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As aging progresses, there is a consequent increase in chronic diseases, such as osteoporosis and osteopenia, and vitamin D (cholecalciferol) supplementation is routinely prescribed. However, indiscriminate use of this supplement can lead to intoxication and systemic changes. Seeking to raise awareness among prescribing physicians and especially older patients, the purpose of this case report was to describe the systemic symptoms and damage that can occur from intoxication due to uncontrolled use of vitamin D, such as hypercalcemia and kidney injury. This report describes the case of an older woman who reported using a cholecalciferol- containing formula for ten years to treat osteoarthritis. She arrived at the hospital with weight loss, acute kidney "injury and hypercalcemia. After ruling out neoplastic diseases, she was diagnosed with vitamin D poisoning. The symptoms and laboratory results improved after treatment. Based on this report, we conclude that geriatricians play a key role in demystifying the use of vitamins and should only prescribe them when medically indicated.

We explored patterns of shortening of the distal radius and investigated the effect of displacement on ‘ulnar variance’ in 250 patients with distal radial fractures. A small number of patients (5%) had a fracture that resulted in true shortening. Thirty-two per cent had fractures that appeared short, but lateral radiographs revealed that the articular surface was tilted, with either the anterior or dorsal rim of the articular surface being proximal to the distal ulna but the other rim was distal to it. We recommend initial assessment of variance on lateral radiographs. If the anterior and dorsal rims of the distal radial articular surface are proximal to the distal ulna, then true shortening is present and lengthening and stabilization, to hold the radius distracted, should be considered. If only one rim is proximal to the distal ulna, then correction of the tilt will lessen the apparent positive variance. Level of evidence: IV

Aims Carpal malalignment after a distal radial fracture occurs due to loss of volar tilt. Several studies have shown that this has an adverse influence on function. We aimed to investigate the magnitude of dorsal tilt that leads to carpal malalignment, whether reduction of dorsal tilt will correct carpal malalignment, and which measure of carpal malalignment is the most useful. Methods Radiographs of patients with a distal radial fracture were prospectively collected and reviewed. Measurements of carpal malalignment were recorded on the initial radiograph, the radiograph following reduction of the fracture, and after a further interval. Linear regression modelling was used to assess the relationship between dorsal tilt and carpal malalignment. Receiver operating characteristic (ROC) analysis was used to identify which values of dorsal tilt led to carpal malalignment. Results A total of 250 consecutive patients with 252 distal radial fractures were identified. All measures of carpal alignment were significantly associated with dorsal tilt at each timepoint. This relationship persisted after adjustment for age, sex, and the position of the wrist. Capitate shift consistently had the strongest relationship with dorsal tilt and was the only parameter that was not influenced by age or the position of the wrist. ROC curve analysis identified that abnormal capitate shift was seen with > 9° of dorsal tilt. Conclusion Carpal malalignment is related to dorsal tilt following a distal radial fracture. Reducing the fracture and improving dorsal tilt will reduce carpal malalignment. Capitate shift is easy to assess visually, unrelated to age and sex, and appears to be the most useful measure of carpal malalignment. The aim during reduction of a distal radial fracture should be to realign the capitate with the axis of the radius and prevent carpal malalignment. Cite this article: Bone Joint J 2020;102-B(1):137–143

The goal of this study was to examine how various degrees of perceptual decoupling during mind wandering affect fine motor control. We hypothesized that while under normal circumstances attention ensures an optimal control strategy that leads to accurate motor performance, during mind wandering the process becomes disrupted. In this study, we conducted a computer-based experiment with a tracking task. During mind wandering, motor movements were more erratic and less variable, indicative of reduced attentiveness to the continuous demands of the external task. Importantly, the deeper the reported mind wandering, the less accurate and less variable were the mouse movements, suggesting that perceptual decoupling may take place in a graded rather than in an all or nothing manner. Greater movement intermittency was associated with higher tracking accuracy, suggesting that more corrective movements toward a moving target were functional to task performance. Moreover, greater variance in velocity was negatively correlated with tracking accuracy. These findings suggest that periods of inattention to the task have a negative impact on fine motor movement control by making behavior unpredictable, providing support for the idea that there is a decoupling of sensory-motor processes during mind wandering.

