SARS-CoV-2 and cytomegalovirus co-infections—a case series of critically ill patients

The SARS-CoV-2 pandemic has placed great strain on the most developed of health care systems, especially in the context of critical care. Although co-infections with cytomegalovirus (CMV) are frequent in the critically ill due to underlying immune suppression of multiple causes, the impact on COVID-19 patients remains unclear. Furthermore, severe COVID-19 has recently been associated with significant immune suppression, and this may in turn impact CMV reactivation, possibly contributing to clinical course. Nevertheless, multiple confounding factors in these patients will certainly challenge upcoming research. The authors present a case series of five patients admitted to the intensive care unit (ICU) in the context of respiratory failure due to severe COVID-19. All patients evolved with CMV reactivation during ICU stay.publishersversionpublishe

The Role of Biomarkers, Pharmacokinetics, and Pharmacodynamics

The high prevalence of infectious diseases in the intensive care unit (ICU) and consequently elevated pressure for immediate and effective treatment have led to increased antimicrobial therapy consumption and misuse. Moreover, the emerging global threat of antimicrobial resistance and lack of novel antimicrobials justify the implementation of judicious antimicrobial stewardship programs (ASP) in the ICU. However, even though the importance of ASP is generally accepted, its implementation in the ICU is far from optimal and current evidence regarding strategies such as de-escalation remains controversial. The limitations of clinical guidance for antimicrobial therapy initiation and discontinuation have led to multiple studies for the evaluation of more objective tools, such as biomarkers as adjuncts for ASP. C-reactive protein and procalcitonin can be adequate for clinical use in acute infectious diseases, the latter being the most studied for ASP purposes. Although promising, current evidence highlights challenges in biomarker application and interpretation. Furthermore, the physiological alterations in the critically ill render pharmacokinetics and pharmacodynamics crucial parameters for adequate antimicrobial therapy use. Individual pharmacokinetic and pharmacodynamic targets can reduce antimicrobial therapy misuse and risk of antimicrobial resistance.publishersversionpublishe

Deep Emotion Recognition in Textual Conversations: A Survey

While Emotion Recognition in Conversations (ERC) has seen a tremendous advancement in the last few years, new applications and implementation scenarios present novel challenges and opportunities. These range from leveraging the conversational context, speaker and emotion dynamics modelling, to interpreting common sense expressions, informal language and sarcasm, addressing challenges of real time ERC, recognizing emotion causes, different taxonomies across datasets, multilingual ERC to interpretability. This survey starts by introducing ERC, elaborating on the challenges and opportunities pertaining to this task. It proceeds with a description of the emotion taxonomies and a variety of ERC benchmark datasets employing such taxonomies. This is followed by descriptions of the most prominent works in ERC with explanations of the Deep Learning architectures employed. Then, it provides advisable ERC practices towards better frameworks, elaborating on methods to deal with subjectivity in annotations and modelling and methods to deal with the typically unbalanced ERC datasets. Finally, it presents systematic review tables comparing several works regarding the methods used and their performance. The survey highlights the advantage of leveraging techniques to address unbalanced data, the exploration of mixed emotions and the benefits of incorporating annotation subjectivity in the learning phase

risk factors associated with a delayed diagnosis in Portugal

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Síndrome de congestão pélvica: afecção rastreável?

