When Portugal is too small to build case study: Mota-Engil

The construction sector has a key role in any country’s economy. The distinctiveness of this industry is related to its complexity, to its range of possible inputs and outputs, the long value-chain, the development of externalities, and by the construction investment multiplicative effect on economy, particularly in the employment. On the other hand, it is a sector intrinsically dependent on the economy business cycles, particularly to public expenditure and credit access and the evolution of interest rates. The financial crisis had a tremendous negative impact in the Portuguese construction, motivating/forcing the major Portuguese contractors to endeavor to the internationalization solution. These firms had different motivations, generally seeking out to achieve growth levels that were not possible if they stayed in a Portugal that seems to be getting smaller to the contractor’s ambitions to build, and doing so, in a context that the construction/engineering industry in Portugal starts to show signs of recovery after the recession, and the major contractors are reporting around 80% revenue overseas. In this context, the subject of internationalization in the industry of construction gains especial interest to understand the cases of success. The success case in study will be the Mota-Engil Group, by far the Portuguese leader and best performing company, the only construction and engineering company in the PSI20 - the main Portuguese Stock Index - in 2017, reporting a turnover of 2,597 million Euros and a backlog that reached €5,138 Mn, of which 79% outside Europe. Present in the 51st position on ENR’s 2018 Top 250 International Contractors, after ranking 58th in 2017. In the year of 2018 the company entered in 4 new markets extending their presence to more than 30 countries.O sector da construção tem um papel importante em qualquer economia. Os fatores diferenciadores desta indústria prendem-se com a sua complexidade, com a variedade de possíveis componentes e resultados, da sua cadeia de valor, da criação de externalidades, e pelo seu efeito multiplicador no resto da economia, em particular na criação de emprego. Contudo, o sector da construção é um sector intrinsecamente dependente dos ciclos económicos, do investimento público, da evolução de outros sectores e, significativamente, pelo acesso ao crédito e à evolução das taxas de juro. A crise financeira teve tremendos impactos negativos na construção em Portugal, motivando ou mesmo forçando, os principais players da construção em Portugal em aventurarem-se na internacionalização. Estas empresas tiveram diferentes razões para a sua internacionalização, genericamente todas procuraram “lá fora” por uma solução para continuar os níveis de crescimento que não eram possíveis se se mantivessem, num Portugal que parece cada vez mais pequeno para as aspirações das empresas construtoras. Assim sendo, num contexto em que o sector em Portugal começa a dar os primeiros sinais de recuperação, após, e em que as principais empresas de construção reportam cerca de 80% do seu volume de negócios vindo de mercados externos. Neste contexto, o tema da internacionalização da construção portuguesa ganha especial interesse em estudar os casos de sucesso em Portugal. O caso de sucesso em estudo será Grupo Mota-Engil, o líder do sector da construção em Portugal e a empresa com melhor performance, a única empresa construtora pressente no PSI20, principal Índice bolsista português, e que em 2017 reportou 2.597 milhões de euros e uma carteira de negócios que ascendia aos 5.138 milhões de euros, dos quais 79% fora da Europa. A Mota-Engil que este ano subiu 6 posições, em 2018, e alcançando a 51ª posição no ranking da ENR Top 250 das construtoras mais internacionais, tendo como base a receita proveniente dos mercados externos. No ano de 2018, a empresa já anunciou a entrada em 4 novos mercados, ultrapassando a marca dos 30 países

A narrative synthesis of research evidence for tinnitus-related complaints as reported by patients and their significant others

Background: There are a large number of assessment tools for tinnitus, with little consensus on what it is important to measure and no preference for a minimum reporting standard. The item content of tinnitus assessment tools should seek to capture relevant impacts of tinnitus on everyday life, but no-one has yet synthesised information about the range of tinnitus complaints. This review is thus the first comprehensive and authoritative collection and synthesis of what adults with tinnitus and their significant others report as problems in their everyday lives caused by tinnitus. Methods: Electronic searches were conducted in PubMed, Embase, CINAHL, as well as grey literature sources to identify publications from January 1980 to June 2015 in which participants were enrolled because tinnitus was their primary complaint. A manual search of seven relevant journals updated the search to December 2017. Of the 3,699 titles identified overall, 84 records (reporting 86 studies) met our inclusion criteria and were taken through to data collection. Coders collated generic and tinnitus specific complaints reported by people with tinnitus. All relevant data items were then analyzed using an iterative approach to narrative synthesis to form domain groupings representing complaints of tinnitus, which were compared patients and significant others. Results: From the 86 studies analyzed using data collected from 16,381 patients, 42 discrete complaints were identified spanning physical and psychological health, quality of life and negative attributes of the tinnitus sound. This diversity was not captured by any individual study alone. There was good convergence between complaints collected using open- and closed-format questions, with the exception of general moods and perceptual attributes of tinnitus (location, loudness, pitch and unpleasantness); reported only using closed questions. Just two studies addressed data from the perspective of significant others (n=79), but there was substantial correspondence with the patient framework, especially regarding relationships and social life. Conclusions: Our findings contribute fundamental new knowledge and a unique resource that enables investigators to appreciate the broad impacts of tinnitus on an individual. Our findings can also be used to guide questions during diagnostic assessment, to evaluate existing tinnitus-specific HR-QoL questionnaires and develop new ones, where necessary

