System for surgical block schedule optimization

Proper distribution and utilization of operating rooms is one of the biggest factors when combating the ever growing waiting lists for surgical interventions. In this ecosystem, the incorrect prediction of a procedure’s duration will imply the remaining scheduled procedures, further more when this prediction is an underestimation. This problem is is exacerbated by the sheer amount of different interventions with their specificities and conditions. Tackling this question, we developed an application running along side the main surgery schedule of Centro Hospitalar de São João, in charge of applying regression algorithms to better calculate the expected surgery duration. With these, we were able to apply a scheduling algorithm that produces a viable surgery table. Our final implementation was able to work independently of human interaction, producing a possible alternative to the manual methods common on these situations.A distribuição e utilização adequada dos blocos operatórios é um dos principais fatores quando se visa diminuir o constante aumento das listas de espera para intervenções cirúrgicas. Neste ecossistema, uma má previsão da duração de um procedimento trará problemas na restante calendarização dos procedimentos, ainda mais quando esta previsão é menor que o tempo real de cirurgia. A resolução deste problema é exacerbada pela quantidade de diferentes intervenções, com as suas especificidades e condições. Para fazer face a esta questão, desenvolvemos uma aplicação que corre ao lado do calendário principal do Centro Hospitalar de São João, encarregado de aplicar algoritmos de regressão para melhorar o calculo da duração da cirurgia. A nossa implementação final foi capaz de trabalhar independentemente da interação humana, produzindo uma alternativa apossável aos métodos manuais comuns nestas situações

A Case Study for Decentralized Heat Storage Solutions in the Agroindustry Sector Using Phase Change Materials

The development of thermal energy storage solutions (TES) in agroindustry allows reduction of production costs and improvement of operation sustainability. Such solutions require high storage capacity and the ability to adapt to existing equipment. The use of phase change materials (PCMs), which are able to store thermal energy as latent heat, creates new opportunities for heat storage solutions (LHS, latent heat storage) with higher energy density and improved performance when compared to sensible heat storage. New architectures are envisaged where heat storage is distributed throughout the production chain, creating prospects for the integration of renewable generation and recovery of industrial heat waste. This work aims to investigate the benefits of decentralized thermal storage architecture, directly incorporating PCM into the existing equipment of an agroindustry production line. To assess the feasibility and potential gain in the adoption of this TES/LHS distributed solution, a tempering and mixing equipment for food granules is selected as a case study, representing a larger cluster operating under the operation paradigm of water jacket heating. The behavior of the equipment, incorporating an inorganic PCM, is modeled and analyzed in the ANSYS Fluent software. Subsequently, a prototype is instrumented and used in laboratory tests, allowing for data collection and validation of the simulation model. This case study presents a demonstration of the increase in storage capacity and the extension of the discharge process when compared to a conventional solution that uses water for sensible heat storage.publishersversionpublishe

Parasitas Pulmonares em Pequenos Ruminantes: Mais Conhecimento, Melhor Diagnóstico

A pneumonia parasitária por nematodes da superfamília Trichostrongyloidea e Metastrongyloidea, também conhecida como estrongilose pulmonar, apresenta elevada prevalência nalgumas regiões geográficas, mas tem merecido pouca atenção por parte dos Médicos Veterinários e investigadores [1,2]. Os estudos de prevalência disponíveis assentam predominantemente na deteção de lesões pulmonares em matadouro e no diagnóstico in vivo, com recurso à técnica de Baermann. No entanto, a velocidade de processamento das carcaças no matadouro limita substancialmente a probabilidade de deteção de lesões características de estrongilose e a técnica de Baermann, apesar de ser considerada a gold standard para diagnóstico in vivo, apresenta uma sensibilidade que não ultrapassa os 90%, é demorada e exige conhecimentos técnicos para a sua correta execução [3,4,5]. Em Portugal, do ponto de vista clínico, estas parasitoses são subdiagnosticadas, na medida em que a pesquisa de parasitas pulmonares raramente é incluída nos testes parasitológicos de rotina, requisitados pelos Médicos Veterinários aos laboratórios [6], o que, associado à escassez de investigação científica na área, cria uma lacuna no conhecimento da distribuição geográfica e de outros aspetos da epidemiologia destas infeções, comprometendo o seu tratamento e controlo. Apesar da desparasitação regular (anual ou bianual) de pequenos ruminantes estar amplamente instituída, alguns princípios ativos frequentemente utilizados para o controlo de parasitas gastrointestinais são pouco eficazes nos nematodes pulmonares, particularmente nalgumas espécies da família Protostrongylidae, pelo que a abordagem terapêutica deve ser integrada e assente no diagnóstico parasitológico prévio. Assim, este trabalho, assente na revisão da bibliografia disponível e na experiência prática dos técnicos e investigadores do Laboratório de Anatomia Patológica da Escola Superior Agrária de Viseu (LAP, ESAV) e do Laboratório de Parasitologia Victor Caeiro da Universidade de Évora (LPVC, UE), pretende sensibilizar os profissionais de saúde animal e investigadores dedicados aos pequenos ruminantes para as infeções por nematodes pulmonares, fornecendo ainda ferramentas de diagnóstico laboratorial acessíveis e orientações para a abordagem terapêutica e profilática.info:eu-repo/semantics/publishedVersio

