil. A pesquisa foi realizada em artigos científicos, teses e dissertações publicados nas bases de dados Lilacs, Scielo e Pubmed seguindo as orientações PRISMA. Foram encontrados 2057 registros, e de acordo com os critérios de elegibilidade, 11 publicações foram escolhidas. Oito dos onze estudos selecionados obtiveram classificação como excelente na verificação Downs and Black Quality Assessment. Os resultados foram classificados em duas categorias: aspectos emocionais (n= 6) e aspectos pedagógicos (n=7), através da análise de conteúdo de Bardin (2011). Os estudos apontam que o medo e o ambiente interferem diretamente na adaptação da natação infantil, que a posição do corpo é modificada em diferentes profundidades e indicam uma progressão pedagógica, da piscina mais rasa para a mais funda, de acordo com a evolução aquática do aluno. Assim, entendemos que a profundidade das piscinas é uma variável relevante no tocante ao ensino da natação infantil. Sugerimos que esse fator seja avaliado cuidadosamente, para uma abordagem humanizada e respeitosa, inclusive com novos estudos a respeito do ambiente aquático durante a fase de adaptação. Palavras-chave: Natação, Aprendizagem, Profundidade, Medo, Ambiente.

The vascular system is inefficiently repaired after spinal cord injury (SCI) in mammals, resulting in secondary tissue damage and immune deregulation that contribute to the limited functional recovery. Unlike mammals, zebrafish can repair the spinal cord (SC) and restore motility, but the vascular response to injury has not been investigated. Here, we describe the zebrafish SC blood vasculature, starting in development with the initial vessel ingression in a body size-dependent manner, the acquisition of perivascular support and the establishment of ventral to dorsal blood circulation. The vascular organization grows in complexity and displays multiple barrier specializations in adulthood. After injury, vessels rapidly regrow into the lesion, preceding the glial bridge and axons. Vascular repair involves an early burst of angiogenesis that creates dysmorphic and leaky vessels. Dysfunctional vessels are later removed, as pericytes are recruited and the blood–SC barrier is re-established. This study demonstrates that zebrafish can successfully re-vascularize the spinal tissue, reinforcing the value of this organism as a regenerative model for SCI.

Background: Whole-Body Diffusion-Weighted Imaging (WBDWI) is an established technique for staging and evaluating treatment response in patients with multiple myeloma (MM) and advanced prostate cancer (APC). However, WBDWI scans show inter- and intra-patient intensity signal variability. This variability poses challenges in accurately quantifying bone disease, tracking changes over follow-up scans, and developing automated tools for bone lesion delineation. Here, we propose a novel automated pipeline for inter-station, inter-scan image signal standardisation on WBDWI that utilizes robust segmentation of the spinal canal through deep learning. Methods: We trained and validated a supervised 2D U-Net model to automatically delineate the spinal canal (both the spinal cord and surrounding cerebrospinal fluid, CSF) in an initial cohort of 40 patients who underwent WBDWI for treatment response evaluation (80 scans in total). Expert-validated contours were used as the target standard. The algorithm was further semi-quantitatively validated on four additional datasets (three internal, one external, 207 scans total) by comparing the distributions of average apparent diffusion coefficient (ADC) and volume of the spinal cord derived from a two-component Gaussian mixture model of segmented regions. Our pipeline subsequently standardises WBDWI signal intensity through two stages: (i) normalisation of signal between imaging stations within each patient through histogram equalisation of slices acquired on either side of the station gap, and (ii) inter-scan normalisation through histogram equalisation of the signal derived within segmented spinal canal regions. This approach was semi-quantitatively validated in all scans available to the study (N = 287). Results: The test dice score, precision, and recall of the spinal canal segmentation model were all above 0.87 when compared to manual delineation. The average ADC for the spinal cord (1.7 × 10−3 mm2/s) showed no significant difference from the manual contours. Furthermore, no significant differences were found between the average ADC values of the spinal cord across the additional four datasets. The signal-normalised, high-b-value images were visualised using a fixed contrast window level and demonstrated qualitatively better signal homogeneity across scans than scans that were not signal-normalised. Conclusion: Our proposed intensity signal WBDWI normalisation pipeline successfully harmonises intensity values across multi-centre cohorts. The computational time required is less than 10 s, preserving contrast-to-noise and signal-to-noise ratios in axial diffusion-weighted images. Importantly, no changes to the clinical MRI protocol are expected, and there is no need for additional reference MRI data or follow-up scans.

Beef dry-aging consists of a selection of unpackaged prime cuts placed in a controlled environment cold room for several weeks. The goals are to concentrate flavors like nutty and beefy and to improve tenderness. The aim of this study was to verify the microbiological and physicochemical behavior and sensory perception of meat during a sample process example of meat dry-aging. Twelve beef loins were selected for 90 days of dry aging and placed in a cold room with average temperature, relative humidity and forced air 3.2 ± 0.7 °C, 60.7 ± 4.2% and 0.5–2 m/s, respectively. Samples of crust and lean meat were collected on days 1, 14, 21, 35, 60 and 90 of the dry aging process for microbiological, physicochemical (pH, aw, color L*a*b*) and sensory analysis. During drying, no pathogenic bacteria were detected, and the average counts were higher for the crust. The average values for water activity (aw) and pH were 0.98 ± 0.02 and 5.77 ± 0.015, respectively. A slight decrease in aw and an increase in pH were observed over the aging period (p < 0.05). The lower microbial counts on the lean meat and the overall assessment of freshness confirm the importance of good manufacturing and storage practices during dry aging.