We aimed to establish if fracture reduction will correct scapholunate angle in dorsally displaced distal radial fractures and to identify the relationship with other measures of distal radial position and carpal alignment. Radiographs of 131 patients with a distal radial fracture and of 50 patients with normal radiographs were reviewed. We measured the scapholunate, radiolunate, capitolunate and metacarporadial angles on the lateral views. Linear regression modelling showed that all parameters measured were significantly associated with scapholunate angle on the first radiograph following injury. Scapholunate angle increased following distal radial fracture. Reduction of the fracture improved scapholunate angle, and this was most strongly related to change in dorsal tilt. We conclude that scaphoid flexion is likely to compensate for the dorsal tilt of the lunate as an attempt to counter its dorsal tilt, and to stabilize the wrist to maintain hand function. Level of evidence: IV

Mind wandering is a state in which an individual’s attention is decoupled from the task at hand. Mind wandering affects performance in many tasks requiring focused attention, including online learning. Previous studies have focused primarily on investigating mind wandering in contexts which are conducive to mind wandering, that is, for highly repetitive and monotonous tasks or during tasks with very low attentional demands. However, mind wandering also occurs during highly engaging and demanding tasks. In this study, we examine whether mouse tracking can be used to predict mind wandering in an engaging task involving classical computer interfaces. Assuming that mouse trajectories towards a particular response on the screen are continuously updated by time-dependent and temporally-dynamic cognitive processes, as a behavioral methodology, mouse tracking can provide unique insights into attentional processes. In our experiment, a total of 272 students completed a mouse-based operation span task, during which their thoughts were probed and their mouse movements recorded. Naive Bayes, Linear Discriminant Analyses, K-Nearest Neighbors, Tree Bag, and Random Forest classifiers were able to predict mind wandering with F1-scores of up to 15% above a random-chance baseline. The results show that hand reach movements can be tracked to detect mind wandering in a user-independent manner in online tasks, thus providing a viable alternative to self-report methods and (neuro)physiological measures. Our finding has relevant implications for a variety of user interfaces which require hand and finger movements for the purposes of human–computer interactions.

Objectives: To investigate the resilience of caregivers of people with mild and moderate Alzheimer’s disease (PwAD) and the related sociodemographic and clinical characteristics.Methods: Cross-sect...

Background In 2016/2017, Mozambique conducted a countrywide long-lasting insecticidal nets (LLINs) universal coverage campaign (UCC). This paper aims to describe the planning and implementation process of the campaign in Mozambique. Methods A cross-sectional and descriptive design was used for reporting the planning and implementation process of the UCC. The UCC used a collaborative approach, involving institutional and non-institutional actors, namely: National Malaria Control Programme (NMCP), provincial and district health authorities, community members and civil society partners. A new household registration strategy based on coupons, stickers, and one LLIN per two persons as allocation criterion was implemented. The campaign was implemented in phases, allowing for continuous improvement of implementation quality by applying lessons learnt from each phase. Results A total of 7,049,894 households were registered corresponding to a total of 31,972,626 registered persons. A total of 16,557,818 LLINs were distributed between November 2016 and December 2017, corresponding to 97% of LLINs needs based on household registration, and covering 95% of the registered households (6,708,585 households), resulting in an estimated 85% of the total Mozambican population with LLIN access. Conclusions The collaborative planning process and strong coordination of campaign actors allowed Mozambique’s NMCP and partners to successfully carry out the first countrywide LLINs UCC in the country. The increased access to LLINs in households will likely result in increased LLIN use and a reduction of the malaria burden in the country, therefore contributing to the achievement of the 2016–2030 Global Technical Strategy for Malaria goals. Electronic supplementary material The online version of this article (10.1186/s12936-018-2406-2) contains supplementary material, which is available to authorized users.