Results from a population-based cohort study

Funding Information: We have read the journal's policy and the authors of this manuscript have the following competing interests: ARF reports travel grants from Roche and advisory board fees from Daiichi Sankyo, Gilead, Merck Sharp & Dohme, Novartis and Roche, outside the submitted work. DMB reports travel grants from LEO Farmacêuticos, Merck Sharp & Dohme, Ipsen, Janssen, Roche, and Novartis, advisory board fees from Janssen, Pfizer, Merck Sharp & Dohme, Angelini, AstraZeneca, and Novartis, and institutional grants from F. Hoffmann-La Roche, outside the submitted work. The other authors have declared that no competing interests exist. Funding Information: The authors acknowledge the RON network that cooperated in providing up-to-date information on cases diagnosed and treated with the drug of interest (participating institutions: Centro Hospitalar Universit?rio de S?o Jo?o, Centro Hospitalar Universit?rio Lisboa Norte, Centro Hospitalar Universit?rio do Algarve, Hospital de Braga, Centro Hospitalar e Universit?rio de Coimbra, Centro Hospitalar de Tr?s-os-Montes e Alto Douro, Hospital Central do Funchal, Centro Hospitalar de Vila Nova de Gaia/Espinho, Centro Hospitalar Lisboa Ocidental, Hospital Garcia de Orta, Centro Hospitalar Universit?rio Lisboa Central, Hospital Distrital de Santar?m, Centro Hospitalar de Entre o Douro e Vouga, Hospital da Senhora da Oliveira Guimar?es, Centro Hospitalar de Set?bal, Centro Hospitalar e Universit?rio do Porto, Centro Hospitalar Tondela Viseu, Hospital do Esp?rito Santo de ?vora, Centro Hospitalar Barreiro Montijo, Hospital Beatriz ?ngelo, Hospital do Santo Esp?rito da Ilha Terceira, Hospital do Divino Esp?rito Santo de Ponta Delgada, Hospital Pedro Hispano ? ULS Matosinhos, Hospital do Litoral Alentejano ? Santiago do Cac?m ? ULS Litoral Alentejano, Centro Hospitalar do Oeste, Centro Hospitalar M?dio Tejo, Hospital Jos? Joaquim Fernandes ? Beja ? ULS Baixo Alentejo, Centro Hospitalar Universit?rio da Cova da Beira, Centro Cl?nico Champalimaud, Hospitais CUF, Hospitais da Luz, Hospitais dos Lus?adas, Hospital Particular do Algarve). Publisher Copyright: © 2022 The AuthorsBackground: Real-world (RW) data may provide valuable information on the effectiveness and safety of medicines, which is particularly relevant for clinicians, patients and third-party payers. Evidence on the effectiveness of palbociclib plus fulvestrant is scarce, which highlights the need of additional studies. The aim of this study was to evaluate the effectiveness of palbociclib plus fulvestrant in advanced breast cancer (ABC). Materials and methods: We conducted a population-based retrospective cohort study and cases of interest were identified through the Portuguese National Cancer Registry database and additional data sources. Patients aged≥18 years, diagnosed with ABC and exposed to palbociclib plus fulvestrant between May 31, 2017 and March 31, 2019 were included. Patients were followed-up until death or cut-off date (February 28, 2021). Primary outcome was rw-progression-free survival (rwPFS). Secondary outcomes were rw-overall survival (rwOS), rw-time to palbociclib failure (rwTPF) and rw-time to next treatment (rwTTNT). Results: A total of 210 patients were included. Median age was 58 years (range 29–83) and 99.05% were female. Median follow-up time was 23.22 months and, at cut-off date, treatment had been discontinued in 189 patients, mainly due to disease progression (n = 152). Median rwPFS was 7.43 months (95% confidence interval [CI] 6.28–9.05) and 2-year rwPFS was 16.65% (95%CI 11.97–22.00). Median rwOS was 24.70 months (95%CI 21.58–29.27), median rwTPF was 7.5 months (95%CI 6.51–9.08) and median rwTTNT was 11.74 months (95%CI 10.33–14.08). Conclusion: Palbociclib plus fulvestrant seems an effective treatment for ABC in real-world context. Compared to registrations studies, rwPFS and rwOS were shorter in real-life setting.publishersversionpublishe

