Optical coherence tomography angiography in herpetic leucoma

Herpes simplex virus (HSV) keratitis remains a leading infectious cause of blindness worldwide. Although all forms of HSV keratitis are commonly recurrent, the risk is greatest in stromal keratitis, which is the most likely to result in corneal scarring, thinning, and neovascularization. Recent studies showed the ability of Optical Coherence Tomography Angiography (OCTA) to detect and study vascular abnormalities in the anterior segment, including abnormal corneal vessels. This study intends to investigate the potential of OCTA device to image and describe quantitatively the vascularization in eyes diagnosed with herpetic leucoma and to discuss and review the usefulness of this technique in this pathology. A Cross-sectional study was made, including 17 eyes of 15 patients with leucoma secondary to herpetic keratitis. All eyes underwent anterior segment Slit-Lamp photography (SLP), and OCTA with en-face, b-scans and c-scans imaging. The vessel density (VD) was analyzed in the inferior, nasal and temporal corneal margin in all patients, and in the central area, in eyes with central corneal neovascularization (CoNV). The measurements were calculated after binarization with ImageJ software, using OCTA scans with 6 × 6 mm in a depth of 800 μm. Patients included had a mean age 53.267 ± 21.542 (years ± SD). The mean total vessel area was 50.907% ± 3.435%. VD was higher in the nasal quadrant (51.156% ± 4.276%) but there were no significant differences between the three analyzed areas (p = 0.940). OCTA was able to identify abnormal vessels when SLP apparently showed no abnormal vessels; OCTA was able to distinguish between larger and smaller vessels even in central cornea; OCTA scans allowed the investigation of several corneal planes and the relation of them with clinical findings. OCTA can be useful in both qualitative and quantitative follow-up of patients and may become a non-invasive alternative to objectively monitor treatment response in eyes with corneal vascularization due to herpetic infection.info:eu-repo/semantics/publishedVersio

Characterization of tasks and skills of workers, middle and top managers in the Industry 4.0 context

This study intends to make a characterization of the main tasks and skills needed to face the Industry 4.0. Moreover, it gives special attention to the different company’s hierarchical levels. To achieve the goals of this paper, a methodology based on Collaborative Decision Making method was used. Firstly, thirty participants were interviewed to understand their point of views. Next, they were split into Group Works to refine the results. Finally, a Group Concordance took place to create the final list of tasks and skills. The skills were organized into four categories: Technical, Social, Methodological and Personal. The results show different requirements in each level. In the Workers level, due to the presence of more technical tasks, eight of the top ten skills belong to the Technical category. In the Middle Managers level, there are tasks of both leading and analyzing nature and thus the top ten skills needed are split through the four categories. Finally, in the Top Managers level, due to the presence of mainly strategy tasks, the top ten skills are split between the Methodological and Social categories. To the authors’ knowledge, this is one of the first studies to use a Collaborative Decision Making methodology to develop a set of tasks and skills that future work environments will demand on the different hierarchical levels of the organization.This work was supported by the research unit on Governance, Competitiveness and Public Policy (UIDB/04058/2020) and by Algoritmi Research Unit (UIDB/00319/2020), funded by national funds through FCT—Fundação para a Ciência e a Tecnologia

Microbial Source Tracking as a Method of Determination of Beach Sand Contamination

This article belongs to the Special Issue Environmental Microbiology: Perspectives for Medicine and Public Health.Beach sand may act as a reservoir for numerous microorganisms, including enteric pathogens. Several of these pathogens originate in human or animal feces, which may pose a public health risk. In August 2019, high levels of fecal indicator bacteria (FIB) were detected in the sand of the Azorean beach Prainha, Terceira Island, Portugal. Remediation measures were promptly implemented, including sand removal and the spraying of chlorine to restore the sand quality. To determine the source of the fecal contamination, during the first campaign, supratidal sand samples were collected from several sites along the beach, followed by microbial source tracking (MST) analyses of Bacteroides marker genes for five animal species, including humans. Some of the sampling sites revealed the presence of marker genes from dogs, seagulls, and ruminants. Making use of the information on biological sources originating partially from dogs, the municipality enforced restrictive measures for dog-walking at the beach. Subsequent sampling campaigns detected low FIB contamination due to the mitigation and remediation measures that were undertaken. This is the first case study where the MST approach was used to determine the contamination sources in the supratidal sand of a coastal beach. Our results show that MST can be an essential tool to determine sources of fecal contamination in the sand. This study shows the importance of holistic management of beaches that should go beyond water quality monitoring for FIB, putting forth evidence for beach sand monitoring.Financial support came from CESAM (UID/AMB/50017-POCI-01-0145-FEDER-007638) and CITAB (UID/AGR/04033/2019), via FCT/MCTES, from national funds (PIDDAC), cofounded by FEDER (PT2020 Partnership Agreement and Compete 2020)info:eu-repo/semantics/publishedVersio

