ABSTRACT Background: The impact of coronavirus disease-19 on the management of multiple myeloma (MM) has been recognized. However, the real effect on clinical outcomes remains poorly understood. Objective: We describe a local experience of the management of MM patients and report their outcomes during the current pandemic. Methods: All consecutive symptomatic MM patients seen at our center since 03/20 were evaluated. Results: A cohort of 156 patients diagnosed from 01/19 to 12/20 was analyzed to interrogate differences in presentation patterns. A total of 553 MM patients were seen and/or treated at Tom Baker Cancer Center in the year of 2020. From those, 47.1% (n = 261) were tested for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Sixteen patients tested positive and data are presented. In addition, a decrease of 21.7% in the rate of new smoldering MM/MM diagnosis was observed in 2020 as compared to 2019. Further, an increase in deaths was also observed in 2020. Conclusions: Our study confirms an increase lethality for MM patients infected with SARS-CoV-2. A balance between safety and need for cancer control should be emphasized.

Background: Patients with monoclonal gammopathy of undetermined significance (MGUS) have clinical features including older age, presence of medical comorbidities, susceptibility to infections, and thrombotic tendencies which are relevant when assessing their risk during the coronavirus disease (COVID-19) pandemic. Objective: To study the vulnerability of patients with MGUS during the COVID-19 pandemic, we assessed the local management of MGUS patients and their clinical outcomes. Methods: Retrospective chart reviews were performed for all patients with MGUS seen at a university medical center clinic (2014-2020). Results: A total of 228 MGUS patients were included; 211 patients are alive, 7 patients died before the pandemic, and 10 patients died since the pandemic declaration. The mean age and the overall survival (OS) of the patients who died before versus during the pandemic were 83.0 versus 75.2 years, p = 0.4, and OS 40.6 versus 53.2 months, p = 0.3, respectively. One patient died of COVID-19. Nine patients had venous thromboembolisms (VTE), all of which occurred before the pandemic onset. Conclusions: There were no significant differences found in the mean age or OS of the MGUS patients who died before versus after the pandemic onset. An increase in VTE rates was not seen. Study results are limited by small patient numbers.

Objective: To evaluate the associations of moderate to vigorous physical activity (MVPA), vigorous physical activity (VPA), moderate physical activity (MPA), and sedentary behavior (SB) with depressive, anxiety, and co-occurring depressive and anxiety symptoms (D&A) during the COVID-19 pandemic in Brazil.Methods: Cross-sectional online survey in self-isolating people. Self-reported MVPA, VPA, MPA, and SB (exposures), and depressive and anxiety symptoms (Beck Depression and Anxiety Inventories [BDI and BAI]) were collected. Associations of MVPA, VPA, MPA, and SB with prevalent depressive (BDI>9), anxiety (BAI>7), and D&A (BDI>9+BAI>7) symptoms were investigated using logistic regressions, presented as odds ratio (OR) and 95% confidence interval (95%CI). Linear regressions were performed testing associations with symptom severity. Models were adjusted for confounding factors. Results: Participants (n=937, females=72.3%) performing ≥30min/day MVPA or ≥15min/day VPA had lower odds of prevalent depressive (ORMVPA=0.71, 95%CI=0.53-0.96; ORVPA=0.60, 95%CI=0.43-0.82), anxiety (ORMVPA=0.71, 95%CI=0.54-0.96; ORVPA=0.70, 95%CI=0.51-0.96), and co-occurring D&A symptoms (ORMVPA=0.71, 95%CI=0.52-0.96; ORVPA=0.59, 95%CI=0.41-0.83). People spending ≥10h/day sedentary were more likely to have depressive symptoms (OR=1.39,95%CI=1.02-1.90). Each hour spent sedentary corresponded to 0.22 (95%CI=0.10-0.33) points and 0.16 (95%CI=0.02-0.31) points higher on the BDI and BAI, respectively.Conclusion: Higher MVPA and VPA levels are associated with lower odds of depressive, anxiety and D&A symptoms. Higher SB is associated with higher odds of depressive symptoms.