Introdução: Os exercí­cios de Pilates possuem um papel importante na mudança da postura. A cifose em termos anatômicos refere-se í curvatura primária torácica e sacral posterior. Mulheres sedentárias após a menopausa exibem uma mudança nesta curva, aumentando o grau de cifose, e com isso, afetando a estrutura do corpo inteiro. Objetivo: Avaliar a efetividade de um treinamento fí­sico utilizando o método de Pilates para a postura e as funções respiratórias de mulheres com cifose. Metodologia: O estudo foi um ensaio clí­nico randomizado com 41 mulheres divididas em dois grupos (intervenção e controle). Os exercí­cios foram conduzidos por 30 semanas. Para analisar a postura, foram vistos exame radiológico e teste de ângulo de Cobb. As funções respiratórias foram medidas por espirômetro e manômetro. Os ângulos da coluna foram avaliados e medidos em graus. Resultados: A análise radiológica apresentou uma diferença significativa entre os grupos, -8,0 ± 7,5 graus para o grupo experimental e -0,6 ± 3,4 graus para o grupo controle com p < 0,001. A porcentagem de gordura corporal e o IMC também apresentaram diferenças significativas (0,001). Conclusão: O grupo que realizou o treinamento de Pilates mostrou uma melhora significativa na pressão expiratória. A comparação entre os grupos antes e após a intervenção mostrou valores significativos de p < 0,05. Os resultados mostraram que o método de Pilates é eficaz para melhorar a postura e a pressão expiratória de mulheres com cifose.Palavras-chave: Pilates, hipermicéfose, postura, funções respiratórias, ensaio clí­nico randomizado.

Background: Mind wandering is a prevalent phenomenon. However, the concept of mind wandering is associated with distinct and often orthogonal concepts, and researchers are still debating the best strategies to gain access to mind-wandering processes. Nonetheless, there is a progressive acknowledgment that mind wandering is a multidimensional and heterogeneous construct. We argue that to fully understand mind wandering, we need to look at dimensions assessing the process (i.e., perceptual decoupling), dynamics (i.e., mental improvisation), and content (i.e., mental navigation). Objective: The objective of this study was to develop a self-report measure of mind wandering—the Mind Wandering Inventory (MWI)—to capture the heterogeneity of mind wandering in terms of process, dynamic, and content components. Method: Five language versions of the MWI were administered to an international sample of 1,162 individuals. Results: Results showed that the MWI had good levels of internal consistency. In terms of internal structure, we found a first factor to index perceptual decoupling, a second to index mental improvisation, and a third to index mental navigation. Additionally, a study of concurrent validity with Spontaneous and Deliberate Mind Wandering scales suggested that MWI has significant correlations with previous mind-wandering scales and that factors 1 (perceptual decoupling) and 2 (mental improvisation) seemed to be more closely associated with spontaneous than deliberate mind wandering. Finally, individuals coming from sciences major background reported increased levels of mind wandering when compared with participants from both health, social and human sciences background., (undefined)