Abstract The presence of a corrosion layer on lead art and archæological objects can severely impede the interpretation of inscriptions, thus hampering our overall understanding of the object and its context. While the oxidation of lead that dominates corrosion may be chemically reversible via reduction, potentially providing some access to inscriptions otherwise obscured by time, corrosion damage is overall neither entirely reversible nor is the reduction process in all cases easy or feasible to carry out. In this study, by taking advantage of the unique penetration ability of terahertz radiation and the abundant frequency bands covered by a single-cycle terahertz pulse, we perform nondestructive terahertz multispectral imaging to look under the corrosion on a sixteenth century lead funerary cross (croix d’absolution) from Remiremont in Lorraine, France. The multispectral images obtained from various terahertz frequency bands are fed into a judiciously designed post-processing chain for image restoration and enhancement, thus allowing us for the first time to read obscured inscriptions that might have otherwise been lost. Our approach, which brings together in a new way the THz properties of the constituent materials and advanced signal- and image-processing techniques, opens up new perspectives for multi-resolution analysis at terahertz frequencies as a technique in archæometry and will ultimately provide unprecedented information for digital acquisition and documentation, character extraction, classification, and recognition in archæological studies.

IntroductionIn both the ICD-11 Classification of Personality Disorders and the DSM-5 Alternative Model of Personality Disorders (AMPD) personality disorders (PD) are characterized by impairments in self- and interpersonal functioning which distinguish the various levels of dysfunction. Moreover, pathological traits are used by these classification systems to define the stylistic expression of personality dysfunction. Negative affectivity, detachment, antagonism/dissociality, and disinhibition feature as trait domains in each of these models. However, there are also differences between the two models, namely, in the psychoticism domain, which does not feature as a personality trait domain in the ICD-11, and in the anankastia domain, corresponding to compulsivity in the DSM-5, which was removed from the final AMPD model. Furthermore, facets are acknowledged by the DSM-5 within each trait domain, while this does not occur in the ICD-11. In view of the similarity between these classification systems, their harmonization would be beneficial for the clinical profession. With this goal in mind, the PID5BF + M, an algorithm that assesses the DSM-5 and ICD-11 six trait domains and 18 facets, was developed and has proven to adequately characterize the ICD-11 trait domains by means of DSM-5 trait facets.MethodsThe current study compares a community sample (N = 280, Mage = 48.01, 53.2% females) with a PD sample (N = 131, Mage = 42.66, 45.0% females) along with the PID5BF + M, the LPFS-SR and the PID-5. Given that the PID5BF + M total can be seen as a measure of the level of personality dysfunction, strong relations between the PID5BF + M total and the LPFS-SR total are expected. Strong relations between the trait specifiers measured by the PID5BF + M and the PID-5 are also expected. Finally, the community and clinical samples are expected to differentiate by means of the dimensions assessed through the three afore-mentioned measures. The Spearman rank-order correlation coefficient was used to measure the strength and direction of associations between the PID5BF + M total and the LPFS-SR total and between the PID5BF + M and the PID-5 traits. Group differences were explored using the Mann–Whitney U test for independent samples.ResultsAs expected, there were strong, significant, and positive relations between the measures. Furthermore, higher scores were observed in all the variables for the PD group against the community group.DiscussionAlthough this study has limitations, its findings sustain that the PID5BF + M has potential to assess the severity of personality disfunction and to characterize the stylistic features of PD as they are conceived by both the ICD-11 and the DSM-5. Although more research is needed regarding the convergent validity of the PID5BF + M, this new test contributes to the harmonization of both systems and to parsimony in the assessment of PD, which is the main objective of clinical practice.

O caráter polifacetado da carta faz dela um objeto de estudo particularmente estimulante, porque transversal a várias áreas. Justifica-se por isso a escolha da correspondência como tema deste número da Diacrítica. Nele se pretende reunir um conjunto de trabalhos originais ilustrativos de diferentes tipos de abordagem que permitam ilustrar a riqueza e as potencialidades de um domínio tão amplo e diversificado a que vem sendo dedicada crescente atenção. Sem excluir outras possibilidades, a presente chamada para artigos dirige-se particularmente a contributos provenientes dos estudos linguísticos, dos estudos literários e dos estudos culturais. No primeiro caso, enquanto produto linguístico, a carta permite tratar questões relacionadas com a heterogeneidade composicional, a organização textual, as estratégias linguísticas da (des)cortesia ou da (in)delicadeza, da representação do “eu” e do destinatário, da implicação deste no texto, entre outras. No domínio dos estudos literários, tanto as cartas de escritores, com ou sem recorte literário, como o aproveitamento literário do modelo textual da carta ou o emprego da carta como elemento narrativo, apresentam fecundas vias de abordagem, que vão desde o lugar da correspondência na obra de um escritor, às relações entre a epistolografia e os géneros autobiográficos, à construção da imagem do “eu” como escritor, às relações entre as cartas de um escritor e a sua restante obra, por exemplo. A emergência e as metamorfoses da carta são, desde logo, assunto do foro dos estudos culturais. Para além destes assuntos mais vastos, a carta poderá também fornecer pistas sobre a construção social da intimidade, sobre questões de sociabilidade, de género, de relacionamento entre géneros, ou, atendendo à sua particular relação com a viagem, sobre questões de auto e hetero-representação. A conjugação de diversos olhares concorrerá para encarar de outro modo esta forma de memória que, utilizando ou não recursos artísticos, não se limita a ser o território da expressão de um “eu”.

Manifestações psiquiátricas estão presentes em pelo menos um terço dos doentes com cancro. Apesar disso, menos de 50% são devidamente acompanhados. Este artigo contribui para a escassa literatura existente sobre sintomas psicóticos em doentes com tumores neuroendócrinos ‐ uma apresentação rara de uma doença rara. Enfatiza uma possível associação entre tumor carcinoide do pulmão e sintomas psicóticos, discute o diagnóstico diferencial e apresenta uma opção terapêutica psicofarmacológica eficaz, nunca publicada, até onde sabemos. Relatamos o caso de uma doente de 69 anos com um tumor carcinoide atípico do pulmão, sem história psiquiátrica prévia. O quadro clínico caracterizou‐se por ideias delirantes paranoides e autoreferenciais, atividade alucinatória acústico‐verbal, humor depressivo e ansiedade extrema secundários. Foi admitida uma psicose orgânica em provável relação com a sua doença neoplásica, que foi tratada com aripiprazol, com boa resposta e tolerância.

