João Manuel Moreira

Infection with Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae in solid organ transplantation.

Klebsiella pneumoniae carbapenemase (KPC)‐producing K. pneumoniae is spreading globally and represents a challenge in infection control and treatment. Solid organ transplant (SOT) recipients are especially at risk for infection by multidrug‐resistant bacteria, and little is known about infection with KPC‐producing organisms in this setting. The aim of this study was to describe the clinical and microbiologic aspects of KPC‐producing K. pneumoniae infections in SOT recipients. A KPC‐2‐producing K. pneumoniae outbreak was identified in a public teaching tertiary care hospital in São Paulo, Brazil, in June 2009. During the outbreak, cases of KPC‐2‐producing K. pneumoniae infection in SOT recipients occurred between July 2009 and February 2010; these cases were retrospectively reviewed. Overall, 12 episodes of infection with KPC‐producing K. pneumoniae occurred in 2 heart, 4 liver, and 6 kidney transplant recipients with incidence rates of 16.7%, 12.9%, and 26.3% in heart, liver, and kidney transplantation, respectively. Infection occurred at a median time of 20 days after transplantation. Primary infection sites were as follows: 4 urinary tract infections, 4 bloodstream infections, 2 pneumonias, and 2 surgical site infections. All patients except one had received antibiotics in the last 30 days, mostly piperacillin‐tazobactam or glycopeptides. All strains exhibited susceptibility to amikacin and gentamicin. Patients were treated with tigecycline plus polymyxin B (3 cases), polymyxin B plus carbapenem (3 cases), polymyxin B alone (3 cases), or tigecycline plus imipenem (1 case). In 2 cases, patients received only carbapenem, and death occurred before the final culture result. The overall 30‐day mortality rate was 42%. In this series of KPC‐producing K. pneumoniae infection in SOT recipients, the infection occurrence was high during an institutional outbreak and was potentially life threatening.

Perceived social support as an offshoot of attachment style

Abstract Questionnaires were completed by college students (N=182), with the purpose of examining the role of adult attachment and social support as predictors of psychological distress. Factor analyses of the attachment and social support measures yielded three factors for attachment (Preoccupation, Avoidance, Dismissiveness), and two for social support (Intimate, Casual). Both types of support were significant zero-order predictors of distress, but intimate support effects were rendered non-significant when attachment style was controlled for. In contrast, attachment style (Preoccupation) exerted a significant additional effect after social support was controlled for. Analyses of interactions suggested that Preoccupation reduces the effect of Intimate Support, while Avoidance enhances the effect of Casual Support. These results support the hypothesis that perceived social support, and particularly Intimate Support is, to a large extent, a by-product of attachment style, but also point towards possible moderator effects of attachment style upon the impact of support.

Individual memory and the emergence of cooperation

The social brain hypothesis states that selection pressures associated with complex social relationships have driven the evolution of sophisticated cognitive processes in primates. We investigated how the size of cooperative primate communities depends on the memory of each of its members and on the pressure exerted by natural selection. To this end we devised an evolutionary game theoretical model in which social interactions are modelled in terms of a repeated Prisoners Dilemma played by individuals who may exhibit a different memory capacity. Here, memory is greatly simplified and mapped onto a single parameter m describing the number of conspecifics whose previous action each individual can remember. We show that increasing m enables cooperation to emerge and be maintained in groups of increasing sizes. Furthermore, harsher social dilemmas lead to the need for a higher m in order to ensure high levels of cooperation. Finally, we show how the interplay between the dilemma individuals face and their memory capacity m allows us to define a critical group size below which cooperation may thrive, and how this value depends sensitively on the strength of natural selection.

Social competence, personality and adult attachment style in a Portuguese sample

Abstract The aim of the present study was to examine the correlates of adult attachment style, measured using a Portuguese translation of the paragraphs proposed by Hazan and Shaver (1987). University students ( N = 138) responded to this measure, to the Social Competence Questionnaire (ComQ) and to the Eysenck Personality Inventory (EPI). Percentages found for each attachment style were similar to those found by other authors. Secure participants scored higher in social competence. In the EPI, the anxious/ambivalent group was higher in neuroticism, whereas the avoidants leaned toward introversion. Differences in correlations among social competence and personality scales were also found in different attachment styles.

Neonatal Behavioral Assessment Scale (NBAS): Confirmatory factor analysis of the six behavioral clusters

The Neonatal Behavioral Assessment Scale (NBAS) is a widely used in the neurobehavioral assessment of neonates in clinical practice and research. Lesters data reduction system for the NBAS items is the most often used in research, but the few factor analytic studies carried out with it leave gaps in its validation. The current study aimed to test and compare (a) the factorial structure of the Lesters data reduction system for the NBAS and (b) an alternative data reduction system, slightly modified from Lesters system. The NBAS was administered to 196 healthy Portuguese full-term infants (51% male) in the first 72 h of life (M = 43.63 h). Construct validity of the data reduction systems was tested through confirmatory factor analysis (CFA). Lesters original system was compared to three alternative models, two of which included a revision of the scoring rules for three items and the exclusion of five items. The CFA generally supported the six-factor structure. However, fit indices for Lesters original model were only fair. An alternative, revised model with a second-order factor - Self-Organizing System - demonstrated a better fit. The results provide evidence to support a modified form of Lesters six behavioral clusters as a data reduction model for the NBAS items.

