The validity, reliability and minimal clinically important difference of the patient specific functional scale in snake envenomation

Objective: Valid, reliable, and clinically relevant outcome measures are necessary in clinical studies of snake envenomation. The aim of this study was to evaluate the psychometric (validity and reliability) and clinimetric (minimal clinically important difference [MCID]) properties of the Patient-Specific Functional Scale (PSFS) in snakebite envenomation. Methods: We performed a secondary analysis of two existing snakebite trials that measured clinical outcomes using the PSFS as well as other quality of life and functional assessments. Data were collected at 3, 7, 10, and 17 days. Reliability was determined using Cronbach’s alpha for internal consistency and the intraclass correlation coefficient (ICC) for temporal stability at 10 and 17 days. Validity was assessed using concurrent validity correlating with the other assessments. The MCID was evaluated using the following criteria: (1) the distribution of stable patients according to both standard error of measurement (SEM) and responsiveness techniques, and (2) anchor-based methods to compare between individuals and to detect discriminant ability of a positive change with a receiver operator characteristic (ROC) curve and optimal cutoff point. Results: A total of 86 patients were evaluated in this study. The average PSFS scores were 5.37 (SD 3.23), 7.95 (SD 2.22), and 9.12 (SD 1.37) at 3, 7, and 10 days, respectively. Negligible floor effect was observed (maximum of 8% at 3 days); however, a ceiling effect was observed at 17 days (25%). The PSFS showed good reliability with an internal consistency of 0.91 (Cronbach’s alpha) (95% CI 0.88, 0.95) and a temporal stability of 0.83 (ICC) (95% CI 0.72, 0.89). The PSFS showed a strong positive correlation with quality of life and functional assessments. The MCID was approximately 1.0 for all methods. Conclusions: With an MCID of approximately 1 point, the PSFS is a valid and reliable tool to assess quality of life and functionality in patients with snake envenomation

Association between Metabolic Disorders and Cholangiocarcinoma: Impact of a Postulated Risk Factor with Rising Incidence

Introduction and objectives: The incidence of cholangiocarcinoma (CCA) has been increasing globally. Although a concomitant increase in the incidence of metabolic disorders might suggest a causal relationship, the data are scarce. We aimed to describe the prevalence of metabolic disorders in patients with CCA and report the clinical features and outcomes. Patients and Methods: Retrospective study including patients with CCA. Patients were divided into: (1) past history of diabetes or/and overweight/obesity (“metabolic disorder group”) and (2) without any of these features (“non-metabolic-disorder group”). A Cox regression model was used to determine the prognostic factors. Results: 122 patients were included. In total, 36 (29.5%) had overweight/obesity, 24 (19.7%) had diabetes, and 8 (6.6%) had both. A total of 29 (23.8%) patients had resectable disease and received upfront surgery. A total of 104 (85.2%) received chemotherapy for advanced/recurrent disease. The overall survival of the cohort was 14.3 months (95% CI: 10.1–17.3). ECOG-PS 0 (p < 0.0001), resectable disease (p = 0.018) and absence of vascular invasion (p = 0.048) were independently associated with better prognosis. The “metabolic disorder group” (n = 52) had a median survival of 15.5 months (95% CI 10.9–33.9) vs. 11.5 months (95% CI 8.4–16.5) in the “non-metabolic-disorder group” (n = 70) (HR: 1.10; 95% CI 0.62–1.94). Patients with resectable disease in the “metabolic group” had longer survival than patients in the “non-metabolic group” (43.4 months (95% CI 33.9-NR) vs. 21.8 months (95% CI 8.6–26.9); HR = 0.12, 95% CI 0.03–0.59). Conclusion: Metabolic disorders are frequent among CCA patients. Underlying metabolic comorbidities may be associated with prognosis in resectable CCA. There is a need to explore the mechanism that drives CCA carcinogenesis in a metabolic background

Methylene tetrahydrofolate reductase (MTHFR) and vascular endothelial growth factor (VEGF) polymorphisms in Brazilian patients with Hepatitis C virus (HCV)-related hepatocellular carcinoma (HCC)

OBJECTIVE: The folate pathway is involved in hepatic carcinogenesis and angiogenesis. Polymorphisms in genes related to such processes, including methylene tetrahydrofolate reductase (MTHFR) and vascular endothelial growth factor (VEGF)] may play an important role in the development of hepatocellular carcinoma (HCC). The objective of this study was to evaluate&nbsp;MTHFR&nbsp;and&nbsp;VEGF&nbsp;polymorphisms in Brazilian patients with hepatitis C virus (HCV)-related HCC. METHODS: A total of 119 patients diagnosed with confirmed HCC and HCV were included in the study. SNP genotyping assays were performed using real-time PCR. VEGFA (rs2010963, rs3025039, and rs833061) and MTHFRC677T (rs1801133, rs1801131) polymorphisms were evaluated. RESULTS: The C alleles of&nbsp;MTHFR&nbsp;(rs1801131) and&nbsp;VEGF&nbsp;(rs2010963) were associated with protection against the development of multinodular HCC, while the T allele of&nbsp;MTHFR&nbsp;(rs1801133) was associated with a higher risk of multinodular presentation [p=0.04 OR 1.835 CI (1.022-3.297)]. Multivariate analysis revealed that the GG/GC genotypes of&nbsp;VEGF&nbsp;rs2010963 were independently associated with multinodular tumors at diagnosis (p=0.013; OR 4.78 CI (1.38-16.67)]. CONCLUSION: Our results suggest that these polymorphisms may increase the risk of rapid tumor progression in patients with HCV infection. This subgroup of patients with HCC and who present polymorphism is more likely to be diagnosed with multinodular disease and not be amenable to receiving curative treatments. These data must be validated in larger cohorts, and the screening intervals can be customized based on genetic history

