Cut-off points of the 1-minute sit-to-stand test to detect functional impairment and mortality risk in people with COPD

Introduction: Functional status is a key outcome in people with chronic obstructive pulmonary disease (COPD) and can be defined as an individual’s ability to perform normal daily activities required to meet basic needs, fulfill usual roles, and maintain health and well-being. The 1-minute sit-to-stand test (1-min STS) is a wellestablished measure to assess functional status in people with COPD that can be used in different settings (e.g., office, clinic, hospital, home) with limited resources (i.e., a chair and a stopwatch). This test is a strong predictor of exacerbations, hospitalizations and mortality in people with COPD. Yet, cut-off points to determine functional impairment with the 1-min STS in people with COPD are lacking for use in clinical practice. Recently, our group established a cut-off (19.5 repetitions) for increased mortality risk, however, it still lacks external validation. Objectives: To explore the predictive ability of the 1-min STS to detect functional impairment and the validity of the previously established cut-off for increased risk of mortality in people with COPD. Methods: A cross-sectional study was conducted with people with COPD. Age, sex, body mass index (BMI), lung function, the 1-min STS and the five-repetitions sit-to-stand tests were collected. We used two cut-offs for the five-repetitions sit-to-stand test known to be associated with low functional performance (12.1 seconds) and increased risk of mortality (15.98 seconds) in people with COPD. Receiver operating characteristics analysis (ROC) was performed and the area under the curve (AUC), sensitivity, specificity, and accuracy were calculated. The optimal cut-off points were identified by the highest Younden index. Results: In total, 302 people with COPD (67.5 ± 10.4 years; 79.1% male; BMI 26.7 ± 4.6 kg/m²; FEV1 55.2 ± 20.4%predicted) participated. Cut-off points in the 1-min STS of 23.5 repetitions for low functional performance (AUC = 0.92; 95%CI 0.89-0.95; 96.4% sensitivity; 80.9% specificity; accuracy = 0.84) and 18.5 repetitions for increased risk of mortality (AUC = 0.97; 95%CI 0.94-0.987; 95.5% sensitivity; 88.6% specificity; accuracy = 0.89) were found in people with COPD. Conclusions: The 1-min STS showed an outstanding discriminative ability and excellent accuracy in determining low functional performance and increased risk of mortality in people with COPD. A cut-off of 23.5 repetitions can be used to identify people with functional impairment. The cut-off point found for increased risk of mortality is similar to the previously published using the 6-minute walk test as an anchor, reinforcing the validity of this cut-off. These cut-offs support healthcare professionals in tailoring an appropriate management plan for this treatable trait and might possibly contribute to the implementation of timely preventive or palliative strategies.publishe

Energia, ambiente, economia e olival no Alentejo. Estudo preliminar

Prevê-se que o consumo de energia na agricultura irá aumentar significativamente nos próximos anos com a intensificação dos sistemas de produção. As melhorias na eficiência energética dos sistemas de produção estão relacionadas com a redução do uso de energia para um determinado serviço ou nível de actividade, ou a um aumento de produtividade para a mesma energia consumida. Os sistemas de produção agrícola estão muito dependentes de um consumo directo de energia (combustíveis), mas também de um consumo indirecto devido à energia gasta na produção de diversos factores de produção. Uma correcta avaliação de consumos energéticos deve considerar estas duas componentes. Neste trabalho analisaram-se 3 sistemas de produção do Olival (tradicional, intensivo e super-intensivo), uma das culturas mais importantes em Portugal. Para cada sistema de produção, calcularam-se os custos de capital e de operação das diferentes actividades, assim como os consumos energéticos (directos e indirectos) e o nível de emissões de gás com efeito estufa (GHG) traduzido em CO2eq. Verificou-se um acréscimo significativo de energia consumida, de produção de GHG e custos totais com a intensificação da produção. Mas também um aumento significativo da produção o que conduziu a um maior lucro para o agricultor. O sucesso da actividade agrícola está dependente do lucro, pelo que nesta cultura a tendência será caminhar para a intensificação. Deste modo será difícil diminuir o consumo de energia associado à produção do olival, mas será necessário aumentar a sua eficiência de utilização. Dado o elevado grau de mecanização dos sistemas intensivos, o aumento da eficiência energética na produção de azeitona no Alentejo terá de passar pela melhoria nas práticas de gestão culturais, no sentido de optimizar o uso das máquinas que lhes estão associadas. Ou ainda pela utilização de técnicas de agricultura de precisão numa tentativa de reduzir e optimizar a utilização de diferentes factores de produção, entre outras potenciais alternativas

