Impact of changes in perinatal care on bronchopulmonary dysplasia: an overview of the last two decades

Objective: To compare the clinical approach and outcomes of bronchopulmonary dysplasia (BPD) patients in the last two decades (1996-2005 vs 2006-2015) in a neonatal intensive care unit. Methods: Out of 1,196 admissions of very low birth weight and/or less than 32 weeks of gestational age infants, 96 had BPD and were dichotomized into two groups according to the year of birth (1996-2005 and 2006-2015). Their clinical data were studied and conclusions were drawn about their morbidity and mortality. Results: There was a decrease in mortality (23.3% vs. 14.4%, p < 0.001) and in BPD prevalence (9.7% vs 6.1%, p = 0.023); in the delivery room, early nasal continuous positive airways pressure (nCPAP) was used in 41.2% vs 1.6%, p < 0.001 and tracheal intubation in 70.6% vs 96.8%, p < 0.001. We observed an increase on the duration of non-invasive ventilation (nCPAP, 22.5 vs 45.5 days, p < 0.001) and a decrease of invasive ventilation (39.5 vs 20 days, p = 0.013) from the first to the second period. Conclusions: Improvement in perinatal and neonatal intensive care practices, namely the use of non-invasive methods of mechanical ventilation implemented in the last years, probably contributed to the better evolution of preterm infants with BPD.This study was funded by: FEDER through the Operational Programme “Competitiveness and Internationalization” and national funding from the Foundation for Science and Technology – FCT (Portuguese Ministry of Science, Technology and Higher Education), under the Unidade de Investigação em Epidemiologia – Instituto de Saúde Públicada Universidade do Porto (EPIUnit) (POCI-01-0145-FEDER-006862; Ref. UID/DTP/04750/2013); the PhD Grant SFRH/BD/111794/2015 (Carina Rodrigues), co-funded by the FCT and the POPH/FSE Program

Management of Anticoagulation Around Cardiac Implantable Electronic Device Surgery

The number of patients requiring cardiovascular implantable electronic device (CIED, e.g., pacemaker and defibrillator) surgery is increasing rapidly and at least a quarter of them are using chronic oral anticoagulation (OAC). Recently, the traditional approach of withholding anticoagulation and using heparin bridging has been challenged by studies showing safety of performing CIED surgery under anticoagulation with vitamin K antagonists. Bridging with heparin is associated with incremental healthcare costs, prolonged hospital admission, and also with an augmented relative risk of pocket hematoma. The risk of embolic events seems to be low and similar with the use of two strategies (heparin bridging and continuous warfarin). Experience with novel oral anticoagulants is limited. Few studies suggest that withholding 48–72 hours before surgery and performing the procedure under anticoagulation are safe alternatives. However, larger randomized clinical trials are needed before definitive conclusions. In this chapter, we review the management of anticoagulation around cardiac implantable electronic device surgery under new conditions

Um experimento em que a força de empuxo aponta para baixo

Em hidrostática, o princípio de Arquimedes prevê uma força vertical para cima sempre que um corpo encontra-se submerso em um líquido. Contrariamente ao senso comum, esta lei física não está livre de exceções, como, por exemplo, quando o corpo está em contato com o recipiente. Isto fica mais evidente quando um paralelepípedo menos denso do que o líquido encontra-se em repouso no fundo do recipiente, sem nenhum líquido abaixo dele, um caso em que uma força para baixo é esperada, de acordo com um trabalho recente do primeiro autor. Neste trabalho nós apresentamos um experimento simples e de baixo custo que permite a detecção de tal força. Este resultado contra-intuitivo mostra que o princípio de Arquimedes é inadequado para casos em que há contato do corpo com o recipiente.In hydrostatics, the Archimedes principle predicts an upward force whenever a body is submerged in a liquid. In contrast to common sense, this physical law is not free of exceptions, as for example when the body touches the container. This is more evident when a rectangular block less dense than the liquid rests on the bottom, with no liquid underneath it, a case in which a downward force is expected, according to a recent work by the first author. In the present work, we describe a simple, low-cost experiment which allows the detection of such force. This counterintuitive result shows the inadequacy of Archimedes' principle for treating "contact" cases

Modelagem e Desenvolvimento de um Inversor CSI Multistring Fotovoltaico de Estágio Único sem Transformador Conectado à Rede Elétrica

Este artigo traz o projeto e desenvolvimento de um inversor fonte de corrente (do inglês, CSI) fotovoltaico multistring de estágio único sem transformador, destinado exclusivamente a operar em conexão com a rede elétrica. Em virtude do comportamento como CSI, dentro das contribuições do presente trabalho tem-se a ampliação da literatura deste tipo de topologia a partir da implementação de técnicas de controle e operação de potência usuais em outras estruturas topológicas. Além disso, o sistema proposto foi simulado no PSIM® e os resultados computacionais e experimentais obtidos evidenciaram um comportamento satisfatório da estrutura em prol da injeção de corrente na rede elétrica com baixa distorção harmônica e elevado fator de potência, atendendo normas nacionais e internacionais

A New Mouse Model for Marfan Syndrome Presents Phenotypic Variability Associated with the Genetic Background and Overall Levels of Fbn1 Expression

Marfan syndrome is an autosomal dominant disease of connective tissue caused by mutations in the fibrillin-1 encoding gene FBN1. Patients present cardiovascular, ocular and skeletal manifestations, and although being fully penetrant, MFS is characterized by a wide clinical variability both within and between families. Here we describe a new mouse model of MFS that recapitulates the clinical heterogeneity of the syndrome in humans. Heterozygotes for the mutant Fbn1 allele mgΔloxPneo, carrying the same internal deletion of exons 19–24 as the mgΔ mouse model, present defective microfibrillar deposition, emphysema, deterioration of aortic wall and kyphosis. However, the onset of a clinical phenotypes is earlier in the 129/Sv than in C57BL/6 background, indicating the existence of genetic modifiers of MFS between these two mouse strains. In addition, we characterized a wide clinical variability within the 129/Sv congenic heterozygotes, suggesting involvement of epigenetic factors in disease severity. Finally, we show a strong negative correlation between overall levels of Fbn1 expression and the severity of the phenotypes, corroborating the suggested protective role of normal fibrillin-1 in MFS pathogenesis, and supporting the development of therapies based on increasing Fbn1 expression

On energy debt: Managing consumption on evolving software

This paper introduces the concept of energy debt: a new metric, reflecting the implied cost in terms of energy consumption over time, of choosing a flawed implementation of a software system rather than a more robust, yet possibly time consuming, approach. A flawed implementation is considered to contain code smells, known to have a negative influence on the energy consumption. Similar to technical debt, if energy debt is not properly addressed, it can accumulate an energy "interest". This interest will keep increasing as new versions of the software are released, and eventually reach a point where the interest will be higher than the initial energy debt. Addressing the issues/smells at such a point can remove energy debt, at the cost of having already consumed a significant amount of energy which can translate into high costs. We present all underlying concepts of energy debt, bridging the connection with the existing concept of technical debt and show how to compute the energy debt through a motivational example.This work is financed by National Funds through the Portuguese funding agency, FCT - Fundação para a Ciência e a Tecnologia, within project UIDB/50014/2020. The first author is also financed by FCT grant SFRH/BD/132485/2017. The last author is also supported by operation Centro-01-0145-FEDER-000019 - C4 - Centro de Competências em Cloud Computing, cofinanced by the European Regional Development Fund (ERDF) through the Programa Operacional Regional do Centro (Centro 2020), in the scope of the Sistema de Apoio à Investigação Científica e Tecnológica - Programas Integrados de IC&DT