Atitudes face ao recovery na doença mental em utilizadores e profissionais de uma organização comunitária: Uma ajuda na planificação de intervenções efectivas?

Em Portugal, a literatura bem como a investigação relativas ao recovery na doença mental é escassa. Este trabalho tem como principal objectivo o aferir das atitudes relativas ao recovery na doença mental em dois grupos distintos: pessoas com doença mental e profissionais de Saúde Mental numa organização comunitária. A amostra foi constituída por 30 elementos, 15 por cada um dos grupos atrás referidos. O instrumento utilizado foi o questionário, “Recovery Attitudes Questionnaire 16” (J. R. Borkin, J. J. Steffen, L. B. Ensfield, K. Krzton, H. Wishnick, K. Wilder, & N. Yangarber, 2000), o qual foi traduzido e adaptado para o presente estudo. Foram ainda adicionadas duas questões, com o objectivo de constatar se existem diferenças nos dois grupos relativamente à questão do recovery ser entendido como um processo ou como resultado. Concluiu-se que as atitudes de ambos os grupos são bastante positivas, não se observando grandes diferenças entre os respondentes dos grupos. Em relação à questão do paradigma do recovery, ambos os grupos tenderam a rejeitar a hipótese do recovery como processo

Médicos-Sentinela: relatório de atividades 2011

A Rede Médicos-Sentinela (MS) é constituída por médicos de Medicina Geral e Familiar (MGF) cuja atividade profissional é desenvolvida, na sua maioria, em Centros de Saúde do Serviço Nacional de Saúde. No ano em análise participaram 54 Médicos-Sentinela cuja prática se desenvolvia em 27 Unidades de Saúde Familiar e uma Unidade de Cuidados de Saúde Personalizados. Os principais objetivos da atividade desta rede são: - Fazer investigação clínica, epidemiológica e em Serviços de Saúde; - Estimar as taxas de incidência anuais ou semanais de algumas doenças ou de situações com elas relacionadas que ocorrem na população inscrita na lista dos Médicos-Sentinela; - Fazer a vigilância epidemiológica de algumas doenças que ocorrem na comunidade, de forma a permitir a identificação precoce de eventuais “surtos”; - Constituir uma base de dados que possibilite, em qualquer momento, a análise epidemiológica aprofundada de doenças com interesse para a saúde pública. A participação de Médicos de Família na Rede Médicos-Sentinela é voluntária e concretiza-se através da: - Notificação contínua, semanal, dos novos casos de doença ocorridos nos utentes inscritos nas listas dos médicos participantes; - Apresentação de propostas, realização de estudos-satélite e participação em estudos nacionais e internacionais. A Rede deu os primeiros passos em finais da década de 80, no Distrito de Setúbal, e foi sendo progressivamente alargada a outros distritos, até abranger, em 1992, os 18 Distritos do Continente, em 1996, a Região Autónoma da Madeira e em 1997, a Região Autónoma dos Açores. Constitui um objetivo fundamental para a coordenação da Rede dos Médicos-Sentinela aumentar o envolvimento dos médicos na atividade da mesma. Para tal, incentiva-se a apresentação de propostas para a realização de estudos-satélite. Um dos marcos no desenvolvimento da rede é a reunião anual, onde se faz o balanço das atividades passadas e se projeta o futuro próximo. Nestas reuniões: - Apresentam-se os resultados preliminares da análise dos dados da notificação contínua e dos estudos satélites do ano anterior e ainda a descrição das outras atividades desenvolvidas no âmbito da rede; - Os Médicos-Sentinela, ou outros interessados, propõem os novos temas para notificação contínua e novos estudos-satélite. Essas propostas têm sido discutidas em plenário e em grupos de trabalho criados com esse objetivo específico; - Discutem-se aspetos relacionados com a utilização dos dados e com a estrutura e organização da rede. É de salientar a abertura destas reuniões à participação externa de eventuais interessados. Assim, tem sido possível contar, frequentemente, com a presença e colaboração de médicos especialistas de várias instituições e outras nacionalidades. As características metodológicas, as potencialidades e fragilidades da informação obtida através da Rede Médicos-Sentinela constam do presente relatório, de modo a orientar a consulta e interpretação dos resultados. A informação sobre a Rede Médicos-Sentinela encontra-se disponível na Internet, no endereço www.insa.pt

