The Palaeolithic occupation of southern Alentejo: the Sado

ABSTRACT The Sado River Drainage Survey project (2004-2008) was designed to fill a significant gap in our knowledge of the prehistory of Portugal. Southern Alentejo constitutes nearly one third of the total land mass of continental Portugal, but has received comparatively little attention from Palaeolithic archaeologists. Practically nothing was known about the prehistory of the Sado River basin, which includes the southern Alentejo plain, before now. The results of the Sado River Drainage Survey (SRDS) indicate that the Sado River basin was likely occupied at low population densities during the Middle Palaeolithic. There is some evidence for a Lower Palaeolithic presence but little or no evidence of an Upper Palaeolithic occupation. The emerging pattern suggests either an occupational hiatus or a major shift in settlement pattern towards the end of the Middle Palaeolithic. Possible explanations for this pattern, including aridification driven by climate change, are explored here

Cateterismo venoso periférico: compreensão e avaliação das práticas de enfermagem

Objective: to understand the nursing practices related to peripheral venipuncture and to analyze the incidence of complications in patients with venous catheters. Method: mixed design, involving: case study, sectional study, cohort study and focus group. The sample consisted of nurses and patients from a medical clinic in Portugal. Thematic analysis and descriptive statistics were performed. Results: stressors capable of influencing nursing practices were identified, including: the decisions of the medical team, the age and characteristics of the venous network of the patient, the availability of other catheters in the institution, the low level of knowledge of nurses regarding the care of patients in the insertion, maintenance and removal of the peripherally inserted central venous catheter. The following complications and their respective incidences were documented in patients with peripheral venous catheters: phlebitis (22.2%), obstruction (27.7%), fluid exiting through insertion site (36.1%), infiltration (38.8%) and accidental catheter removal (47.2%). Catheter obstruction with an incidence of 22.2% was only observed in those who used the peripherally inserted central venous catheter. The following benefits were observed with the use of the peripherally inserted central venous catheter: safe administration of drugs; pain reduction, number of venous punctures and complications. Conclusions: the peripherally inserted central venous catheter is presented as a valid and viable alternative that can improve the quality of nursing care and the safety and well-being of patients.Objetivo: compreender as práticas de enfermagem relacionadas com o cateterismo venoso periférico e analisar a incidência de complicações durante a permanência do cateter venoso no paciente. Método: delineamento misto, envolvendo: estudo de caso, estudo seccional, estudo de coorte e grupo focal. A amostra foi constituída por enfermeiros e pacientes de um serviço de clínica médica de Portugal. Efetuada análise temática e estatística descritiva. Resultados: identificou-se estressores capazes de influenciar as práticas de enfermagem, sendo eles: as decisões da equipe médica, a idade e as características da rede venosa do paciente, a disponibilização de outros cateteres pela instituição e o baixo nível de conhecimento dos enfermeiros sobre os cuidados aos pacientes na inserção, manutenção e remoção do cateter venoso central de inserção periférica. Nos pacientes portadores de cateter venoso periférico, documentou-se as seguintes complicações e suas respectivas incidências: flebite (22,2%), obstrução (27,7%), saída de fluido pela inserção (36,1%), infiltração (38,8%) e remoção acidental do cateter (47,2%). Naqueles que usaram o cateter venoso central de inserção periférica, identificou-se apenas a obstrução desse cateter, com incidência de 22,2%. Verificou-se os seguintes benefícios com a utilização do cateter venoso central de inserção periférica: administração segura de medicamentos e redução da dor, do número de punções venosas e de complicações. Conclusão: o cateter venoso central de inserção periférica apresenta-se como alternativa válida e viável para melhorar a qualidade da assistência de enfermagem, a segurança e o bem-estar dos pacientes

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

A global multinational survey of cefotaxime-resistant coliforms in urban wastewater treatment plants

