O aprovisionamento de matérias-primas líticas na gruta de Oliveira (Torres Novas)

Tese de mestrado em Geoarqueologia, apresentada à Universidade de Lisboa, através da Faculdade de Ciências, 2012O estudo das matérias‐primas provenientes de uma amostra da unidade estratigráfica 14 da Gruta da Oliveira, datada de cerca de 45.000 anos, foi conduzido segundo uma metodologia de observação a diferentes escalas. Numa primeira fase, com o auxílio de bibliografia específica, foram definidas e prospectadas as potenciais áreas de aprovisionamento, tendo sido identificados e amostrados 21 afloramentos de rochas em posição primária e secundária no Maciço Calcário Estremenho e na Bacia Sedimentar do Tejo. O estudo foi centrado no sílex. Foram realizadas análises petrográficas à escala macro e microscópica, focadas nas características genéticas e pós‐genéticas dos materiais, permitindo a classificação de 11 tipos distintos. Considerando que o estudo de proveniências deve ser encarado como o primeiro passo da Chaîne Opératoire, dando assim uma dimensão espacial da tecnologia, o material arqueológico foi classificado tipologicamente e segundo classes tecnológicas, num total de 3071 artefactos líticos talhados. O sílex foi analisado petrograficamente, à escala macroscópica, tendo sido identificados seis tipos genéticos. Com estes resultados, cruzados com os dados provenientes das amostras geológicas, foi possível verificar que o aprovisionamento de matérias‐primas foi realizado de modos distintos. O quartzo e quartzito, especialmente o de “grão fino”, ocorrem localmente, enquanto que o sílex provém de afloramentos localizados num raio de 30 km ao redor da gruta. Ainda que ocorra localmente foi explorado na sua maioria pelo menos a cerca de 15 km a Sudoeste da gruta. O aprovisionamento em sílex do Oxfordiano a cerca de 25 km a Nordeste, num corredor natural desenvolvido ao longo do vale do rio Nabão, pode ser interpretado no quadro da ocupação do território relacionada com as modalidades de exploração dos recursos pelos grupos neandertais. Os resultados obtidos permitiram abrir uma janela à compreensão da mobilidade das populações neandertais durante Paleolítico médio final nesta região do país, o que nos possibilita uma abordagem, até agora inexistente, à economia e subsistência destes grupos humanos.The study of raw materials in a sample from Gruta da Oliveira stratigraphic unit 14, dated to ~45,000 years ago, was conducted using a methodology that emphasizes observation at multiple scales. Through an initial review of the literature, potential procurement areas were defined and surveyed. Eventually, 21 outcrops were identified and sampled in both primary and secondary position in the Estremadura Limestone Massif and in the Sedimentary Basin of the Tagus River. Petrographic analyses, focused mainly on the chert, were conducted at macro and microscopic scales allowing the identification of 11 distinct types based on the genetic and post‐genetic characteristics of the rocks. The sourcing study, which should be considered the first step in the reconstruction of the chaîne opératoire gives a spatial dimension to technological organization at Gruta da Oliveira. Among the archaeological material, a total of 3071 lithic artifacts typologically and technologically classified, six genetic types of chert were identified, through petrographical study at a macroscopical scale. Combined with the data from the geological samples, the artifact analysis showed that two kinds of raw material procurement were in existence. Quartz and quartzite, especially the "fine grained" materials, occur locally. The chert comes from a 30 km radius. Some occurs locally, but it was mostly collected at sources located at least 15 km to the southwest; one particular type of flint from the Oxfordian has its closest sources some 25 km to the northeast, along the natural corridor represented by the valley of the Nabão River. These results, obtained through a methodological approach that hitherto remained to be applied to the sites of this region/period, provide novel insights into Neanderthal mobility, economy, and subsistence during the late Middle Paleolithic of Portugal

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Reduction of cardiac imaging tests during the COVID-19 pandemic: The case of Italy. Findings from the IAEA Non-invasive Cardiology Protocol Survey on COVID-19 (INCAPS COVID)