Geochemical fingerprinting of Roman pottery production from Manta Rota kilns (Southern Portugal)

The Roman site of Manta Rota, located in Algarve region, Portugal, is known from the XIXth century when Estacio da Veiga recovered a few pottery fragments and identified the foundations of Roman structures. References in early XXth century refer to a pottery kiln and to the remains of both amphorae and lamps. In 1992, emergency excavations directed by Cristina Garcia excavated a structure identified as a kiln and recovered abundant amphorae fragments of a locally produced Dressel 14 type. There is evidence of production of tiles, common ware and amphora. The study of the remains collected (terra sigillata and amphorae) in the excavations shows that Roman occupation of the site covers a period from the middle of the 1st century until the 5th century AD. The major production of the kiln area was the Dressel 14 fish sauce amphora centered in the middle/second half of the 1st century but the production of Almagro 51c is also attested. A preliminary macroscopic analysis of both the amphorae and the common ware show identical features. The aim of this paper is to present chemical characterization of the production of Manta Rota and to compare the results with different workshops in the Algarve region as Quinta do Lago, near Faro or S. Bartolomeu de Castro Marim, in the proximity of the studied area, in order to establish geochemical fingerprints of Manta Rota ceramic production center. Preliminary results point to a fine geochemical differentiation of the Manta Rota ceramics in comparison with the other two roman production centers of Algarve region

Chiral Symmetry Breaking with Scalar Confinement

Spontaneous chiral symmetry breaking is accepted to occur in low energy hadronic physics, resulting in the several successful theorems of PCAC. On the other hand scalar confinement is suggested both by the spectroscopy of hadrons and by the string picture of confinement. However these two evidences are apparently conflicting, because chiral symmetry breaking requires a chiral invariant coupling to the quarks, say a vector coupling like in QCD. Here we reformulate the coupling of the quarks to the string, and we are able to comply with chiral symmetry breaking, using scalar confinement. The results are quite encouraging.Comment: 4 pages, 5 figures, contribution to the XXXVIIIth Rencontres de Moriond QCD and High Energy Hadronic Interaction

Identification and functional analysis of novel genes expressed in the Anterior Visceral Endoderm

During early vertebrate development, the correct establishment of the body axes is critical. The anterior pole of the mouse embryo is established when Distal Visceral Endoderm (DVE) cells migrate to form the Anterior Visceral Endoderm (AVE). Symmetrical expression of Lefty1, Cer1 and Dkk1 determines the direction of DVE migration and the future anterior side. In addition to the establishment of the Anterior-Posterior axis, the AVE has also been implicated in anterior neural specification. To better understand the role of the AVE in these processes, we have performed a differential screening using Affymetrix GeneChip technology with AVE cells isolated from cer1P-EGFP transgenic mouse embryos. We found 175 genes which were upregulated in the AVE and 36 genes in the Proximal-posterior sample. Using DAVID software, we characterized the AVE cell population regarding cellular component, molecular function and biological processes. Among the genes that were found to be upregulated in the AVE, several novel genes were identified. Four of these transcripts displaying high-fold change in the AVE were further characterized by in situ hybridization in early stages of development in order to validate the screening. From those four selected genes, one, denominated Adtk1, was chosen to be functionally characterized by targeted inactivation in ES cells. Adtk1 encodes for a serine/threonine kinase. Adtk1 null mutants are smaller and present short limbs due to decreased mineralization, suggesting a potential role in chondrogenesis during limb development. Taken together, these data point to the importance of reporting novel genes present in the AVE.F.C.T.; IGC/FCG; IBB/CBME, L

