possible impact of healthcare burden and hospital bed occupancy on clinical management and outcomes, March-December 2020

Copyright © 2023 Ricoca Peixoto, Vieira, Aguiar, Carvalho, Thomas, Sousa, Nunes and Abrantes.AIM: Identify factors associated with COVID-19 intensive care unit (ICU) admission and death among hospitalized cases in Portugal, and variations from the first to the second wave in Portugal, March-December 2020. INTRODUCTION: Determinants of ICU admission and death for COVID-19 need further understanding and may change over time. We used hospital discharge data (ICD-10 diagnosis-related groups) to identify factors associated with COVID-19 outcomes in two epidemic periods with different hospital burdens to inform policy and practice. METHODS: We conducted a retrospective cohort study including all hospitalized cases of laboratory-confirmed COVID-19 in the Portuguese NHS hospitals, discharged from March to December 2020. We calculated sex, age, comorbidities, attack rates by period, and calculated adjusted relative risks (aRR) for the outcomes of admission to ICU and death, using Poisson regressions. We tested effect modification between two distinct pandemic periods (March-September/October-December) with lower and higher hospital burden, in other determinants. RESULTS: Of 18,105 COVID-19 hospitalized cases, 10.22% were admitted to the ICU and 20.28% died in hospital before discharge. Being aged 60-69 years (when compared with those aged 0-49) was the strongest independent risk factor for ICU admission (aRR 1.91, 95%CI 1.62-2.26). Unlike ICU admission, risk of death increased continuously with age and in the presence of specific comorbidities. Overall, the probability of ICU admission was reduced in the second period but the risk of death did not change. Risk factors for ICU admission and death differed by epidemic period. Testing interactions, in the period with high hospital burden, those aged 80-89, women, and those with specific comorbidities had a significantly lower aRR for ICU admission. Risk of death increased in the second period for those with dementia and diabetes. DISCUSSION AND CONCLUSIONS: The probability of ICU admission was reduced in the second period. Different patient profiles were identified for ICU and deaths among COVID-19-hospitalized patients in different pandemic periods with lower and higher hospital burden, possibly implying changes in clinical practice, priority setting, or clinical presentation that should be further investigated and discussed considering impacts of higher burden on services in health outcomes, to inform preparedness, healthcare workforce planning, and pandemic prevention measures.publishersversionpublishe

Determinants for hospitalisations, intensive care unit admission and death among 20,293 reported COVID-19 cases in Portugal, March to April 2020

Publisher Copyright: © 2021 European Centre for Disease Prevention and Control (ECDC). All rights reserved.Background: Determinants of hospitalisation, intensive care unit (ICU) admission and death are still unclear for COVID-19. Few studies have adjusted for confounding for different clinical outcomes including all reported cases within a country. Aim: We used routine surveillance data from Portugal to identify risk factors for severe COVID-19 outcomes, and to support risk stratification, public health interventions, and planning of healthcare resources. Methods: We conducted a retrospective cohort study including 20,293 laboratory- confirmed cases of COVID-19 reported between 1 March and 28 April 2020 through the national epidemiological surveillance system. We calculated absolute risk, relative risk (RR) and adjusted relative risk (aRR) to identify demographic and clinical factors associated with hospitalisation, ICU admission and death using Poisson regressions. Results: Increasing age (≥ 60 years) was the major determinant for all outcomes. Age ≥ 90 years was the strongest determinant of hospital admission (aRR: 6.1), and 70-79 years for ICU (aRR: 10.4). Comorbidities of cardiovascular, immunodeficiency, kidney and lung disease (aRR: 4.3, 2.8, 2.4, 2.0, respectively) had stronger associations with ICU admission, while for death they were kidney, cardiovascular and chronic neurological disease (aRR: 2.9, 2.6, 2.0). Conclusions: Older age was the strongest risk factor for all severe outcomes. These findings from the early stages of the COVID-19 pandemic support risk-stratified public health measures that should prioritise protecting older people. Epidemiological scenarios and clinical guidelines should consider this, even though under-ascertainment should also be considered.publishersversionpublishe

large decrease in clinical notifications and epidemiological investigation questionnaires for laboratory-confirmed cases after the 2nd epidemic wave, Portugal March 2020–July 2021

