Predictors of Poststroke Depression: a Retrospective Study in a Rehabilitation Unit

INTRODUÇÃO/OBJECTIVOS: O Acidente Vascular Cerebral (AVC) pode limitar de forma importante a funcionalidade. As complicações psiquiátricas têm sido identificadas como factores determinantes na reabilitação pós-AVC, sendo a Depressão a complicação psiquiátrica mais frequente e a que está associada a pior prognóstico. Subsiste ainda incerteza quanto à sua etiologia e factores de risco. Na revisão sistemática mais recente, reconhecem-se como factores preditivos a gravidade do AVC, o grau de incapacidade do doente e o défice cognitivo. Questões metodológicas impediram a determinação de outros factores. Assim, urge definir novos factores que facilitem um diagnóstico atempado, que possa diminuir os efeitos negativos sobre o processo de reabilitação. Objectivos: determinação da incidência da Depressão de novo pós-AVC (DPA) e o estudo das variáveis descritas na literatura como possíveis factores preditivos de DPA: sexo, idade, tipo de AVC, lateralidade, território vascular e presença de afasia. Foi definido como endpoint secundário o estudo do tipo de afasia. MATERIAIS E MÉTODOS: Estudo longitudinal retrospectivo, envolvendo todos os doentes admitidos no internamento de um Serviço de MFR com o diagnóstico de AVC de novo, entre 1-1-2009 e 31-12-2009. Foram colhidos elementos demográficos e clínicos dos processos clínicos, num total de 74 doentes. Critérios de exclusão: ‘AVC prévio’, ‘Doença psiquiátrica com perturbação do humor prévia’ e ‘Medicação antidepressiva à data do AVC’. Para o tratamento estatístico usou-se o SPSS 11.5. RESULTADOS: A incidência da DPA observada foi de 44,6%. Dos possíveis factores preditivos testados, apenas a presença de afasia apresentou uma relação estatisticamente significativa com a depressão (p=0.02). Não se encontrou relação com o tipo de afasia. Os restantes factores preditivos testados não mostraram correlação estatística significativa. Parece existir uma relação entre o sexo masculino e a DPA (p=0.07), que não atingiu significância no tamanho da amostra conseguido (n). CONCLUSÕES: Este estudo estabelece a afasia como factor preditivo da DPA. A elevada incidência de DPA nesta população particular concorda com os estudos existentes, sendo necessário outro tipo de estudo que permita justificar o valor encontrado. São necessários mais estudos não só para aumentar o conhecimento dos factores de risco para a DPA, como para melhorar os resultados dos programas de reabilitação

Polymyalgia Rheumatica (PMR) Special Interest Group at OMERACT 11: outcomes of importance for patients with PMR

We worked toward developing a core outcome set for clinical research studies in polymyalgia rheumatica (PMR) by conducting (1) patient consultations using modified nominal group technique; (2) a systematic literature review of outcome measures in PMR; (3) a pilot observational study of patients presenting with untreated PMR, and further discussion with patient research partners; and (4) a qualitative focus group study of patients with PMR on the meaning of stiffness, using thematic analysis. (1) Consultations included 104 patients at 4 centers. Symptoms of PMR included pain, stiffness, fatigue, and sleep disturbance. Function, anxiety, and depression were also often mentioned. Participants expressed concerns about diagnostic delay, adverse effects of glucocorticoids, and fear of relapse. (2) In the systematic review, outcome measures previously used for PMR include pain visual analog scores (VAS), morning stiffness, blood markers, function, and quality of life; standardized effect sizes posttreatment were large. (3) Findings from the observational study indicated that asking about symptom severity at 7 AM, or "on waking," appeared more relevant to disease activity than asking about symptom severity "now" (which depended on the time of assessment). (4) Preliminary results were presented from the focus group qualitative study, encompassing broad themes of stiffness, pain, and the effect of PMR on patients' lives. It was concluded that further validation work is required before a core outcome set in PMR can be recommended. Nevertheless, the large standardized effect sizes suggest that pain VAS is likely to be satisfactory as a primary outcome measure for assessing response to initial therapy of PMR. Dissection of between-patient heterogeneity in the subsequent treatment course may require attention to comorbidity as a potential confounding factor

Photometric redshifts for the Kilo-Degree Survey. Machine-learning analysis with artificial neural networks

We present a machine-learning photometric redshift analysis of the Kilo-Degree Survey Data Release 3, using two neural-network based techniques: ANNz2 and MLPQNA. Despite limited coverage of spectroscopic training sets, these ML codes provide photo-zs of quality comparable to, if not better than, those from the BPZ code, at least up to zphot<0.9 and r<23.5. At the bright end of r<20, where very complete spectroscopic data overlapping with KiDS are available, the performance of the ML photo-zs clearly surpasses that of BPZ, currently the primary photo-z method for KiDS. Using the Galaxy And Mass Assembly (GAMA) spectroscopic survey as calibration, we furthermore study how photo-zs improve for bright sources when photometric parameters additional to magnitudes are included in the photo-z derivation, as well as when VIKING and WISE infrared bands are added. While the fiducial four-band ugri setup gives a photo-z bias $\delta z=-2e-4$ and scatter $\sigma_z<0.022$ at mean z = 0.23, combining magnitudes, colours, and galaxy sizes reduces the scatter by ~7% and the bias by an order of magnitude. Once the ugri and IR magnitudes are joined into 12-band photometry spanning up to 12 $\mu$, the scatter decreases by more than 10% over the fiducial case. Finally, using the 12 bands together with optical colours and linear sizes gives $\delta z<4e-5$ and $\sigma_z<0.019$. This paper also serves as a reference for two public photo-z catalogues accompanying KiDS DR3, both obtained using the ANNz2 code. The first one, of general purpose, includes all the 39 million KiDS sources with four-band ugri measurements in DR3. The second dataset, optimized for low-redshift studies such as galaxy-galaxy lensing, is limited to r<20, and provides photo-zs of much better quality than in the full-depth case thanks to incorporating optical magnitudes, colours, and sizes in the GAMA-calibrated photo-z derivation.Comment: A&A, in press. Data available from the KiDS website http://kids.strw.leidenuniv.nl/DR3/ml-photoz.php#annz

