Palácio Nacional de Mafra e Turismo Cultural: Uma Análise Netnográfica da sua Imagem de Marca

Em 2017, o Palácio Nacional de Mafra celebra 300 anos. Pela sua relevância como monumento nacional e símbolo da História de Portugal, distingue-se culturalmente como um destino de excelência. A sua ligação ao romance de José Saramago, «Memorial do Convento», assim como o seu incontornável valor patrimonial, contribuíram como elementos fundamentais para a determinação do presente estudo, que visa analisar os atributos da imagem de marca do Palácio pelos traços das associações de memória percecionados pelos visitantes. É com este propósito, no âmbito do turismo cultural e literário, que a nossa investigação levou a efeito esta pesquisa através da netnografia e da análise de conteúdo com base no modelo de associações de memória da imagem de marca de Keller, trabalhando com os comentários recolhidos no site TripAdvisor entre setembro de 2015 e outubro de 2016. Os principais resultados do tipo e da natureza das associações são positivos, fortes e, na sua maioria, favoráveis. Apesar da existência de pontos fracos e desfavoráveis – expectáveis –, existe também um leque de opiniões mistas. Com base nos resultados, são apresentadas propostas para a gestão da imagem de marca e dos meios de comunicação do Palácio Nacional de Mafra como local de atração turística do ponto de vista cultural e literário

Técnica para diagnosticar o ceratocone

PURPOSE: To test whether corneal hysteresis (CH) and corneal resistance factor (CRF) can discriminate between keratoconus and normal eyes and to evaluate whether the averages of two consecutive measurements perform differently from the one with the best waveform score (WS) for diagnosing keratoconus. METHODS: ORA measurements for one eye per individual were selected randomly from 53 normal patients and from 27 patients with keratoconus. Two groups were considered the average (CH-Avg, CRF-Avg) and best waveform score (CH-WS, CRF-WS) groups. The Mann-Whitney U-test was used to evaluate whether the variables had similar distributions in the Normal and Keratoconus groups. Receiver operating characteristics (ROC) curves were calculated for each parameter to assess the efficacy for diagnosing keratoconus and the same obtained for each variable were compared pairwise using the Hanley-McNeil test. RESULTS: The CH-Avg, CRF-Avg, CH-WS and CRF-WS differed significantly between the normal and keratoconus groups (p<0.001). The areas under the ROC curve (AUROC) for CH-Avg, CRF-Avg, CH-WS, and CRF-WS were 0.824, 0.873, 0.891, and 0.931, respectively. CH-WS and CRF-WS had significantly better AUROCs than CH-Avg and CRF-Avg, respectively (p=0.001 and 0.002). CONCLUSION: The analysis of the biomechanical properties of the cornea through the ORA method has proved to be an important aid in the diagnosis of keratoconus, regardless of the method used. The best waveform score (WS) measurements were superior to the average of consecutive ORA measurements for diagnosing keratoconus.OBJETIVO: Testar se a histerese corneana (CH) e o fator de resistência corneano (CRF) podem discriminar olhos com ceratocone e avaliar se a média de duas medidas consecutivas apresenta desempenho diferente da medida única com a melhor waveform score para diagnósticar o ceratocone. MÉTODOS: Foram realizadas medidas do ORA de um olho por indivíduo, selecionados aleatoriamente a partir de 53 pacientes normais e de 27 pacientes com ceratocone. Dois grupos foram considerados: a média (CH-médio, o CRF-médio) e melhor waveform score (CH-WS, CRF-WS). O teste de Mann-Whitney U-teste foi utilizado para avaliar se as variáveis apresentaram distribuições semelhantes entre os grupos. As curvas (ROC) foram calculadas para cada parâmetro para avaliar eficácia no diagnóstico e as obtidas para cada variável foram comparadas usando o teste de Hanley-McNeil. RESULTADOS: CH-médio, CRF-médio, CH-WS e CRF-WS diferiram significativamente entre os grupos (p<0,001). Já as áreas sob a curva ROC para CH-médio, CRF-médio, CH-WS, e CRF-WS foram 0,824, 0,873, 0,891, 0,931, respectivamente. CH-WS e CRF-WS obtiveram AUROCs significativamente melhores do que CH-médio e CRF-médio (p=0,001 e 0,002). CONCLUSÃO: A análise das propriedades biomecânicas da córnea através do ORA demonstrou ser um método auxiliar importante no diagnóstico de ceratocone, independente do método utilizado. As melhores medidas waveform score foram superiores à média das medições consecutivas para o diagnóstico de ceratocone.Universidade Federal de São Paulo (UNIFESP) Department for ophthalmologyHospital de Olhos de SergipeRio de Janeiro Corneal Tomography and Biomechanics Study GroupInstituto de Olhos Renato AmbrósioUNIFESP, Department for ophthalmologySciEL