Predictors of cardiac involvement in idiopathic inflammatory myopathies

Copyright © 2023 Bandeira, Dourado, Melo, Martins, Fraga, Ferraro, Saraiva, Sousa, Parente, Soares, Correia, Almeida, Dinis, Pinto, Oliveira Pinheiro, Rato, Beirão, Samões, Santos, Mazeda, Chícharo, Faria, Neto, Lourenço, Brites, Rodrigues, Silva-Dinis, Dias, Araújo, Martins, Couto, Valido, Santos, Barreira, Fonseca and Campanilho-Marques. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.Objectives: Idiopathic inflammatory myopathies (IIM) are a group of rare disorders that can affect the heart. This work aimed to find predictors of cardiac involvement in IIM. Methods: Multicenter, open cohort study, including patients registered in the IIM module of the Rheumatic Diseases Portuguese Register (Reuma.pt/Myositis) until January 2022. Patients without cardiac involvement information were excluded. Myo(peri)carditis, dilated cardiomyopathy, conduction abnormalities, and/or premature coronary artery disease were considered. Results: 230 patients were included, 163 (70.9%) of whom were females. Thirteen patients (5.7%) had cardiac involvement. Compared with IIM patients without cardiac involvement, these patients had a lower bilateral manual muscle testing score (MMT) at the peak of muscle weakness [108.0 ± 55.0 vs 147.5 ± 22.0, p=0.008] and more frequently had oesophageal [6/12 (50.0%) vs 33/207 (15.9%), p=0.009] and lung [10/13 (76.9%) vs 68/216 (31.5%), p=0.001] involvements. Anti-SRP antibodies were more commonly identified in patients with cardiac involvement [3/11 (27.3%) vs 9/174 (5.2%), p=0.026]. In the multivariate analysis, positivity for anti-SRP antibodies (OR 104.3, 95% CI: 2.5-4277.8, p=0.014) was a predictor of cardiac involvement, regardless of sex, ethnicity, age at diagnosis, and lung involvement. Sensitivity analysis confirmed these results. Conclusion: Anti-SRP antibodies were predictors of cardiac involvement in our cohort of IIM patients, irrespective of demographical characteristics and lung involvement. We suggest considering frequent screening for heart involvement in anti-SRP-positive IIM patients.info:eu-repo/semantics/publishedVersio

Transtorno de ansiedade generalizada: revisão de literatura

Transtornos de ansiedade são os transtornos psiquiátricos mais comuns na sociedade e apresentam grandes demandas no serviço público e privado no mundo. De acordo com a OMS, o Brasil possui a população com maior taxa de transtornos de ansiedade no mundo, totalizando aproximadamente 9,3% da população com o quadro, seguido do Paraguai (7,6%) e Noruega (7,4%). Para a elaboração do trabalho foi utilizado a metodologia revisão bibliográfica integrativa. A ansiedade é considerada uma emoção humana natural, mas que de maneira excessiva torna-se patológica e gera diversos prejuízos ao indivíduo e à sociedade. A revisão apresenta como objetivo analisar epidemiologia e fatores de risco, etiologia, diagnóstico, tratamento e prognóstico. Conclui-se através desse estudo que o diagnóstico realizado de maneira eficaz com base nos critérios recomendados pelo Diagnostic and Statistical Manual of Mental Disorders V (DSM-V) é fundamental para uma boa condução do tratamento psicoterápico e farmacológico do quadro. Para realizar o diagnóstico e o tratamento, o médico deve levar os critérios técnicos comprovados na literatura médica e o desejo do paciente

MAMMALS IN PORTUGAL : A data set of terrestrial, volant, and marine mammal occurrences in P ortugal

Mammals are threatened worldwide, with 26% of all species being includedin the IUCN threatened categories. This overall pattern is primarily associatedwith habitat loss or degradation, and human persecution for terrestrial mam-mals, and pollution, open net fishing, climate change, and prey depletion formarine mammals. Mammals play a key role in maintaining ecosystems func-tionality and resilience, and therefore information on their distribution is cru-cial to delineate and support conservation actions. MAMMALS INPORTUGAL is a publicly available data set compiling unpublishedgeoreferenced occurrence records of 92 terrestrial, volant, and marine mam-mals in mainland Portugal and archipelagos of the Azores and Madeira thatincludes 105,026 data entries between 1873 and 2021 (72% of the data occur-ring in 2000 and 2021). The methods used to collect the data were: live obser-vations/captures (43%), sign surveys (35%), camera trapping (16%),bioacoustics surveys (4%) and radiotracking, and inquiries that represent lessthan 1% of the records. The data set includes 13 types of records: (1) burrowsjsoil moundsjtunnel, (2) capture, (3) colony, (4) dead animaljhairjskullsjjaws, (5) genetic confirmation, (6) inquiries, (7) observation of live animal (8),observation in shelters, (9) photo trappingjvideo, (10) predators dietjpelletsjpine cones/nuts, (11) scatjtrackjditch, (12) telemetry and (13) vocalizationjecholocation. The spatial uncertainty of most records ranges between 0 and100 m (76%). Rodentia (n=31,573) has the highest number of records followedby Chiroptera (n=18,857), Carnivora (n=18,594), Lagomorpha (n=17,496),Cetartiodactyla (n=11,568) and Eulipotyphla (n=7008). The data setincludes records of species classified by the IUCN as threatened(e.g.,Oryctolagus cuniculus[n=12,159],Monachus monachus[n=1,512],andLynx pardinus[n=197]). We believe that this data set may stimulate thepublication of other European countries data sets that would certainly contrib-ute to ecology and conservation-related research, and therefore assisting onthe development of more accurate and tailored conservation managementstrategies for each species. There are no copyright restrictions; please cite thisdata paper when the data are used in publications.info:eu-repo/semantics/publishedVersio