Consulta de enfermagem na Atenção Primária à Saúde: cuidado às pessoas com doenças crônicas cardiometabólicas

Objective: to design a nursing consultation instrument for people with high blood pressure and/or type 2 diabetes mellitus being followed up in Primary Health Care. Method: methodological study comprising two stages developed in a Basic Health Unit (BHS) in the interior of the state of São Paulo. Stage 1 was related to designing the instrument and validating its content with five judges. Stage 2 was related to pre-testing and evaluation of its measurement properties. The questionnaire was pre-tested with 30 people with high blood pressure and/or diabetes mellitus that attended the UBS. Results: the questionnaire had a high content validity index (CVI = 0,96) and moderate feasibility (considering the administration time). Conclusion: the instrument was adequate to the reality and need of primary health care in terms of content.Objetivo: desenvolver um instrumento para Consulta de Enfermagem às pessoas com hipertensão arterial e/ou diabetes mellitus tipo 2 em seguimento na Atenção Primária à saúde. Método: estudo metodológico, composto por duas etapas, desenvolvido em Unidade Básica de Saúde (UBS) no interior do Estado de São Paulo. A Etapa 1 correspondeu à Construção do Instrumento e à Validação de Conteúdo por cinco juízes. A Etapa 2 correspondeu ao pré-teste e à avaliação de suas propriedades de medida. O questionário foi pré-testado com 30 pessoas com hipertensão arterial e/ou debates mellitus usuárias da UBS. Resultados: o questionário apresentou alto índice de validade de conteúdo (IVC=0,96) e moderada aplicabilidade (pelo tempo de aplicação). Conclusão: o instrumento se apresentou adequado à realidade e à necessidade da Atenção Primária em termos de conteúdo

Insights on catheter-related bloodstream infections: a prospective observational study on the catheter colonization and multi-drug resistance

Observational StudyBackground: Central venous catheter-related bloodstream infection (CRBSI) is a huge public health concern with considerable impact on mortality and health costs. Aim: A three-year observational study enrolling three tertiary hospitals located in Lisbon, Portugal, was designed to identify the major aetiological agents of CRBSI, their ability to colonize central venous catheters and their antimicrobial resistance profiles. Methods: Aetiological agents of CRBSI were identified by Vitek 2. Whole-genome sequencing was used to confirm CRBSI by the most prevalent aetiological agents and characterize their resistome. Central venous catheter colonization (namely by biofilm assembly) was monitored by scanning electron microscopy. Findings: Staphylococci were the most prevalent causative agent (36/58, 62.0%), with S. aureus and coagulase-negative S. epidermidis accounting for 24.1% and 36.2% of CRBSIs, respectively. Fifty-nine of 72 staphylococci isolates were meticillin resistant. Comparative genomic analysis of central venous catheters/haemoculture pairs of isolates revealed genomic matches for 35 of 36 pairs and a good correlation between antibiotic susceptibility phenotype and the presence of antimicrobial resistance genetic determinants. Biofilms were present on 48.6% of the central venous catheters; nevertheless, no statistically significant association was established between biofilm assembly and CRBSI, and the presence/absence of ica operon and agr groups did not correlate with biofilm phenotypes, highlighting the need for further studies to elucidate biofilms' role on this healthcare-associated infection. Conclusion: Whole-genome sequencing was shown to be a valuable tool to confirm CRBSI. Although more than 42.3% of the central venous catheters were colonized by staphylococci, no statistically significant association was found between CRBSI and biofilms.This research was partially funded by Fundação para a Ciência e a Tecnologia (FCT) as part of the Bilateral Cooperation Program between Portugal and Slovakia 2019-2021 (Grant FCT/487/15/01/2019/S).info:eu-repo/semantics/publishedVersio

