253 research outputs found
A composite indicator for supply chain performance measurement: a case study in a manufacturing company
This paper proposes a methodology to develop and implement a Composite Indicator (CI) to measure the performance of Supply Chain processes. It reflects the aggregation of individual measures, related to the same process, with a weighted average, in order to assess the global performance in terms of both efficiency and effectiveness. Through a case study in a manufacturing company, a concept validation was performed by implementing the methodology in the Return process of the Supply Chain. The results showed that the combination between a Composite Indicator and a Business Intelligence tool provides a better understanding of the overall performance of a given process, facilitating also the identification of root causes. This paper aims to contribute to the supply chain performance management research field, proposing a methodology to implement a Composite Indicator, which is a topic insufficiently explored in the existent literature.- This work has been supported by national funds through FCT - Fundacao para a Ciencia e Tecnologia within the Project Scope: UID/CEC/00319/2019
Les droits disciplinaires des fonctions publiques : « unification », « harmonisation » ou « distanciation ». A propos de la loi du 26 avril 2016 relative à la déontologie et aux droits et obligations des fonctionnaires
The production of tt‾ , W+bb‾ and W+cc‾ is studied in the forward region of proton–proton collisions collected at a centre-of-mass energy of 8 TeV by the LHCb experiment, corresponding to an integrated luminosity of 1.98±0.02 fb−1 . The W bosons are reconstructed in the decays W→ℓν , where ℓ denotes muon or electron, while the b and c quarks are reconstructed as jets. All measured cross-sections are in agreement with next-to-leading-order Standard Model predictions.The production of , and is studied in the forward region of proton-proton collisions collected at a centre-of-mass energy of 8 TeV by the LHCb experiment, corresponding to an integrated luminosity of 1.98 0.02 \mbox{fb}^{-1}. The bosons are reconstructed in the decays , where denotes muon or electron, while the and quarks are reconstructed as jets. All measured cross-sections are in agreement with next-to-leading-order Standard Model predictions
Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome : Insights from the LUNG SAFE study
Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). Conclusions: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073publishersversionPeer reviewe
I Congresso Ibero-Americano de Bibliotecas Escolares
Actas de la primera edición del I Congreso Iberoamericano de Bibliotecas Escolares, CIBES 2015, organizado por la Universidad Carlos III de Madrid (España), la Universidad Estatal Paulista (Brasil) y el Ayuntamiento de Getafe (España). Celebrado: 21 - 23 de octubre de 2015 en la Universidad Estatal Paulista (Marília) y 26 - 28 de octubre de 2015 en la Universidad Carlos III de Madrid (Getafe)Universidad Carlos III de Madrid (España)Universidad Estatal Paulista (Brasil)Ayuntamiento de Getafe (España)Dimensiones y visiones de la biblioteca escolar en una Educación por competencias: la
necesidad de una política estratégica / Miguel Ángel Marzal. -- Getafe ciudad educadora,
lectora y escritora: Bibliotecas escolares / Lourdes Muñoz Santiuste. -- Presente y
futuro: biblioteca escolar-CREA y proyectos interdisciplinares / Rosa Piquín. -- Cultura
en información: un reto esencial de la biblioteca escolar / Mónica Baró. -- Bibliotecas
escolares de Galicia: un mundo de oportunidades a favor de la Educación / Cristina Novoa.