Funding Information: The present publication was funded by Fundação Ciência e Tecnologia, IP national support through CHRC (UIDP/04923/2020). Publisher Copyright: Copyright © 2023 Ricoca Peixoto, Vieira, Aguiar, Sentis, Carvalho, Rhys Thomas, Abrantes and Nunes.Introduction: In Portugal, COVID-19 laboratory notifications, clinical notifications (CNs), and epidemiological investigation questionnaires (EI) were electronically submitted by laboratories, clinicians, and public health professionals, respectively, to the Portuguese National Epidemiological Surveillance System (SINAVE), as mandated by law. We described CN and EI completeness in SINAVE to inform pandemic surveillance efforts. Methods: We calculated the proportion of COVID-19 laboratory-notified cases without CN nor EI, and without EI by region and age group, in each month, from March 2020 to July 2021. We tested the correlation between those proportions and monthly case counts in two epidemic periods and used Poisson regression to identify factors associated with the outcomes. Results: The analysis included 909,720 laboratory-notified cases. After October 2020, an increase in the number of COVID-19 cases was associated with a decrease in the submissions of CN and EI. By July 2021, 68.57% of cases had no associated CN nor EI, and 96.26% had no EI. Until January 2021, there was a positive correlation between monthly case counts and the monthly proportion of cases without CN nor EI and without EI, but not afterward. Cases aged 75 years or older had a lower proportion without CN nor EI (aRR: 0.842 CI95% 0.839–0.845). When compared to the Norte region, cases from Alentejo, Algarve, and Madeira had a lower probability of having no EI (aRR;0.659 CI 95%0.654–0.664; aRR 0.705 CI 95% 0.7–0.711; and aRR 0.363 CI 95% 0.354–0.373, respectively). Discussion: After January 2021, CN and EI were submitted in a small proportion of laboratory-confirmed cases, varying by age and region. Facing the large number of COVID-19 cases, public health services may have adopted other registry strategies including new surveillance and management tools to respond to operational needs. This may have contributed to the abandonment of official CN and EI submission. Useful knowledge on the context of infection, symptom profile, and other knowledge gaps was no longer adequately supported by SINAVE. Regular evaluation of pandemic surveillance systems' completeness is necessary to inform surveillance improvements and procedures considering dynamic objectives, usefulness, acceptability, and simplicity.publishersversionpublishe

Comunidade infestante sob duas condições de irrigação na cultura do arroz de sequeiro

The objective of the work was to evaluate the weeds and dry mass in the culture of the upland rice, under two conditions of irrigation (with and without it dry stress). The experiment was installed in the Experimental Station of the Campus of Gurupi-TO, belonging to the Federal University of Tocantins (UFT). The survey of the weeds was made to the end of the reproductive cycle of the rice plants, by the sampling method, being the same ones, collected to evaluate the dry mass. Among weed families found in the experiment, it was evidenced occurrence of lesser number (8 families) in area with dry stress in relation to the area without stress (9 families). The number of joined species was the same (13 species) in both areas, having variation, according to the culture environment. The species that more detached had been would type Digitariahorizontalis and Emilia sonchifolia for both conditions. The weeds, in the condition of dry stress, tended to present minor dry mass when comparer to those under condition without it stress for water deficiency.O objetivo do trabalho foi avaliar as plantas daninhas e a massa seca na cultura do arroz de terras altas, sob duas condições de irrigação (com e sem estresse seco). O experimento foi instalado na Estação Experimental do Campus de Gurupi-TO, pertencente à Universidade Federal do Tocantins (UFT). O levantamento das plantas daninhas foi realizado até o final do ciclo reprodutivo das plantas de arroz, pelo método de amostragem, sendo os mesmos, coletados para avaliar a massa seca. Entre as famílias de plantas daninhas encontradas no experimento, foi evidenciada ocorrência de menor número (8 famílias) em área com estresse seco em relação à área sem estresse (9 famílias). O número de espécies unidas foi o mesmo (13 espécies) em ambas as áreas, apresentando variação de acordo com o ambiente da cultura. As espécies mais destacadas digitariam Digitariahorizontalis e Emilia sonchifolia para ambas as condições. As plantas daninhas, na condição de estresse seco, tenderam a apresentar menor massa seca quando comparadas àquelas sob condição sem estresse por deficiência hídrica

Crescimento e produção de pinhão-manso (Jatropha curcas L.) sob doses de fósforo

This study aimed to evaluate the influence of phosphorus on the growth and yield of physic nut (Jatropha curcas L.). Physic nut seedlings, two months old were transplanted in February 2007. In June 2008 it was held in drastic pruning all plants in height of 80 cm of soil. The treatments consisted of P2O5 doses: 0, 50, 100, 150 and 200 g-1 pit. The experimental design was a randomized block with four replications of eight plants, totaling 40 plants per block. The evaluation period of the experiment it was realized between October 2008 to October 2009 (corresponding to the 2nd year of assessment), and between October 2009 and October 2010 (corresponding to the 3rd year of assessment), and the evaluated variables: the number of branches prior to pruning, the number of branches after pruning, the number of branches in inflorescence, number of inflorescences plant 1, the number of branches with clusters, the number of clusters plant-1 and productivity. Pruning stimulated the growth and production of physic nut. The increase in phosphorus fertilization increased the productivity of physic nut, reaching a stable starting dose of 150 g ha-1 of P2O5. The cultivation of physic nut can be considered a species that responds to fertilization.O presente trabalho objetivou avaliar a influência da adubação fosfatada sobre o crescimento e produção do pinhão-manso (Jatropha curcas L.). Mudas de pinhão-manso, com dois meses de idade foram transplantadas no mês de fevereiro de 2007. No mês de junho de 2008 foi realizada poda drástica em todas as plantas na altura de 80 cm do solo. Os tratamentos foram constituídos pelas doses de P2O5: 0, 50, 100, 150 e 200 g cova-1.O delineamento experimental utilizado foi em blocos casualizados,com quatro repetições de oito plantas, totalizando 40 plantas por bloco. O período de avaliação do experimento compreendeu-se entre o mês de outubro de 2008 a outubro de 2009 (correspondente ao 2° ano de avaliação), e entre o mês de outubro de 2009 a outubro de 2010 (correspondente ao 3° ano de avaliação),sendo as variáveis avaliadas:o número de ramos antes da poda, o número de ramos após a poda,o número de ramos com inflorescência,o número de inflorescência planta-1,o número de ramos com cachos,o número de cachos planta-1 e aprodutividade. A poda estimulou o crescimento e produção do pinhão-manso. O incremento na adubação fosfatada elevou a produtividade de pinhão-manso, alcançando uma estabilidade a partir da dose de 150 g ha-1 de P2O5. A cultura de Pinhão-manso pode ser considerada uma espécie que responde à adubação fosfatada

