Social media and tourism : a wishful relationship

For decades hospitality firms were used to domain the communication process. Thematic social network sites such as TripAdvisor became very important tools for travelers when deciding which hotels to book, and what restaurants and tourist attractions to visit, been a visible part of tourism communication evolution. Evidence suggests that e-WOM serves as a primary information source when tourists choose destinations, hotels, and other experiences. The role and use of social media in tourists’ decision making has been widely discuss in tourism and hospitality research, especially in the research phase of the tourist’ travel planning process. With the wide adoption of social media the influence of customers’ word-of-mouth increased and influences not only the research phase, but the repetition and overall customers’ experiences. To answer these questions a model assessing e-wom was developed and data was gathering from TripAdvisor regarding customer’s opinion in restaurant experiences. The results found establish the bases for understanding tourists’ engagement level and profiles.N/

Estado nutricional e qualidade de vida em pessoas idosas com doença tipo demência de Alzheimer

[resumo][abstract

La patogenia del Sarcoma de Ewing. Implicaciones de las Células Madre Mesenquimales y Nuevas Estrategias Terapéuticas

[ES]El Sarcoma de Ewing (SE) es un tumor maligno que afecta mayoritariamente a niños o adultos jóvenes. Dentro del grupo de sarcomas, después del osteosarcoma, es el que tiene peor pronóstico con una media de supervivencia del 30% en los casos metastásicos. A nivel molecular el SE se caracteriza por la presencia de una fusión génica entre el gen EWS y genes de la familia ETS principalmente FLI 1 (>90% casos) y ERG (5-10% casos . El producto de esta fusión es una proteína quimérica que actúa como factor de transcripción aberrante, desregulando ciertos genes tales como CD99 y genes relacionados con la ruta de IGF1R, entre otros genes. A nivel morfológico, las células de SE se caracterizan por la presencia de una elevada expresión del receptor de superficie CD99 en el 99% de las células. El tratamiento de primera línea se basa por regímenes multi-terapéuticos incluyendo quimioterapia con combinaciones de doxorubicina, vincristina, ifosfamida y etopósido, combinada con radioterapia y/o cirugía. Además en pacientes con tumores de mal pronóstico se han realizado varios ensayos clínicos con inhibidores de PARP, inhibidores de IGF1R y trasplante autólogo de células stem combinado con radioterapia, entre otros tratamientos. Todos estos estudios reflejan que la mejor estrategia terapéutica es el uso de de multi-tratamientos. En este sentido, estudios preclínicos, in vitro e in vivo han mostrado varias estrategias terapéuticas que podrían ser eficaces en el tratamiento de pacientes con SE de entre los cuales hay que destacar el bloqueo de las dianas clave en SE: la fusión génica, el eje IGF1-IGF1R y en segundo plano la sobre expresión de CD99.Este proyecto de tesis ha sido financiado por: - La Fundação para a Ciência e Tecnologia, Governo de Portugal, con el Proyecto: “The pathogenesis of Ewing Sarcoma: implications for novel treatment strategies” (SFRH/BD/69318/2010). - La Red de Excelencia de la Comunidad Europea EUROBONET, con el Proyecto Europeo “Molecular Pathology of Bone Tumors” (FP6-2004-Lifescihealth-5, 018814). - European Clinical trials in Rare Sarcomas within an integrated translational trial network (EUROSARC) FP7-HEALTH-2011-two-stage (Project ID 278742 Comisión Europea) - El Ministerio de Ciencia e Innovación, a través del Instituto de Salud Carlos III (RD12/0036/0017, RD06/0020/0059, PI1203102, PI1100018, PI081828, PI052524) -La Fundación Asociación Española Contra el Cáncer (AECC), con el proyecto “Búsqueda, validación y traslación clínica de nuevas dianas terapéuticas a partir de estudios de genómica y epigenómica integrativa en sarcoma de Ewing”. (GCB13131578DE Á