ABSTRACT Introduction To characterize initial presentation and PSA screening status in a contemporary cohort of men treated for metastatic prostate cancer at our institution. Materials and methods We reviewed records of 160 men treated for metastatic prostate cancer between 2008-2014 and assessed initial presentation, categorizing patients into four groups. Groups 1 and 2 presented with localized disease and received treatment. These men suffered biochemical recurrence late (>1 year) or earlier (<1 year), respectively, and developed metastases. Groups 3 and 4 had asymptomatic and symptomatic metastases at the outset of their diagnosis. Patients with a first PSA at age 55 or younger were considered to have guideline-directed screening. Results Complete records were available on 157 men for initial presentation and 155 men for PSA screening. Groups 1, 2, 3 and 4 included 27 (17%), 7 (5%), 69 (44%) and 54 (34%) patients, respectively. Twenty (13%) patients received guideline-directed PSA screening, 5/155 (3%) patients presented with metastases prior to age 55 with their first PSA, and 130/155 (84%) had their first PSA after age 55, of which 122/130 (94%) had metastasis at the time of diagnosis. Conclusion Despite widespread screening, most men treated for metastatic prostate cancer at our institution presented with metastases rather than progressed after definitive treatment. Furthermore, 25 (16%) patients received guideline-directed PSA screening at or before age 55. These data highlight that, despite mass screening efforts, patients treated for incurable disease at our institution may not have been a result of a failed screening test, but a failure to be screened.

BACKGROUND: The World Health Organisation recommends that services accompany wheelchair distribution. This study examined the relationship of wheelchair service provision in Kenya and the Philippines and wheelchair-use-related outcomes. METHOD: We surveyed 852 adult basic manual wheelchair users. Participants who had received services and those who had not were sought in equal numbers from wheelchair-distribution entities. Outcomes assessed were daily wheelchair use, falls, unassisted outdoor use and performance of activities of daily living (ADL). Descriptive, bivariate and multivariable regression model results are presented. RESULTS: Conditions that led to the need for a basic wheelchair were mainly spinal cord injury, polio/post-polio, and congenital conditions. Most Kenyans reported high daily wheelchair use (60%) and ADL performance (80%), while these practices were less frequent in the Philippine sample (42% and 74%, respectively). Having the wheelchair fit assessed while the user propelled the wheelchair was associated with greater odds of high ADL performance in Kenya (odds ratio [OR] 2.8, 95% confidence interval [CI] 1.6, 5.1) and the Philippines (OR 2.8, 95% CI 1.8, 4.5). Wheelchair-related training was associated with high ADL performance in Kenya (OR 3.2, 95% CI 1.3, 8.4). In the Philippines, training was associated with greater odds of high versus no daily wheelchair use but also odds of serious versus no falls (OR 2.5, 95% CI 1.4, 4.5. CONCLUSION: Select services that were associated with some better wheelchair use outcomes and should be emphasised in service delivery. Service providers should be aware that increased mobility may lead to serious falls.