-- 10 años de la Red de Bibliotecas Escolares de Extremadura (REBEX) / Casildo Macías
Pereira. -- Biblioteca Escolar y uso ético de la información para una Cultura de Paz / Ana
Barrero Tíscar. -- Dinamización de la Biblioteca Escolar Plumita durante el curso escolar
2014/15 / María Antonia Cano Cañada. -- Experiencia de la creación de una biblioteca
escolar / Susana Santos Martín. -- Grupo cooperativo Bibliotecas escolares en Red-Albacete
/ José Manuel Garrido Argandoña y Eva Leal Scasso. -- La BCREA "Juan Leiva". El fomento de
la lectura desde la web social / Andrés Pulido Villar. -- Proceso de implantación de una
herramienta de autoevaluación en la red de bibliotecas escolares de Extremadura (REBEX) /
Casildo Macías Pereira. -- La biblioteca escolar: abriendo fronteras / Lorena Verónica
Cabrera Orellana. -- O programa RBE e a avaliaçao das bibliotecas escolares: melhoria,
desenvolvimiento e innovaçao / Elsa Conde. -- Profesional de Biblioteconomía y
Documentación: esencial en la plantilla de la escuela / Pilar del Campo Puerta. -- Una
mirada activa al proceso educativo desde la biblioteca escolar / María Jesús Fontela
Fernández . -- Con otra mirada "La ilustración como vehículo de comunicación y aprendizaje
en las bibliotecas escolares" / Pablo Jurado Sánchez-Galán. -- Fingertips. Recriar a
biblioteca escolar na sala de aula / Rui Alfonso Mateus. -- Hablemos de libros. Cómo
transformar una clase de literatura en una comunidad de interpretación de textos /
Francisco César Díaz Rey. -- Inclusión social de familias inmigrantes a través de un
programa de aprendizaje de la lengua castellana / Ana Carmen Tolino Fernández-Henarejos.
-- O desenvolvimento de atividades de mediação de leitura em biblioteca escolar: o caso da
biblioteca da Escola Sesc de Ensino Médio / Vagner Amaro. -- La biblioteca escolar.
Proceso de enseñanza-aprendizaje de padres a hijos / Ana Carmen Tolino Fernández-
Henarejos. -- Leo con y para los demás / Ismael Fernández Fernández, Ana María Moreno
Vicente y Ana Beatriz Vicente Pérez. -- Nanas y arrullo. Poesía a la deriva / Bernardo
Fuentes Navarrete y Carlos García-Romeral Pérez. -- Gestión y evaluación de servicios
bibliotecarios para personas con dislexia: una biblioteca escolar inclusiva desde una
perspectiva internacional / Carmen Jorge García-Reyes. -- Sueños lectores compartidos
hechos realidad: la biblioteca escolar del C.E.I.P-S.E.S-A.A “LA PAZ” de Albacete / Ana
Rosa Cabañero Tobarra, Juan Manuel Herráez, Eva Leal Scasso, María Marín Sánchez, Ana
Belén Medrano Martínez y María José Nortes Ruipérez. -- El programa biblioteca escuela en
Civican. La literatura como elemento motivador para la alfabetización informacional /
Villar Arellano Yanguas. -- La competencia digital en el diseño curricular: desde la
biblioteca al aula / Felicidad Campal García. -- O deselvomimento da pesquisa escolar por
meio da competência em informaçao / Luciane de Fátima Cavalcante Beckman y Marta Leandro
da Mata. -- Proyecto escolar de investigación documental "Te pillé leyendo" / José Manuel
Garrido Argandoña. -- Aprender com a Biblioteca Escolar: formar para as literacias / Paula
Correia y Isabel Mendinhos. -- Sucedió en el siglo XX / María Antonia Becerra Montalbán,
Ángel Bernabé Muñoz y Sofía Vaz Romero. -- El Club de lectura en la nube / Belén Benito
Blázquez y Ana Ordás García. -- Promover a leitura e a escrita na era digital:
prácticas nas bibliotecas escolares / María Raquel Ramos. -- A biblioteca escolar e o
desafío da interculturalidade: o projeto Ser + cidadao / María da Conceição Tomé. --