Residual stress analysis of drive shafts after induction hardening

Typically, for automotive shafts, shape distortion manifests itself in most cases after the induction hardening by an effect known as bending. The distortion results in a boost of costs, especially due to machining parts in the hardened state to fabricate its final tolerances. In the present study, residual stress measurements were carried out on automotive drive shafts made of DIN 38B3 steel. The samples were selected in consequence of their different distortion properties by an industrial manufacturing line. One tested shaft was straightened, because of the considerable dimensional variation and the other one not. Firstly, the residual stress measurements were carried out by using a portable difractometer, in order to avoid cutting the shafts and evaluate the original state of the stresses, and afterwards a more detailed analysis was realized by a conventional stationary diffractometer. The obtained results presented an overview of the surface residual stress profiles after induction hardening and displayed the influence of the straightening process on the redistribution of residual stresses. They also indicated that the effects of the straightening in the residual stresses cannot be neglecte

Long-Baseline Neutrino Facility (LBNF) and Deep Underground Neutrino Experiment (DUNE) Conceptual Design Report Volume 2: The Physics Program for DUNE at LBNF

The Physics Program for the Deep Underground Neutrino Experiment (DUNE) at the Fermilab Long-Baseline Neutrino Facility (LBNF) is described

Super-tough biodegradable poly(vinyl alcohol)/poly(vinyl pyrrolidone) blends plasticized by glycerol and sorbitol

Tough biodegradable films were prepared using a poly(vinyl alcohol) (PVA)/poly(vinyl pyrrolidone) (PVP) (1:1) blend with plasticizers of glycerol (GLY), sorbitol (SOR), and their (one to one) mixture. We studied the effect of plasticization on the structural, thermal, and mechanical properties of the PVA/PVP blend films. Fourier transform infrared spectra indicated good miscibility of the two components due to the H-bonding between the PVA and PVP molecules. The addition of plasticizers reduced the interaction between PVA and PVP, evidenced by an increase in the intensity of PVA diffraction peaks observed in the X-ray diffraction (XRD) characterization. Thermal degradation of the blends increased as a function of the plasticizer used. GLY affected thermal degradation more than SOR and the mixtures. The incorporation of the plasticizers promoted the growth of PVA crystals as evidenced by XRD patterns and the enthalpy of fusion (ΔHf) obtained by differential scanning calorimetry measurements. The introduction of SOR to the binary blend increased toughness seven times and imparted simultaneous and pronounced improvements to maximum tensile stress and elongation at break. This behavior holds out great promise for the development of a new generation of mechanically robust, yet thoroughly biodegradable materials that could effectively supplant conventional polymers in demanding applications. © 2018 Wiley Periodicals, Inc. J. Appl. Polym. Sci. 2018, 135, 46406

Current Wildland Fire Patterns and Challenges in Europe : A Synthesis of National Perspectives

Changes in climate, land use, and land management impact the occurrence and severity of wildland fires in many parts of the world. This is particularly evident in Europe, where ongoing changes in land use have strongly modified fire patterns over the last decades. Although satellite data by the European Forest Fire Information System provide large-scale wildland fire statistics across European countries, there is still a crucial need to collect and summarize in-depth local analysis and understanding of the wildland fire condition and associated challenges across Europe. This article aims to provide a general overview of the current wildland fire patterns and challenges as perceived by national representatives, supplemented by national fire statistics (2009-2018) across Europe. For each of the 31 countries included, we present a perspective authored by scientists or practitioners from each respective country, representing a wide range of disciplines and cultural backgrounds. The authors were selected from members of the COST Action "Fire and the Earth System: Science & Society" funded by the European Commission with the aim to share knowledge and improve communication about wildland fire. Where relevant, a brief overview of key studies, particular wildland fire challenges a country is facing, and an overview of notable recent fire events are also presented. Key perceived challenges included (1) the lack of consistent and detailed records for wildland fire events, within and across countries, (2) an increase in wildland fires that pose a risk to properties and human life due to high population densities and sprawl into forested regions, and (3) the view that, irrespective of changes in management, climate change is likely to increase the frequency and impact of wildland fires in the coming decades. Addressing challenge (1) will not only be valuable in advancing national and pan-European wildland fire management strategies, but also in evaluating perceptions (2) and (3) against more robust quantitative evidence.Peer reviewe