Resumo A Educação Histórica, como a própria história, é uma conquista precária; é vulnerável a agendas políticas e educacionais que procuram mesclá-la com outras partes do currículo ou reduzi-la a um veículo para a cidadania ou valores comuns patrióticos. Se tivermos a expectativa de nos engajarmos em uma discussão séria na Educação Histórica em face destes desafios, devemos evitar lemas polares como "tradicional versus progressista", "centrado na criança versus centrado na matéria" e "habilidades versus conteúdo", que têm produzido muita confusão na literatura. Em particular, deve-se evitar falar de competências, com a sua infeliz concessão de licenças a convenientes e tolos currículos genéricos. A história é uma forma pública de conhecimento e o desenvolvimento de uma tradição metacognitiva, com as suas próprias normas e critérios. Há evidências que sugerem que a história é contraintuitiva e que entendê-la envolve a alteração ou até mesmo o abandono de ideias cotidianas que tornam o conhecimento do passado impossível. Consequentemente o ensino de história envolve o desenvolvimento de um aparato conceitual de segunda ordem que permite que a história siga em frente, em vez de imobilizá-la e, ao fazê-lo, abre a perspectiva de mudança de uma visão cotidiana da natureza e do estado do conhecimento do passado para uma de conhecimento histórico. Isto nos permite dar conta do que significa saber um pouco de história - um provisório conceito de literacia histórica - como um aprendizado de uma compreensão disciplinar da história, como a aquisição das disposições que derivam e impulsionam essa compreensão histórica e como o desenvolvimento de uma imagem do passado, que permite que os alunos se orientem no tempo. Existem pesquisas para informar o debate sobre o primeiro componente, mas há pouco disponível para o segundo. Há um interesse atual considerável no terceiro componente, mas o debate centrou-se sobre a questão perene da "ignorância" das crianças, em vez de reconhecer que o problema é encontrar maneiras de permitir que os alunos adquiram passados históricos utilizáveis que não são histórias fixas. A obtenção de literacia histórica potencialmente transforma a visão de mundo de crianças (e de adultos) e permite ações até então - literalmente - inconcebíveis para eles. Entender a importância disto para o ensino da história significa abandonar hábitos de pensar com base em um presente instantâneo, em que uma forma de apartheid temporal separa o passado do presente e do futuro. Significa, também, desencaixotar as formas em que a história pode transformar como vemos o mundo. Tais transformações podem ser dramáticas em longas extensões ou mais localizadas e específicas. Elas podem mudar a forma como vemos oportunidades e constrangimentos políticos ou sociais, a nossa própria identidade ou dos outros, a nossa percepção das feridas e fardos que herdamos e a adequação das explicações das principais características do nosso mundo. Elas podem sugerir revisões constrangedoras do nosso entendimento e expectativas de como o mundo humano funciona. E elas podem nos ajudar a conhecer melhor o que não dizer. Literacia histórica envolve tratar o passado como uma ecologia temporal interconectada capaz de suportar uma gama indefinida de histórias, não apenas algo que usamos para contar a história que melhor se adapte aos nossos objetivos e desejos imediatos. Como outras formas públicas de conhecimento, a história é uma tradição metacognitiva que as pessoas têm lutado longa e duramente para desenvolver e ser capaz de praticar. É uma conquista frágil, a ser tratada com respeito e cuidado nas escolas.

Abstract History Education, as history itself, is a precarious achievement; and it is vulnerable to political and educational schedules that try to mix it with other parts of the curriculum or reduce it to a medium for citizenship or common patriotic values. If we expect to engage in a serious discussion about History Education in view of these challenges, we should avoid polar opposite mottos as "traditional against progressive", "focused on the child against focused on the subject" and "skills against the contents", which have caused great confusion over literature. In particular, we should avoid talking about competences, with their bad permission granted to convenient and foolish generic curricula. History is a public manner of knowledge and the development of a metacognitive tradition, with its own rules and criteria. There are evidences suggesting that history is counterintuitive, and that understanding it involves altering or even abandoning everyday ideas that make knowledge of the past impossible. Consequently, teaching history involves the development of a second-class conceptual tool that allows history to move forward, instead of making it pause, and making it, it offers the perspective of change of an everyday view of nature and of the state of knowledge of the past to the one in history knowledge. It allows us that we account for the meaning of knowing a little history - a provisional concept of historical literacy - as the learning of a disciplinary understanding of history, as the acquisition of the tools that cause and promote this history understanding, and how the development of an image from the past allows students to find their way in time. There are researches to inform the discussion about the first component, but there is little available to the second. There is a current considerable interest in the third component, but the discussion focused on the perennial matter of the children's "ignorance", instead of recognizing that the problem is to find ways that allow students to acquire usable historical pasts that are not fixed histories. Acquiring historical literacy potentially transforms the world vision of children (and of adults) and it permits actions so far - literally - inconceivable to them. Understanding its importance to the teaching of history means breaking habits of thinking based on an instantaneous present, in which a manner of time apartheid cuts the past from the present and from the future. It means also to unpack the manners in which history can transform how we see the world. Such transformations may be dramatic in large extents, or more located and specific. They may change how we see political or social opportunities and embarrassments, our own or others' identity, our perception of wounds and burdens we inherit, and the adequacy of the explanations of the main characteristics of our world. They may suggest embarrassing reviews of our understanding and expectations of how the human world operates. And they may help us to know better what not to say. Historical literacy involves dealing with the past as an interconnected temporal ecology that can support an indefinite range of stories, not only something that we use to tell the history that better adapts to our immediate objectives and wishes. Like other public manners of knowledge, history is a metacognitive tradition that people have struggled hard for a long time to develop and to be able to practice. It is a fragile achievement to be handled respectfully and carefully in the schools.