Os mosquitos do g?nero Aedes, end?mico em todo o Brasil, s?o os transmissores dos v?rus da Zika (ZIKV), Dengue (DENV) e Chikungunya (CHIKV). Esses v?rus s?o os causadores de doen?as infecciosas virais que podem apresentar diferentes quadros cl?nicos, e em alguns casos, geram consequ?ncias graves para a sa?de, incluindo complica??es neurol?gicas com grande risco de sequelas permanentes. Em uma parcela dos pacientes, acredita-se que o v?rus pode desencadear rea??es imunes que resultariam em doen?as inflamat?rias agudas tanto do sistema nervoso central (SNC) quanto do sistema nervoso perif?rico (SNP). Dentre elas, encefalomielite disseminada aguda (ADEM), dist?rbio do espectro da neuromielite ?ptica (NMOSD), neurites ?pticas, mielites transversas, s?ndrome de Guillain-Barr? (SGB) e a polineuropatia desmielinizante inflamat?ria cr?nica (CIDP). No entanto, a rela??o entre a infec??o viral e o risco de desenvolvimento destas doen?as ? pouco compreendida. O presente estudo teve como objetivo investigar as complica??es neuroimunol?gicas secund?rias ? infec??o por arbov?rus (Zika, Dengue e Chikungunya) no soro de pacientes infectados. Noventa e oito amostras de soro coletadas no Nordeste e Sudeste do Brasil foram analisadas atrav?s de t?cnicas imunoenzim?ticas e de imunofluoresc?ncia indireta para verificar a positividade das arboviroses. Testes de detec??o de autoanticorpos anti-ganglios?deos, anti-aquaporina-4 (anti-AQP4) e anti-glicoprote?na da mielina dos oligodendr?citos (anti-MOG) foram realizados por meio de immunoblotting e pelo ensaio baseado em c?lulas (CBA). Do total de amostras testadas, 77 foram positivas para detec??o de DENV e ZIKV, e 52 foram positivas para detec??o de CHIKV. Devido ao tempo decorrido entre o in?cio dos sintomas cl?nicos at? a realiza??o da coleta, a maioria dos pacientes j? estavam num per?odo convalescente da infec??o demonstrando um status sorol?gico IgM negativo. Os autoanticorpos anti-AQP4 foram negativos para todas as amostras, e somente duas foram positivas para autoanticorpos anti-MOG. Os autoanticorpos anti-ganglios?deos IgG foram negativos para todas as amostras, e os IgM tiveram uma rea??o fraca (borderline) para 8 amostras. O sintoma viral mais relatado foi febre (20,7%) e o sintoma neurol?gico, foi d?ficit motor (32,1%). A SGB e suas variantes foram as neuropatias mais encontradas nos pacientes poliflaviv?rus reativos. J? CIDP, polineuropatia aguda e mononeurite foram as outras neuropatias mais encontradas nos pacientes alphav?rus reativos. Em conjunto, estes dados contribuem para que n?o somente a SGB seja associada ?s infec??es por arbov?rus, mas tamb?m outras doen?as neurol?gicas. ? de fundamental import?ncia investigar a amplitude de outras s?ndromes, como mielopatia, CIDP, encefalite, ADEM, NMOSD e neurite ?ptica que podem estar associadas ?s infec??es pelo ZIKV, DENV e CHIKV. Mosquitoes of the genus Aedes, endemic throughout Brazil, are the transmitters of the Zika (ZIKV), Dengue (DENV) and Chikungunya (CHIKV) viruses. These viruses are the cause of viral infectious diseases that can present different clinical conditions, and in some cases have serious health consequences, including neurological complications with a high risk of permanent sequelae. In a portion of patients, it is believed that the virus can trigger immune reactions that would result in acute inflammatory diseases of both the central nervous system (CNS) and the peripheral nervous system (PNS). Among them, acute disseminated encephalomyelitis (ADEM), spectrum disorder of optic neuromyelitis (NMOSD), optic neuritis, transverse myelitis, Guillain-Barr? syndrome (GBS) and chronic inflammatory demyelinating polyneuropathy (CIDP). However, the relationship between viral infection and the risk of developing these diseases is poorly understood. The present study aimed to investigate the neuroimmunological complications secondary to arbovirus infection (Zika, Dengue and Chikungunya) in the serum of infected patients. Ninety eight serum samples collected in the Northeast and Southeast of Brazil were analyzed by immunoenzymatic and indirect immunofluorescence techniques to verify the positivity of arboviruses. Autoantibodies against gangliosides, aquaporin-4 (AQP4) and myelin oligodendrocyte glycoprotein (MOG) were detected by immunoblotting and cell-based assay (CBA). Of the total samples tested, 77 were positive for DENV and ZIKV detection, and 52 were positive for CHIKV detection. Due to the time elapsed between the beginning of the clinical symptoms until the collection, the majority of the patients were already in a convalescent period of the infection demonstrating a negative IgM serological status. Anti-AQP4 autoantibodies were negative for all samples, and only two were positive for anti-MOG autoantibodies. IgG anti-ganglioside autoantibodies were negative for all samples, and IgM had a weak (borderline) reaction for 8 samples. The most reported viral symptom was fever (20.7%), and the neurological symptom was motor deficit (32.1%). GBS and its variants were the neuropathies most found in reactive polyflaviviruses. Already, CIDP, acute polyneuropathy and mononeuritis were the others neuropathies most found in reactive alphavirus patients. Together, these data contribute to clarify the fact that not only the GBS is associated with arbovirus infections, but also other neurological diseases. It is of fundamental importance to investigate the amplitude of other syndromes, such as myelopathy, CIDP, encephalitis, ADEM, NMOSD and optic neuritis, which may be associated with ZIKV, DENV and CHIKV infections. Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPES

The identification of autoantibodies in central nervous system (CNS) inflammatory disorders improves diagnostic accuracy and the identification of patients with a relapsing disease. Usual methods to detect autoantibodies are usually divided into 3 categories: tissue-based assays, protein-based assays and cell-based assays (CBA). Tissue-based assays are commonly used for initial identification of autoantibodies based on staining patterns and co-localization. Once the antigen is known, autoantibodies can be detected using other antigen-specific methods based on recombinant proteins and CBA using transfected cells expressing the protein in their cell membranes. Compared to traditional methods using recombinant proteins such as ELISA and western blot, the CBA have advantage of detecting conformational sensitive antibodies using natively folded proteins in the cell membrane. This article reviews the utility of CBA into the clinical practice.

