Motorways, sprawl, and the (un)sustainable economy

Mestrado Bolonha em ManagementUrban sprawl is usually addressed with a negative connotation due to its negative impacts on land uptake and contribution to a greater dependence on the automobile, which subsequently affects the environment as more fuel is consumed and more greenhouse gas emissions are emitted. There is also international evidence that investments in motorways have promoted urban expansion models akin to urban sprawl, particularly low density and dispersed suburbanization patterns. Portugal has one of the densest motorway networks in the EU and experienced a relatively late process of urbanization compared to other European countries. We study the relationship between motorways, urban sprawl and its impacts on travel mobility patterns and fuel consumption for Portugal over the period from 1991 to 2011. The results show that both motorways and urban sprawl have played a role in the shift in travel mobility towards greater automobile dependency and greater fuel consumption, which limit the country’s ability to meet the climate change targets set out in the national strategy for carbon neutrality by 2050.info:eu-repo/semantics/publishedVersio

Sensor Networks For Aquaculture Monitoring Systems

Aquaculture is one of the fastest growing food producing sectors in the world, and its economic importance is increasing. Due to the increased demand for food, market pressure and growing concern about environmental and food quality issues, special techniques have been developed and applied to increase food production and improve product quality. Scientific advances in recent years in this sector have been facilitated largely by the application of science and the introduction of new technologies[1]. Emerging technologies in areas of sensor network, network computing and ubiquitous computing are enabling the development of practical and innovative solutions, improving monitoring and decision-making capabilities[2]. Innovations in water quality monitoring, fish feeding, biomass estimation, fish behavior monitoring, disease diagnosis and food waste management can not only improve the degree of automation of aquaculture and the level of scientific management, but also reduce the cost of production, improve environmental control and increase product quality[3]. Despite the great progress of science and technology, the optimization and management of production processes of aquaculture systems is facing great challenges[4]. The objectives of the present work are to review and analyze the currently scientific advances in technology applied in aquaculture systems, exploring the processes, architectures, the automation level and the role of sensors and new information technologies in this sector of activity.Research is supported by Portugal 2020 AQUATROPOLIS project. The “AQUATROPOLIS - Intelligent Management System for Sustainable Aquaculture” is an Incentive System for Research and Technological Development (SI I&DT) project in cooperation with the following entities: Compta - Emerging Business, S.A.; AlgaPlus - Production and Commercialization of Algae and its Derivatives Lda; Domatica - Global Solutions, S.A.; Polytechnic Institute of Leiria (IPL); Polytechnic Institute of Tomar (IPT) and Tagusvalley - Association for the Promotion and Development of the Tecnopolo Valley of the Tagus Valley. The main objective of the “Aquatropolis” project – Intelligent Management System for Sustainable Aquaculture – is to develop a disruptive solution for an intelligent, optimized and automated management of aquaculture operations, in order to promote the sustainable development of the Aquaculture industry in the countries of the Atlantic region.info:eu-repo/semantics/publishedVersio

Erro médico e prevenção de ações judiciais: Análise dos deveres anexos na relação médico-paciente para além da assistência técnica / Medical error and prevention of legal actions: Analysis of the annexed duties inthe medical-patient relationship beyond technical assistance

O trabalho propõe uma breve abordagem acerca do conceito de erro médico e os deveres anexos do contrato que permeiam a relação médico-paciente sob a perspectiva do panorama da judicialização da saúde. Para isto, serão analisados os argumentos utilizados pelo Poder Judiciário para condenar o médico nas ações judiciais, mesmo após restar comprovado por meio de prova pericial ausência de erro médico. Além disso discute-se a necessidade de compreensão da classe médica acerca dos deveres anexos do contrato, para além da assistência técnica, a partir do novo paradigma constitucional da autonomia do paciente, este passou a participar do processo de escolha em seu tratamento. Por fim, este artigo pretende apresentar estudos de como se antecipar aos processos judiciais e como se prevenir de reclamações durante a prática médica. Visando compreender a situação legal da profissão médica para que seja exercida dignamente, tendo por princípio a retomada da ideal relação me?dico-paciente.