Viral genetic clustering and transmission dynamics of the 2022 mpox outbreak in Portugal

Pathogen genome sequencing during epidemics enhances our ability to identify and understand suspected clusters and investigate their relationships. Here, we combine genomic and epidemiological data of the 2022 mpox outbreak to better understand early viral spread, diversification and transmission dynamics. By sequencing 52% of the confirmed cases in Portugal, we identified the mpox virus sublineages with the highest impact on case numbers and fitted them into a global context, finding evidence that several international sublineages probably emerged or spread early in Portugal. We estimated a 62% infection reporting rate and that 1.3% of the population of men who have sex with men in Portugal were infected. We infer the critical role played by sexual networks and superspreader gatherings, such as sauna attendance, in the dissemination of mpox virus. Overall, our findings highlight genomic epidemiology as a tool for the real-time monitoring and control of mpox epidemics, and can guide future vaccine policy in a highly susceptible population.info:eu-repo/semantics/publishedVersio

Familial hypercholesterolaemia in children and adolescents from 48 countries: a cross-sectional study

Background: Approximately 450 000 children are born with familial hypercholesterolaemia worldwide every year, yet only 2·1% of adults with familial hypercholesterolaemia were diagnosed before age 18 years via current diagnostic approaches, which are derived from observations in adults. We aimed to characterise children and adolescents with heterozygous familial hypercholesterolaemia (HeFH) and understand current approaches to the identification and management of familial hypercholesterolaemia to inform future public health strategies. Methods: For this cross-sectional study, we assessed children and adolescents younger than 18 years with a clinical or genetic diagnosis of HeFH at the time of entry into the Familial Hypercholesterolaemia Studies Collaboration (FHSC) registry between Oct 1, 2015, and Jan 31, 2021. Data in the registry were collected from 55 regional or national registries in 48 countries. Diagnoses relying on self-reported history of familial hypercholesterolaemia and suspected secondary hypercholesterolaemia were excluded from the registry; people with untreated LDL cholesterol (LDL-C) of at least 13·0 mmol/L were excluded from this study. Data were assessed overall and by WHO region, World Bank country income status, age, diagnostic criteria, and index-case status. The main outcome of this study was to assess current identification and management of children and adolescents with familial hypercholesterolaemia. Findings: Of 63 093 individuals in the FHSC registry, 11 848 (18·8%) were children or adolescents younger than 18 years with HeFH and were included in this study; 5756 (50·2%) of 11 476 included individuals were female and 5720 (49·8%) were male. Sex data were missing for 372 (3·1%) of 11 848 individuals. Median age at registry entry was 9·6 years (IQR 5·8-13·2). 10 099 (89·9%) of 11 235 included individuals had a final genetically confirmed diagnosis of familial hypercholesterolaemia and 1136 (10·1%) had a clinical diagnosis. Genetically confirmed diagnosis data or clinical diagnosis data were missing for 613 (5·2%) of 11 848 individuals. Genetic diagnosis was more common in children and adolescents from high-income countries (9427 [92·4%] of 10 202) than in children and adolescents from non-high-income countries (199 [48·0%] of 415). 3414 (31·6%) of 10 804 children or adolescents were index cases. Familial-hypercholesterolaemia-related physical signs, cardiovascular risk factors, and cardiovascular disease were uncommon, but were more common in non-high-income countries. 7557 (72·4%) of 10 428 included children or adolescents were not taking lipid-lowering medication (LLM) and had a median LDL-C of 5·00 mmol/L (IQR 4·05-6·08). Compared with genetic diagnosis, the use of unadapted clinical criteria intended for use in adults and reliant on more extreme phenotypes could result in 50-75% of children and adolescents with familial hypercholesterolaemia not being identified. Interpretation: Clinical characteristics observed in adults with familial hypercholesterolaemia are uncommon in children and adolescents with familial hypercholesterolaemia, hence detection in this age group relies on measurement of LDL-C and genetic confirmation. Where genetic testing is unavailable, increased availability and use of LDL-C measurements in the first few years of life could help reduce the current gap between prevalence and detection, enabling increased use of combination LLM to reach recommended LDL-C targets early in life