Introducao: Os exercicios do Metodo Pilates tem um papel importante na alteracao da postura e aumento da resistencia muscular. Objetivo: Comparar os efeitos dos exercicios basicos do Metodo Pilates em mulheres com cifose e alteracoes na composicao corporal. Material e Metodos: Foram selecionadas 41 mulheres, com idade media de 59 anos. Estas foram separadas em dois grupos, 22 mulheres ficaram no grupo experimental e 19 no grupo controle. Os exercicios foram executados em aparelhos como: reformer, cadillac, wunda chair e wall unit . No solo, utilizaram-se os seguintes materiais: spine corrector , thera-band e small ball. Para a analise da composicao corporal, foram avaliadas as medidas antropometricas. Na postura, foram analisados exames radiologicos e ângulo de Cobb, alem de fotos antes e apos a intervencao. Resultados: Na analise radiologica, entre os dois grupos, observou-se uma diferenca significativa de (-8 ± 7,5) para o experimental e (-0,61 ± 3,38) para o controle, com o p > 0,001. Comparando as medidas posturais com as medidas da composicao corporal, verificou-se uma reducao significativa em todas as medidas, exceto no peso corporal. Conclusao: Os resultados mostraram uma significância nas diferencas entre os dois grupos. A diminuicao do grau da cifose mostrou aumento da capacidade do desempenho do sistema neuromuscular. Palavras-chave: Pilates, cifose, postura, composicao corporal, ensaio clinico randomizado.

BackgroundMalaria data reported through Mozambique's routine health information system are used to guide the implementation of prevention and control activities. Although previous studies have identified issues with the quality of aggregated data reported from public health facilities in the country, no studies have evaluated the quality of routine indicators recorded in health facility registries. This study addresses this issue by comparing indicators calculated from data from exit interviews and re-examinations of patients with data based on registry records from health facilities in order to measure the quality of registry data and data reporting in three provinces in Mozambique.MethodsData were collected from 1,840 outpatients from 117 health facilities in Maputo, Zambézia, and Cabo Delgado Provinces interviewed and examined as part of a malaria-specific health facility survey. Key indicators based on exit interview / re-examination data were compared to the same indicators based on records from health facility registries. Multivariable regression was performed to identify factors associated with indicators matching in re-examination / exit interview data and health facility registries. Aggregated indicators abstracted from facility registries were compared to those reported through the routine health management information system (HMIS) for the same time period.ResultsSensitivity of exit interview / re-examination data compared with those recorded in facility registries was low for all indicators in all facilities. The lowest sensitivities were in Maputo, where the sensitivity for recording negative RDT results was 9.7%. The highest sensitivity was for recording positive RDT results in Cabo Delgado, at 75%. Multivariable analysis of factors associated with agreement between gold standard and registry data showed patients were less likely to be asked about having a fever in the triage ward in Maputo and Cabo Delgado (adjusted Odds Ratio 0.75 and 0.39 respectively), and in the outpatient ward in Cabo Delgado (aOR = 0.37), compared with the emergency department. Patients with positive RDT were also more likely to have RDT results recorded in all three provinces when patients had been managed according to national treatment guidelines during initial examination. Comparison of retrospective data abstracted from facility registries to HMIS data showed discrepancies in all three provinces. The proportion of outpatient cases with suspected and confirmed malaria were similar in registry and HMIS data across all provinces (a relatively low difference between registry and HMIS data of 3% in Maputo and Zambézia), though the total number of all-cause outpatient cases was consistently higher in the HMIS. The largest difference was in Maputo, where a total of 87,992 all-cause outpatient cases were reported in HMIS, compared with a total of 42,431 abstracted from facility registries.ConclusionThis study shows that care should be taken in interpreting trends based solely on routine data due to data quality issues, though the discrepancy in all-cause outpatient cases may be indicative that register availability and storage are important factors. As such, simple steps such as providing consistent access and storage of registers that include reporting of patient fever symptoms might improve the quality of routine data recorded at health facilities.