Nationwide access to endovascular treatment for acute ischemic stroke in portugal

Publisher Copyright: Copyright Ordem dos M dicos 2021.Introduction: Since the publication of endovascular treatment trials and European Stroke Guidelines, Portugal has re-organized stroke healthcare. The nine centers performing endovascular treatment are not equally distributed within the country, which may lead to differential access to endovascular treatment. Our main aim was to perform a descriptive analysis of the main treatment metrics regarding endovascular treatment in mainland Portugal and its administrative districts. Material and Methods: A retrospective national multicentric cohort study was conducted, including all ischemic stroke patients treated with endovascular treatment in mainland Portugal over two years (July 2015 to June 2017). All endovascular treatment centers contributed to an anonymized database. Demographic, stroke-related and procedure-related variables were collected. Crude endovascular treatment rates were calculated per 100 000 inhabitants for mainland Portugal, and each district and endovascular treatment standardized ratios (indirect age-sex standardization) were also calculated. Patient time metrics were computed as the median time between stroke onset, first-door, and puncture. Results: A total of 1625 endovascular treatment procedures were registered. The endovascular treatment rate was 8.27/100 000 inhabitants/year. We found regional heterogeneity in endovascular treatment rates (1.58 to 16.53/100 000/year), with higher rates in districts closer to endovascular treatment centers. When analyzed by district, the median time from stroke onset to puncture ranged from 212 to 432 minutes, reflecting regional heterogeneity. Discussion: Overall endovascular treatment rates and procedural times in Portugal are comparable to other international registries. We found geographic heterogeneity, with lower endovascular treatment rates and longer onset-to-puncture time in southern and inner regions. Conclusion: The overall national rate of EVT in the first two years after the organization of EVT-capable centers is one of the highest among European countries, however, significant regional disparities were documented. Moreover, stroke-onset-to-first-door times and in-hospital procedural times in the EVT centers were comparable to those reported in the randomized controlled trials performed in high-volume tertiary hospitalspublishersversionpublishe

Acesso a Tratamento Endovascular para Acidente Vascular Cerebral Isquémico em Portugal

Introduction: Since the publication of endovascular treatment trials and European Stroke Guidelines, Portugal has re-organized stroke healthcare. The nine centers performing endovascular treatment are not equally distributed within the country, which may lead to differential access to endovascular treatment. Our main aim was to perform a descriptive analysis of the main treatment metrics regarding endovascular treatment in mainland Portugal and its administrative districts. Material and Methods: A retrospective national multicentric cohort study was conducted, including all ischemic stroke patients treated with endovascular treatment in mainland Portugal over two years (July 2015 to June 2017). All endovascular treatment centers contributed to an anonymized database. Demographic, stroke-related and procedure-related variables were collected. Crude endovascular treatment rates were calculated per 100 000 inhabitants for mainland Portugal, and each district and endovascular treatment standardized ratios (indirect age-sex standardization) were also calculated. Patient time metrics were computed as the median time between stroke onset, first-door, and puncture. Results: A total of 1625 endovascular treatment procedures were registered. The endovascular treatment rate was 8.27/100 000 inhabitants/year. We found regional heterogeneity in endovascular treatment rates (1.58 to 16.53/100 000/year), with higher rates in districts closer to endovascular treatment centers. When analyzed by district, the median time from stroke onset to puncture ranged from 212 to 432 minutes, reflecting regional heterogeneity. Conclusion: The overall national rate of EVT in the first two years after the organization of EVT-capable centers is one of the highest among European countries, however, significant regional disparities were documented. Moreover, stroke-onset-to-first-door times and in-hospital procedural times in the EVT centers were comparable to those reported in the randomized controlled trials performed in high-volume tertiary hospitals.Introdução: A aprovação do tratamento endovascular para o acidente vascular cerebral isquémico obrigou à reorganização dos cuidados de saúde em Portugal. Os nove centros que realizam tratamento endovascular não estão distribuídos equitativamente pelo território, o que poderá causar acesso diferencial a tratamento. O principal objetivo deste estudo é realizar uma análise descritiva da frequência e métricas temporais do tratamento endovascular em Portugal continental e seus distritos. Material e Métodos: Estudo de coorte nacional multicêntrico, incluindo todos os doentes com acidente vascular cerebral isquémico submetidos a tratamento endovascular em Portugal continental durante um período de dois anos (julho 2015 a junho 2017). Foram colhidos dados demográficos, relacionados com o acidente vascular cerebral e variáveis do procedimento. Taxas de tratamento endovascular brutas e ajustadas (ajuste indireto a idade e sexo) foram calculadas por 100 000 habitantes/ano para Portugal continental e cada distrito. Métricas de procedimento como tempo entre instalação, primeira porta e punção foram também analisadas. Resultados: Foram registados 1625 tratamentos endovasculares, indicando uma taxa bruta nacional de tratamento endovascular de 8,27/100 000 habitantes/ano. As taxas de tratamento endovascular entre distritos variaram entre 1,58 e 16,53/100 000/ano, com taxas mais elevadas nos distritos próximos a hospitais com tratamento endovascular. O tempo entre sintomas e punção femural entre distritos variou entre 212 e 432 minutos. Conclusão: Portugal continental apresenta uma taxa nacional de tratamento endovascular elevada, apresentando, contudo, assimetrias regionais no acesso. As métricas temporais foram comparáveis com as observadas nos ensaios clínicos piloto

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