Background: In early 2020, COVID-19 massively hit Italy, earlier and harder than any other European country. This caused a series of strict containment measures, aimed at blocking the spread of the pandemic. Healthcare delivery was also affected when resources were diverted towards care of COVID-19 patients, including intensive care wards. Aim of the study: The aim is assessing the impact of COVID-19 on cardiac imaging in Italy, compare to the Rest of Europe (RoE) and the World (RoW). Methods: A global survey was conducted in May–June 2020 worldwide, through a questionnaire distributed online. The survey covered three periods: March and April 2020, and March 2019. Data from 52 Italian centres, a subset of the 909 participating centres from 108 countries, were analyzed. Results: In Italy, volumes decreased by 67% in March 2020, compared to March 2019, as opposed to a significantly lower decrease (p &lt; 0.001) in RoE and RoW (41% and 40%, respectively). A further decrease from March 2020 to April 2020 summed up to 76% for the North, 77% for the Centre and 86% for the South. When compared to the RoE and RoW, this further decrease from March 2020 to April 2020 in Italy was significantly less (p = 0.005), most likely reflecting the earlier effects of the containment measures in Italy, taken earlier than anywhere else in the West. Conclusions: The COVID-19 pandemic massively hit Italy and caused a disruption of healthcare services, including cardiac imaging studies. This raises concern about the medium- and long-term consequences for the high number of patients who were denied timely diagnoses and the subsequent lifesaving therapies and procedures

International Impact of COVID-19 on the Diagnosis of Heart Disease

Background: The coronavirus disease 2019 (COVID-19) pandemic has adversely affected diagnosis and treatment of noncommunicable diseases. Its effects on delivery of diagnostic care for cardiovascular disease, which remains the leading cause of death worldwide, have not been quantified. Objectives: The study sought to assess COVID-19's impact on global cardiovascular diagnostic procedural volumes and safety practices. Methods: The International Atomic Energy Agency conducted a worldwide survey assessing alterations in cardiovascular procedure volumes and safety practices resulting from COVID-19. Noninvasive and invasive cardiac testing volumes were obtained from participating sites for March and April 2020 and compared with those from March 2019. Availability of personal protective equipment and pandemic-related testing practice changes were ascertained. Results: Surveys were submitted from 909 inpatient and outpatient centers performing cardiac diagnostic procedures, in 108 countries. Procedure volumes decreased 42% from March 2019 to March 2020, and 64% from March 2019 to April 2020. Transthoracic echocardiography decreased by 59%, transesophageal echocardiography 76%, and stress tests 78%, which varied between stress modalities. Coronary angiography (invasive or computed tomography) decreased 55% (p &lt; 0.001 for each procedure). In multivariable regression, significantly greater reduction in procedures occurred for centers in countries with lower gross domestic product. Location in a low-income and lower–middle-income country was associated with an additional 22% reduction in cardiac procedures and less availability of personal protective equipment and telehealth. Conclusions: COVID-19 was associated with a significant and abrupt reduction in cardiovascular diagnostic testing across the globe, especially affecting the world's economically challenged. Further study of cardiovascular outcomes and COVID-19–related changes in care delivery is warranted

Impact of COVID-19 on Diagnostic Cardiac Procedural Volume in Oceania: The IAEA Non-Invasive Cardiology Protocol Survey on COVID-19 (INCAPS COVID)

Objectives: The INCAPS COVID Oceania study aimed to assess the impact caused by the COVID-19 pandemic on cardiac procedure volume provided in the Oceania region. Methods: A retrospective survey was performed comparing procedure volumes within March 2019 (pre-COVID-19) with April 2020 (during first wave of COVID-19 pandemic). Sixty-three (63) health care facilities within Oceania that perform cardiac diagnostic procedures were surveyed, including a mixture of metropolitan and regional, hospital and outpatient, public and private sites, and 846 facilities outside of Oceania. The percentage change in procedure volume was measured between March 2019 and April 2020, compared by test type and by facility. Results: In Oceania, the total cardiac diagnostic procedure volume was reduced by 52.2% from March 2019 to April 2020, compared to a reduction of 75.9% seen in the rest of the world (p&lt;0.001). Within Oceania sites, this reduction varied significantly between procedure types, but not between types of health care facility. All procedure types (other than stress cardiac magnetic resonance [CMR] and positron emission tomography [PET]) saw significant reductions in volume over this time period (p&lt;0.001). In Oceania, transthoracic echocardiography (TTE) decreased by 51.6%, transoesophageal echocardiography (TOE) by 74.0%, and stress tests by 65% overall, which was more pronounced for stress electrocardiograph (ECG) (81.8%) and stress echocardiography (76.7%) compared to stress single-photon emission computerised tomography (SPECT) (44.3%). Invasive coronary angiography decreased by 36.7% in Oceania. Conclusion: A significant reduction in cardiac diagnostic procedure volume was seen across all facility types in Oceania and was likely a function of recommendations from cardiac societies and directives from government to minimise spread of COVID-19 amongst patients and staff. Longer term evaluation is important to assess for negative patient outcomes which may relate to deferral of usual models of care within cardiology