Abstract In sub-Saharan Africa, grain legumes (pulses) are essential food sources and play an important role in sustainable agriculture. Among the major pulse crops, the native cowpea (Vigna unguiculata) and introduced common bean (Phaseolus vulgaris) stand out. This paper has two main goals. First, we provide a comprehensive view of the available genetic resources of these genera in Africa, including data on germplasm collections and mapping biodiversity-rich areas. Second, we investigate patterns of physicochemical and cytogenomic variation across Africa to explore the geographical structuring of variation between native and introduced beans. Our results revealed that 73 Vigna and 5 Phaseolus species occur in tropical regions of Africa, with 8 countries accounting for more than 20 native species. Conversely, germplasm collections are poorly represented when compared to the worldwide collections. Regarding the nuclear DNA content, on average, V. unguiculata presents significantly higher values than P. vulgaris. Also, V. unguiculata is enriched in B, Mg, S, and Zn, while P. vulgaris has more Fe, Ca, and Cu. Overall, our study suggests that the physicochemical and cytogenomic diversity of native Vigna species is higher than previously thought, representing valuable food resources to reduce food insecurity and hunger, particularly of people living in African developing countries.

One of the major challenges in forensic document analysis is estimating the age of ink deposition on a manually written document. The present work aims to develop and optimise a methodology, based on the evaporation of 2-phenoxyethanol (PE) over time, that can contribute to ink age estimation. A black BIC® Crystal Ballpoint Pen was purchased in a commercial area, and ink deposition began in September 2016 over 1095 days. For each ink sample, 20 microdiscs were subjected to n-hexane extraction in the presence of an internal standard (ethyl benzoate) followed by derivatisation with a silylation reagent. A gas chromatography-mass spectrometry (GC/MS) method was optimised for PE-trimethylsilyl (PE-TMS) to characterise the ageing curve. The developed method presented good linearity between 0.5 and 50.0 μg mL−1, as well as limits of detection and quantification of 0.026 and 0.104 μg mL−1, respectively. It was possible to characterise PE-TMS concentration over time, which reveals a two-phase decay behaviour. First, there was a substantial decline between the 1st and the 33rd day of deposition, followed a by a stabilisation of the signal, which allowed to detect the presence of PE-TMS up to 3 years. Two unknown compounds were also present and allowed to identify three dating time frames for the same ink stroke: (i) between time 0 and 33 days, (ii) between time 34 and 109 days, and (iii) more than 109 days. The developed methodology allowed to characterise the behaviour of PE over time and to establish a relative dating of three-time frames.

Abstract Background Cancer trials often incorporate intensive imaging with Magnetic Resonance Imaging (MRI) and Positron Emission Tomography with Computerised Tomography (PET/CT), which can be physically and mentally exhausting for patients. This questionnaire study aimed to determine the aspects of imaging that affect a patient’s decision to participate in clinical trials in order to inform the design of future trials that utilise imaging. This should achieve greater patient compliance and improve the patient experience. Method A detailed questionnaire assessing patient expectation and acceptability of imaging within clinical trials was developed in collaboration with two patient representatives. The questionnaire addressed the influence of scan type, length, frequency, scheduling, invasiveness and staff support on acceptability of imaging. It was applied to three patient groups. Group 1 consisted of patients newly recruited to studies with imaging, Group 2 consisted of previous participants in studies with imaging and Group 3 consisted of patients having imaging for clinical care. Results One hundred ninety six patients completed the questionnaires (Group 1:47; Group 2: 50 and Group 3: 99). The use of ionising radiation and number of scans required were identified as negative influences on decision to participate by 25% of Group 3 but only by 6% of Groups 1 and 2. Scan duration >30mins was perceived as a negative factor for decision to participate by all Groups (12–22%). Good communication provided by researchers in terms of discussing the study before and after reading study materials was a key factor in influencing decision to participate (> 50% in Groups 1 and 2 and > 20% in Group 3). Conclusion Factors relating to imaging procedures within clinical trials that affect participation have been identified with communication around study materials as the key determinant. These data will be used to influence the development of future research protocols. Modification of imaging requirements within clinical trials will improve patient tolerance and acceptability and is likely to raise recruitment.

O presente artigo problematiza a dualidade existente entre os termos Terra e mundo sob o contexto da crise climática do século XXI. Nele são propostos, a partir da desconstrução de valores antropocêntricos e ecocêntricos, uma análise do paradigma filantropo/sustentável, como modo de compreender interdisciplinaridade da coexistência entre o Homem e a Natureza. Para isso, são demonstrados alguns desequilíbrios hierárquicos presentes na concessão da cultura ocidental proposta por Samuel Huntington, no imaginário ecológico das comunidades indígenas defendidas por Zoe Todd e no impacto ambiental da sociedade de consumo pela perspetiva de Patrick Curry, Richard Sylvan e David Bennett. Como resultado, é demonstrada a importância da compreensão de um equilíbrio entre o consumo e a produção, responsabilizando o antropocentrismo elitista das comunidades ocidentais como causa e solução da problemática ecológica, transversalmente ilustrada a partir do mercado e mundo da arte sob a conceção de inutilidade prática da sua existência e dado a sua contribuição para um problema de superprodução.