Introdução: A dor pélvica crónica (DPC) constitui uma das queixas mais comuns em Ginecologia, correspondendo a 10-40% dos motivos de consulta. Porém, a sua etiologia mantém-se desconhecida em 60% dos casos. A presença de varizes pélvicas pode estar na origem de DPC sem outra causa evidente, sendo que em 50% dos casos, será possível detectar sinais de congestão pélvica (CP). Apesar do seu provável papel preponderante na etiologia de DPC, a Síndrome de Congestão Pélvica (SCP) continua subdiagnosticada. Uma vez que o método de referência, a venografia, é técnica invasiva e que só se efectua em centros especializados, a ecografia ginecológica, transvaginal, é proposta como exame complementar de primeira linha a efectuar para o diagnóstico de SCP. Objectivos: Pretendeu-se elaborar e avaliar um protocolo de correlação clínica e ecográfica dirigido à definição e estandardização dos parâmetros a medir, para uma futura abordagem de rastreio mas, sobretudo, verificar da sua aplicabilidade na rotina de exames ecográficos ginecológicos. Também se elaborou e aplicou um questionário complementar de detecção de sintomatologia atribuível à SCP, tendo como objectivo principal verificar a adesão ao seu preenchimento. Métodos: Desenhou-se um protocolo de avaliação que abordava três locais anatómicos: as veias ováricas (direita e esquerda), o plexo venoso pélvico (PVP) e os ovários. Previamente à sua aplicação prática, 2 ginecologistas receberam uma formação dirigida sobre a técnica de visualização das veias ováricas por via transabdominal. Realizou-se um estudo prospectivo, recolhendo dados de 34 mulheres que tinham solicitada ecografia ginecológica, no Serviço de Ginecologia do Centro Hospitalar Cova da Beira, EPE (CHCB). Todas as pacientes responderam a um questionário especificamente elaborado para este estudo. Paralelamente, solicitou-se a uma ecografista independente a expressão das bases conducentes no exercício diário ao diagnóstico de varicocelo pélvico. Resultados: Mostrou-se inconsistente a avaliação das veias ováricas. Os parâmetros do PVP e ovários foram mensuráveis na maioria das pacientes. Segundo a definição de caso estipulada, identificaram-se 6 casos com diâmetros dos vasos ≥5 mm. A grande maioria das inquiridas respondeu autonomamente ao inquérito complementar mas houve necessidade de ajuda num pequeno número delas. A análise oportunista das respostas obtidas aponta para a inexistência de diferenças significativas entre os grupos de mulheres com e sem CP relativamente aos dados inquiridos no questionário. Conclusão: O protocolo de avaliação não é, no presente, linearmente aplicável, pois a técnica de visualização das veias ováricas não foi eficaz. Há necessidade de aferição dos meios de medição deste parâmetro, bem assim como de critérios de avaliação global da circulação pélvica para que haja possibilidade de dar continuação a este projecto. Outros parâmetros como o estudo de calibre dos vasos pélvicos e uterinos e de estudo dinâmico do fluxo vascular são mensuráveis, e serão certamente cruciais numa investigação programada para a detecção do SCP. Nesta fase preliminar do estudo, pelas dificuldades de colheita apontadas, a amostragem não foi suficiente para atingir força estatística, o que não constituía, porém, como pressuposto inicial deste trabalho.Introduction: Chronic pelvic pain (CPP) is one of the most common complaints of patients in Gynecology, constituting 10-40% of all gynecologic referrals. However, its etiology remains unknown in 60% of cases. The presence of pelvic varicose veins could be responsible for cases of CPP without other apparent cause, since in 50% of cases, it is possible to detect signs of pelvic congestion (PC). Despite its probable preponderant etiologic role in CPP, the Pelvic Congestion Syndrome (PCS) remains under-diagnosed. Since the gold standard venography is an invasive technique realized in specialized centers, transvaginal gynecologic ultrasound is proposed as the initial diagnostic modality for the diagnosis of PCS. Goals: One of the main goals was to elaborate and evaluate a protocol of clinical and ecographic correlation for the definition and standardization of parameters to be measured in a future screening approach and, moreover, to verify its applicability during routine gynecologic ultrasound exams. A complementary questionnaire was also created to detect symptoms attributable to the PCS, mainly to verify the degree of adherence, by the patients, for its completion. Methods: A protocol of evaluation was designed, covering three anatomic components: the right and left ovarian veins, the pelvic venous plexus (PVP) and the ovaries. Before its practical application, 2 gynecologists received specialized training on transabdominal visualization of the ovarian veins. A prospective study was realized, with the gathering of data pertaining to 34 women who had a solicited gynecologic ultrasound, in the Department of Gynecology of the CHCB. All of the selected patients answered the questionnaire specifically designed for this study. An independent gynecologist, specialized in ecography, was solicited for pertinent data regarding regular procedure with respect to the diagnosis of pelvic varices. Results: The evaluation of the ovarian veins was found to be inconsistent. The parameters of the PVP and ovaries were measurable in the majority of patients. According to the stipulated case definition, 6 cases were identified with venous diameters ≥5 mm. A great majority of the patients answered the complementary questionnaire autonomously, while a few required assistance. The analysis of the obtained answers points to the inexistence of significant differences between groups of women with and without PC with respect to the inquired data of the questionnaire. Conclusion: The protocol of evaluation is not currently entirely applicable since the technique for the visualization of the ovarian veins was not executable. An evaluation of the means of measurement of this parameter is necessary, as are criteria for the global evaluation of pelvic circulation, for the continuation of this project. Other parameters, such as the caliber of pelvic and uterine vasculature and the dynamic study of vascular blood flow are measurable, and certainly crucial in a programmed investigation for the detection of the PCS. In this preliminary phase of the study, due to difficulties pertaining to the gathering of data, the sample was not sufficient to achieve statistical strength. However, this was not part of the initial goals of our study

