In Adolescents With Epilepsy, High Scores Of Anxiety And Depression Are Associated With Occurrence Of Seizures In Public Places.

Objective To assess depression and anxiety symptoms of adolescents with epilepsy compared with adolescents without epilepsy. Method The study sample consisted of: case participants (50 subjects) attending the pediatric epilepsy clinic of a tertiary hospital and control participants (51 subjects) from public schools. The instruments utilized were: identification card with demographic and epilepsy data, Beck Depression Inventory and State-Trait Anxiety Inventory. Results No significant differences were founded between the groups regarding scores for depression and anxiety symptoms but both groups presented moderate scores of anxiety. A correlation was found between low scores anxiety and not frequent seizures, low scores anxiety and perception of seizure control, high scores of anxiety and depression and occurrence of seizures in public places. Conclusion Low scores of anxiety are associated with not frequent seizures; high scores of anxiety and depression are associated with occurrence of seizures in public places.73205-1

On the groove pressing of Ni-W alloy: microstructure, texture and mechanical properties evolution

International audienceThe microstructure, texture and mechanical properties of the Ni-14%W(wt.%) alloy with two different initial grain sizes and textures were investigated after groove pressing (GP) at 450 °C to 4 cycles using Electron Back Scatter Diffraction (EBSD) and microhardness measurements. The initial first series was characterized by small equiaxed grains and Cube dominant texture component. The second series has elongated grains and β-fiber texture. EBSD analysis has shown that GP processing led to a slight refinement (less than 15%) of equiaxed grains in series I while greater refinement (~55%) of the mean spacing along normal direction was observed in series II. The texture did not drastically change from the initial ones and was characterized by the weakening of the Cube component in series I and rapid decrease of Copper component for series II. GP processing reduces very slightly the plastic anisotropy of the alloy with initial elongated granular microstructure

Cr cluster characterization in Cu-Cr-Zr alloy after ECAP processing and aging using SANS and HAADF-STEM

International audienceThe precipitation of nano-sized Cr clusters was investigated in a commercial Cu-1Cr-0.1Zr (wt.%) alloy processed by Equal-Channel Angular Pressing (ECAP) and subsequent aging at 550 °C for 4 hours using small angle neutron scattering (SANS) measurements and high-angle annular dark-field-scanning transmission electron microscopy (HAADF-STEM). The size and volume fraction of nano-sized Cr clusters were estimated using both techniques. These parameters assessed from SANS (d~3.2 nm, Fv~1.1 %) agreed reasonably with those from HAADF-STEM (d ~2.5 nm, Fv~2.3%). Besides nano-sized Cr clusters, HAADF-STEM technique evidenced the presence of rare cuboid and spheroid sub-micronic Cr particles about 380-620 nm mean size. Both techniques did not evidence the presence of intermetallic CuxZry phases within the aging conditions

Efeito da elevação sobre a estrutura horizontal e riqueza da vegetação em planos de manejo na Amazônia.

Understanding ecological variations in tropical forests is essential for defining conservation and management strategies. Changes in the composition and structure of forests, in relation to altitude, have been investigated on many tropical slopes. Although the degradation of its natural habitat continues, the Amazon biome represents 30% of the world's tropical forests and houses at least 10% of the known biodiversity. Considering the magnitude of Amazon diversity, this study evaluated the influence of terrain elevation on abundance, dominance and floristic richness of the primary vegetation in four neighboring farms (Caçula, Guarujá, Anhumas and Jaraguá) located in State of Acre, Brazil, by means of Shuttle Radar Topography Mission (SRTM) image. Data from each area were obtained from Acre Institute of the Environment's (IMAC) census inventory. Segmented linear regression models were used to observe the effect of the terrain elevation on the variables studied. The selection of models was made considering the Akaike?s Information Criterion (AIC). For Guarujá and Jaraguá farms, the models indicated a relationship between altitude and ecological variation. On the other hand, in Caçula and Anhumas, it was not possible to observe the influence of terrain elevation on any variable. It is important to take into consideration the impact of break-points, applicable in Guarujá and Jaraguá farms, when creating altitude stratified limits to manage the landscape

On some Features of the Grain and Subgrain Size in a Cu-Cr-Zr Alloy After ECAP Processing and Aging

A Cu-1Cr-0.1Zr alloy has been subjected to ECAP processing via route Bc and aging at 250-800°C. Electron BackScatter diffraction (EBSD), Transmission Electron Microscopy (TEM) and X-Ray Diffraction Line Profile Analysis (XRDLPA) techniques have been used to unveil some peculiarities of the grain and subgrain structure with a special emphasis on the comparison of the grain size estimated by the three techniques. For the alloy ECAP processed and aged up to 16 passes, the grain size (from EBSD, 0.2 < d < 5 μm), subgrain size (from TEM, d ~ 0.75 μm) and “apparent” average crystallite size (from XRDLPA, d < 0.25 μm) are manifestly different. The results were compared to the published data and analyzed based on the fundamental aspects of these techniques

Implementation strategies for knowledge products in primary healthcare: A systematic review of systematic reviews