A introdução de quotas legislativas (33,3%), em Portugal, em 2006, influenciou positivamente a proporção de mulheres eleitas, mas, ao contrário dos restantes patamares políticos, no governo local a imparidade subsiste acentuadamente em alguns órgãos e cargos, situação que representa terreno fértil de pesquisa. Contudo, verifica­se uma escassez de estudos sobre o tema. O artigo equaciona a relação entre a falta de conhecimento sobre as especificidades locais e o desacerto da solução legislativa. O levantamento exaustivo de literatura, que identificou 43 títulos, e o contacto com investigadoras/es significativas/os permitiram clarificar causas da eficácia diferenciada da Lei da Paridade, explicar a escassez de estudos e anotar tópicos para investigação futura.

The ICD-11 Classification of Personality Disorders delineates five trait domain qualifiers (i.e., negative affectivity, detachment, dissociality, disinhibition, and anankastia), whereas the DSM-5 Alternative Model of Personality Disorders also delineates a separate domain of psychoticism. These six combined traits not only characterize individual stylistic features, but also the severity of their maladaptive expressions. It was, therefore, the aim of this study to investigate the utility of ICD-11 and DSM-5 trait domains to differentiate patients with personality disorders (PD) from patients with other mental disorders (non-PD). The Personality Inventory for DSM-5 Brief Form Plus (PID5BF+M) was administered to a sample of patients diagnosed with a personality disorder (N = 124, Mage = 42.21, 42.7% females) along with a sample of patients diagnosed with other mental disorders (N = 335, Mage = 44.83, 46.6% females). Group differences were explored using the independent sample t test or the Mann–Whitney U test for independent samples, and discriminant factor analysis was used to maximize group differences for each trait domain and facet score. The PD group showed significantly higher scores for the total PID5BF+M composite score, for the trait domains of negative affectivity, antagonism/dissociality, and disinhibition and for the trait facets of emotional lability, manipulativeness, deceitfulness, and impulsivity. The trait domains of disinhibition, negative affectivity, and antagonism/dissociality as well as the trait facets of impulsivity, deceitfulness, emotional lability, and manipulativeness were the best discriminators between PD and non-PD patients. The global PID5BF+M composite score was also one of the best discriminators supporting its potential as a global severity index for detecting personality dysfunction. Finally, high scores in three or more of the 18 PID5BF+M facets suggested the possible presence of a PD diagnosis. Despite some limitations, our findings suggest that the ICD-11 and DSM-5 traits have the potential to specifically describe the stylistic features that characterize individuals with PD, including the severity of their maladaptive expressions.

The World Health Organization Call to Eliminate Cervical Cancer resonates in cities like Manaus, Brazil, where the burden is among the world's highest. Manaus has offered free cytology-based screening since 1990 and HPV immunization since 2013, but the public system is constrained by many challenges and performance is not well-defined. We obtained cervical cancer prevention activities within Manaus public health records for 2019 to evaluate immunization and screening coverage, screening by region and neighborhood, and the annual Pink October screening campaign. We estimated that among girls and boys age 14-18, 85.9% and 64.9% had 1+ doses of HPV vaccine, higher than rates for age 9-13 (73.4% and 43.3%, respectively). Of the 90,209 cytology tests performed, 24.9% were outside the target age and the remaining 72,230 corresponded to 40.1% of the target population (one-third of women age 25-64). The East zone had highest screening coverage (49.1%), highest high-grade cytology rate (2.5%) and lowest estimated cancers (38.1/100,000) compared with the South zone (32.9%, 1.8% and 48.5/100,000, respectively). Largest neighborhoods had fewer per capita screening locations, resulting in lower coverage. During October, some clinics successfully achieved higher screening volumes and high-grade cytology rates (up to 15.4%). Although we found evidence of some follow-up within 10 months post-screening for 51/70 women (72.9%) with high-grade or worse cytology, only 18 had complete work-up confirmed. Manaus has successfully initiated HPV vaccination, forecasting substantial cervical cancer reductions by 2050. With concerted efforts during campaigns, some clinics improved screening coverage and reached high-risk women. Screening campaigns in community locations in high-risk neighborhoods using self-collected HPV testing can achieve widespread coverage. Simplifying triage and treatment with fewer visits closer to communities would greatly improve follow-up and program effectiveness. Achieving WHO Cervical Cancer Elimination goals in high-burden cities will require major reforms for screening and simpler follow-up and treatment.

Purpose: To characterize the voxel-wise uncertainties of Apparent Diffusion Coefficient (ADC) estimation from whole-body diffusion-weighted imaging (WBDWI). This enables the calculation of a new parametric map based on estimates of ADC and ADC uncertainty to improve WBDWI imaging standardization and interpretation: NoIse-Corrected Exponentially-weighted diffusion-weighted MRI (niceDWI).Methods: Three approaches to the joint modeling of voxel-wise ADC and ADC uncertainty (σADC) are evaluated: (i) direct weighted least squares (DWLS), (ii) iterative linear-weighted least-squares (IWLS), and (iii) smoothed IWLS (SIWLS). The statistical properties of these approaches in terms of ADC/σADC accuracy and precision is compared using Monte Carlo simulations. Our proposed post-processing methodology (niceDWI) is evaluated using an ice-water phantom, by comparing the contrast-to-noise ratio (CNR) with conventional exponentially-weighted DWI. We present the clinical feasibility of niceDWI in a pilot cohort of 16 patients with metastatic prostate cancer.Results: The statistical properties of ADC and σADC conformed closely to the theoretical predictions for DWLS, IWLS, and SIWLS fitting routines (a minor bias in parameter estimation is observed with DWLS). Ice-water phantom experiments demonstrated that a range of CNR could be generated using the niceDWI approach, and could improve CNR compared to conventional methods. We successfully implemented the niceDWI technique in our patient cohort, which visually improved the in-plane bias field compared with conventional WBDWI.Conclusions: Measurement of the statistical uncertainty in ADC estimation provides a practical way to standardize WBDWI across different scanners, by providing quantitative image signals that improve its reliability. Our proposed method can overcome inter-scanner and intra-scanner WBDWI signal variations that can confound image interpretation.