different delays, different risk factors

Funding Information: The study was supported by the Foundation for Science and Technology—FCT (Portuguese Ministry of Science, Technology and Higher Education) under the National School of Public Health, Universidade NOVA de Lisboa, Lisboa, Portugal (PTDC/SAU-PUB/31346/2017). Publisher Copyright: © 2021, The Author(s).Background: Delay in Tuberculosis (TB) diagnosis affects foreign-born and nationals in different ways, especially in low-incidence countries. This study characterises total delay and its components amongst foreign-born individuals in Portugal. Additionally, we identify risk factors for each type of delay and compare their effects between foreign-born and nationals. Methods: We analysed data from the Portuguese TB surveillance system and included individuals with pulmonary TB (PTB), notified between 2008 and 2017. We described patient, healthcare, and total delays. Cox regression was used to identify factors associated with each type of delay. All analyses were stratified according to the origin country: nationals (those born in Portugal) and foreign-born. Results: Compared with nationals, foreign-born persons presented statistically significant and longer median total and patient delays (Total: 67 vs. 63; Patient: 44 vs. 36 days), and lower healthcare services delays (7 vs. 9 days). Risk factors for delayed diagnosis differed between foreign-born and nationals. Being unemployed, having drug addiction, and having comorbidities were identified as risk factors for delayed diagnosis in national individuals but not in foreigners. Alcohol addiction was the only factor identified for healthcare delay for both populations: foreign-born (Hazard Ratio 1.34 [95% confidence interval 1.17;1.53]); nationals (Hazard Ratio 1.20 [95% confidence interval 1.13;1.27]). Conclusions: Foreign-born individuals with PTB take longer to seek health care. While no specific risk factors were identified, more in-depth studies are required to identify barriers and support public health intervention to address PTB diagnosis delay in foreign-born individuals.publishersversionpublishe

Context-Dependent Embedding Utterance Representations for Emotion Recognition in Conversations

Emotion Recognition in Conversations (ERC) has been gaining increasing importance as conversational agents become more and more common. Recognizing emotions is key for effective communication, being a crucial component in the development of effective and empathetic conversational agents. Knowledge and understanding of the conversational context are extremely valuable for identifying the emotions of the interlocutor. We thus approach Emotion Recognition in Conversations leveraging the conversational context, i.e., taking into attention previous conversational turns. The usual approach to model the conversational context has been to produce context-independent representations of each utterance and subsequently perform contextual modeling of these. Here we propose context-dependent embedding representations of each utterance by leveraging the contextual representational power of pre-trained transformer language models. In our approach, we feed the conversational context appended to the utterance to be classified as input to the RoBERTa encoder, to which we append a simple classification module, thus discarding the need to deal with context after obtaining the embeddings since these constitute already an efficient representation of such context. We also investigate how the number of introduced conversational turns influences our model performance. The effectiveness of our approach is validated on the open-domain DailyDialog dataset and on the task-oriented EmoWOZ dataset.Comment: WASSA'2