Intensity and safety of community-based physical activities for people with COPD

Background: long-term maintenance of the benefits obtained with pulmonary rehabilitation (PR) in people with COPD is of upmost importance, yet highly challenging. Integrating these people in community-based physical activities (PAs), after PR, can be a promising strategy to maintain achieved benefits. Nevertheless, to confidently advise people with COPD to enrol these community-based PAs, clinicians must ensure those are safe and ideally are of at least moderate intensity (following PAs guidelines). This study aimed to explore safety and intensity level of community-based PAs (cardiofitness room, senior gymnastics, and aquatic gymnastics) in people with COPD, after PR. Methods: an observational cross-sectional study, part of a larger trial (NCT04223362) was conducted. People with COPD that had finished a community-based PR programme, conducted in the Respiratory Research and Rehabilitation Laboratory (Lab3R) or in four primary health care centres (Aveiro, Estarreja, Oliveira do Bairro and Montemor-o-Velho), and that had a positive risk-benefit analysis regarding their inclusion on community-based PAs were included. Participants were given the opportunity to choose among the available community-based PAs (previously identified as adequate), the one(s), they wanted to try, and were then accompanied by a physiotherapist. During the community-based PAs, dyspnoea and fatigue perception were assessed every 20 minutes using the modified Borg 0-10 scale; and heart rate (HR) and percentage of peripheral oxygen saturation (SpO2) were constantly monitored. Participants wore the SenseWear Armband on the left triceps to estimate the Metabolic Equivalent Task (METs) of each community-based PA. The final community-based PAs intensity level was obtained by summing the intensity levels yielded by: dyspnoea and fatigue Borg scores, maximal HR percentage predicted (HRmax%predicted) (where HRmaxpredicted=220-age), and METs; with 3-6 Borg scores, 64-76% of HRmax%predicted, and 3-6 METs identifying moderate intensities. For security standards, SpO2 below 88% and HRmax%predicted above 85% were considered. The occurrence of any adverse event during the PAs was registered. Results: three community-based PAs were included, cardiofitness room (9 people with COPD, 68±9 years, 100% men, 58±21 FEV1 %predicted), senior gymnastics (8 people with COPD, 70±9 years, 75% men, 53±11 FEV1 %predicted), and aquatic gymnastics (6 people with COPD, 68±10 years, 100% men, 49±16 FEV1 %predicted). Overall, the explored community-based PAs were classified as of moderate intensity (Figure 1 – a, b, c). Only one participant presented a SpO2 below 88% on the cardiofitness room (lowest SpO2 registered was 86%) and the HRmax%predicted was below 85% in all participants. Mean values of SpO2 and HRmax%predicted are presented in Figure 1 (d, e, f). No adverse event was registered. Conclusion: Cardiofitness room, senior gymnastics, and aquatic gymnastics seem safe and of moderate intensity for people with COPD. Enrolment of people with COPD on these community-based PAs, following PR, should be advised, as these may facilitate the long-term maintenance of PR benefits, while promoting a more physically active lifestyle in this population. Nevertheless, caution is needed when interpreting these results, since intensity of PA is highly influenced by individual factors and patients’ enrolment must be preceded by a careful patient selection to ensure their safety.publishe

Chemical tracers of Lusitanian amphorae kilns from the Tagus estuary (Portugal)

In this paper, the characterization of Roman amphorae from the Porto dos Cacos (PC) and Quinta do Rouxinol (QR) workshops, in the Tagus estuary, dating to a period between the 1st and 5th century AD was carried out on the basis of instrumental neutron activation analysis data on 260 amphorae fragments, together with mineralogical compositional studies obtained by X-ray diffraction. Special attention was devoted to the study of the Dressel 14, Almagro 50/51c and Lusitana 3/9 amphorae in an attempt to establish whether or not it is possible to establish any correlation between the composition and typology, and between and within the production centres studied. A description of the geochemical patterns associated with each production centre was first carried out separately, followed by a discussion comparing the two centres situated in the same sedimentary basin, identifying diagnostic chemical tracers for each one; also, in certain cases, a relative correlation with the typology was achieved. Both the definition of reference groups and the attribution of amphorae to their workshop origin relied on the use of chemometric techniques for data structure analysis, coupled with geochemical data analysis, especially regarding trace element data and its geochemical behaviour and distribution according to the geological environment of the region. This approach complements and reinforces the conclusions drawn from typological and archaeological analyses. Considering the two kiln sites studied, we may talk of the production of two types of Roman amphorae in the lower Tagus, with the establishment of compositional groups defined according to their corresponding chemical signatures. The products of the PC workshop are characterized by high concentrations of Co, As and U, and low concentrations of Fe, Zn, Sb, Rb, K; QR workshop amphorae show instead higher concentrations of Fe, Sb, and also of Rb and Zn, and lower amounts of U. These results make it possible to understand the crucial importance of the lower course of the Tagus River within the framework of the analysis of the economy of the estuary at the time. This, in turn, may lead to a better understanding of production and trade within Lusitania and also with other Roman provinces