Introdução: A doença degenerativa cervical é uma condição relacionada com a idade, apresentando sinais e/ou sintomas numa minoria dos casos. Este relato de caso tem como objetivo alertar para a importância em reconhecer a Mielopatia Espondilótica Cervical como um diagnóstico diferencial perante quadros arrastados de diminuição progressiva da força muscular dos membros inferiores e alterações do padrão da marcha. Descrição do caso: Paciente do sexo masculino, 64 anos, observado em consulta programada por um quadro de alteração do padrão habitual da marcha com cerca de 3 anos de evolução. Ao exame físico, apresentava marcha de base alargada e sinais compatíveis com atingimento do neurónio motor superior: paraparésia espástica com hiperreflexia dos membros inferiores e sinal de Babinski positivo bilateralmente. Do estudo efetuado, destacou-se a presença de alterações degenerativas espondilodiscais da coluna cervical com compromisso medular, evidenciando a presença de um quadro de Mielopatia Espondilótica Cervical. Submetido a laminectomia descompressiva cervical, encontra-se atualmente inserido em programa de reabilitação fisiátrica com recuperação praticamente total do seu padrão de marcha. Comentário: A Mielopatia Espondilótica Cervical é a condição clínica que representa a principal causa de mielopatia nos adultos. Poderá representar um desafio diagnóstico, quer pela ausência de achados específicos quer pelo elevado número de diagnósticos diferenciais. A sua suspeita aumenta na presença de alterações progressivas da marcha associado a queixas sensoriais ou motoras nos membros superiores em indivíduos com mais de 55 anos.

Abstract Background Heart Failure (HF) is a low grade inflammatory condition. High sensitivity C-reactive protein (hsCRP) is an established marker of inflammation. A cut-off value of hsCRP beyond which an infection should be sought has never been studied in HF. We aimed to determine the best hsCRP cut-off for infection prediction in acute HF. Methods We analyzed patients included in an acute HF registry – EDIFICA (Estratificação de Doentes com InsuFIciência Cardíaca Aguda). Admission hsCRP measurement was available as part of the registry’s protocol. Patients with acute coronary syndrome as the cause of acute HF were excluded from the registry. Infection was considered according to the diagnosis registered in the discharge record. A receiver-operating characteristic (ROC) curve was used to determine the best hsCRP cut-off for infection prediction. Results We studied 615 patients. Mean age was 76 years, 45.2% were male, 60.3% had systolic dysfunction. Median admission hsCRP was 20.3 (9.5–55.5)mg/L; in 41.6% the cause of decompensation was an infection. The area under the ROC curve for admission hsCRP in the prediction of infection was 0.79 (0.76–0.83); the best hsCRP cut-off was 25 mg/L with a sensitivity of 72.7%, specificity 77.2%, positive predictive value 69.4% and negative predictive value 79.9%. Age and elevated hsCRP independently associated with an infection as the precipitant of acute HF. Conclusions We suggest 25 mg/L as a cut-off beyond which an infection should be sought underlying acute HF. Almost 80% of the patients with hsCRP

Invasive pulmonary aspergillosis (IPA) has become a recognizable complication in coronavirus disease 2019 (COVID-19) patients admitted to intensive care units (ICUs). Alveolar damage in the context of acute respiratory distress syndrome (ARDS) appears to be the culprit in facilitating fungal invasion in COVID-19 patients, leading to a COVID-19-associated pulmonary aspergillosis (CAPA) phenomenon. From November 2020 to 15 February 2021, 248 COVID-19 patients were admitted to our ICUs, of whom ten patients (4% incidence) were classified as either probable (six) or possible (four) CAPA cases. Seven patients had positive cultural results: Aspergillus fumigatus sensu stricto (five), A. terreus sensu stricto (one), and A. welwitschiae (one). Five patients had positive bronchoalveolar lavage (BAL) and galactomannan (GM), and two patients had both positive cultural and GM criteria. All but two patients received voriconazole. Mortality rate was 30%. Strict interpretation of classic IPA definition would have resulted in eight overlooked CAPA cases. Broader diagnostic criteria are essential in this context, even though differentiation between Aspergillus colonization and invasive disease might be more challenging. Herein, we aim to raise awareness of CAPA in view of its potential detrimental outcome, emphasizing the relevance of a low threshold for screening and early antifungal treatment in ARDS patients.

Free heme is cytotoxic as exemplified by hemolytic diseases and genetic deficiencies in heme recycling and detoxifying pathways. Thus, intracellular accumulation of heme has not been observed in mammalian cells to date. Here we show that mice deficient for the heme transporter SLC48A1 (also known as HRG1) accumulate over ten-fold excess heme in reticuloendothelial macrophage lysosomes that are 10 to 100 times larger than normal. Macrophages tolerate these high concentrations of heme by crystallizing them into hemozoin, which heretofore has only been found in blood-feeding organisms. SLC48A1 deficiency results in impaired erythroid maturation and an inability to systemically respond to iron deficiency. Complete heme tolerance requires a fully-operational heme degradation pathway as haplo insufficiency of HMOX1 combined with SLC48A1 inactivation causes perinatal lethality demonstrating synthetic lethal interactions between heme transport and degradation. Our studies establish the formation of hemozoin by mammals as a previously unsuspected heme tolerance pathway.