Aumento de la concentración de elementos traza en tejidos de la almeja Ruditapes decussatus trasplantada a zonas influenciadas por actividades humanas (ría Formosa, Portugal)

To examine the extent to which human activities near the Ria Formosa coastal lagoon influence the accumulation of trace elements (TE) in Ruditapes decussatus, individuals were transplanted from a natural bank located in the lower lagoon to three sites located in clam growth grounds under the influence of a small city (Faro), a fish farming centre (Olhão) and a site near the lagoon inlet (Lavajo). Concentrations were determined in substrate of the clam grounds and in the digestive gland, gills, mantle plus siphons, and remaining tissues of clams in four periods of the year. These measurements were accomplished with the monthly survey of the gametogenic stages, condition index, proteins, glycogen, total lipids, pH and osmolarity of hemolymph. Arsenic, Cu, Mn, V, Cr and Pb were preferentially linked to the digestive gland, while Cd was linked to the gills. TE concentrations in the digestive gland and remaining tissues were higher in winter, most likely reflecting additional inputs associated with rain. The lack of disruptions in biological parameters and the prolonged period of spawning and gonad recovery in clams suggest that the current TE availability in the lagoon has a minor influence on the reproductive cycle and hence on clam production.Para examinar en qué medida las actividades humanas cercanas a la laguna costera ría Formosa influyen en la acumulación de elementos traza (ET) en Ruditapes decussatus, se trasplantaron individuos desde un banco natural situado en la parte baja de la laguna a tres sitios localizados en zonas de cultivo de almejas bajo la influencia de una ciudad pequeña (Faro), un centro piscícola (Olhão) y cerca de la entrada de una laguna (Lavajo). Se determinaron las concentraciones de ET en el substrato de locales y en la glándula digestiva, branquias, manto más sifones, y en los tejidos restantes de las almejas en cuatro períodos a lo largo de un año. Estas mediciones fueron realizadas con el estudio mensual de las etapas gametógenas, índice de condición, proteínas, glicóneo, lípidos totales, pH y osmolaridad de la hemolinfa. El As, Cu, Mn, V, Cr y Pb fueron relacionados preferencialmente a la glándula digestiva, mientras que el Cd fue a las branquias. La concentración de ET en la glándula digestiva y los tejidos restantes fue más elevada en invierno, probablemente reflejando los aportes adicionales asociados con la lluvia. La falta de alteraciones de los parámetros biológicos, el período prolongado de desove y la recuperación de las gónadas en las almejas sugieren que la disponibilidad actual de ET en la laguna tienen una influencia menor durante el ciclo reproductivo y, por lo tanto, en la producción de almejas

Support of advanced technologies in supply chain processes and sustainability impact

This paper aims to present a study of the type of advanced technologies used across manufacturing supply chains in supporting the main processes of the supply chain operations reference model (SCOR). It also intends to identify a set of sustainable performance indicators (environmental, economic, and social) suitable to evaluate a supply chain 4.0 (SC4.0). To attain this objective, based on the literature review, a conceptual model is proposed. The multiple case study is used with a cross-case comparison to identify the type of advanced technologies more commonly used in SC4.0, and the performance indicators more suitable for assessing a SC4.0 sustainability performance. A sample of ten case studies was considered with companies belonging to different manufacturing SCs, from different countries, and belonging to different echelons. Main findings revealed that the level of adoption of advanced technologies in the Supply Chain SCOR processes varies amongst the case studies. Some technologies are quite commonly used among the several SCOR processes and companies while others are seldom applied. Some indicators were also identified that are regarded as very or extremely suitable to evaluate the sustainability performance of a SC4.0. The main contribution of this research to the body of knowledge is the empirical insights on the SC4.0 field and on Supply Chain Sustainability performance measurement. The results provide guidelines for the selection of advanced technologies to support SC processes and for the design of sustainable SC4.0 performance measurement systems.This work has been funded by national funds through FCT—Fundação para a Ciência e a Tecnologia, I.P., Projects UIDB/05037/2020, UIDB/04058/2020 and UIDB/00319/2020