Optimizing antimicrobial drug dosing in critically ill patients

Funding Information: Conflicts of Interest: P.P. has received lecture fees and advisory board from MSD, Gilead, Pfizer; L.C. and P.M. declared no conflicts of interest related to the underlying topics; J.G.P. received unre‐ stricted research grants from Merck Sharp and Dohme; received lecture and advisory board fees from Merck Sharp and Dohme, Angelini Pharmaceuticals; lecture fees from Pfizer Pharmaceuticals, Atral Pharmaceuticals, Biomerieux. Publisher Copyright: © 2021 by the authors. Licensee MDPI, Basel, Switzerland. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.A fundamental step in the successful management of sepsis and septic shock is early empiric antimicrobial therapy. However, for this to be effective, several decisions must be addressed simultaneously: (1) antimicrobial choices should be adequate, covering the most probable pathogens; (2) they should be administered in the appropriate dose, (3) by the correct route, and (4) using the correct mode of administration to achieve successful concentration at the infection site. In critically ill patients, antimicrobial dosing is a common challenge and a frequent source of errors, since these patients present deranged pharmacokinetics, namely increased volume of distribution and altered drug clearance, which either increased or decreased. Moreover, the clinical condition of these patients changes markedly over time, either improving or deteriorating. The consequent impact on drug pharmacokinetics further complicates the selection of correct drug schedules and dosing during the course of therapy. In recent years, the knowledge of pharmacokinetics and pharmacodynamics, drug dosing, therapeutic drug monitoring, and antimicrobial resistance in the critically ill patients has greatly improved, fostering strategies to optimize therapeutic efficacy and to reduce toxicity and adverse events. Nonetheless, delivering adequate and appropriate antimicrobial therapy is still a challenge, since pathogen resistance continues to rise, and new therapeutic agents remain scarce. We aim to review the available literature to assess the challenges, impact, and tools to optimize individualization of antimicrobial dosing to maximize exposure and effectiveness in critically ill patients.publishersversionpublishe

Da educação pré-escolar ao ensino do 1º ciclo do Ensino Básico : as práticas no domínio da leitura