ANÁLISE DA EVOLUÇÃO DAS RELAÇÕES DE COAUTORIA NOS PROGRAMAS DE PÓS-GRADUAÇÃO EM COMPUTAÇÃO NO BRASIL

This paper describes the basis for a study of the dynamic relationships of (co- )authorship among full time professors from Brazilian Computer Science graduate programs. 889 researchers were identified, working in 45 graduate programs. A robust entity resolution heuristic was developed, allowing the identification of (co-)authorship relationships among researchers with accuracy above 96%. The social network analysis allowed for the discovery of some interesting phenomena about the dynamics of the Brazilian scientific production, related to the increasing in the production within and among graduate programs.Este trabalho descreve as bases para um estudo da dinâmica de relações de coautoria entre pesquisadores associados aos programas de pós-graduação em Ciência da Computação, avaliados pela CAPES no triênio 2007-2009. Ao todo, foram identificados 889 pesquisadores permanentes nos 45 programas de pós-graduação avaliados. Uma heurística robusta de resolução de entidades foi desenvolvida, possibilitando a identificação das relações de coautoria entre pesquisadores, com uma taxa de acerto superior a 96%. Com base na análise das redes de coautoria foi possível observar fenômenos interessantes da dinâmica da pesquisa brasileira, relacionados especialmente ao aumento da produção conjunta inter e intra programas de pós-graduação

Habitat determinants of golden‐headed lion tamarin (Leontopithecus chrysomelas) occupancy of cacao agroforests: Gloomy conservation prospects for management intensification

Organismal distributions in human‐modified landscapes largely depend on the capacity of any given species to adapt to changes in habitat structure and quality. The golden‐headed lion tamarin (GHLT; Leontopithecus chrysomelas) is an Endangered primate from the Brazilian Atlantic Forest whose remaining populations occupy heterogeneous landscapes consisting primarily of shade cacao (Theobroma cacao) agroforestry, locally known as cabrucas. This cash crop can coexist with high densities of native tree species and holds a significant proportion of the native fauna, but its widely extolled wildlife‐friendly status is increasingly threatened by management intensification. Although this potentially threatens to reduce the distribution of GHLTs, the main determinants of tamarin's occupancy of cabrucas remain unknown, thereby limiting our ability to design and implement appropriate conservation practices. We surveyed 16 cabruca patches in southern Bahia, Brazil, and used occupancy modeling to identify the best predictors of GHLT patch occupancy. Key explanatory variables included vegetation structure, critical resources, landscape context, human disturbance, and predation pressure. We found a negative relationship between GHLT occupancy and the prevalence of jackfruit trees (Artocarpus heterophylus), which is likely associated with the low representation of other key food species for GHLTs. Conversely, cabrucas retaining large‐diameter canopy trees have a higher probability of GHLT occupancy, likely because these trees provide preferred sleeping sites. Thus, key large tree resources (food and shelter) are currently the main drivers of GHLT occupancy within cabruca agroecosystems. Since both factors can be directly affected by crop management practices, intensification of cabrucas may induce significant habitat impacts on GHLT populations over much of their remaining range‐wide distribution

Search for the standard model Higgs boson in the H to ZZ to 2l 2nu channel in pp collisions at sqrt(s) = 7 TeV

A search for the standard model Higgs boson in the H to ZZ to 2l 2nu decay channel, where l = e or mu, in pp collisions at a center-of-mass energy of 7 TeV is presented. The data were collected at the LHC, with the CMS detector, and correspond to an integrated luminosity of 4.6 inverse femtobarns. No significant excess is observed above the background expectation, and upper limits are set on the Higgs boson production cross section. The presence of the standard model Higgs boson with a mass in the 270-440 GeV range is excluded at 95% confidence level.Comment: Submitted to JHE

Search for New Physics with Jets and Missing Transverse Momentum in pp collisions at sqrt(s) = 7 TeV

A search for new physics is presented based on an event signature of at least three jets accompanied by large missing transverse momentum, using a data sample corresponding to an integrated luminosity of 36 inverse picobarns collected in proton--proton collisions at sqrt(s)=7 TeV with the CMS detector at the LHC. No excess of events is observed above the expected standard model backgrounds, which are all estimated from the data. Exclusion limits are presented for the constrained minimal supersymmetric extension of the standard model. Cross section limits are also presented using simplified models with new particles decaying to an undetected particle and one or two jets

Search for anomalous t t-bar production in the highly-boosted all-hadronic final state

A search is presented for a massive particle, generically referred to as a Z', decaying into a t t-bar pair. The search focuses on Z' resonances that are sufficiently massive to produce highly Lorentz-boosted top quarks, which yield collimated decay products that are partially or fully merged into single jets. The analysis uses new methods to analyze jet substructure, providing suppression of the non-top multijet backgrounds. The analysis is based on a data sample of proton-proton collisions at a center-of-mass energy of 7 TeV, corresponding to an integrated luminosity of 5 inverse femtobarns. Upper limits in the range of 1 pb are set on the product of the production cross section and branching fraction for a topcolor Z' modeled for several widths, as well as for a Randall--Sundrum Kaluza--Klein gluon. In addition, the results constrain any enhancement in t t-bar production beyond expectations of the standard model for t t-bar invariant masses larger than 1 TeV.Comment: Submitted to the Journal of High Energy Physics; this version includes a minor typo correction that will be submitted as an erratu