Genetic variants of the IFITM3 gene reveal a potential modifier of influenza severity

As epidemias de gripe representam um sério problema de saúde pública com elevados custos económicos. Foi sugerido que um dos alelos do gene IFITM3 (rs12252-C) constitui um impor tante fator de risco de base populacional para as formas graves da gripe por infeção pelo vírus A(H1N1)pdm09. Analisámos variantes do IFITM3 associadas à gravidade da doença em doentes por tugueses (n=41). Foram identificados sete SNPs no amplicão de 352bp do IFITM3 em torno do rs12252. De acordo com HapMap, o SNP rs34481144 per tence ao mesmo bloco de desequilíbrio de ligação (LD) que rs12252, e está em LD com rs6421983. A associação negativa com formas sintomáticas graves em relação a ligeiras obser vada para o alelo rs34481144-A é sugestiva de um efeito protetor no modelo de hereditariedade dominante. Para além disso, o haplótipo Hap4 com rs34481144-A, e sem o rs12252-C, mostrou estar significativamente associado a gripe sintomaticamente ligeira. Por outro lado, apesar de a um nível de significância limiar, o haplótipo Hap1 com rs34481144-G, sem rs12252-C, mostrou-se associado à gripe com sintomatologia grave. Em comparação com a população por tuguesa em geral, foram obser vadas diferenças significativas nas frequências do alelo possivelmente protetor rs34481144-A no grupo com sintomatologia grave, do Hap1 deletério no grupo com sintomatologia ligeira e do Hap4 protetor no grupo com doença grave. A proporção de casos com sintomas graves que poderiam ser evitados se todos os indivíduos da população apresentassem o alelo protetor rs34481144-A foi estimada em 56% e 64%, respetivamente na população em geral e no grupo de indivíduos com doença ligeira. A implicação destas variantes nos fenótipos da doença necessita de estudos de validação, nomeadamente de natureza funcional.Influenza epidemics are a serious global public health and economic problem. The IFITM3 allele (rs12252-C) was suggested as a strong population-based genetic risk factor for severe influenza virus infection by A(H1N1)pdm09. We analyzed IFITM3 variants for association to influenza severity in Por tuguese patients (n=41). Seven SNPs, within the 352bp IFITM3 amplicon around rs12252, were identified. According to HapMap SNP rs34481144 belongs to the same linkage disequilibrium (LD) block as rs12252, and is in strong LD with rs6421983. A negative association with severe relative to mild disease was obser ved for allele rs34481144-A, indicating a protective ef fect under the dominant model. Moreover, haplotype Hap4 with rs34481144-A, not including rs12252-C, was significantly associated to mild influenza. Conversely, although with borderline significance, haplotype Hap1 with rs34481144-G, not including rs12252-C, was associated to severe disease. Moreover, in comparison to the general Por tuguese population, statistical significant dif ferences in the frequencies of the protective allele rs34481144-A in the severe disease group, the deleterious Hap1 in the mild disease group and the protective Hap4 in the severe disease group, were obser ved. The population attributable risk (PAR) for the targeted rs34481144 allele or genotype was of 55.91% and 64.44% in the general population and the mildly infected individuals, respectively. Implication of these variants in disease phenotype needs fur ther validation, namely through functional analysis.Este trabalho foi financiado pela Fundação Luso-Americana para o Desenvolvimento (LACR Award program - 2007) e pela Fundação para a Ciência e Tecnologia (FCT), Portugal, (POCTI/ESP/44826/2002), com a comparticipação dos fundos da Comunidade Europeia (FEDER).info:eu-repo/semantics/publishedVersio

Levantamento bibliográfico sobre tecnologias assistivas baseadas em realidade aumentada para desenvolvimento de atividades com crianças autistas / Bibliographical survey on assistive technologies based on augmented reality for the development of activities with autistic children

Este trabalho é resultado de um levantamento bibliográfico feito a partir de pesquisas a respeito de uma tecnologia assistiva baseada em realidade aumentada para o desenvolvimento no tratamento de crianças autistas. A pesquisa dos artigos foram obtidas a partir de uma busca com strings no acervo do IEEE contendo limitações quanto a data de publicação e coerência com o tema proposto. Os resultados coletados mostram que a realidade aumentada, e outras ferramentas tecnológicas, corroboram de forma conveniente para o desenvolvimento da criança. 