Mestrado em Educação Pré-Escolar e Ensino do 1º Ciclo do Ensino Básico (Relatório de Estágio).A elaboração do presente Relatório de Estágio é o culminar do trabalho realizado nas Práticas Educativas Supervisionadas I e II, dando resposta a uma exigência estabelecida para a obtenção do Grau de Mestre em Educação Pré-escolar e Ensino do 1º Ciclo de Ensino Básico, como estabelecido no seu regulamento publicado no Diário da República, 1ª Série, nº43 de 22 de Fevereiro de 2007. Nele, estão plasmadas questões que se prendem com a teoria e a prática curricular, nomeadamente a análise e a reflexão necessárias para que se possa crescer enquanto indivíduo e futuro profissional. Por outro lado, o mesmo visa fundamentar as práticas levadas a efeito, recorrendo a literatura científica da especialidade, procurando, deste modo, dar consistência ao trabalho realizado no decurso do estágio no Pré-escolar e no 1º Ciclo. Do conjunto de áreas e domínios explorados junto da população estudantil, foi opção da mestranda aprofundar, neste documento, o domínio da leitura, dada a relevância que o seu caráter transversal assume em todas as áreas disciplinares, bem como na aprendizagem e no desenvolvimento global das crianças. Assim, privilegiou-se, na elaboração deste relatório, um capítulo dedicado às intervenções realizadas quer na Educação do Pré-escolar quer no Ensino 1º Ciclo, capazes de desenvolver competências leitoras e, consequentemente, o gosto pela leitura. Ao longo das intervenções nos estágios realizados, diligenciou-se no sentido de a comunidade onde a escola estava inserida fosse envolvida nas atividades desenvolvidas, para que a consecução dos objetivos delineados fosse garantida. Também foi preocupação da mestranda incluir neste relatório uma reflexão fundamentada sobre a prática desenvolvida. Neste sentido, foram focados aspetos como a razão pela opção de determinadas atividades, o seu contributo para o desenvolvimento de competências leitoras nas crianças, bem como uma análise à sua prestação e à experiência vivida no decurso do processo formativo. Recorde-se, a este propósito, que as Práticas Educativas Supervisionadas I e II assumiram-se como um ponto alto na nossa formação, dado o seu contributo importante para o desenvolvimento pessoal e profissional, em consequência do encontro entre os discursos teóricos e os discursos práticos, culminando numa caminhada de aprendizagem. Em suma, a redação deste relatório foi crucial para o nosso crescimento pessoal e profissional.ABSTRACT: The elaboration of this Internship Report is the culmination of the work conducted during the Supervised Practices I and II and emerges in response to the requirements for obtaining the Master Degree in Pre-school Education and Teaching of Cycle I of Elementary Education (as set out in its respective ordinance published in Diário da República, 1st Series, No. 38, February 22, 2007). This report explores issues that relate to curriculum theory and practice, including the necessary analysis and reflection which allow one to grow as an individual and as a future professional. It is also intended to provide evidence, through the field’s scientific literature, for the formulated statements. Hence, it aims to provide consistency to the work accomplished during the internship in Pre-school and Cycle I. Since its cross-cutting characteristics are significant in all the educational areas, including on learning and on the overall development of children, this graduate student opted to further utilize this document to explore the theme of promotion of reading and its importance in school success. Thus, this report encompasses a chapter on interventions for both Pre-school and Cycle I, which are directed at stimulating the development of reading skills and, in parallel, developing the taste for reading. Along the interventions put in place during the internships and in order to guarantee that the outlined goals were attained, measures were taken to involve the school’s surrounding community in all the activities being developed. Additionally, we also include in this report a deep reflection on the practice carried out by focusing on aspects such as the reason for choosing particular activities and their contribution to the development of reading skills in children; but also by reviewing performance and experiences during the internships. In this respect, the Supervised Practice I and II was a high point in our training, since as a consequence of the union between the theoretical and practical pathways, it resulted in an important contribution to personal and professional development and in a culmination of everything we have learned. It was then, a privileged space for our training process

Rapid Sap Nutrient Analysis Methods in Malus Domestica Borkh Cv. ‘Gala’

Sap quick tests are well established in vegetable crops. However, there is less equivalent investigation for perennial crops, such as apple trees. Accessing the nutrient content, as opposed to the foliar analysis, would increase the opportunity of adjusting the fertilization, along the growing cycle. This work evaluates the relation between the NO3 −, K+, Ca2+, Mg2+, PO4 3- and NH4 + contents in apple petiole sap, measured with the RQflex® test strips and laboratory methods to assess the possibility of using this tool with accuracy in in-situ sap analysis. Petiole samples were collected from six apple tree orchards, frozen and pressed. Dilution was mandatory for all nutrient determination, except NO3 −. The dilution factor varied with the stage of the annual cycle. The levels of NO3 −, K+, Mg2+, and Ca2+ followed the same pattern during the growing cycle, with both methods. Regression analysis resulted in high determination coefficients for NO3 − (R2 = 0.85), K+ (R2 = 0.86), Mg2+ (R2 = 0.81) and Ca2+ (R2 = 0.95), between RQflex® and laboratory methods. No equivalent relation was found for ammonium and phosphate determination. These tests can be useful tools for rational fertilization management, mainly in high-density apple orchards. The calcium content in 45 DAFB leaves correlated well with the calcium content in sap at the same timinginfo:eu-repo/semantics/publishedVersio