Progress in systemic therapy of advanced melanoma between 2011 and 2019

RESUMO: Contexto prévio: Há cerca de dez anos, os doentes diagnosticados com melanoma em estadio IV tinham um prognóstico reservado e uma sobrevivência muito curta. As terapêuticas então disponíveis, nomeadamente dacarbazina, temozolomida e outros citotóxicos, isoladamente ou em combinação com cirurgia e/ou radioterapia, não proporcionavam benefícios clínicos significativos. Na última década, a comunidade médica e científica testemunhou uma revolução no tratamento do melanoma em estadio IV com a introdução da imunoterapia, particularmente dos inibidores de checkpoint, e das terapêuticas alvo, nomeadamente dos inibidores da via da mitogen-activated protein cinase (MAPKi). Ambas as terapêuticas demonstraram benefícios sustentados em termos de sobrevivência global em doentes com melanoma metastizado. Nesta análise, pretendemos investigar se o aumento de sobrevivência global observado nos ensaios clínicos de fase II e III que levaram à aprovação destas terapêuticas, podem ou não ser reproduzidos em contexto de prática clínica diária. População incluída: Nesta análise retrospectiva, multicêntrica, incluímos doentes diagnosticados com melanoma estadio IV entre 2011 e 2018, e tratados no centro oncológico de Tuebingen, ou noutros centros da Alemanha, e documentados prospectivamente no Registo Central de Melanoma Maligno (CMMR) alemão. Os seguintes dados foram obtidos através do CMMR: ano de nascimento, sexo, data de diagnóstico do tumor primário, tipo histológico, localização anatómica, espessura, nível de clark, presença de ulceração, presença de regressão, data da biópsia do gânglio sentinela (se aplicável), presença de metástases no gânglio sentinela, estadio à data do primeiro diagnóstico, e data e localização da recidiva. Outros dados foram posteriormente recolhidos através da consulta do processo clínico: tipo de terapêutica local e sistémica em estadio IV e respectivas datas de início e fim, melhor resposta à terapêutica e respectiva data, de acordo com os critérios RECIST 1.1, data de progressão da doença, data do último contacto, e causa e data da morte. Todos os doentes incluídos foram seguidos durante, pelo menos, três meses. Análise estatística: A sobrevivência livre de progressão (PFS) foi definida como o tempo entre a data de diagnóstico em estadio IV, data de início da terapia sistémica, ou data do diagnóstico de metástases cerebrais, dependendo do tipo de população avaliada, e data de progressão da doença, data do último contacto ou data de óbito no caso dos doentes que não tiveram progressão. A sobrevivência global (OS) foi definida como o tempo entre a data do diagnóstico em estadio IV, data de início da terapia sistémica, ou data do diagnóstico de metástases cerebrais, dependendo do tipo de população avaliada, e data do último contacto ou data de óbito. Usámos estimativas de Kaplan-Meier para o cálculo da PFS e OS. As diferenças entre grupos foram avaliadas utilizando o teste de log-rank. Quando aplicável, foram calculados hazard ratios (HR) com intervalos de confiança de 95% (95% IC) para quantificar o impacto na sobrevivência. Quando aplicável, foram também utilizados modelos de regressão logística multivariada para avaliar associações entre variáveis. As associações entre variáveis foram consideradas estatisticamente significativas para valores de p < 0.05. Para a comparação indirecta entre os MAPKi, foi usado o método de Bucher. Todas as análises foram submetidas e aprovadas pelas Comissões de Ética locais. Resultados: Seis publicações incluindo dados de 3143 doentes diagnosticados com melanoma em estadio IV foram compiladas para a elaboração da presente tese. A taxa de OS aos 3 anos (3-y OS rate) para doentes tratados com quimioterapia em primeira linha, a terapêutica sistémica mais utilizada em 2011-2014 foi de 15.9% (95% CI: 8.8-23); para doentes tratados com imunoterapia em primeira linha no mesmo período, a 3- y OS rate foi de 37.4% (95% CI: 16.6-58.2). No período entre 2015-2018, a 3-y OS rate para doentes tratados com imunoterapia em primeira linha, quase que duplicou em comparação com o período de 2011-2014, e foi de 64.6% (95% CI: 53.2-76) para doentes com resposta completa, resposta parcial ou doença estável. Para doentes com