Little is known about the impact of enrollment on therapeutic clinical trials on adverse event rates. Primary objective was to describe the impact of clinical trial registration on sterile site microbiologically documented infection for children with newly diagnosed acute myeloid leukemia (AML). We conducted a multicenter cohort study that included children aged ≤18 years with de novo AML. Primary outcome was microbiologically documented sterile site infection. Infection rates were compared between those registered and not registered on clinical trials. Five hundred seventy-four children with AML were included of which 198 (34.5%) were registered on a therapeutic clinical trial. Overall, 400 (69.7%) had at least one sterile site microbiologically documented infection. In multiple regression, registration on clinical trials was independently associated with a higher risk of microbiologically documented sterile site infection [adjusted odds ratio (OR) 1.24, 95% confidence interval (CI) 1.01-1.53; p = 0.040] and viridans group streptococcal infection (OR 1.46, 95% CI 1.08-1.98; p = 0.015). Registration on trials was not associated with Gram-negative or invasive fungal infections. Children with newly diagnosed AML enrolled on clinical trials have a higher risk of microbiologically documented sterile site infection. This information may impact on supportive care practices in pediatric AML.

Contains fulltext : 199071.pdf (Publisher’s version ) (Open Access) This study demonstrates that rumination is reflected in two behavioural signals that both play an important role in face-to-face interactions and provides evidence for the negative impact of rumination on social cognition. Sixty-one students were randomly assigned either to a condition in which rumination was induced or to a control condition. Their task was to play a speech-based word association game with an Embodied Conversational Agent during which their word associations, pitch imitation and eye movements were measured. Two questionnaires assessed their ruminative tendencies and mind wandering thoughts, respectively. Rumination predicted differences in task-related mind wandering, polarity of lexical associations, pitch imitation, and blinks while mind wandering predicted differences in saccades. This outcome may show that rumination has a negative impact on certain aspects of social interactions. 20 p.

Introduction: Although caregivers of people with dementia may face difficulties, some positive feelings of caregiving may be associated with resilience.Objective: This study systematically reviewed the definitions, methodological approaches and determinant models associated with resilience among caregivers of people with dementia.Methods: Search for articles published between 2003 and 2014 in ISI, PubMed/MEDLINE, SciELO and Lilacs using the search terms resilience, caregivers and dementia.Results and conclusions: Resilience has been defined as positive adaptation to face adversity, flexibility, psychological well-being, strength, healthy life, burden, social network and satisfaction with social support. No consensus was found about the definition of resilience associated with dementia. We classified the determinant variables into biological, psychological and social models. Higher levels of resilience were associated with lower depression rates and greater physical health. Other biological factors associated with higher levels of resilience were older age, African-American ethnicity and female sex. Lower burden, stress, neuroticism and perceived control were the main psychological factors associated with resilience. Social support was a moderating factor of resilience, and different types of support seemed to relieve the physical and mental overload caused by stress. Introdução: Apesar das dificuldades enfrentadas por cuidadores de pessoas com demência, sentimentos positivos quanto aos cuidados podem estar relacionados à resiliência.Objetivo: Revisamos sistematicamente a literatura sobre a conceituação, abordagens metodológicas e modelos determinantes relacionados à resiliência dos cuidadores de pessoas com demência.Métodos: Foi realizada uma busca por artigos publicados entre 2003 e 2014 nas bases de dados ISI, PubMed/MEDLINE, SciELO e Lilacs, usando os descritores resilience [resiliência], caregivers [cuidadores] e dementia [demência].Resultados e conclusões: A resiliência foi definida como adaptação positiva para enfrentar adversidades, flexibilidade, bem-estar psicológico, força, vida saudável, sobrecarga, rede social e satisfação com o apoio social recebido. Não se encontrou consenso sobre o conceito de resiliência em relação à demência. As variáveis determinantes foram classificadas em modelos biológicos, psicológicos e sociais. Níveis mais altos de resiliência foram relacionados com taxas mais baixas de depressão e melhor saúde física. Os outros aspectos biológicos relacionados a níveis mais altos de resiliência foram idade avançada, etnia de origem africana e sexo feminino. Menos sobrecarga, estresse, neuroticismo e percepção de controle foram os principais aspectos psicológicos relacionados à resiliência. O apoio social foi um fator moderador da resiliência, pois uma variedade de tipos de apoio parece aliviar a sobrecarga física e mental causada pelo estresse.

