Health Technology Assessment and Decision-Making Processes: The Purchase of Magnetic Resonance Imaging Technology

Medical devices play an essential role in health care. For instance, magnetic resonance imaging (MRI) has revolutionized the way images of the human body are acquired. However, although medical devices improve diagnosis and treatment, they are also one of the causes of increasing health expenditure. Thus, the purchase of new technologies and the determination of how and when they should be used are among the most important decisions made in the health care system in general, and by hospital decisionmakers in particular. Health technology assessment (HTA) studies aim to provide a range of stakeholders with accessible, usable and evidence-based information to guide decisions about the use and diffusion of technology and efficient allocation of resources. For this reason, HTA acts as a bridge between evidence and decision-making by ensuring better synthesis, communication and dissemination of information. However, empirical research on decision processes in the purchase of medical devices is sparse, and a gap on this topic was found in the literature. The present research focuses on the Portuguese health system and sheds light on the characterization of decision-making processes by those involved in MRI purchases, in order to understand the influences of HTA. In terms of research design, two strategies were chosen, aiming at different objectives. To characterize the decision-making process a mixed method was chosen. Data was collected using a questionnaire (40 respondents), and parallel semi-structured interviews (27 participants). Both data sets were analysed and merged. Descriptive statistics were chosen as a data analysis strategy, as well as content analysis (categorical analysis). To assess competences for decision-making a questionnaire retrieving only quantitative data was developed (369 valid respondents), and Exploratory Factorial Analysis was performed, followed by Structural Equation Modelling (Confirmatory Factorial Analysis and Path Analysis). Results show that steps in the decision process are well-defined. Cost and suppliers’ characteristics are seen as the most important indicators to guide decisions. Few studies are performed to support the decision, and these are mostly related to the workload of the Radiology Department. No national or international HTA study was used to support any decisions. The decision process is characterized by a bounded rationality, influenced by intuition and a consultant decision-maker. The decision is a bottomup process where information gathering and consensus building is undertaken by a committee, although external consultancy is also used. The reasoning and justification for selection of committee members is unclear. The process is considered to be bureaucratic, time-consuming and long. Patients are negatively perceived as stakeholders in the process. Their experiences, needs and expectations are not considered. vi Decision-makers in Portugal have limited knowledge and training in areas of decision-making, health informatics, health economics and especially HTA. This may limit their ability to truly understand the future implications of their purchase decisions. Recommendations are made to: (1) deepen the present research in particular regarding the elements that influence the strategies and tactics adopted in the decision-making process for the acquisition of medical devices (2) foster the uptake of HTA by decision-makers with the establishment of an HTA in-house unit, able to carry out TA studies considering the hospital context and aiming to inform managerial local decisions on the uptake or disinvestment of medical devices (3) promote a team comprise by not only TA multidisciplinary researchers but also by professionals from the health institution able to carry out HTA studies (3) foster common languages and values to increase uptake of HTA studies

Cross-contamination events of Campylobacter spp. in domestic kitchens associated with consumer handling practices of raw poultry

Contaminated poultry is the major vehicle for consumer's exposure to Campylobacter. This study aimed to perceive potential cross-contamination events during preparation of raw poultry that can contribute to the spread of Campylobacter spp. in domestic kitchen environments and to understand consumers' meanings and justifications on preparation of a poultry dish at home. A total of 18 households were visited to observe consumers preparing a recipe that included poultry. Poultry samples and swabs from the kitchen surfaces and utensils, such as kitchen cloth, hand towel, sponge, cutting boards and the sink, were collected before and after food preparation and tested for the presence of Campylobacter spp. Genotypic characterization of 72 Campylobacter spp. isolates was carried out through Pulse-Field Gel Electrophoresis (PFGE). Fourteen chicken samples were contaminated with Campylobacter spp. (77.8%). Twelve consumers (66.6%) washed the chicken meat under running tap water and eight (44.4%) used cutting boards. Also, only five consumers washed their hands properly prior to or during meal preparation. Cross-contamination events were detected in four kitchens, between the raw chicken and two cutting boards, two sinks and one kitchen cloth. The poultry samples presented different levels of contamination (< 4.0 × 101 CFU/g to 2.2 × 103 CFU/g), being some poultry with lower Campylobacter loads the origin of three cross-contamination events during food preparation. Both C. jejuni and C. coli were recovered. Molecular typing by PFGE showed a high diversity among the isolates. There were different explanations for the practice of cleaning and rinsing chicken, but, in general, it is an habit linked to what they have learned from their families. These results highlight the potential for the dissemination of Campylobacter strains in the domestic environment through the preparation of chicken meat and the need to raise awareness among consumers for an appropriate handling of raw poultry in order to decrease the risk of campylobacteriosis.info:eu-repo/semantics/publishedVersio