Numerical relations and skill level constrain co-adaptive behaviors of agents in sports teams

Similar to other complex systems in nature (e.g., a hunting pack, flocks of birds), sports teams have been modeled as social neurobiological systems in which interpersonal coordination tendencies of agents underpin team swarming behaviors. Swarming is seen as the result of agent co-adaptation to ecological constraints of performance environments by collectively perceiving specific possibilities for action (affordances for self and shared affordances). A major principle of invasion team sports assumed to promote effective performance is to outnumber the opposition (creation of numerical overloads) during different performance phases (attack and defense) in spatial regions adjacent to the ball. Such performance principles are assimilated by system agents through manipulation of numerical relations between teams during training in order to create artificially asymmetrical performance contexts to simulate overloaded and underloaded situations. Here we evaluated effects of different numerical relations differentiated by agent skill level, examining emergent inter-individual, intra- and inter-team coordination. Groups of association football players (national - NLP and regional-level - RLP) participated in small-sided and conditioned games in which numerical relations between system agents were manipulated (5v5, 5v4 and 5v3). Typical grouping tendencies in sports teams (major ranges, stretch indices, distances of team centers to goals and distances between the teams' opposing line-forces in specific team sectors) were recorded by plotting positional coordinates of individual agents through continuous GPS tracking. Results showed that creation of numerical asymmetries during training constrained agents' individual dominant regions, the underloaded teams' compactness and each team's relative position on-field, as well as distances between specific team sectors. We also observed how skill level impacted individual and team coordination tendencies. Data revealed emergence of co-adaptive behaviors between interacting neurobiological social system agents in the context of sport performance. Such observations have broader implications for training design involving manipulations of numerical relations between interacting members of social collectives

Glucose-6-Phosphate Dehydrogenase Deficiency in an Endemic Area for Malaria in Manaus: A Cross-Sectional Survey in the Brazilian Amazon

BACKGROUND: There is a paucity of information regarding glucose-6-phosphate dehydrogenase (G6PD) deficiency in endemic areas for malaria in Latin America. METHODOLOGY/PRINCIPAL FINDINGS: This study determined the prevalence of the G6PD deficiency in 200 male non-consanguineous individuals residing in the Ismail Aziz Community, on the outskirts of Manaus (Brazilian Amazon). Six individuals (3%) were deficient using the qualitative Brewer's test. Gel electrophoresis showed that five of these patients were G6PD A(-). The deficiency was not associated with the ethnic origin (P = 0.571). In a multivariate logistic regression analysis, G6PD deficiency protected against three or more episodes of malaria (P = 0.049), independently of the age, and was associated with a history of jaundice (P = 0.020) and need of blood transfusion (P = 0.045) during previous treatment for malarial infection, independently of the age and the previous malarial exposure. CONCLUSIONS/SIGNIFICANCE: The frequency of G6PD deficiency was similar to other studies performed in Brazil and the finding of a predominant G6PD A(-) variant will help the clinical management of patients with drug-induced haemolysis. The history of jaundice and blood transfusion during previous malarial infection may trigger the screening of patients for G6PD deficiency. The apparent protection against multiple malarial infections in an area primarily endemic for Plasmodium vivax needs further investigation

Performance of CMS muon reconstruction in pp collision events at sqrt(s) = 7 TeV

The performance of muon reconstruction, identification, and triggering in CMS has been studied using 40 inverse picobarns of data collected in pp collisions at sqrt(s) = 7 TeV at the LHC in 2010. A few benchmark sets of selection criteria covering a wide range of physics analysis needs have been examined. For all considered selections, the efficiency to reconstruct and identify a muon with a transverse momentum pT larger than a few GeV is above 95% over the whole region of pseudorapidity covered by the CMS muon system, abs(eta) < 2.4, while the probability to misidentify a hadron as a muon is well below 1%. The efficiency to trigger on single muons with pT above a few GeV is higher than 90% over the full eta range, and typically substantially better. The overall momentum scale is measured to a precision of 0.2% with muons from Z decays. The transverse momentum resolution varies from 1% to 6% depending on pseudorapidity for muons with pT below 100 GeV and, using cosmic rays, it is shown to be better than 10% in the central region up to pT = 1 TeV. Observed distributions of all quantities are well reproduced by the Monte Carlo simulation.Comment: Replaced with published version. Added journal reference and DO