The World Health Organization Global Action Plan recommends integrated surveillance programs as crucial strategies for monitoring antibiotic resistance. Although several national surveillance programs are in place for clinical and veterinary settings, no such schemes exist for monitoring antibiotic-resistant bacteria in the environment. In this transnational study, we developed, validated, and tested a low-cost surveillance and easy to implement approach to evaluate antibiotic resistance in wastewater treatment plants (WWTPs) by targeting cefotaxime-resistant (CTX-R) coliforms as indicators. The rationale for this approach was: i) coliform quantification methods are internationally accepted as indicators of fecal contamination in recreational waters and are therefore routinely applied in analytical labs; ii) CTX-R coliforms are clinically relevant, associated with extended-spectrum ?-lactamases (ESBLs), and are rare in pristine environments. We analyzed 57 WWTPs in 22 countries across Europe, Asia, Africa, Australia, and North America. CTX-R coliforms were ubiquitous in raw sewage and their relative abundance varied significantly (< 0.1% to 38.3%), being positively correlated (p < 0.001) with regional atmospheric temperatures. Although most WWTPs removed large proportions of CTX-R coliforms, loads over 103 colony-forming units per mL were occasionally observed in final effluents. We demonstrate that CTX-R coliform monitoring is a feasible and affordable approach to assess wastewater antibiotic resistance status

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

O LITORAL DOS COUTOS DE ALCOBAÇA. Evolução sedimentar e histórica da Lagoa da Pederneira

O domínio territorial do Mosteiro Cisterciense de Alcobaça (Portugal) estendeu-se por uma região vasta e heterogénea, designada genericamente por Coutos de Alcobaça, limitada a ocidente pela costa, situação única nos Mosteiro desta ordem monástica em Portugal. A proximidade de um litoral acessível e abrigado como as lagoas de Alfeizerão (S. Martinho do Porto) e da Pederneira (Nazaré) proporcionou ao Mosteiro de Alcobaça um recurso natural e estratégico, determinante na organização socioeconómica e espacial dos seus domínios, e da região em geral. A multifuncionalidade que ao longo dos tempos estes espaços desempenharam, terá justificado a forte intervenção humana na manutenção dos sistemas lagunares e portuários, mesmo quando as condições hidrodinâmicas, gerais e locais, favoreciam o assoreamento. O processo evolutivo destes ambientes foi acompanhado de permanente reorganização do espaço de que resultou a deslocação geográfica de pessoas e funções. Apresenta-se uma síntese da evolução da região litoral dos Coutos de Alcobaça com destaque para a antiga Lagoa da Pederneira (Nazaré). A partir do Holocénico Médio as alterações morfológicas e ambientais da área foram muito incrementadas pelas actividades antrópicas. A sequência sedimentar acumulada nos ambientes estuarinos e lagunares revela, desde a Idade Média, um relação estreita com as actividades humanas exercidas nas bacias hidrográficas adjacentes, com destaque para as exercidas pela Comunidade Cisterciense de Alcobaça. A abordagem é feita tendo como base: análise geomorfológica detalhada; localização e identificação de vestígios arqueológicos e históricos; interpretação crítica de documentos escritos e cartográficos; resultados preliminares do estudo dos sedimentos de sondagens realizadas no espaço da antiga laguna

ONTOGENETIC DEVELOPMENT OF SENSORY STRUCTURES ON THE ANTENNULES AND ANTENNAE OF THE GIANT RIVER PRAWN MACROBRACHIUM ROSENBERGII (DE MAN)

In this study the occurrence of sensory structures on the antennules and antennae of the giant river prawn Macrobrachium rosenbergii (De Man) during postembryonic ontogenetic development were examined. Larvae and postlarvae were obtained from hatchery recirculating tanks, juveniles from indoor nursery tanks, and adults from earthen grow-out ponds. The animals were fixed with Karnovsky fixative and dissected. Antennules and antennae were removed, metal-coated, and photodocumented using a scanning electron microscope. The antennules have aesthetascs and simple plumose and pappose setae; the antennae have simple, plumose and pappose setae. These structures increase in density, covered surface, and distribution during ontogeny and should be related to chemoreception and mechanoreception. The antennular statocyst that appears during larval stage VII of the giant river prawn has an array of sensory structures that enable the perception of chemical and tactile stimuli beginning with its early life stages. The ontogenetic changes observed allow an inference that initial-stage larvae, advance-stage larvae, juveniles, and adults have different capacities to exploit the environment