Cuando la competencia digital encontró a la alfabetización informacional o Mucho ruido y
pocas nueces / Felicidad Campal García. -- Hora de ler, un programa para el fomento de la
lectura en contexto educativo / Cristina Novoa. -- Hábitos de lectura para las
competencias en información y alfabetización en información en bibliotecas escolares de
Puerto Rico / Karen Denise Centeno Casillas. -- Repositorios digitales en las bibliotecas
escolares andaluzas: situación, modelos y herramientas para su creación / Dolores Olmos
Olmos y Andrés Pulido Villar. -- Trabajando las competencias clave con las aventuras de
Mozarito en Extremadura / María Teresa Carballosa González y María Esther Nieto Vidal. --
Análisis de modelos de evaluación de la web de la biblioteca escolar / Raúl Cremades
García. -- Emociónate con las historias: El bosque de las emociones e historias con mucho
teatro / Esther Luis Pérez y Ana María Peromingo Fernández. -- Biblioteca escolar de
innovación y continuación / E. María Guerrero Palacios y Silvia Mora Ramírez. -- Uso de
estándares y licencias para la creación y difusión de contenidos en las bibliotecas
escolares / José Luis Barreiro Cebey. -- La biblioteca escolar digital móvil / Javier
Fernández Delgado. -- Uso de aplicaciones móviles para el desarrollo de
la competencia lingüística. Proyecto Hansel App Gretel / Dolores Olmos Olmos. -- A memória
e a mediação segundo Vigotski / Leda Maria Araújo, Patricia Celia Santana, Sueli Bortolin
y Leticia Gorri Molina. -- Bibliotecas escolares como tema de estudo dos alunos de
graduação em blioteconomia do Instituto de Ensino Superior da FUNLEC: estado da arte /
Tiago Pereira Nocera y Rodrigo Pereira. -- Ações de mediação da leitura e da informação
em bibliotecas escolares: um olhar sobre as bibliotecas dos Colégios de Aplicação /
Tatyanne Christina Gonçalves Ferreira Valdez y Alberto Calil Júnior. -- Mediação
pedagógica numa biblioteca de escola pública em Londrina / Rovilson José da Silva, Teba
Silva Yllana y Sueli Bortolin. -- Utilização de categorias por cores em sistema de
biblioteca voltado ao público infanto-juvenil / Liliana Giusti Serra. -- Atividades de
ensino dos atos de leitura com crianças em risco social / Adriana Naomi Fukushima da Silva
y Dagoberto Buim Arena. -- Biblioteca escolar: espaço de significados entre
alunos, professores e bibliotecários / Rodrigo Barbosa Paulo, Marisa Xavier, Helen Castro
Casarin y Creuza Barbaroto. -- A Biblioteca Escolar no Contexto da Legislação e
do Processo Educativo / Eliane Lourdes da Silva Moro, Francisca Rosaline Leite Mota y
Raimundo Martins de Lima. -- O jornal impresso como fonte de informação: a importância da
formação de leitores críticos / Mariana Pícaro Cerigatto. -- Bibliotecas escolares no
estado do Rio Grande do Sul: a trajetória de realização dos fóruns gaúchos pela melhoria
das bibliotecas escolares / Eliane Lourdes da Silva Moro y Lizandra Brasil Estabel. -- O
acesso à informação dos usuários surdos na biblioteca escolar / André Luís Onório
Coneglian y Mayara Melo Santana. -- Aprendizagem coletiva de bibliotecários e a
competência de pesquisa dos docentes: o caso do Instituto Federal do Espírito Santo /
Maristela Almeida Mercandeli Rodrigues y Beatriz Quiroz Villardi. -- Biblioteca escolar:
atores, parâmetros e competências / Mavi Galante Mancera Dall´Acqua Carvalho y Claudio
Marcondes de Castro Filho. -- Estratégias de aprendizagem de escrita no
Ensino Fundamental II / Érika Christina Kohle. -- Bebês e livros: leitura nas bebetecas.