Synthesis and characterization of new injectable and degradable dextran-based hydrogels

Injectable and degradable hydrogels are very interesting networks for drug delivery and cell transplantation applications since they can be administered in the human body in a minimally invasive way. In most cases, the crosslinking reaction occurs by photopolymerisation or free radical polymerisation; however, the use of chemical initiators may promote cell death. In the current work, injectable and degradable dextran-based hydrogels were prepared without the use of initiators. Dextran, a natural glucose-containing polysaccharide, was oxidized with sodium periodate (dexOx) and the derivatives characterized by NMR and FTIR spectroscopy's as well as by colorimetric techniques. The oxidized derivatives were crosslinked with adipic acid dihydrazide (AAD), forming a gel within 2-4 min. The obtained hydrogels were characterized by their mechanical properties, swelling and degradation behavior under physiologic conditions. In addition, the hydrogel interior morphology as well as porous structure was evaluated by scanning electron microscopy (SEM) and mercury intrusion porosimetry (MIP). MIP analysis showed that dexOx hydrogels crosslinked with 10% of AAD were macroporous with pore sizes ranging from 0.32 to 0.08 [mu]m. As expected, the average pore size increased during hydrogel degradation as confirmed by SEM and MIP studies.http://www.sciencedirect.com/science/article/B6TXW-4GX64XT-3/1/4e9cbb2544094cda02e21f70e1abcc6

Immobilization of CalB Lipase by adsorption on magnetic nanoparticles: A heterogeneous biocatalysis/ Imobilização da lipase CalB por adsorção em nanopartículas magnéticas: um biocatalisador heterogêneo

Iron magnetic nanoparticles (Fe3O4) were evaluated as adsorption preparative heterofunctional support for the immobilization of lipase B from Candida antarctica (CALB). Heterogeneous magnetic catalysts are easy to recover by the magnetic field, which may optimize operational cost and enhance the purity of the products. The nanoparticles were produced by the co-precipitation method. Modifications were carried out on the nanoparticles’ surfaces with aminopropyltriethoxysilane (APTS). The adsorption was evaluated for 3.0 mg protein/g of support in the presence of 5mM sodium phosphate buffer, pH 7.0, at 25 °C and 0.5h of immobilization. In a solvent-free medium, under 37 °C, the biocatalyst prepared has shown activity of 2.2 U/g for the esterification of oleic acid after 0.5h, 37 kHz, and 300 W. The results obtained with CALB adsorbed onto magnetic iron nanoparticles were compared with those of lipase B from Candida antartica adsorbed onto acrylic resin (Novozym® 435). In this regard, under the same reactional conditions, Novozym® 435 has presented activity of 2.9 U/g

Patient-physician discordance in assessment of adherence to inhaled controller medication: a cross-sectional analysis of two cohorts

We aimed to compare patient's and physician's ratings of inhaled medication adherence and to identify predictors of patient-physician discordance.(SFRH/BPD/115169/2016) funded by Fundação para a Ciência e Tecnologia (FCT); ERDF (European Regional Development Fund) through the operations: POCI-01-0145-FEDER-029130 ('mINSPIRERS—mHealth to measure and improve adherence to medication in chronic obstructive respiratory diseases—generalisation and evaluation of gamification, peer support and advanced image processing technologies') cofunded by the COMPETE2020 (Programa Operacional Competitividade e Internacionalização), Portugal 2020 and by Portuguese Funds through FCT (Fundação para a Ciência e a Tecnologia).info:eu-repo/semantics/publishedVersio

Cross-contamination of lettuce with Campylobacter spp. via cooking salt during handling raw poultry