The 2nd Baltic Osseointegration Academy and Lithuanian University of Health Sciences Consensus Conference 2019. Summary and consensus statements: Group II - Extraction socket preservation methods and dental implant placement outcomes within grafted sockets

Introduction: The task of Group II was to review and update the existing data concerning extraction socket preservation with or without membranes and soft tissue influence on post-extraction alveolar ridge preservation; extraction socket preservation using different biomaterials as bone grafts, growth factors, and stem cells. Special interest was paid to the dental implant placement outcomes within grafted sockets.Material and Methods: The main areas evaluated by this group were as follows: quantitative and qualitative assessment of the effect of different alveolar preservation techniques performed immediately after tooth extraction, with or without membranes and/or soft tissue grafting, and the use of different bone substitutes, stem cells or growth factors in the postextraction socket. Evaluation of the treatment outcomes of dental implants placed in the grafted sockets in terms of primary and secondary outcomes were assessed. The systematic reviews and/or meta-analyses were registered in PROSPERO, an international prospective register of systematic reviews: http://www.crd.york.ac.uk/PROSPERO/. TThe literature in the corresponding areas of interest was screened and reported following the PRISMA guidelines (Preferred Reporting Item for Systematic Review and Meta-Analysis) Statement: http://www.prisma-statement.org/. Method of preparation of the systematic reviews, based on comprehensive search strategies, was discussed and standardized. The summary of the materials and methods employed by the authors in preparing the systematic reviews and/or meta-analyses is presented in the Preface chapter.Results: The results and conclusions of the review process are presented in the respective papers. Three systematic reviews and one systematic review and meta-analysis were performed. The group's general commentaries, consensus statements, clinical recommendations and implications for research are presented in this article.info:eu-repo/semantics/publishedVersio

evidence- and practice-based guidance

The authors thank Luı́s Veloso, Daniela Carvalho, and Catarina Oliveira Silva (from CTI, Clinical Trial & Consulting Services) for their assistance with the project.Systemic lupus erythematosus (SLE), antiphospholipid syndrome (APS), and Sjögren's syndrome (SS) are heterogeneous autoimmune diseases. Severe manifestations and refractory/intolerance to conventional immunosuppressants demand other options, namely biological drugs, and small molecules. We aimed to define evidence and practice-based guidance for the off-label use of biologics in SLE, APS, and SS. Recommendations were made by an independent expert panel, following a comprehensive literature review and two consensus rounds. The panel included 17 internal medicine experts with recognized practice in autoimmune disease management. The literature review was systematic from 2014 until 2019 and later updated by cross-reference checking and experts' input until 2021. Preliminary recommendations were drafted by working groups for each disease. A revision meeting with all experts anticipated the consensus meeting held in June 2021. All experts voted (agree, disagree, neither agree nor disagree) during two rounds, and recommendations with at least 75% agreement were approved. A total of 32 final recommendations (20 for SLE treatment, 5 for APS, and 7 for SS) were approved by the experts. These recommendations consider organ involvement, manifestations, severity, and response to previous treatments. In these three autoimmune diseases, most recommendations refer to rituximab, which aligns with the higher number of studies and clinical experience with this biological agent. Belimumab sequential treatment after rituximab may also be used in severe cases of SLE and SS. Second-line therapy with baricitinib, bortezomib, eculizumab, secukinumab, or tocilizumab can be considered in SLE-specific manifestations. These evidence and practice-based recommendations may support treatment decision and, ultimately, improve the outcome of patients living with SLE, APS, or SS.publishersversionpublishe

Biological therapy in systemic lupus erythematosus, antiphospholipid syndrome, and Sjögren’s syndrome: evidence- and practice-based guidance

Systemic lupus erythematosus (SLE), antiphospholipid syndrome (APS), and Sjögren’s syndrome (SS) are heterogeneous autoimmune diseases. Severe manifestations and refractory/intolerance to conventional immunosuppressants demand other options, namely biological drugs, and small molecules. We aimed to define evidence and practice-based guidance for the off-label use of biologics in SLE, APS, and SS. Recommendations were made by an independent expert panel, following a comprehensive literature review and two consensus rounds. The panel included 17 internal medicine experts with recognized practice in autoimmune disease management. The literature review was systematic from 2014 until 2019 and later updated by cross-reference checking and experts’ input until 2021. Preliminary recommendations were drafted by working groups for each disease. A revision meeting with all experts anticipated the consensus meeting held in June 2021. All experts voted (agree, disagree, neither agree nor disagree) during two rounds, and recommendations with at least 75% agreement were approved. A total of 32 final recommendations (20 for SLE treatment, 5 for APS, and 7 for SS) were approved by the experts. These recommendations consider organ involvement, manifestations, severity, and response to previous treatments. In these three autoimmune diseases, most recommendations refer to rituximab, which aligns with the higher number of studies and clinical experience with this biological agent. Belimumab sequential treatment after rituximab may also be used in severe cases of SLE and SS. Second-line therapy with baricitinib, bortezomib, eculizumab, secukinumab, or tocilizumab can be considered in SLE-specific manifestations. These evidence and practice-based recommendations may support treatment decision and, ultimately, improve the outcome of patients living with SLE, APS, or SS