resposta completa, a 3-y OS rate foi de 87.7% (95%CI: 70.8-100). Em doentes com mutação BRAFV600 e presença de factores de pior prognóstico, nomeadamente valores elevados de LDH à data de início de tratamento, ECOG PS reduzido e maior volume tumoral, a combinação vemurafenib/cobimetinib demostrou uma redução não significativa do risco de progressão ou morte em comparação com dabrafenib/trametinib, e encorafenib/binimetinib. Em comparação com o melanoma cutâneo, os doentes com melanoma ocular beneficiaram menos da terapia sistémica, mesmo quando tratados com nivolumab/ipilimumab. A sobrevivência global média (mOS) foi de apenas 16.1 meses (95% CI: 12.9-19.3), ainda assim mais elevada do que a reportada em doentes tratados com quimioterapia ou monoterapia com anti-PD-1. Em termos de sobrevivência global, o benefício da imunoterapia e das terapêuticas alvo na doença intracerebral foi semelhante ao observado na doença extracerebral. Isto foi particularmente verdade em doentes tratados com nivolumab/ipilimumab. A mOS foi de 19 meses (95% CI: 15.9-22.0) e a 3-y OS rate foi de 30.1% (95% CI: 22.2-37.9) Para os doentes com resposta completa, a 2-y OS rate foi de 85.6% (95% CI: 69.3-100), muito semelhante às taxas de sobrevivência observadas em outros doentes em estadio IV, sem metastização cerebral. Os doentes que receberam nivolumab/ipilimumab e terapêutica local (radiocirugia ou cirurgia) beneficiaram mais em comparação com os doentes que não receberam terapêutica local - a 2-y OS rate foi de 49.5% versus 40.9% (95% CI: 40.9-58.1 e 26.6-55.2). Este benefício foi observado independentemente do timing em que os doentes receberam terapêutica local, i.e., antes ou depois de iniciar nivolumab/ipilimumab. Conclusões: Os nossos dados da prática clínica diária confirmam uma melhoria em termos de sobrevivência global em doentes com melanoma em estadio IV, diagnosticados e tratados entre 2011-2019. Estes benefícios deveram-se à introdução de novas opções terapêuticas, nomeadamente imunoterapia com inibidores de checkpoint e terapêuticas alvo com MAKi. Os nossos resultados mostraram que actualmente, a imunoterapia com inibidores de checkpoint, deve ser oferecida em primeira linha em todos os doentes com melanoma em estadio IV. Em doentes com mutação BRAFV600 e com presença de factores de pior prognóstico, terapêutica com MAPKi pode igualmente ser considerada em primeira linha metastática. Em doentes com metastização cerebral, a combinação de terapia sistémica e local deve ser discutida e ponderada, em primeira linha ou posteriormente, sempre que viável.ABSTRACT: Background: Ten years ago, stage IV melanoma carried a dismal prognosis, with very short survival. The therapies available then, namely dacarbazine, temozolomide, and other chemotherapies, alone or in combination with surgery and/or radiotherapy, were unable to provide clinically significant benefit. In the last decade, the medical community testified a revolution in the treatment of advanced melanoma with the introduction of immune checkpoint inhibitors, and targeted therapy with mitogen-activated protein kinase inhibitors (MAPKi). Both therapies were able to provide sustainable overall survival benefits in stage IV melanoma. Here, we aimed to investigate whether the survival advantages seen in phase II, and III clinical trials investigating the afore mentioned therapies, were reproducible or not in a real-world setting. Patients and methods: In this retrospective, multicentric analysis, we included stage IV melanoma patients, diagnosed between 2011 and 2018, treated in the skin cancer center in Tuebingen, or in other German centers, and prospectively documented in the German Central Malignant Melanoma Registry (CMMR). The following patients’ and tumor data were collected from the CMMR: year of birth, gender, date of primary tumor diagnosis, type of melanoma, localization, tumor thickness, Clark level, presence of ulceration, presence of regression, date of sentinel lymph node biopsy (if applicable), presence of lymph node metastases, stage at first diagnosis and date and localization of recurrence. The following variables were further included, based on patients’ clinical chart review: date and type of local and systemic therapy in stage IV, date and type of best overall