Kenia Adriana de Aquino Modesto Silva, Juliane Francischeti Martins Motoyama y Renata
Junqueira de Souza. -- Práticas alternativas para organização de acervos nos espaços de
leitura em ambientes escolares / Luciana Souza Gracioso, Ariovaldo Alves,
Débora Nascimento, Suelen Redondo, Tainara Torika Kiri de Castro, Elizabete Angelon y
Eduardo Barbosa. -- Reflexões sobre a modelagem e criação de uma Rede Virtual de Leitores
para Bibliotecas Escolares / Carla Floriana Martins y Raoni Guerra Rajão. -- Biblioteca
escolar: espaço de formação leitora? / Silvana Ferreira de Souza Balsan y Renata
Junqueira de Souza. -- “Se a Biblioteca Escolar é minha mãe, o Google é meu pai”:
representações da relação entre Biblioteca Escolar e Google no imaginário de
alunos do ensino técnico / Adriana Bogliolo Sirihal-Duarte, Maria L. Amorim Antunes y
Raquel Miranda Vilela Paiva. -- Desafios e propostas para a universalização das
bibliotecas escolares no Brasil e na Espanha / Rodrigo Pereira, Daniela Spudeit y Fernanda
de Sales. -- Bibliotecário educador: possibilidades de atuação no contexto da biblioteca
escolar / André Carlos da Silva, Valéria Martin Valls y Mariana de Paula Silva. -- Uma ONG
para Bibliotecas Escolares : estratégia para ampliar a igualdade e capacidade de acesso
e uso da informação e educação escolar de qualidade / Suelen Camilo Ferreira y Luciana de
Souza Gracioso. -- O aluno com deficência: o papel do bibliotecário na disponibilidade de
recursos acessíveis na biblioteca escolar / Adriano de Sales Coelho, Rosilene de Melo
Oliveira y Marcos Pastana Santos. -- Biblioteca digital virtual e o uso do tablete: uma
possibilidade de construção de novas práticas de leitura na escola / Barbara Cibelli da
Silva Monteagudo y Dagoberto Buim Arena. -- A importância da biblioteca na educação de
crianças de 0 a 3 anos / Yngrid Karolline Mendonça Costa y Cyntia Graziella Guizelim
Simões Girotto. -- Comportamento Informacional de adolescentes: a relação com bibliotecas
e escolas / Nelson Sebastian Silva-Jerez y Helen de Castro S. Casarin
Measurement of the J/ψ pair production cross-section in pp collisions at TeV
The production cross-section of J/ψ pairs is measured using a data sample of pp collisions collected by the LHCb experiment at a centre-of-mass energy of TeV, corresponding to an integrated luminosity of 279 ±11 pb. The measurement is performed for J/ψ mesons with a transverse momentum of less than 10 GeV/c in the rapidity range 2.0 < y < 4.5. The production cross-section is measured to be 15.2 ± 1.0 ± 0.9 nb. The first uncertainty is statistical, and the second is systematic. The differential cross-sections as functions of several kinematic variables of the J/ψ pair are measured and compared to theoretical predictions.The production cross-section of pairs is measured using a data sample of collisions collected by the LHCb experiment at a centre-of-mass energy of , corresponding to an integrated luminosity of . The measurement is performed for mesons with a transverse momentum of less than in the rapidity range . The production cross-section is measured to be . The first uncertainty is statistical, and the second is systematic. The differential cross-sections as functions of several kinematic variables of the pair are measured and compared to theoretical predictions
Measurement of forward production in collisions at TeV
A measurement of the cross-section for production in collisions is presented using data corresponding to an integrated luminosity of fb collected by the LHCb experiment at a centre-of-mass energy of TeV. The electrons are required to have more than GeV of transverse momentum and to lie between 2.00 and 4.25 in pseudorapidity. The inclusive production cross-sections, where the decays to , are measured to be \begin{align*} \begin{split} \sigma_{W^{+} \to e^{+}\nu_{e}}&=1124.4\pm 2.1\pm 21.5\pm 11.2\pm 13.0\,\mathrm{pb},\\ \sigma_{W^{-} \to e^{-}\bar{\nu}_{e}}&=\,\,\,809.0\pm 1.9\pm 18.1\pm\,\,\,7.0\pm \phantom{0}9.4\,\mathrm{pb}, \end{split} \end{align*} where the first uncertainties are statistical, the second are systematic, the third are due to the knowledge of the LHC beam energy and the fourth are due to the luminosity determination. Differential cross-sections as a function of the electron pseudorapidity are measured. The cross-section ratio