A ansiedade na performance musical (APM) é descrita como uma apreensão persistente que compromete as competências performativas, tanto em performances a solo como em grupo. Para além dos sintomas fisiológicos, como aumento do batimento cardíaco, hiperventilação, transpiração ou náusea, está associada a sintomas de natureza psicológica e cognitiva de impacto negativo na performance. Este trabalho pretende estudar a eficácia do treino de biofeedback em contexto de performance de música de câmara. Com um desenho do tipo quasi – experimental, foram selecionados 2 quartetos de trombonistas, sendo o quarteto (1) o grupo experimental e o quarteto (2) o grupo de controlo. Ambos realizaram apresentações públicas, antes e depois da intervenção. O quarteto (1) foi submetido a um programa de 8 sessões bissemanais de treino de biofeedback, no intuito de verificar a sua contribuição para diminuir os efeitos da APM. Na avaliação da eficácia da intervenção foram aplicados pré e pós intervenção os questionários State Trait Anxiety Inventory (STAI), Kenny Music Performance Anxiety Inventory (K-MPAI) e Kessler Psychological Distress Scale (K10). Os resultados sugerem que este tipo de intervenção se revela favorável no que diz respeito à diminuição dos níveis de APM em contexto de música de câmara. São referidas algumas implicações deste estudo para a redução da ansiedade de performance quer em contextos de formação e ensino da música quer em contextos de prática profissional.

À primeira vista, “Manhã perdida”, conto de João de Araújo Correia incluído em Folhas de xisto (1959), pouco parece ter em comum com A bicicleta que tinha bigodes (2011), estória da autoria de Ondjaki: são textos classificados de forma distinta, pertencentes a autores de épocas e literaturas diferentes, com mundividências diversas. No entanto, ambos os textos partilham uma dimensão metanarrativa de que nos iremos ocupar, já que os dois giram em torno da questão de como se cria um conto/uma estória: estimulados por um concurso literário, quer o Dr. Ivinho do conto, quer o narrador do livro mais recente, recorrem à ajuda de um escritor encartado para se habilitarem ao apetecido prémio (cinco contos e uma bicicleta, respetivamente). É sobre esta figura do escritor de renome que nos deteremos inicialmente, elencando elementos do seu retrato, em particular aqueles em que assenta a autoridade que lhe é reconhecida. A motivação de ambos os candidatos, bem como o facto de um e outro procurarem a ajuda de um mestre, indicia que escrever uma história envolve mais do que uma simples aptidão natural e implica uma certa aprendizagem. Assim, será importante verificar se o magistério do escritor experimentado surte efeito. A sua atuação e as inquietações dos seus discípulos permitirão ainda identificar as características que ambas as narrativas atribuem ao conto/à estória e as técnicas apontadas para a sua criação.

An agronomic itinerary for Se biofortification of two rice cultivars (Ariete and Ceres) through foliar fertilization with sodium selenate and sodium selenite with different concentrations (25, 50, 75 and 100 g Se.ha−1), was implemented in experimental fields. The selenium toxicity threshold was not exceeded, as shown by the eco-physiological data obtained through leaf gas exchanges. The highest Se enrichment in paddy grains was obtained with selenite for both cultivars, especially at the highest doses, i.e., 75 and 100 g Se.ha−1, with approximately a 5.0-fold increase compared with control values. In paddy grains, Zn was the most affected element by the treatments with Se with decreases up to 54%. When comparing the losses between rough and polished grains regardless of the cultivars, Se species and concentrations, it was observed that only Cu, Mg and Zn exhibited losses 70%. The loss of Se is more pronounced in Ceres cultivar than in Ariete but rarely exceeds 50%. The analysis by µ-EDXRF showed that, in Ariete cultivar, Se is mostly homogeneously distributed in the grain regardless of any treatments, while in Ceres cultivar, the Se distribution seems to favor accumulation in the periphery, perhaps in the bran.

In worldwide production, rice is the second-most-grown crop. It is considered a staple food for many populations and, if naturally enriched in Se, has a huge potential to reduce nutrient deficiencies in foodstuff for human consumption. This study aimed to develop an agronomic itinerary for Se biofortification of Oryza sativa L. (Poaceae) and assess potential physicochemical deviations. Trials were implemented in rice paddy field with known soil and water characteristics and two genotypes resulting from genetic breeding (OP1505 and OP1509) were selected for evaluation. Plants were sprayed at booting, anthesis and milky grain phases with two different foliar fertilizers (sodium selenate and sodium selenite) at different concentrations (25, 50, 75 and 100 g Se·ha−1). After grain harvesting, the application of selenate showed 4.9–7.1 fold increases, whereas selenite increased 5.9–8.4-fold in OP1509 and OP1505, respectively. In brown grain, it was found that in the highest treatment selenate or selenite triggered much higher Se accumulation in OP1505 relatively to OP1509, and that no relevant variation was found with selenate or selenite spraying in each genotype. Total protein increased exponentially in OP1505 genotype when selenite was applied, and higher dosage of Se also increased grain weight and total protein content. It was concluded that, through agronomic biofortification, rice grain can be enriched with Se without impairing its quality, thus highlighting its value in general for the industry and consumers with special needs.

Herpes simplex virus 1 is a prevalent neurotropic pathogen that infects and establishes latency in peripheral sensory neurons. It can migrate into the central nervous system and cause encephalitis. The association between herpes simplex virus encephalitis and cerebral venous thrombosis is rare, with a very limited number of case reports described in the literature, despite the recognized thrombogenic effects of the virus. A 44-year-old man was brought to the emergency department with generalized tonic-clonic seizures requiring sedation and ventilation to control it. Initial brain computed tomography revealed cortical and subcortical edema on the left frontal lobe, and a subsequent contrast-enhanced exam showed absence of venous flow over the anterior half of the superior sagittal sinus. Cerebrospinal fluid polymerase chain reaction was positive for herpes simplex virus type 1, and the patient was started on acyclovir and anticoagulation, with clinical improvement. Acyclovir administration was maintained for 14 days and oral anticoagulation for one year, with no recurrence of thrombotic events or other complications. A well-timed treatment has a validated prognostic impact on herpes simplex encephalitis, making early recognition of its clinical aspects of main importance.