BACKGROUND The cure rate for childhood intracranial ependymoma is approximately 70% in the setting of a gross total resection followed by radiation, but management remains challenging in patients with residual disease. Therefore, robust biomarkers are needed to guide the development of new targeted therapy. The authors evaluated the expression of several biomarkers in pediatric intracranial ependymoma and observed that the expression of enhancer of zeste homolog 2 (EZH2), a polycomb complex protein involved in epigenetic regulation of gene expression, was independently associated with poor survival. METHODS Tissue microarray immunostaining was performed on 180 ependymoma samples from 12 of 16 Canadian pediatric centers. Expression levels of EZH2, Ki-67, B lymphoma Moloney-murine leukemia virus insertion region 1 homolog, tumor protein 16 (P16), Y-box binding protein 1, phosphorylated protein kinase B (pAKT), and epidermal growth factor receptor were evaluated. Cox regression analyses were performed, and the Kaplan-Meier method was used to construct survival curves. RESULTS EZH2 expressed in 16% of tumors was associated with inferior 5-year overall survival. Ki-67 and pAKT levels were associated with a poor outcome in patients with posterior fossa ependymoma, and the absence of P16 was associated with a poor outcome in patients with supratentorial ependymoma. Multivariate analysis revealed that younger age and EZH2 expression (95% confidence interval, 1.1-36.0) were independent markers of a poor prognosis. CONCLUSIONS EZH2 is a novel, independent marker of a poor prognosis in patients with ependymoma, especially in those who have tumors located in the posterior fossa. EZH2, pAKT, and P16 are potential therapeutic targets, particularly for patients who have tumors in which standard gross total resection plus fractionated radiotherapy is not feasible. Cancer 2015;121:1499–1507. © 2015 American Cancer Society.

Awareness of disease can be compromised to some degree in a proportion of people with dementia, with evident differences across domains. We designed this study to determine the factors associated with the impairment of awareness over a period of time. Using a longitudinal design, 69 people with mild Alzheimer's disease and their family caregivers completed the Assessment Scale of Psychosocial Impact of the Diagnosis of Dementia, the Quality of Life in Alzheimer's Disease Scale, the Mini-Mental State Examination, the Clinical Dementia Rating Scale, the Cornell Scale for Depression in Dementia, the Pfeffer Functional Activities Questionnaire, the Neuropsychiatric Inventory, and the Zarit Burden Interview. Univariate and logistic regression analyses were conducted to examine the contribution of the various factors. The level of awareness of disease was significantly lower (p ≤ 0.001) between baseline and at follow up. At follow up, there was no change in the level of awareness of disease in 61.8%, whereas 25.4% worsened. However, the level of awareness improved in 12.3%. Logistic regression demonstrated that functional deficits (OR = 1.12, 95% CI: (1.03-1.22), p ≤ 0.01), and caregivers' quality of life (OR = 0.83, 95% CI: (0.70-0.98), p ≤ 0.05) were a significant predictor of impaired awareness of disease. The results confirmed that awareness and cognition are relatively independent, and showed that in people with mild dementia, unawareness is mainly manifested by poor recognition of changes in the activities of daily living, and decrease in quality of life.

Milkborne transmission of Shiga toxin- producing Escherichia coli (STEC) has raised considerable concern due to recent outbreaks worldwide and poses a threat to public health. The aim of this study was to develop a sensitive and specific multiplex PCR assay to detect the presence of STEC in bovine raw milk. To identify E. coli (ATCC 25922) contamination, the gene uspA was used, and PCR sensitivity and specificity were accessed by testing diluted samples ranging from 2 to 2.0 × 10(6) CFU/mL. To detect STEC, the stx1 and stx2 genes were selected as targets. After reaction standardization, the multiplex assay was tested in raw milk collected from 101 cows on dairy farms. PCR assay for E. coli detection had a specificity of 100% and sensitivity of 79% (P