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

A multi-country test of brief reappraisal interventions on emotions during the COVID-19 pandemic.

The COVID-19 pandemic has increased negative emotions and decreased positive emotions globally. Left unchecked, these emotional changes might have a wide array of adverse impacts. To reduce negative emotions and increase positive emotions, we tested the effectiveness of reappraisal, an emotion-regulation strategy that modifies how one thinks about a situation. Participants from 87 countries and regions (n = 21,644) were randomly assigned to one of two brief reappraisal interventions (reconstrual or repurposing) or one of two control conditions (active or passive). Results revealed that both reappraisal interventions (vesus both control conditions) consistently reduced negative emotions and increased positive emotions across different measures. Reconstrual and repurposing interventions had similar effects. Importantly, planned exploratory analyses indicated that reappraisal interventions did not reduce intentions to practice preventive health behaviours. The findings demonstrate the viability of creating scalable, low-cost interventions for use around the world

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P < 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

Viral genetic clustering and transmission dynamics of the 2022 mpox outbreak in Portugal.

Acknowledgements: We gratefully acknowledge the engagement and willingness of all participants to share information critical to the investigation. We are grateful to the authors and laboratories that originated and submitted the genetic sequences released in GenBank. The acquisition of equipment associated with whole-genome sequencing used in this study (including the Illumina NextSeq 2000) was funded by the HERA (Human and Environmental Risk Assessment) project (Grant/2021/PHF/23776), supported by the European Commission through the European Centre for Disease Prevention and Control (ECDC), and partially funded by the GenomePT project (POCI-01-0145-FEDER-022184), supported by COMPETE 2020 (Operational Programme for Competitiveness and Internationalisation (POCI)), Lisboa Portugal Regional Operational Programme (Lisboa2020), Algarve Portugal Regional Operational Programme (CRESC Algarve2020) under the PORTUGAL 2020 Partnership Agreement through the European Regional Development Fund (ERDF), and by the Portuguese Science and Technology Foundation (FCT). This study was also supported by the ERINHA-Advance project (funded by the European Union’s Horizon 2020 Research & Innovation program, grant agreement no. 824061) and benefited from co-funding from the European Union’s Horizon 2020 Research and Innovation programme under grant agreement no. 773830 (One Health European Joint Programme), in particular by the co-funding of the post-doctoral fellowships of J.S.D. and V.M. and the development of INSaFLU. We also thank M. Pinheiro (iBiMED at the Universidade de Aveiro) for his continuous support in updating the INSaFLU platform and the Infraestrutura Nacional de Computação Distribuída (INCD) for providing computational resources for testing it. INCD was funded by the FCT and FEDER under the project 22153-01/SAICT/2016. M.P.D. is funded by the Gates Cambridge Scholarship (no. OPP1144). The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript. The GAT-Intendente team also thanks A. Vasques, L. Fortuna, J. Moreira, I. Correia and Á. Baginha.Pathogen genome sequencing during epidemics enhances our ability to identify and understand suspected clusters and investigate their relationships. Here, we combine genomic and epidemiological data of the 2022 mpox outbreak to better understand early viral spread, diversification and transmission dynamics. By sequencing 52% of the confirmed cases in Portugal, we identified the mpox virus sublineages with the highest impact on case numbers and fitted them into a global context, finding evidence that several international sublineages probably emerged or spread early in Portugal. We estimated a 62% infection reporting rate and that 1.3% of the population of men who have sex with men in Portugal were infected. We infer the critical role played by sexual networks and superspreader gatherings, such as sauna attendance, in the dissemination of mpox virus. Overall, our findings highlight genomic epidemiology as a tool for the real-time monitoring and control of mpox epidemics, and can guide future vaccine policy in a highly susceptible population