BACKGROUND: The underuse or overuse of knowledge products leads to waste in healthcare, and primary care is no exception. OBJECTIVE: We aimed to characterize which knowledge products are frequently implemented, the implementation strategies used in primary care, and the implementation outcomes that are measured. METHODS: We performed a systematic review of systematic reviews (SR) using the Cochrane systematic approach to include eligible SR. The inclusion criteria were: any primary care contexts; healthcare professionals and patients; any EPOC implementation strategies of specified knowledge products; any comparator; and any implementation outcomes based on the Proctor framework. We searched the Medline, EMBASE, CINAHL, Ovid PsycINFO, Web of Science, and Cochrane Library databases from their inception to October 2019, without any restriction. We searched the references of the included SR. Pairs of reviewers independently performed selection, data extraction and methodological quality assessment with AMSTAR 2. Data extraction was informed by EPOC taxonomy for implementation strategies and the Proctor framework for implementation outcomes. We performed a descriptive analysis and summarized the results using a narrative synthesis. RESULTS: Of the 11,101 records identified, 81 SR were included. Forty-seven SR involved healthcare professionals alone. Fifteen SR were of high or moderate methodological quality. Most of them addressed one type of knowledge product (56/81), common clinical practice guidelines (26/56) or management, and behavioural or pharmacological health interventions (24/56). Mixed strategies were used for implementation (67/81), predominantly educational-based (meetings in 60/81, materials distribution in 59/81, and academic detailing in 45/81), reminder (53/81) and audit and feedback (40/81) strategies. Education meetings (P=.13) and academic detailing (P=.11) seem to be more used when the population is composed of Healthcare professionals alone. The improvement of the adoption of knowledge products was the most commonly measured outcome (72/81). The evidence level was reported in 10/81 SR on 62 outcomes (including 48 improvement of adoption), of which 16 outcomes were of moderate or high level. CONCLUSIONS: Clinical practice guidelines and management, behavioural or pharmacological health interventions are the most commonly implemented knowledge products through the mixed use of educational, reminders and audit and feedback strategies. There is need for a strong methodology for the SR of RCTs to explore their effectiveness and the whole cascade of implementation outcomes. CLINICALTRIAL: Not applicable

Average bioequivalence of single 500 mg doses of two oral formulations of levofloxacin: a randomized, open-label, two-period crossover study in healthy adult Brazilian volunteers

Average bioequivalence of two 500 mg levofloxacin formulations available in Brazil, Tavanic(c) (Sanofi-Aventis Farmacêutica Ltda, Brazil, reference product) and Levaquin(c) (Janssen-Cilag Farmacêutica Ltda, Brazil, test product) was evaluated by means of a randomized, open-label, 2-way crossover study performed in 26 healthy Brazilian volunteers under fasting conditions. A single dose of 500 mg levofloxacin tablets was orally administered, and blood samples were collected over a period of 48 hours. Levofloxacin plasmatic concentrations were determined using a validated HPLC method. Pharmacokinetic parameters Cmax, Tmax, Kel, T1/2el, AUC0-t and AUC0-inf were calculated using noncompartmental analysis. Bioequivalence was determined by calculating 90% confidence intervals (90% CI) for the ratio of Cmax, AUC0-t and AUC0-inf values for test and reference products, using logarithmic transformed data. Tolerability was assessed by monitoring vital signs and laboratory analysis results, by subject interviews and by spontaneous report of adverse events. 90% CIs for Cmax, AUC0-t and AUC0-inf were 92.1% - 108.2%, 90.7% - 98.0%, and 94.8% - 100.0%, respectively. Observed adverse events were nausea and headache. It was concluded that Tavanic(c) and Levaquin(c) are bioequivalent, since 90% CIs are within the 80% - 125% interval proposed by regulatory agencies

Antiinflammatory Therapy with Canakinumab for Atherosclerotic Disease

Background: Experimental and clinical data suggest that reducing inflammation without affecting lipid levels may reduce the risk of cardiovascular disease. Yet, the inflammatory hypothesis of atherothrombosis has remained unproved. Methods: We conducted a randomized, double-blind trial of canakinumab, a therapeutic monoclonal antibody targeting interleukin-1β, involving 10,061 patients with previous myocardial infarction and a high-sensitivity C-reactive protein level of 2 mg or more per liter. The trial compared three doses of canakinumab (50 mg, 150 mg, and 300 mg, administered subcutaneously every 3 months) with placebo. The primary efficacy end point was nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death. RESULTS: At 48 months, the median reduction from baseline in the high-sensitivity C-reactive protein level was 26 percentage points greater in the group that received the 50-mg dose of canakinumab, 37 percentage points greater in the 150-mg group, and 41 percentage points greater in the 300-mg group than in the placebo group. Canakinumab did not reduce lipid levels from baseline. At a median follow-up of 3.7 years, the incidence rate for the primary end point was 4.50 events per 100 person-years in the placebo group, 4.11 events per 100 person-years in the 50-mg group, 3.86 events per 100 person-years in the 150-mg group, and 3.90 events per 100 person-years in the 300-mg group. The hazard ratios as compared with placebo were as follows: in the 50-mg group, 0.93 (95% confidence interval [CI], 0.80 to 1.07; P = 0.30); in the 150-mg group, 0.85 (95% CI, 0.74 to 0.98; P = 0.021); and in the 300-mg group, 0.86 (95% CI, 0.75 to 0.99; P = 0.031). The 150-mg dose, but not the other doses, met the prespecified multiplicity-adjusted threshold for statistical significance for the primary end point and the secondary end point that additionally included hospitalization for unstable angina that led to urgent revascularization (hazard ratio vs. placebo, 0.83; 95% CI, 0.73 to 0.95; P = 0.005). Canakinumab was associated with a higher incidence of fatal infection than was placebo. There was no significant difference in all-cause mortality (hazard ratio for all canakinumab doses vs. placebo, 0.94; 95% CI, 0.83 to 1.06; P = 0.31). Conclusions: Antiinflammatory therapy targeting the interleukin-1β innate immunity pathway with canakinumab at a dose of 150 mg every 3 months led to a significantly lower rate of recurrent cardiovascular events than placebo, independent of lipid-level lowering. (Funded by Novartis; CANTOS ClinicalTrials.gov number, NCT01327846.