Robust stability and physiological correlates of infants’ patterns of regulatory behavior in the still-face paradigm at 3 and 9 months.

This study examined the stability of three patterns of infant regulatory behavior identified in the face-to-face still-face (FFSF) paradigm at 3 and 9 months—social-positive oriented, distressed-inconsolable, and self-comfort oriented—and whether variations in infants’ heart-rate were correlated with them. Although some studies have examined the stability of discrete infant behaviors, none have investigated the stability of early regulatory patterns across FFSF episodes over time. Healthy full-term infants and their mothers (N = 112) were videotaped in the FFSF when infants were 3 and 9 months old. Infants’ regulatory patterns were scored with the Coding System for Regulatory Patterns in the FFSF. Infants’ heart-rate level during each episode of the FFSF was also assessed. The social-positive-oriented pattern was the most prevalent at both ages. Cross-tabulation analysis showed a robust stability (Cohen’s &kgr; = .72) of the regulatory patterns from 3 to 9 months. The heart-rate level of infants with a social-positive-oriented pattern at 3 and 9 months showed recovery to baseline levels following the still-face. In contrast, the heart-rate level of infants with a distressed-inconsolable pattern at 9 months increased from the still-face to the reunion episode, whereas the heart-rate level of infants with a self-comfort-oriented pattern at 9 months did not change from the still-face to the reunion episodes. These results suggest that infants exhibit distinct organized regulatory patterns as early as 3 months that are stable over a 6-month interval and associated with variations in infants’ physiological responses across FFSF episodes at both ages.

Os Sete Lados do Triângulo: Desenvolvimento do Questionário Multidimensional de Comportamentos Extrarrelacionais (QMCER)

portuguesA infidelidade nas relacoes de casal e um acontecimento frequente e com consequencias potencialmente gravosas para os envolvidos. Apesar desta importância, existe uma escassez de instrumentos para a sua avaliacao psicologica, que importa minorar. Nesse sentido, foi elaborado o Questionario Multidimensional de Comportamentos Extrarrelacionais (QMCER), composto por 6 seccoes. Analises em componentes principais (N≥156) sustentam a ideia de que o QMCER permite avaliar a ocorrencia de 3 tipos de comportamentos extrarrelacionais (envolvimento sexual, envolvimento afetivo e desejo sexual), 7 dimensoes associadas as carateristicas da infidelidade, suas motivacoes e consequencias da mesma, e 4 fatores ligados a motivacao para a fidelidade, que se organizam de forma semelhante a postulada pela teoria da autodeterminacao. Os valores do coeficiente alfa de Cronbach sao geralmente adequados, com excecao de algumas escalas que requerem desenvolvimento futuro. As correlacoes entre as escalas e com outros instrumentos fornecem dados positivos quanto a validade do QMCER. EnglishInfidelity in couple relationships is a common event, and one with potentially serious consequences for those involved. In spite of its importance, there is a scarcity of instruments for its psychological evaluation, which it would be important to compensate for. For that purpose, the Questionario Multidimensional de Comportamentos Extrarrelacionais (QMCER; Multidimensional Extra-Relational Behaviors Questionnaire) has been developed, and is composed of 6 sections. Principal components analyses (N≥156) sustain the idea that the QMCER can evaluate the occurrence of 3 types of extra-relational behaviors (sexual involvement, affective involvement and sexual desire), 7 dimensions associated with infidelity characteristics, motivations, and consequences, and 4 factors related to motivations for fidelity, which are organized in a way compatible with self-determination theory. Cronbach alpha values are generally adequate, with the exception of a few scales that need further development. Correlations among the scalesand with other instruments provide good indications regarding the validity of the QMCER.

Evolving the Asymmetry of the Prisoner’s Dilemma Game in Adaptive Social Structures

Empirical studies show that most real social networks exhibit both a significant average connectivity and marked heterogeneity. While the first precludes the emergence of cooperation in static networks, it has been recently shown that the latter induces a symmetry breaking of the game, as cooperative acts become dependent on the social context of the individual. Here we show how adaptive networks can give rise to such diversity in social contexts, creating sufficient conditions for cooperation to prevail as a result of a positive assortment of strategies and the emergence of a symmetry breaking of the game. We further show that realistic heterogeneous networks of high average connectivity where cooperation prevails can result from a simple topological dynamics.