response, according to the Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST 1.1), date of progressive disease, date of last contact, cause of death, and death date. Patients included had a minimum follow-up of three months. Progression free survival (PFS) was defined as the time between date of stage IV diagnosis, start date of systemic therapy, or date of melanoma brain metastases (MBM) diagnosis, depending on the type of population evaluated, and date of progressive disease, or last contact or death, for the patients that didn’t progress. Overall survival (OS) was defined as the time between stage IV diagnosis, start date of systemic therapy, or date of MBM diagnosis, depending on the type of population evaluated, and date of last contact or death. Kaplan-Meier estimates were used for the calculation of PFS and OS. Differences between groups were assessed using the log-rank test. When applicable, hazard ratios (HR) with 95% confidence intervals (CI) were calculated to quantify the impact on survival. Multivariate logistic regression models were used to examine associations between variables, when appropriate. Results were reported as two-sided p values with 95% CIs. All p-values presented are two-sided tests of statistical significance at 0.05. For the indirect comparison between MAPKi, the Bucher method was used. All analyses were submitted to and approved by the local Ethics Committee. Results: Six publications reporting data from 3143 stage IV melanoma patients were included in this thesis. The 3-years (3-y) OS rate for patients treated with first-line chemotherapy, the most used systemic therapy in 2011-2014 was 15.9% (95% CI: 8.8-23). For patients treated with first-line immunotherapy in the same period, the 3-y OS rate was 37.4% (95% CI: 16.6-58.2). In the period of 2015-2018, the 3-y OS rate for patients treated with first-line immunotherapy almost duplicated compared to the 2011-2014 period, and was 64.6% (95% CI: 53.2–76) for patients achieving a complete response (CR), partial response (PR) or stable disease (SD). For patients achieving a CR, the 3-y OS rate was 87.7% (95% CI: 70.8–100). In patients harboring a BRAFV600 mutation, and with presence of worse prognostic factors, namely elevated baseline lactate dehydrogenase (LDH), worse Eastern Cooperative Oncology Group Performance Status (ECOG PS) and higher tumor volume, the combination of vemurafenib plus cobimetinib showed a non-significant lower risk for progression or death, compared to dabrafenib plus trametinib, and encorafenib plus binimetinib. Compared to cutaneous melanoma, patients with uveal melanoma derived less benefit from systemic therapy, even when treated with combined immunotherapy. The median OS (mOS) was only 16.1 months (95% CI: 12.9–19.3), but still higher than those reported for both chemotherapy and programmed cell death protein 1 (PD-1) monotherapy in this sub-group. The benefit observed in intracerebral disease was similar to the benefit in extracerebral disease, when combined immunotherapy (nivolumab plus ipilimumab) was used. The mOS in patients with MBM was 19 months (95% CI: 15.9-22.0). For the whole collective of patients receiving nivolumab plus ipilimumab, the 3-y OS rate was 30.1% (95% CI: 22.2-37.9). For patients achieving a CR, the 2-y OS rate was 85.6% (95%CI: 69.3-100), very similar to other stage IV patients. Patients receiving combined immunotherapy and local therapy (surgery or stereotactic radiotherapy) had a better outcome when compared to patients that didn’t receive local therapy – the 2-y OS rate was 49.5% versus 40.9 % (95%CI: 40.9-58.1 and 26.6-55.2). This benefit was observed regardless the timing of local therapy, i.e., before or after starting nivolumab plus ipilimumab. Conclusions: Our real-world data confirmed the improvement of survival outcomes in stage IV melanoma patients with the introduction of immune checkpoint inhibitors, and MAPKi in the last decade. Results show that, currently, PD-1 based immunotherapy should be offered as first-line therapy in stage IV melanoma. In patients with BRAFV600 mutation and worse prognostic features, first-line systemic therapy with MAPKi could be considered. In patients with MBM, combination of systemic immunotherapy and local therapy should be offered, when feasible