Campylobacter spp. are the most common bacterial pathogens associated with human gastroenteritis in industrialized countries. Contaminated chicken is the food vehicle associated with the majority of reported cases of campylobacteriosis, either by the consumption of undercooked meat or via cross- contamination of ready-to-eat (RTE) foods during the handling of contaminated raw chicken parts and carcasses. Our results indicate that cooking salt (used for seasoning) is a potential vehicle for Campylobacter spp. cross-contamination from raw chicken to lettuce, through unwashed hands after handling contaminated chicken. Cross-contamination events were observed even when the chicken skin was contaminated with low levels of Campylobacter spp. (ca. 1.48 Log CFU/g). The pathogen was recovered from seasoned lettuce samples when raw chicken was contaminated with levels ≥ 2.34 Log CFU/g. We also demonstrated that, once introduced into cooking salt, Campylobacter spp. are able to survive in a culturable state up to 4 hours. After six hours, although not detected following an enrichment period in culture medium, intact cells were observed by transmission electron microscopy. These findings reveal a "novel"indirect cross-contamination route of Campylobacter in domestic settings, and a putative contamination source to RTE foods that are seasoned with salt, that might occur if basic food hygiene practices are not adopted by consumers when preparing and cooking poultry dishes.info:eu-repo/semantics/publishedVersio

Óleo e azeite de coco babaçu (Orbignya speciosa Mart.) como matériasprimas para produção de biodiesel

The use of renewable energy sources, such as vegetable oils like babassu coconut (Orbignya speciosa Mart.) oil extracted industrially and manually, has economic and environmental advantages. In this scenario, the present work presents the production and characterization biodiesel of babassu coconut oil extracted industrially and manually. Biofuels were obtained by alkaline transesterification, using potassium hydroxide and methanol. The characterization was performed by infrared with Fourier transform (FTIR), kinematic viscosity, density, sulphated ash, acidity index, pour point, flash point and gas chromatography. According to the results, the Fourier-transform infrared spectroscopy FTIR spectra showed characteristic absorption of esters, the C=O bond stretches (1704 cm-1 and 1742 cm-1) and C-O (1112 cm-1 and 1111 cm-1). The results of the kinematic viscosity, density, acidity index, pour point and flash point tests were in compliance with the limits established by the ANP, Resolution no. 45/2014. The gas chromatography showed the predominance of methyl esters derived from lauric (C12:0), miristic (C14:0) and palmitic (C16:0) acids. Thus, babassu coconut oil extracted industrially and manually proved to be viable for the production of biodiesel, presenting itself as a potential raw material for the biofuel sector, given the significant volume of babassu plantations in the state of Maranhão.El uso de fuentes de energía renovable, como los aceites vegetales, aceite de coco babasú (Orbignya speciosa Mart.) extraído industrialmente y manualmente, tiene ventajas económicas y ambientales. En este escenario, el presente trabajo presenta la producción y caracterización del aceite de coco babasú extraído industrialmente y manualmente y el biodiésel. Los biocombustibles se obtuvieron por transesterificación alcalina, utilizando hidróxido de potasio y metanol. La caracterización se realizó mediante infrarrojo con transformada de Fourier (FTIR), viscosidad cinemática, densidad, cenizas sulfatadas, índice de acidez, punto de fluidez, punto de inflamación y cromatografía de gases. Según los resultados, los espectros FTIR mostraron una absorción característica del éster, los estiramientos de enlace C=O (1704 cm-1 y 1742 cm-1) y C-O (1112 cm-1 y 1111 cm-1). Los resultados de las pruebas de viscosidad cinemática, densidad, índice de acidez, punto de fluidez y punto de inflamación se ajustaron a los límites establecidos por la ANP, Resolución nº 45/2014. La cromatografía de gases mostró el predominio de ésteres metílicos derivados de los ácidos láurico (C12:0), mirístico (C14:0) y palmítico (C16:0). Así, el aceite de coco y el aceite de coco babasú extraído industrialmente y manualmente resultaron viables para la producción de biodiésel, presentándose como una potencial materia prima para el sector de biocombustibles, dado el volumen expresivo de las plantaciones de babasú en el estado de Maranhão.A utilização de fontes renováveis de energia, como os óleos vegetais, a exemplo o óleo e azeite de coco babaçu (Orbignya speciosa Mart.), apresentam vantagens econômicas e ambientais. Neste cenário, o presente trabalho apresenta a produção e caracterização do biodiesel de óleo e azeite de coco babaçu. Os biocombustíveis foram obtidos por transesterificação alcalina, utilizando-se hidróxido de potássio e metanol. A caracterização foi realizada por infravermelho com transformada de Fourier (FTIR), viscosidade cinemática, densidade, cinzas sulfatadas, índice de acidez, ponto de fluidez e ponto de fulgor e cromatografia gasosa. De acordo com os resultados, os espectros de FTIR apresentaram absorções características de ésteres, os estiramentos da ligação C=O (1704 cm-1 e 1742 cm-1) e C-O (1112 cm-1 e 1111 cm-1). Os resultados dos ensaios de viscosidade cinemática, densidade, índice de acidez, ponto de fluidez e ponto de fulgor apresentaram conformidade com os limites estabelecidos pela ANP, Resolução nº 45/2014. A cromatografia gasosa apontou a predominância de ésteres metílicos derivados dos ácidos láurico (C12:0), mirístico (C14:0) e palmítico (C16:0). Desta forma, o óleo e o azeite de coco babaçu se mostraram viáveis para a produção de biodiesel, apresentando-se como potencial matéria-prima para o setor de biocombustíveis, dado o volume expressivo das plantações de babaçuais do estado do Maranhão