First ribs - the first or most superior ribs in the thorax - are rare in the hominin fossil record, and when found, have the potential to provide information regarding the upper thorax shape of extinct hominins. Here, we describe a partial first rib from Member 4 of the Sterkfontein Caves, South Africa. The rib shaft is broken away, so only the head and neck are preserved. The rib is small, falling closest to small-bodied Australopithecus first ribs (AL 288-1 and MH1). Given that it was recovered near the StW 318 femur excavation, which also represents a small individual, we suggest that the two may be associated. Three-dimensional geometric morphometric analyses were used to quantify the rib fragment morphology and compare it to extant hominoid and other fossil hominin ribs. While only the proximal end is preserved, our analyses show that South African Australopithecus share derived features of the proximal first rib more closely resembling A. afarensis and later hominins than great apes.

A partir da constatação de que ninguém escapa do passado e da importância da relação que as pessoas estabelecem com o passado, buscou-se apontar, a partir de pesquisa em fontes relacionadas à filosofia da História, alguns fundamentos para o significado da aprendizagem da história. Nesse sentido, temas como a importância da História para a validação do passado, a relevância das evidências, a problemática das leis e generalizações, bem como o significado da experiência vicária para a construção da aprendizagem histórica, foram objetos de análise, no sentido de se mostrar por que é importante aprender História.

Knowing that nobody escapes from the past and the importance of the relationship that people establish with the past, this aimed to point out some fundaments for the meaning of History learning, based in researches related to History's philosophy. Thus, themes such as the importance of History to validate the past, the relevance of evidences, the problematic of laws and generalizations and also the meaning of vicarial experience to build the learning of History were objects of analysis with the objective of showing why it is important to learn History.

OBJECTIVE: To estimate the cost of scaling up childhood immunization services required to reach the WHO-UNICEF Global Immunization Vision and Strategy (GIVS) goal of reducing mortality due to vaccine-preventable diseases by two-thirds by 2015. METHODS: A model was developed to estimate the total cost of reaching GIVS goals by 2015 in 117 low- and lower-middle- income countries. Current spending was estimated by analysing data from country planning documents, and scale-up costs were estimated using a bottom-up, ingredients-based approach. Financial costs were estimated by country and year for reaching 90% coverage with all existing vaccines; introducing a discrete set of new vaccines (rotavirus, conjugate pneumococcal, conjugate meningococcal A and Japanese encephalitis); and conducting immunization campaigns to protect at-risk populations against polio, tetanus, measles, yellow fever and meningococcal meningitis. FINDINGS: The 72 poorest countries of the world spent US$ 2.5 (range: US$ 1.8-4.2) billion on immunization in 2005, an increase from US$ 1.1 (range: US$ 0.9-1.6) billion in 2000. By 2015 annual immunization costs will on average increase to about US$ 4.0 (range US$ 2.9-6.7) billion. Total immunization costs for 2006-2015 are estimated at US$ 35 (range US$ 13-40) billion; of this, US$ 16.2 billion are incremental costs, comprised of US$ 5.6 billion for system scale-up and US$ 8.7 billion for vaccines; US$ 19.3 billion is required to maintain immunization programmes at 2005 levels. In all 117 low- and lower-middle-income countries, total costs for 2006-2015 are estimated at US$ 76 (range: US$ 23-110) billion, with US$ 49 billion for maintaining current systems and $27 billion for scaling-up. CONCLUSION: In the 72 poorest countries, US$ 11-15 billion (30%-40%) of the overall resource needs are unmet if the GIVS goals are to be reached. The methods developed in this paper are approximate estimates with limitations, but provide a roadmap of financing gaps that need to be filled to scale up immunization by 2015.