Abstract Objective To adapt and validate a widely used set of moral dilemmas to European Portuguese, which can be applied to assess decision-making. Moreover, the classical formulation of the dilemmas was compared with a more focused moral probe. Finally, a shorter version of the moral scenarios was tested. Methods The Portuguese version of the set of moral dilemmas was tested in 53 individuals from several regions of Portugal. In a second study, an alternative way of questioning on moral dilemmas was tested in 41 participants. Finally, the shorter version of the moral dilemmas was tested in 137 individuals. Results Results evidenced no significant differences between English and Portuguese versions. Also, asking whether actions are “morally acceptable” elicited less utilitarian responses than the original question, although without reaching statistical significance. Finally, all tested versions of moral dilemmas exhibited the same pattern of responses, suggesting that the fundamental elements to the moral decision-making were preserved. Conclusions We found evidence of cross-cultural validity for moral dilemmas. However, the moral focus might affect utilitarian/deontological judgments.

Agricultural residues represent a disposal problem and a biomass source for chemical production. Lignocellulosic composition varies in plants as a function of several factors such as physiological age and tissue function. Banana pseudostem is a large biomass resource that is usually wasted, in spite of the possibility that it can be used as a source of organic compounds such as cellulose and hemicelluloses. The aim of this paper is compare the lignocellulosic content and physicochemical properties of different sheaths of Pacovan banana pseudostems. The trunk was divided into four different fractions, from the outermost sheaths to the core of the structure. There was a significant difference between the lignocellulosic compositions of the fractions. The X-ray diffraction, Fourier transform infrared spectroscopy, thermogravimetric analysis, and differential scanning calorimetry measurements reflected this difference in the sheaths. These results indicate that the Pacovan banana pseudostem cannot be considered to be a uniform biomass, and future approaches to its use as a biorefinery feedstock must consider a preliminary separation of the sheaths prior to chemical extraction of organic components.

Children with delayed development of language functions can have difficulty reading and writing. Social problems can exacerbate situations of failure, while access to specialized services for the reduction or elimination of these difficulties is restricted, and costly for low-income families. The aim of the present study was therefore to develop and offer a program of cognitive-behavioral intervention to children in a public school, in order to stimulate changes in lexical processing, and determine its effectiveness in reducing deficiencies. After a meeting at the school, and with parental consent, 40 children were evaluated, considering the phonological, lexical, and semantic aspects of language, using the Neuropsychological Lexical Processing Assessment Set. Five children, aged six to 10 years, with performance below expectations for their age in some of the tasks, were included in the stimulation program. The children were invited to participate in an intervention, which comprised the second stage of the project. In the intervention, the children were subjected to a psycholinguistics stimulation program consisting of tasks aimed at stimulating functions that were mainly related to the performance of reading and writing. The data were analyzed using the Statistical Package for the Social Sciences. A descriptive statistical analysis was first used to identify those children that were below the standard deviation of the first tasks in the assessment set, and the analysis was repeated after reassessment of the children following the intervention activities. The comparative statistical results demonstrated the effect of the psycholinguistic program. Gains in the interest and participation of the children in the school activities were also observed by teachers.

Zebrafish are able to regenerate the spinal cord and recover motor and sensory functions upon severe injury, through the activation of cells located at the ependymal canal. Here, we show that cells surrounding the ependymal canal in the adult zebrafish spinal cord express Foxj1a. We demonstrate that ependymal cells express Foxj1a from their birth in the embryonic neural tube and that Foxj1a activity is required for the final positioning of the ependymal canal. We also show that in response to spinal cord injury, Foxj1a ependymal cells actively proliferate and contribute to the restoration of the spinal cord structure. Finally, this study reveals that Foxj1a expression in the injured spinal cord is regulated by regulatory elements activated during regeneration. These data establish Foxj1a as a pan-ependymal marker in development, homeostasis and regeneration and may help identify the signals that enable this progenitor population to replace lost cells after spinal cord injury.

In contemporary society, education has become a challenge because school and society live in constant dichotomy which experts call “cultural blindness” in contrast to the “call” (un)aware of students who reflect the “rainbow” diversity of our heterogeneous society. We recognize that society delegates to the school the primary role of education and it reflects the development of society which calls for Intercultural Education and inclusion for all students regardless of their specific needs and are entitled to an effective education and values. Therefore, this research will seek to understand the ways of the inclusive school movement and interculturalism, through understanding of these phenomena are interrelated and complementary. In addition to an overview of this topic this research will focus on the pre-school education. The focus at this level has take into account the educational attainment of a case study about the interdisciplinary work between teacher (kindergarten teacher) and therapists (occupational and speech) for the inclusion of a five-years-old child, with features of autism spectrum in a room of the preschool education in Oporto, Portugal

Neste artigo, descrevemos o processo de pesquisa que culminou na tradução do prólogo das Eumênides, de Ésquilo. Em nossa pesquisa, refletimos sobre a viabilidade de encenação de textos teatrais gregos antigos na atualidade, partindo de uma discussão sobre a teatralidade nas traduções preexistentes desses textos. Com base num estudo de teoria da tradução, identificamos alguns problemas nas traduções e debruçamo-nos sobre o prólogo das Eumênides, de Ésquilo, almejando alcançar uma tradução apta à encenação. Nessa busca, tivemos que refletir também sobre um caminho que nos levasse ao nosso objetivo: essa tradução do prólogo das Eumênides. Esse caminho se deu pela associação de teorias da criação de texto traduzido com métodos próprios da criação teatral, o que gerou uma prática de tradução com particularidades que discutimos neste trabalho.