and production charge asymmetry are also reported. Results are compared with theoretical predictions at next-to-next-to-leading order in perturbative quantum chromodynamics. Finally, in a precise test of lepton universality, the ratio of boson branching fractions is determined to be \begin{align*} \begin{split} \mathcal{B}(W \to e\nu)/\mathcal{B}(W \to \mu\nu)=1.020\pm 0.002\pm 0.019, \end{split} \end{align*} where the first uncertainty is statistical and the second is systematic.A measurement of the cross-section for production in collisions is presented using data corresponding to an integrated luminosity of fb collected by the LHCb experiment at a centre-of-mass energy of TeV. The electrons are required to have more than GeV of transverse momentum and to lie between 2.00 and 4.25 in pseudorapidity. The inclusive production cross-sections, where the decays to , are measured to be \begin{equation*} \sigma_{W^{+} \to e^{+}\nu_{e}}=1124.4\pm 2.1\pm 21.5\pm 11.2\pm 13.0\,\mathrm{pb}, \end{equation*} \begin{equation*} \sigma_{W^{-} \to e^{-}\bar{\nu}_{e}}=\,\,\,809.0\pm 1.9\pm 18.1\pm\,\,\,7.0\pm \phantom{0}9.4\,\mathrm{pb}, \end{equation*} where the first uncertainties are statistical, the second are systematic, the third are due to the knowledge of the LHC beam energy and the fourth are due to the luminosity determination. Differential cross-sections as a function of the electron pseudorapidity are measured. The cross-section ratio and production charge asymmetry are also reported. Results are compared with theoretical predictions at next-to-next-to-leading order in perturbative quantum chromodynamics. Finally, in a precise test of lepton universality, the ratio of boson branching fractions is determined to be \begin{equation*} \mathcal{B}(W \to e\nu)/\mathcal{B}(W \to \mu\nu)=1.020\pm 0.002\pm 0.019, \end{equation*} where the first uncertainty is statistical and the second is systematic.A measurement of the cross-section for W → eν production in pp collisions is presented using data corresponding to an integrated luminosity of 2 fb collected by the LHCb experiment at a centre-of-mass energy of TeV. The electrons are required to have more than 20 GeV of transverse momentum and to lie between 2.00 and 4.25 in pseudorapidity. The inclusive W production cross-sections, where the W decays to eν, are measured to be where the first uncertainties are statistical, the second are systematic, the third are due to the knowledge of the LHC beam energy and the fourth are due to the luminosity determination
Measurement of the B0s→μ+μ− Branching Fraction and Effective Lifetime and Search for B0→μ+μ− Decays
A search for the rare decays Bs0→μ+μ- and B0→μ+μ- is performed at the LHCb experiment using data collected in pp collisions corresponding to a total integrated luminosity of 4.4 fb-1. An excess of Bs0→μ+μ- decays is observed with a significance of 7.8 standard deviations, representing the first observation of this decay in a single experiment. The branching fraction is measured to be B(Bs0→μ+μ-)=(3.0±0.6-0.2+0.3)×10-9, where the first uncertainty is statistical and the second systematic. The first measurement of the Bs0→μ+μ- effective lifetime, τ(Bs0→μ+μ-)=2.04±0.44±0.05 ps, is reported. No significant excess of B0→μ+μ- decays is found, and a 95% confidence level upper limit, B(B0→μ+μ-)<3.4×10-10, is determined. All results are in agreement with the standard model expectations.A search for the rare decays and is performed at the LHCb experiment using data collected in collisions corresponding to a total integrated luminosity of 4.4 fb. An excess of decays is observed with a significance of 7.8 standard deviations, representing the first observation of this decay in a single experiment. The branching fraction is measured to be , where the first uncertainty is statistical and the second systematic. The first measurement of the effective lifetime, ps, is reported. No significant excess of decays is found and a 95 % confidence level upper limit, , is determined. All results are in agreement with the Standard Model expectations
Measurements of prompt charm production cross-sections in pp collisions at TeV
