How to break access control in a controlled manner

The Electronic Medical Record (EMR) integrates heterogeneous information within a Healthcare Institution stressing the need for security and access control. The Biostatistics and Medical Informatics Department from Porto Faculty of Medicine has recently implemented a Virtual EMR (VEMR) in order to integrate patient information and clinical reports within a university hospital. With more than 500 medical doctors using the system on a daily basis, an access control policy and model were implemented. However, the healthcare environment has unanticipated situations (i.e. emergency situations) where access to information is essential. Most traditional policies do not allow for overriding. A policy that allows for Break-The-Glass (BTG) was implemented in order to override access control whilst providing for non-repudiation mechanisms for its usage. The policy was easily integrated within the model confirming its modularity and the fact that user intervention in defining security procedures is crucial to its successful implementation and use

Survival analysis of mortality and development of lupus nephritis in patients with systemic lupus erythematosus up to 40-years of follow-up

OBJECTIVES: Patients with systemic lupus erythematosus (SLE) have increased mortality compared with age and sex-matched controls. Lupus nephritis (LN) is a severe manifestation of SLE and an important cause of death. We carried out a retrospective survival analysis to investigate factors that could influence risk of mortality and LN in a large multi-ethnic cohort of patients with SLE. METHODS: By careful review of medical records, we identified 496 patients with SLE for whom we had complete information regarding period of observation and occurrence of death and nephritis. Patients were stratified into groups according to sex, ethnicity, age at start of follow-up and time-period of diagnosis. Kaplan-Meier analysis was used to investigate differences between the groups. RESULTS: Of 496 patients in the study, 91(18.3%) died, 165(33.3%) developed LN and 33(6.7%) developed end-stage renal failure. There was no difference between men and women in either mortality or development of LN. Caucasian patients were significantly less likely to develop LN than other ethnic groups (p< 0.0001) but not less likely to die. Patients diagnosed before the median age of 28 years were significantly more likely to develop LN (p< 0.0001) but significantly less likely to die (p= 0.0039) during the period of observation. There has been a significant improvement in survival between patients diagnosed between 1978-1989 and those diagnosed between 2006-11 (p= 0.019). CONCLUSION: In our cohort, non-Caucasian ethnicity and younger age at diagnosis are associated with risk of developing LN. There is evidence of improvement in survival of patients with SLE over time

Formigas associadas aos pulgões Cinara spp (wilson, 1919) em plantios de Pinus taeda, no sul do Brasil.

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Neoplasia Blástica de Células Dendríticas Plasmocitóides

Blastic plasmacytoid dendritic cell neoplasm is a rare and aggressive hematodermic neoplasia with frequent cutaneous involvement and leukemic dissemination. We report the case of a 76-year-old man with a 2 month history of violaceous nodules and a tumor with stony consistency, located on the head, and mandibular, cervical and supraclavicular lymphadenopathies. Multiple thoracic and abdominal adenopathies were identified on computerized tomography. Flow cytometry analysis of the skin, lymph node and bone marrow biopsies demonstrated the presence of plasmocytoid dendritic cell neoplastic precursor cells (CD4+, CD45+, CD56+ and CD123+ phenotype). After initial clinical and laboratorial complete remission with chemotherapy, the patient died due to relapse of the disease associated with the appearance of a cervical mass with medullary compromise

Total plaque area and plaque echogenicity are novel measures of subclinical atherosclerosis in patients with systemic lupus erythematosus

OBJECTIVES: Patients with systemic lupus erythematosus (SLE) have an increased risk of developing cardiovascular disease (CVD). Multiple studies have shown that these patients have increased numbers of carotid plaques and greater intima-media thickness (IMT) than healthy controls. Measures such as total plaque area (TPA) and plaque echogenicity may be more sensitive and more relevant to cardiovascular risk than presence of plaque and IMT alone. Our objective was to produce the first report of TPA and echogenicity in a population of. PATIENT: s with SLE. METHODS: One hundred patients with SLE and no history of clinical CVD were recruited. Clinical, serological and treatment variables were recorded and serum was tested for antibodies to apolipoprotein A-1 and high-density lipoprotein. Both carotid and both femoral artery bifurcations of each patient were scanned to determine IMT, TPA and echogenicity of plaques. Univariable and multivariable statistical analyses were carried out to define factors associated with each of these outcomes. RESULTS: Thirty-six patients had carotid and/or femoral plaque. Increasing age was associated with presence of plaque and increased IMT. Triglyceride levels were associated with presence of plaque. Mean (SD) TPA was 60.8 (41. 6) mm2. Patients taking prednisolone had higher TPA. Most plaques were echolucent but increased echogenicity was associated with prednisolone therapy and persistent disease activity. CONCLUSION: TPA and plaque echogenicity in patients with SLE are associated with different factors than those associated with presence of plaque and IMT. Longitudinal studies may show whether these outcome measures add value in the management of cardiovascular risk in SLE