Os enfermeiros têm um papel fundamental na gestão eficaz da dor. A avaliação da dor, a intervenção imediata e a apreciação dos resultados clínicos obtidos com a intervenção são necessários para uma gestão eficaz. Muitos enfermeiros podem não estar preparados para assumir uma atitude crítica quer por falta de conhecimentos, quer por atitudes individuais negativas perante a dor. Desta forma, o Workgroup Dor da Associação de Enfermagem Oncológica Portuguesa (AEOP) decidiu pesquisar quais os conhecimentos e atitudes dos enfermeiros que fazem parte desta associação, sobre a dor. Para tal, foi utilizado o questionário (versão adaptada) “Knowledge and Attitudes Survey Regarding Pain” (KASRP), já validado em vários estudos internacionais semelhantes. Os resultados obtidos dos 87 questionários respondidos foram satisfatórios, já que cerca de 79,5% das questões relacionadas com os conhecimentos e atitudes foram corretamente respondidas. No entanto, alguns destes resultados demonstraram haver ainda algumas lacunas, como por exemplo na área de conhecimentos relativos à farmacologia. Assim, o Workgroup Dor já se encontra a trabalhar em estratégias de educação e formação na área da dor, pretendendo dar respostas a algumas das lacunas identificadas. Pretende também proceder à tradução, adaptação linguística e cultural do KASRP para a língua portuguesa e, posteriormente, alargar esta pesquisa a uma amostra maior de enfermeiros. Este artigo é o desenvolvimento de um poster apresentado nas Jornadas da Primavera em Évora, em Março de 2015, e de uma comunicação livre apresentada na AEOP7, ambos premiados.

Two types of root nodule symbioses are known for higher plants, legume and actinorhizal symbioses. In legume symbioses, bacterial signal factors induce the expression of ENOD40 genes. We isolated an ENOD40 promoter from an actinorhizal plant, Casuarina glauca, and compared its expression pattern in a legume (Lotus japonicus) and an actinorhizal plant (Allocasuarina verticillata) with that of an ENOD40 promoter from the legume soybean (GmENOD402). In the actinorhizal Allocasuarina sp., CgENOD40-GUS and GmENOD40-2-GUS showed similar expression patterns in both vegetative and symbiotic development, and neither promoter was active during nodule induction. The nonsymbiotic expression pattern of CgENOD40-GUS in the legume genus Lotus resembled the nonsymbiotic expression patterns of legume ENOD40 genes however, in contrast to GmENOD40-2-GUS, CgENOD40-GUS was not active during nodule induction. The fact that only legume, not actinorhizal, ENOD40 genes are induced during legume nodule induction can be linked to the phloem unloading mechanisms established in the zones of nodule induction in the roots of both types of host plants.

Intensive care is a critical area of medicine having a multidisciplinary nature requiring all types of healthcare professionals. Given the critical environment of intensive care units (ICUs), the need to use information technologies, like decision support systems, to improve healthcare services and ICU management is evident. It is proven that unplanned and prolonged admission to the ICU is not only prejudicial to a patient's health, but also such a situation implies a readjustment of ICU resources, including beds, doctors, nurses, financial resources, among others. By discovering the common characteristics of the admitted patients, it is possible to improve these outcomes. In this study clustering techniques were applied to data collected from admitted patients in an intensive care unit. The best results presented a silhouette of 1, with a distance to centroids of 6.2 × 10−17 and a Davies–Bouldin index of −0.652.

JOSÉ AND JOSÉ: THE LAST INTERVIEW OF SARAMAGO BY RODRIGUES DOS SANTOS Media and consumer society have changed the conception of writer. Today writers keep being interviewed throughout their lives, especially when they win a prize, as has happened to José Saramago. In this paper, we will study his last interview, edited in a book by José Rodrigues dos Santos, aiming at discussing the relevance of serializing the so called literary interviews and analyzing the image of the Portuguese Nobel conveyed by this text.

Introdução: A doença pode ser causa ou consequência da rutura de uma homeostasia pré-existente na família. O médico de família ocupa um lugar privilegiado para identificar fatores de risco familiar, reconhecer recursos e estratégias aquando de doença. Esta tarefa pode tornar-se difícil quando vários membros da família adoecem em simultâneo. Descrição do caso: A., 37 anos, sexo feminino, caucasiana, pertencente a uma família nuclear, fase IV do ciclo de Duvall. Em maio de 2012, no puerpério da segunda gravidez, inicia quadro de sudorese, astenia e perda ponderal. Em setembro apresenta febre vespertina e tosse. Recorre à Unidade de Saúde Familiar em novembro onde foram pedidos exames complementares de diagnóstico cujos resultados motivaram encaminhamento ao Serviço de Hematologia do Hospital… Em dezembro foi confirmado diagnóstico de linfoma não Hodgkin. Esteve internada para vários ciclos de quimioterapia, tendo as filhas ficado ao cuidado do marido. Este assumiu as tarefas e a responsabilidade parental para que as filhas sentissem o menos possível a ausência da mãe. Nesse mês foi também diagnosticada neoplasia maligna do cólon à mãe de A., submetida a tratamento cirúrgico no Hospital… Em fevereiro de 2013, a filha mais velha de A. foi submetida a cirurgia otorrinolaringológica e a de 9 meses, em consulta de saúde infantil, apresentava dificuldade na posição de sentar. Em junho, A. terminou a quimioterapia e a filha de 13 meses mantinha atraso do desenvolvimento psicomotor. Comentário: A equipa de saúde, com o objetivo de manter a funcionalidade e minimizar o impacto das várias doenças na família, procurou mobilizar e gerir os recursos de saúde e capacitar os vários membros da família no desenvolvimento de novas competências.

In search of plant genes expressed during early interactions between Casuarina glauca and Frankia, we have isolated and characterized a C. glauca gene that has strong homology to subtilisin-like protease gene families of several plants including the actinorhizal nodulin gene ag12 of another actinorhizal plant, Alnus glutinosa. Based on the expression pattern of cg12 in the course of nodule development, it represents an early actinorhizal nodulin gene. Our results suggest that subtilisin-like proteases may be a common element in the process of infection of plant cells by Frankia in both Betulaceae (Alnus glutinosa) and Casuarinaceae (Casuarina glauca) symbioses.