OBJETIVO: Estimar el costo de extender masivamente los servicios de inmunización infantil requeridos para alcanzar la meta de la Visión y Estrategia Mundial de Inmunización (GIVS) OMS-UNICEF de reducir la mortalidad por enfermedades prevenibles mediante vacunación en dos tercios para 2015. MÉTODOS: Se elaboró un modelo para estimar el costo total del logro de las metas de GIVS para 2015 en 117 países de ingresos bajos o medios bajos. El gasto actual se estimó a partir de datos extraídos de los documentos de planificación de los países, y los costos de la extensión masiva se estimaron mediante un método ascendente basado en componentes. Se calcularon los costos financieros requeridos por país y año para alcanzar una cobertura del 90% con todas las vacunas existentes; introducir un conjunto de vacunas nuevas (contra rotavirus, antineumocócica conjugada, conjugada contra el meningococo A y contra la encefalitis japonesa); y realizar campañas de inmunización para proteger a las poblaciones de riesgo contra la poliomielitis, el tétanos, el sarampión, la fiebre amarilla y la meningitis meningocócica. RESULTADOS: Los 72 países más pobres del mundo invirtieron US$ 2500 millones (intervalo: US$ 1800 - 4200 millones) en actividades de inmunización en 2005, lo que supone un aumento respecto a los US$ 1100 millones (intervalo: US$ 900 - 1600 millones) de 2000. Para 2015, los costos anuales de la inmunización aumentarán por término medio a unos US$ 4000 millones (intervalo: US$ 2900 - 6700 millones). Los costos totales de la inmunización para 2006-2015 se estiman en US$ 35 000 millones (intervalo: US$ 13 000 - 40 000 millones); de esa cantidad, US$ 16 200 millones son costos adicionales, de los que US$ 5600 millones corresponden a la expansión del sistema y US$ 8700 millones a las vacunas; se necesitan US$ 19 300 millones para mantener los programas de inmunizacion a los niveles de 2005. En el conjunto de los 117 países de ingresos bajos y medios bajos, se estima que los costos totales para 2006 - 2015 ascenderán a US$ 76 000 millones (intervalo: US$ 23 000 - 110 000 millones): US$ 49 000 millones para mantener los sistemas actuales y US$ 27 000 millones para expandirlos. CONCLUSIÓN: Considerando los 72 países más pobres, se necesitan aún US$ 11 000 - 15 000 millones (30% - 40% de los recursos globales necesarios) para poder alcanzar las metas de la GIVS. Los métodos desarrollados en este artículo arrojan estimaciones aproximadas que presentan limitaciones, pero proporcionan una hoja de ruta para financiar los déficits que hay que cubrir a fin de expandir la inmunización para 2015.

