The reality of an Obesity Surgical Treatment Center in Portugal

Introduction: Obesity surgery is used as the most effective treatment for morbid obesity, with better cost-benefit, less morbidity and mortality. The present study aimed to analyze the results of a surgical center for obesity treatment and integrate them with the most recent scientific evidence. Methods: Retrospective cross-sectional observational study involving 270 patients aged 18 years or older, who underwent bariatric surgery between July 2008 and February 2020 in a private hospital in Portugal. Results: The sample presented an average age of 44 ± 12 years, being mostly female (83.7%). The average pre-surgery Body Mass Index was 41.1 ± 4.9 kg/m2 . The most performed surgery was Gastric Bypass (80.4%), followed by Gastric Banding (14.8%) and Gastric Sleeve (4.8%). One month after surgery, there was a percentage of excess weight lost (% EWL) of 25.2 ± 9.6%. After 6 months, there was an average % EWL of 67.2 ± 23.2%. One year after surgery, the average % EWL was 75.7 ± 25.7%, the average Body Mass Index was 29.3 ± 4.6 kg/m2 and the average weight loss percentage was 29.5 ± 9.4%. Conclusion: Gastric Bypass is the mostly performed surgery, because it is the Gold Standard method for surgical treatment of obesity in this center. On average, all surgeries performed have extremely positive results of excess weight lost. After 1 year, patients maintained an average weight loss percentage of 29.5 ± 9.4%, in line with data presented in a study that estimated an average recorded weight loss percentage of 28.9%. Data like those presented by the American Society for Nutrition (ASN), the Obesity Action Coalition (OAC), the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO), the International Society for the Perioperative Care of the Obese Patient (ISPCOP) and the American Society for Parenteral and Enteral Nutrition (ASPEN) (2019), indicate a target weight loss percentage between 20 and 45%.info:eu-repo/semantics/publishedVersio

Food Intake in Pregnant Women with Gestational Diabetes Mellitus

Rationale: The aim of the present study was to verify the fulfillment of the nutritional requirements of macronutrients of pregnant women diagnosed with Gestational Diabetes Mellitus (GDM) at Lusíadas Lisboa Hospital. Inadequate glycemic control in GDM increases the risk of maternal, fetal and neonatal consequences, in this sense, nutritional therapy is essential during the follow-up of these pregnant women. Methods: Cross-sectional observational study. The study sample included 20 pregnant women diagnosed with GDM. Participants were asked to answer a questionnaire that included relevant data and to complete a three-day food record, for which they gave consent. A statistical analysis was performed with IBM® SPSS® 25. Results: The mean age measured was 35±4 years and 75% of the sample were in the 3º trimester. In the pre-gestational period, the sample had a Body Mass Index (BMI) of 26,2±5,3kg/m2 . The mean fasting capillary blood glucose was 89±9mg/dL and the postprandial was 119±19mg/dL. 75% reached the fasting glycemic objective and 95% the postprandial. It was also found that pregnant women who didn´t meet the goal set for fasting blood glucose, had higher pre-gestational BMI. In terms of macronutrients, it was found that 75% of the sample didn´t reach Total Energy Requirements (TER), 50% didn´t reach protein (1,1g/kg of current weight/day and 15-20% TER), 10% lipid (30% TER) and all carbohydrates (50-55% TER), with only 35% reaching the daily minimum of carbohydrates (175g). It was also found that sample didn´t reach 28g/day of fiber. Conclusions: The present study demonstrated the importance of an individualized nutritional intervention by a nutritionist with pregnant women diagnosed with GDM. The importance of this intervention is based on adherence to an adequate dietary pattern that prevents nutritional deficits, enhances clinical outcomes and contributes to the prevention of the incidence of GDM.info:eu-repo/semantics/publishedVersio