A new sense for living: a comprehensive study about the adaptation process following spinal cord injuries

Este estudo teve como finalidade explorar e descrever o fenómeno de adaptação após lesão medular, enfatizando a explicação das estratégias de adaptação adotadas, e procurando identificar as implicações que têm nos cuidados de enfermagem. A metodologia utilizada foi a Qualitativa, tendo como referência metodológica a Grounded Theory. Para tal, foi dada voz ativa a nove indivíduos que sofreram lesão medular, com um percurso de adaptação de sucesso à nova condição, utilizando a entrevista semidirigida. Foi efetuada também análise documental de alguns relatos de vida, partindo para a análise dos dados à luz da Grounded Theory. Foi possível explicar o fenómeno de adaptação após lesão medular, sendo evidenciada a influência do encontro com um novo sentido da vida, na manutenção da disposição para gerir as consequências que advêm do confronto com uma lesão medular. O tema central do estudo prende-se assim com a dimensão espiritual da pessoa, o que antevê uma intervenção de enfermagem específica nesta área, junto do indivíduo após lesão medular.Este estudio tuvo como finalidad explorar y describir el fenómeno de adaptación después de una lesión medular, enfatizando la explicación de las estrategias de adaptación utilizadas y buscando identificar las implicaciones que tienen en los cuidados de enfermería. La metodología utilizada fue la Cualitativa, teniendo como referencia metodológica la Grounded Theory. Para esto, fue dada voz activa a nueve individuos que sufrieron lesión medular, que atravesaron un período de adaptación con éxito en la nueva condición, utilizando la entrevista semiestructurada. Fue efectuado también un análisis documental de algunos relatos de vida, partiendo para el análisis de los datos a la luz de la Grounded Theory. Fue posible explicar el fenómeno de adaptación después de una lesión medular, colocando en evidenciada la influencia del encuentro con un nuevo sentido de la vida, en la manutención de la disposición para administrar las consecuencias que advienen del enfrentar una lesión medular. El tema central del estudio está relacionado con la dimensión espiritual de la Persona, lo que permite una intervención de enfermería específica en esta área, junto al individuo después de una lesión medular.The present study explores and describes the adaptation phenomena following spinal cord injury, focusing on the applied strategies of adaptation and identifying the necessary nursing care. The research used a qualitative approach, applying the Grounded Theory as a methodological reference. A group of nine individuals who had spinal cord injuries, and who presented a successful adaptation to a new way of life, was assessed by means of semi-directed interviews. Documentary analyses about life histories were performed and the Grounded Theory was used for data analyses. The study allowed for the explanation of the adaptation phenomena following the event of the spinal cord injury, which highlighted the influence of the acceptance of a new meaning of life and the maintenance of the will to manage new situations and challenges stemming from the injury. The central subject of this study is the spiritual dimension of the Individual. This anticipates a specific nursing intervention for people suffering from spinal cord injuries

Nutritional risk and survival in cancer patients undergoing percutaneous Endoscopic Gastrostomy in the Instituto Português de Oncologia do Porto Francisco Gentil, EPE.