Influence of Dissolved Oxygen Level on Chitin–Glucan Complex and Mannans Production by the Yeast Pichia pastoris

LA/P/0140/2020The yeast Pichia pastoris was cultivated under different dissolved oxygen (DO) levels (5, 15, 30 and 50% of the air saturation) to evaluate its impact on the production of the cell-wall polysaccharide chitin–glucan complex (CGC) and mannans. Decreasing the DO level from 50 to 15% had no significant impact on cell growth but substrate conversion into biomass was improved. Under such conditions, a mannans content in the biomass of 22 wt% was reached, while the CGC content in the biomass was improved from 15 to 18 wt%, confirming that the DO level also impacted on P. pastoris cell-wall composition. Overall mannans and CGC volumetric productivity values of 10.69 and 8.67 g/(L. day) were reached, respectively. On the other hand, the polymers’ composition was not significantly affected by decreasing the DO level. These results demonstrated that considerable energy savings can be made in the polysaccharide production process by reducing the DO level during cultivation of P. pastoris by improving the overall polymers’ productivity without altering their composition. This has impact on the polysaccharide production costs, which is of considerable relevance for process scale-up and products’ commercialization.publishersversionpublishe

Le magmatisme terminal de la chaîne hercynienne : signification géodynamique d'une association magmatique identifiée dans le Carbonifère terminal du Massif Hercynien Central Marocain

Na parte oriental do Maciço Hercínico Central de Marrocos afloram alguns filões intercalados em formações do Carbónico superior do Sudeste da bacia de Azrou-Kénifra. Estes filões instalaram-se paralelamente à estratificação e foram deformados por dobramentos associados aos cavalgamentos que controlaram a sedimentação, o que demonstra o seu carácter sintectónico. A sua composição química permitiu distinguir dois tipos de sequências magmáticas sobrepostas nas séries de Tariwalt e Talgarat, respectivamente de idades V3b e Namuriano-V3c, provável. A primeira inclui rochas básicas de carácter transicional e afinidade alcalina, enquanto a segunda possui uma assinatura calco-alcalina. Estas sequências magmáticas apresentam estreitas semelhanças petrográficas e geoquímicas com as que ocorrem em ambientes de margem activa. As assinaturas geoquímicas e a evolução magmática destas rochas são compatíveis com os dados tectono-sedimentares que caracterizam a bacia de Azrou-Kénifra como uma bacia desenvolvida em regime compressivo, integrada num sistema de "avant pays" determinado por sequências de cavalgamentos propagando-se para NW

Reverse osmosis powered by concentrating solar power (CSP): a case study for Trapani, Sicily

The objective of this paper is to analyse the physical performance of two technologies in a water and electricity co-generation scheme: Concentrated Solar Power (CSP) plant coupled to a Reverse Osmosis (RO) unit for a location in the city of Trapani, in southern Italy. The modelled system is compared with the results of another study [2], in which a Multi-Effect Desalination (MED) is powered by a CSP plant for the same location in Italy, using as reference an existing stand-alone gas powered MED plant located at Trapani [3] (which has operated until very recently). The overall aim is to assess and compare these two cogeneration schemes, using as reference the existing MED plant. This work was conducted using as the main simulation tool: the System Advisor Model (SAM) developed by the US National Renewable Energy Laboratory (NREL); a recent upgrade to SAM made available to this work through Laboratório Nacional de Energia e Geologia I.P. (LNEG); and the Reverse Osmosis System Analysis (ROSA) developed by the Dow Chemical Company. A technical visit to a real commercial RO plant in the south of Portugal (Alvor) was conducted, and the data gathered was used in the validation of the ROSA model. The results for the Trapani case study show that the CSP-RO arrangement has the capability to produce ~50% of the total production of the full scale plant at Trapani, if operated at nominal capacity, year round. Also, the CSP-RO system provides ~20% more electricity and water than the CSP-MED system throughout the studied period of one year. The two co-generation schemes provide promising potential to fight the issues related to fresh water shortages and dependency on fossil fuelled desalination. Thus, they can aid in decreasing the effects associated with CO2 emissions and climate change