Plano de negócios: incubadora de investigação e desenvolvimento para a inovação de dispositivos médicos em Portugal - Região Autónoma dos Açores

Em Portugal verifica-se a inexistência de uma organização orientada para o desenvolvimento e inovação em Dispositivos Médicos (DMs), neste mercado em constante expansão no setor da saúde. Apresenta-se um projeto-piloto para a implementação de uma incubadora especializada em investigação e desenvolvimento para a inovação de DMs, que concentre serviços, potencie a geração das ideias e motive a capacidade de inovação dos empreendedores e "startups" nesta área. A incubadora proposta localizar-se-á em Portugal, na Região Autónoma dos Açores, tirando partido do seu enquadramento geográfico, económico e das iniciativas de desenvolvimento tecnológico promovidas na região, potenciadoras de sucesso para a implementação de uma incubadora de base nacional a internacionalizar. A AZORES MEDTECH nos diferentes cenários identificados - otimista, realista e pessimista - apresenta como fatores críticos comuns de sucesso e viabilidade a angariação de empresas locais e a captação e fidelização de empreendedores e "startups", que se prevêm de todo o mundo, durante as diversas fases de exploração. As prestações provenientes das empresas locais servirão para adquirir todo o capital fixo e fazer face às despesas resultantes da atividade. A execução deste projeto no cenário realista exigirá um custo inicial de cerca de 87 000 euros em 2018, gerando no primeiro ano de exploração proveitos de 151 280 euros, os quais ascenderão a 176 440 euros em 2021, com um Valor Atual Líquido (VAL) positivo de 110 210 euros. Para os restantes cenários delineados o projeto é rentável para os quatro anos em análise, apresentando um VAL positivo.In Portugal there is a lack of an organization dedicated to the development and innovation in Medical Devices (MDs), a market in constant expansion in the health setor. It is presented a pilot project for the implementation of an incubator specialized in research and development of innovation in MDs that concentrates services, promotes the generation of ideas and motivates the entrepreneurs and startups capacity for innovation in this field. The proposed incubator will be located in Portugal, in the Autonomous Region of the Azores, taking advantage of its geographic, economic environment and of the technological development initiatives promoted in the region, key for the successful implementation of a national-based incubator with internationalization intent. The AZORES MEDTECH in the different scenarios identified - optimistic, realistic and pessimistic - presents as common critical factors of success and viability the capture of local companies and fidelization of entrepreneurs and startups, expected from all over the world during the various phases of exploration. The instalments obtained from these companies will be used to acquire all the fixed capital and cover the activity expenses. The execution of this project in the realistic scenario will require an initial cost of around 87 000 euros in 2018, generating in the first year of operation revenue of 151 280 euros, which will increase to 176 440 euros in 2021, with a positive Net Present Value (NPV) of 110 210 euros. For the remaining outlined scenarios, the project is profitable for the four years under analysis, presenting a positive NPV

NEOTROPICAL ALIEN MAMMALS: a data set of occurrence and abundance of alien mammals in the Neotropics

Biological invasion is one of the main threats to native biodiversity. For a species to become invasive, it must be voluntarily or involuntarily introduced by humans into a nonnative habitat. Mammals were among first taxa to be introduced worldwide for game, meat, and labor, yet the number of species introduced in the Neotropics remains unknown. In this data set, we make available occurrence and abundance data on mammal species that (1) transposed a geographical barrier and (2) were voluntarily or involuntarily introduced by humans into the Neotropics. Our data set is composed of 73,738 historical and current georeferenced records on alien mammal species of which around 96% correspond to occurrence data on 77 species belonging to eight orders and 26 families. Data cover 26 continental countries in the Neotropics, ranging from Mexico and its frontier regions (southern Florida and coastal-central Florida in the southeast United States) to Argentina, Paraguay, Chile, and Uruguay, and the 13 countries of Caribbean islands. Our data set also includes neotropical species (e.g., Callithrix sp., Myocastor coypus, Nasua nasua) considered alien in particular areas of Neotropics. The most numerous species in terms of records are from Bos sp. (n = 37,782), Sus scrofa (n = 6,730), and Canis familiaris (n = 10,084); 17 species were represented by only one record (e.g., Syncerus caffer, Cervus timorensis, Cervus unicolor, Canis latrans). Primates have the highest number of species in the data set (n = 20 species), partly because of uncertainties regarding taxonomic identification of the genera Callithrix, which includes the species Callithrix aurita, Callithrix flaviceps, Callithrix geoffroyi, Callithrix jacchus, Callithrix kuhlii, Callithrix penicillata, and their hybrids. This unique data set will be a valuable source of information on invasion risk assessments, biodiversity redistribution and conservation-related research. There are no copyright restrictions. Please cite this data paper when using the data in publications. We also request that researchers and teachers inform us on how they are using the data

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research

Delaying surgery for patients with a previous SARS-CoV-2 infection

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