[resumo][abstract

Risco nutricional e desnutrição em doentes com cancro do pulmão não pequenas células

[resumo][abstract

The Good, the Bad and the Ugly: Food Quality in UGC

AbstractUser-generated content diffusion on social networks has triggered an explosive attention in various disciplines. Within tourism activities, social media has growth in the past years rapidly through regular social network sites, or thematic social network sites such as TripAdvisor. The present study aims to provide a deeper insight into this matter, having as starting point the thought that clients posts good or bad reviews, regarding to different aspects of their experience; and, that a client who has a good experience in restaurant tends to revisit it and recommended it to friends, as opposite if the experience was bad they tell this to friend and recommend not visit. To assess customers’ reviews of restaurants, data was gathered on TripAdvisor of Top 10 restaurants in two island context Azores and Hawaii. All the comments were studied carefully and categorized in set of dimensions that measured how the entirety of a meal was perceived: sight, hearing, smell, taste and touch. As the results showed, food is the most decisive variable adopted in the UGC. Additionally, our findings support the notion that the overall quality of the meal reflects a lot more than flavor or taste of the food. To these elements, we need to add visual effect, freshness of the ingredients, and healthiness of the meal, among others as main contents spread on SNS. Thus, results reinforce the literature relative to the social media and ads to the knowledge of the contents created and shared by tourists relative to restaurant experience as a whole

A competency definition based on the knowledge, skills, and human dispositions constructs

The competency-based learning approach arose from the Bologna signed declaration. However, a competency definition has never been easy and has been evolving and adapted over time, from indicators and learning goals to learning outcomes, which were formulated in terms of competencies. Meanwhile, the competency concept becomes discussed by pears, in particular, associating knowledge, skills, and human dispositions or attitudes into the competency defi-nition. This information will be an essential update to the previous approaches and certainly contribute to achieving more accurate and reliable competencies information for employers and higher education institutions (HEI). This paper aims to reinforce the relevance of these concepts and suggest how each construct of “knowledge, skills and human dispositions” could be approached to formulate a competency. In addition, due to accelerated digital transformation, an example of a digital competency defined by the DigComp 2.0 framework, with proposed information regarding each of the three constructs, will be presented to consoli-date this challenge. As future work, it is intended to analyze the eight different levels, and competency profiles defined by the European Qualification Frame-work (EQF) and assign a profile to each defined competency. In the end, it is expected altogether to contribute to achieving a competency roadmap definition.FCT -Fundação para a Ciência e a Tecnologia (UIDB/00319/2020

AcademiaUP: Empowering Distance Education at University of Porto

In recent years, there has been a growing demand for online. University of Porto (U.Porto), established an unit of Educational Technologies 20 years ago and after an accumulated experience in providing an Learning Management Systems (LMS) to support face-to-face teaching and learning (T&L), in 2016, the U.Porto developed AcademiaUP, a portal and a LMS platform for the delivery of e-learning and blended learning courses. Based on LMS Moodle, AcademiaUP considers the specificities of deployment and creation of distance education contents and materials, as well as the target audience characteristics. Moodle was chosen because our acquired experience but also for its maturity, for being open source and fully customizable and for a large support community.AcademiaUP, has an extensively customized interface and technical infrastructure. It integrates with external tools, BigBlueButton to better respond to synchronous online communication and Panopto for lecture capture and video production. AcademiaUP uses new plugins and a new theme to improve usability and enable a more suitable navigation for formal and non-formal T&L environments - sequential content delivery and contextual presentation of activities and resources. When designing the new LMS for AcademiaUP we were inspired in Coursera Massive Open Online Courses (MOOC) approach for the marketing of the courses and in Open2Study for the delivering of the courses. All changes, however, avoided altering Moodle's core code, allowing for easier upgrades whenever newer Moodle versions are available.For the future, we intend to integrate AcademiaUP with the University information system to improve consistency of courses and users essential to accreditation procedures and quality assurance