Estudo comparativo da adequação da estrutura física em uma unidade da alimentação e nutrição do tipo comercial em relação a legislação vigente, no município de Fortaleza CE. / Comparative study of the adequacy of the physical structure in a commercial food and nutrition unit in relation to current legislation, in the city of Fortaleza CE.

Este estudo teve como objetivo principal avaliar o nível de adequação da estrutura física funcional e layout, de uma unidade de alimentação e nutrição do tipo comercial na cidade de Fortaleza CE. Trata-se de um estudo com caráter comparativo entre o atual layout da unidade e a legislação RDC n° 216 e seu checklist. Para a realização da pesquisa utilizou-se o checklist da RDC 216/2004 (com ênfase apenas no primeiro bloco, consideração as edificações, instalações, equipamentos, móveis e utensílios) a fim de classificar a UAN. Após a análise dos dados foi proposto um novo layout para a unidade, visando adequá-lo dentro dos parâmetros da legislação. Como ferramenta avaliativa foi utilizado o checklist da RDC n° 216/2004, para então classificar a unidade. Após sua aplicação o estabelecimento foi classificado no segundo grupo, apresentando um quantitativo de 64 itens adequados equivalendo em percentual a 68%. Foram encontrados na UAN em estudo, problemas relacionados ao fluxo da unidade, podendo ocasionar contaminações cruzadas e acidentes de trabalho. Tendo como principais exemplos os fluxos utilizados pelos colaboradores responsáveis pela produção de doces e pães até a área de distribuição, e o fluxo de lixo. Assim, foi sugerida uma nova planta com as devidas adequações. Para tanto recomenda-se um trabalho conjunto de profissionais da área de engenharia e nutricionistas comtemplando as normatizações de cada área. No que diz respeito a aplicação do checklist, foi concluído que a empresa obteve pontuação de 68% ficando adequada, classificando-se no segundo grupo do checklist da RDC 216/2004

CARACTERÍSTICAS HIDROGEOMORFOMÉTRICAS E DINÂMICA DA COBERTURA DO SOLO NA MICROBACIA DO RIO SERENO, AMAZÔNIA OCIDENTAL, BRASIL