Mammals in Portugal: a data set of terrestrial, volant, and marine mammal occurrences in Portugal

Mammals are threatened worldwide, with ~26% of all species being included in the IUCN threatened categories. This overall pattern is primarily associated with habitat loss or degradation, and human persecution for terrestrial mammals, and pollution, open net fishing, climate change, and prey depletion for marine mammals. Mammals play a key role in maintaining ecosystems functionality and resilience, and therefore information on their distribution is crucial to delineate and support conservation actions. MAMMALS IN PORTUGAL is a publicly available data set compiling unpublished georeferenced occurrence records of 92 terrestrial, volant, and marine mammals in mainland Portugal and archipelagos of the Azores and Madeira that includes 105,026 data entries between 1873 and 2021 (72% of the data occurring in 2000 and 2021). The methods used to collect the data were: live observations/captures (43%), sign surveys (35%), camera trapping (16%), bioacoustics surveys (4%) and radiotracking, and inquiries that represent less than 1% of the records. The data set includes 13 types of records: (1) burrows | soil mounds | tunnel, (2) capture, (3) colony, (4) dead animal | hair | skulls | jaws, (5) genetic confirmation, (6) inquiries, (7) observation of live animal (8), observation in shelters, (9) photo trapping | video, (10) predators diet | pellets | pine cones/nuts, (11) scat | track | ditch, (12) telemetry and (13) vocalization | echolocation. The spatial uncertainty of most records ranges between 0 and 100 m (76%). Rodentia (n =31,573) has the highest number of records followed by Chiroptera (n = 18,857), Carnivora (n = 18,594), Lagomorpha (n = 17,496), Cetartiodactyla (n = 11,568) and Eulipotyphla (n = 7008). The data set includes records of species classified by the IUCN as threatened (e.g., Oryctolagus cuniculus [n = 12,159], Monachus monachus [n = 1,512], and Lynx pardinus [n = 197]). We believe that this data set may stimulate the publication of other European countries data sets that would certainly contribute to ecology and conservation-related research, and therefore assisting on the development of more accurate and tailored conservation management strategies for each species. There are no copyright restrictions; please cite this data paper when the data are used in publications

O trabalho emocional em enfermagem pediátrica face às repercussões da COVID-19 na infância e adolescência

Objetivo: Refletir sobre o trabalho emocional em enfermagem pediátrica face às repercussões da COVID-19 na infância e adolescência. Método: Reflexão embasada em aspectos teóricos e evidências científicas do trabalho emocional em enfermagem pediátrica. Resultados: Diante das repercussões da COVID-19 em crianças e adolescentes, cabe ao enfermeiro reconhecê-las e nutrir o cuidado não traumático e afetuoso. No entanto, observamse implicações das medidas de controle da doença na forma de cuidar. Nesta conjuntura, o trabalho emocional torna-se essencial à medida que orienta a gestão das emoções da criança e família, associadas ao sofrimento causado pela pandemia e à experiência emocional do enfermeiro ao cuidar. Conclusão: O trabalho emocional é imprescindível em pediatria, sobretudo em um momento estressante como o de pandemia, o qual requer a transformação positiva das vivências intensas e perturbadoras das pessoas em interação para o alcance do bem-estar psicossocial. Palavras-chave: Enfermagem pediátrica. Cuidados de enfermagem. Emoções. Infecções por coronavírus. Pandemias

Método e composições para controle genético de insetos-praga em plantas de algodão através do silenciamento de genes da família da lacase

Universidade Federal do Rio Grande do SulEmpresa Brasileira de Pesquisa AgropecuáriaDepositad

Método e composições para controle genético de insetos-praga em plantas de algodão através do silenciamento de genes da família da lacase

Universidade Federal do Rio Grande do SulEmpresa Brasileira de Pesquisa AgropecuáriaDepositad