Simulation of masonry arch bridges using 3D discrete element modeling

The analysis of masonry arch bridges is still a challenge for engineers due to its complex and nonlinear behavior. In practice, structural behavior of masonry arch bridges is studied by following relatively simple methods, e.g. limit analysis, which does not require a significant number of parameters. Two-dimensional nonlinear finite element models are also common in the literature; however, these do not reflect the full structural response, since they neglect the out-of-plane actions. These models neglect spandrel walls, 3D point load effect and skew arches, among other effects. The objective of this study is to present a methodology that can simulate three-dimensional masonry arch bridge behavior comprehensively and can include various possible failure mechanisms. Discrete element method (DEM), which is a discontinuum approach, is used to understand the influence of essential structural components, such as the arch barrel, spandrel wall and back-fill material on several masonry arch structures. The masonry units are modeled using discrete blocks and back-fill material is generated as a continuum mesh, based on the plasticity theory. Load carrying capacity and related collapse mechanisms are investigated through a set of parametric studies on the mechanical properties of back-fill material. Out-of-plane spandrel wall failures were further explored by taking advantage of a discontinuous approach. The results indicated that soil characteristics (elastic modulus, internal friction angle and cohesion) have remarkable influence on the behavior and load carrying capacity of the masonry arch bridges. Further, the analyses are also validated with previously published experimental work as well as an existing historical bridge.- (undefined

To what extent are land resource managers preparing for high-end climate change in Scotland?

We explore the individual and institutional conditions and the climate information used to underpin decision-making for adaptation to high-end climate change (HECC) scenarios in a land resource management context. HECC refers to extreme projections with global annual temperature increases of over 4 °C. We analyse whether HECC scenarios are used in the adaptation decision-making of stakeholders who will tackle the potential problem. We also explore whether the adaptation actions being considered are pertinent only to future climate change or whether other drivers and information types are used in decision-making (including non-climate drivers). We also address the role of knowledge uncertainty in adaptation decision-making. Decision-makers perceive HECC as having a low probability of occurrence and so they do not directly account for HECC within existing actions to address climate change. Such actions focus on incremental rather than transformative solutions in which non-climate drivers are at least as important, and in many cases more important, than climate change alone. This reflects the need to accommodate multiple concerns and low risk options (i.e. incremental change). Uncertainty in climate change information is not a significant barrier to decision-making and stakeholders indicated little need for more climate information in support of adaptation decision-making. There is, however, an identified need for more information about the implications of particular sectoral and cross-sectoral impacts under HECC scenarios. The outcomes of this study provide evidence to assist in contextualising climate change information by creating usable, cross-sectoral, decision-centred information

A specification-based QoS-aware design framework for service-based applications

Effective and accurate service discovery and composition rely on complete specifications of service behaviour, containing inputs and preconditions that are required before service execution, outputs, effects and ramifications of a successful execution and explanations for unsuccessful executions. The previously defined Web Service Specification Language (WSSL) relies on the fluent calculus formalism to produce such rich specifications for atomic and composite services. In this work, we propose further extensions that focus on the specification of QoS profiles, as well as partially observable service states. Additionally, a design framework for service-based applications is implemented based on WSSL, advancing state of the art by being the first service framework to simultaneously provide several desirable capabilities, such as supporting ramifications and partial observability, as well as non-determinism in composition schemas using heuristic encodings; providing explanations for unexpected behaviour; and QoS-awareness through goal-based techniques. These capabilities are illustrated through a comparative evaluation against prominent state-of-the-art approaches based on a typical SBA design scenario

Spatial dysregulation of T follicular helper cells impairs vaccine responses in aging.

The magnitude and quality of the germinal center (GC) response decline with age, resulting in poor vaccine-induced immunity in older individuals. A functional GC requires the co-ordination of multiple cell types across time and space, in particular across its two functionally distinct compartments: the light and dark zones. In aged mice, there is CXCR4-mediated mislocalization of T follicular helper (TFH) cells to the dark zone and a compressed network of follicular dendritic cells (FDCs) in the light zone. Here we show that TFH cell localization is critical for the quality of the antibody response and for the expansion of the FDC network upon immunization. The smaller GC and compressed FDC network in aged mice were corrected by provision of TFH cells that colocalize with FDCs using CXCR5. This demonstrates that the age-dependent defects in the GC response are reversible and shows that TFH cells support stromal cell responses to vaccines

Economic impact of infections and antibiotics

In this chapter, we review several aspects with respect to the burden of infectious diseases, its impact in morbidity and mortality, and its economic burden. Furthermore, we referenced the actual situation with relation to the use of antimicrobial, the resistance problem and misuse of antibiotic, and the economic impact in the health systems