The Sereno river microbasin is located in the municipality of Cabixi-RO, and despite its social, economic and environmental importance, there is no information about the characteristics of its landscape to assist in the planning and management of natural resources. Thus, the objective of this study was to provide information on the hydrogeomorphometric characteristics and dynamics of soil cover in the Sereno river microbasin. We used geotechnologies and images from Alos, Landsat 5 and Landsat 8 satellites to acquire the data. The Sereno river microbasin has an area of ​​9.25 km2, perimeter of 17.04 km, elongated shape, altitudes from 220 to 302 m, predominance of smooth-wavy relief, dendritic drainage pattern with rivers of up to 3rd order, low to medium density of springs, medium drainage density, very straight main channel, maintenance coefficient of 760.1 m2 m-1 and concentration time of 1.78 h. In the period from 1984 to 2021, native vegetation was suppressed for the implementation of agricultural systems, reaching 77.73% of the total area of ​​the microbasin and 26.25% of the riparian zone in the last year. We conclude that the microbasin has potential for the development of agricultural activities, however, the excessive suppression of native vegetation can compromise the conservation of natural resources and, consequently, the sustainable development of the region. We recommend the insertion of the arboreal component in the productive systems and the recovery of the native vegetation in the riparian zone area that is occupied with agriculture and livestock.La cuenca del río Sereno se encuentra en el municipio de Cabixi-RO, y a pesar de su importancia social, económica y ambiental, existe una falta de información sobre las características de su paisaje para ayudar en la planificación y gestión de los recursos naturales. En vista de lo anterior, el objetivo de este estudio fue proporcionar información sobre las características hidrogeomorfométricas y la dinámica de la cobertura del suelo en la cuenca del río Sereno. Se utilizaron geotecnologías e imágenes de los satélites Alos, Landsat 5 y Landsat 8 para la adquisición de datos. La cuenca tiene una superficie de 9,25 km2, perímetro de 17,04 km, forma alargada, altitudes de 220 a 302 m, predominio de relieve ondulado liso (51,23%), patrón de drenaje dendrítico con ríos de hasta 3er orden, densidad baja a media de manantiales, densidad de drenaje media, canal principal muy recto, coeficiente de mantenimiento de 760,1 m2 m-1 y tiempo de concentración de 1,78 h. De 1984 a 2021 se suprimió la vegetación nativa para la implementación de sistemas agrícolas, alcanzando el 77,73% del área total de la cuenca y el 26,25% de la zona ribereña en el último año analizado. Concluimos que la cuenca tiene el potencial para el desarrollo de actividades agrícolas, sin embargo, la supresión excesiva de la vegetación nativa puede comprometer la conservación de los recursos naturales y, en consecuencia, el desarrollo sostenible de la región. Se recomienda insertar el componente arbóreo en los sistemas productivos y la recuperación.A microbacia do rio Sereno está localizada no município de Cabixi-RO, e apesar de sua importância social, econômica e ambiental, há uma carência de informações sobre as características de sua paisagem para auxiliar no planejamento e gestão dos recursos naturais. Face ao exposto, objetivou-se com o presente estudo disponibilizar informações sobre as características hidrogeomorfométricas e dinâmica da cobertura do solo na microbacia do rio Sereno. Para a aquisição dos dados foram utilizadas geotecnologias e imagens dos satélites Alos, Landsat 5 e Landsat 8. A microbacia tem área de 9,25 km2, perímetro de 17,04 km, forma alongada, altitudes de 220 a 302 m, predominância do relevo suave ondulado (51,23%), padrão de drenagem dendrítico com rios de até 3ª ordem, baixa a média densidade de nascentes, média densidade de drenagem, canal principal muito reto, coeficiente de manutenção de 760,1 m2 m-1 e tempo de concentração de 1,78 h. No período de 1984 a 2021, a vegetação nativa foi suprimida para a implantação de sistemas agropecuários, chegando a ocupar 77,73% da área total da microbacia e 26,25% da zona ripária no último ano analisado. Concluiu-se que a microbacia tem potencial para o desenvolvimento de atividades agropecuárias, contudo, a supressão excessiva da vegetação nativa pode comprometer a conservação dos recursos naturais e, consequentemente, o desenvolvimento sustentável da região. Recomenda-se a inserção do componente arbóreo nos sistemas produtivos e a recuperação da vegetação nativa na área de zona ripária que se encontra ocupada com agropecuária.A microbacia do rio Sereno está localizada no município de Cabixi-RO, e apesar de sua importância social, econômica e ambiental, há uma carência de informações sobre as características de sua paisagem para auxiliar no planejamento e gestão dos recursos naturais. Em face ao exposto, objetivou-se com o presente estudo disponibilizar informações sobre as características hidrogeomorfométricas e dinâmica da cobertura do solo na microbacia do rio Sereno. Para a aquisição dos dados foram utilizadas geotecnologias e imagens dos satélites Alos, Landsat 5 e Landsat 8. A microbacia tem área de 9,25 km2, perímetro de 17,04 km, forma alongada, altitudes de 220 a 302 m, predominância do relevo suave ondulado (51,23%), padrão de drenagem dendrítico com rios de até 3ª ordem, baixa a média densidade de nascentes, média densidade de drenagem, canal principal muito reto, coeficiente de manutenção de 760,1 m2 m-1 e tempo de concentração de 1,78 h. No período de 1984 a 2021, a vegetação nativa foi suprimida para a implantação de sistemas agropecuários, chegando a ocupar 77,73% da área total da microbacia e 26,25% da zona ripária no último ano analisado. Concluímos que a microbacia tem potencial para o desenvolvimento de atividades agropecuárias, contudo, a supressão excessiva da vegetação nativa pode comprometer a conservação dos recursos naturais e, consequentemente, o desenvolvimento sustentável da região. Recomenda-se a inserção do componente arbóreo nos sistemas produtivos e a recuperação da vegetação nativa na área de zona ripária que se encontra ocupada com agropecuária