OBJECTIF: Estimer le coût du développement à plus grande échelle des services de vaccination infantile nécessaires à la réalisation de l'objectif de l'initiative OMS-UNICEF « La vaccination dans le monde : vision et stratégie (GIVS) », consistant à réduire des deux-tiers d'ici 2015 la mortalité due aux maladies évitables par la vaccination. MÉTHODES: Un modèle a été élaboré pour estimer le coût total de la réalisation de l'objectif de cette initiative d'ici 2015 dans 117 pays à revenu faible ou faible à moyen. Les dépenses actuelles ont été estimées par une analyse des documents de planification nationale et les coûts du passage à l'échelle supérieure en utilisant une démarche partant de la base et des intrants. Les coûts financiers pour atteindre une couverture vaccinale de 90 % ont été estimés par pays et par année pour tous les vaccins existants, dans le cas où l'on introduirait une série discrète de nouveaux vaccins (vaccins antirotavirus, antipneumococcique conjugué, contre le méningocoque de type A et contre l'encéphalite japonaise) et dans celui où l'on mènerait des campagnes de vaccination pour protéger les populations à haut risque contre la polio, le tétanos, la rougeole, la fièvre jaune et la méningite à méningocoque. RÉSULTATS: Les 72 pays les plus pauvres du monde ont consacré US$ 2,5 milliards (plage de variation : US$ 1,8-4,2) à la vaccination en 2005, soit une augmentation de US$ 1,1 milliard (plage de variation : US$ 0,9-1,6) par rapport à l'année 2000. D'ici 2015, les coûts annuels de la vaccination augmenteront en moyenne d'environ US$ 4,0 milliards (plage de variation : US$ 2,9-6,7). Les coûts totaux de la vaccination pour la période 2006-2015 sont estimés à US$ 35 milliards (plage de variation : US$ 13-40), dont US$ 16,2 milliards de surcoûts, se répartissant en US$ 5,6 milliards pour le passage à l'échelle supérieure du système et US$ 8,7 milliards pour les vaccins. US$ 19,3 milliards seront nécessaires pour maintenir les programmes de vaccination aux niveaux de 2005. Pour l'ensemble des 117 pays à revenu faible ou faible à moyen, les coûts totaux pour la période 2006-2015 sont estimés à US$ 76 milliards (plage de variation : US$ 23-110), dont US$ 49 milliards pour maintenir les systèmes actuels et US$ 27 milliards pour passer à l'échelle supérieure. CONCLUSION: Pour les 72 pays les plus pauvres, 30 à 40 % (soit US$ 11 à 15 milliards) des besoins en ressources ne sont pas couverts s'il on veut atteindre l'objectif de la GIVS. Les méthodes présentées dans cet article donnent des estimations approximatives et comportent des limites, mais elles permettent d'identifier les lacunes à combler sur le plan financier pour le passage à l'échelle supérieure des programmes de vaccination d'ici 2015.

Este trabalho pretende esboçar considerações iniciais e muito provisórias de uma noção utilizável de literacia ¹ histórica. Está sustentado sucintamente em algumas considerações filosóficas sugeridas pelos trabalhos de Bevir, Collingwood, Lorenz, Oakeshott e Rüsen, com a finalidade de decidir o que poderia se incluído de forma útil em tal noção. Mais substancialmente, emprega pesquisas empíricas recentes para sugerir qual consideração/aplicação de literacia histórica poderia ser discutida. Qualquer consideração útil exige prestar atenção em dois componentes: primeiro, as idéias dos estudantes sobre a disciplina de história; segundo, sua orientação em direção ao passado (o tipo de passado que eles podem acessar, e a relação deste com o presente e o futuro). Pesquisas conectando esses dois componentes de literacia histórica tiveram seu início recentemente, apesar da abordagem teórica de Rüsen dirigida à consciência histórica ter inspirado a investigação do segundo componente já há algum tempo em partes da Europa. Argumenta-se que o principal projeto para educação histórica deve ser o desenvolvimento de estruturas históricas aproveitáveis do passado, que não sejam "histórias de festas", mas que permitam aos estudantes assimilarem novos eventos e processos, tanto no passado ou no futuro e que sejam eles mesmos adaptáveis ao se defrontar com novo material recalcitrante. Instrumentos chaves daqui serão idéias adequadamente sofisticadas sobre considerações históricas, junto com conceitos proximamente relacionados, como significado, interpretação e mudança.

This paper attempts to sketch an initial and very provisional account of a workable notion of historical literacy. It draws briefly on some philosophical considerations suggested by ¾ among others ¾ the work of Bevir, Collingwood, Lorenz, Oakeshott and Rüsen in order to decide what might be usefully included in such a notion. More substantially, it employs recent empirical research to suggest what an account of historical literacy might need to address. At the very least any useful account ought to pay attention to two components: first, students' ideas about the discipline of history; second, their orientation towards the past (the kind of past they can access, and its relationship to the present and future). Research connecting these two components of historical literacy has only recently begun, although Rüsen's theoretical approach to historical consciousness has inspired investigation of the second component for some time in parts of Europe. It is argued that a major project for history education must be the development of usable historical frameworks of the past that are not 'party histories', but allow students to assimilate new events and processes, whether in the past or the future, and are themselves adaptable in the face of recalcitrant new material. Key tools here will be adequately sophisticated ideas about historical accounts, together with closely related concepts such as significance, interpretation and change.