Production cross-sections of prompt charm mesons are measured using data from collisions at the LHC at a centre-of-mass energy of TeV. The data sample corresponds to an integrated luminosity of pb collected by the LHCb experiment. The production cross-sections of , , , and mesons are measured in bins of charm meson transverse momentum, , and rapidity, . They cover the rapidity range and transverse momentum ranges for and and for and mesons. The inclusive cross-sections for the four mesons, including charge-conjugate states, within the range of are determined to be \begin{equation*} \sigma(pp\rightarrow D^0 X) = 1190 \pm 3 \pm 64\,\mu\text{b} \end{equation*} \begin{equation*} \sigma(pp\rightarrow D^+ X) = 456 \pm 3 \pm 34\,\mu\text{b} \end{equation*} \begin{equation*} \sigma(pp\rightarrow D_s^+ X) = 195 \pm 4 \pm 19\,\mu\text{b} \end{equation*} \begin{equation*} \sigma(pp\rightarrow D^{*+} X)= 467 \pm 6 \pm 40\,\mu\text{b} \end{equation*} where the uncertainties are statistical and systematic, respectively.Production cross-sections of prompt charm mesons are measured using data from pp collisions at the LHC at a centre-of-mass energy of 5 TeV. The data sample corresponds to an integrated luminosity of 8.60 ± 0.33 pb collected by the LHCb experiment. The production cross-sections of D, D, D , and D mesons are measured in bins of charm meson transverse momentum, p, and rapidity, y. They cover the rapidity range 2.0 < y < 4.5 and transverse momentum ranges 0 < p < 10 GeV/c for D and D and 1 < p < 10 GeV/c for D and D mesons. The inclusive cross-sections for the four mesons, including charge-conjugate states, within the range of 1 < p < 8 GeV/c are determined to be where the uncertainties are statistical and systematic, respectively.Production cross-sections of prompt charm mesons are measured using data from collisions at the LHC at a centre-of-mass energy of TeV. The data sample corresponds to an integrated luminosity of pb collected by the LHCb experiment. The production cross-sections of , , , and mesons are measured in bins of charm meson transverse momentum, , and rapidity, . They cover the rapidity range and transverse momentum ranges for and and for and mesons. The inclusive cross-sections for the four mesons, including charge-conjugate states, within the range of are determined to be \sigma(pp\rightarrow D^0 X) = 1004 \pm 3 \pm 54\,\mu\text{b} \sigma(pp\rightarrow D^+ X) = 402 \pm 2 \pm 30\,\mu\text{b} \sigma(pp\rightarrow D_s^+ X) = 170 \pm 4 \pm 16\,\mu\text{b} \sigma(pp\rightarrow D^{*+} X)= 421 \pm 5 \pm 36\,\mu\text{b} where the uncertainties are statistical and systematic, respectively
Revisão sistematizada da literatura e opinião de peritos
Objective: The 3E (Evidence, Expertise, Exchange) Initiative is a multinational effort of rheumatologists aimed at developing evidence-based recommendations addressing specific questions relevant to clinical practice. The objective of the Portuguese contribution for the 3E Initiative was to develop evidence-based recommendations on how to investigate, follow-up and treat undifferentiated peripheral inflammatory arthritis (UPIA) adapted to local reality and develop additional recommendations considered relevant in the national context. Methods: An international scientific committee from 17 countries selected a set of questions concerning the diagnosis and monitoring of UPIA using a Delphi procedure. Evidence-based answers to each question were sought by a systematic literature search, performed in Medline, Embase, the Cochrane Library and ACR/EULAR 2007-2009 meeting abstracts. Relevant articles were reviewed for quality assessment, data extraction and synthesis. In a national meeting, a panel of 63 Portuguese rheumatologists used the evidence which was gathered to develop recommendations, and filled the gaps in the evidence with their expert opinion. Finally, national recommendations were formulated and agreement among the participants was assessed. Results: A total of 54754 references were identified, of which 267 were systematically reviewed. Thirteen national key recommendations about the investigation, follow-up and treatment of UPIA were formulated. One recommendation addressed differential diagnosis and investigations prior to the established operational diagnosis of UPIA, eight recommendations were related to the diagnostic and prognostic value of clinical and laboratory assessments in established UPIA (history and physical examination, acute phase reactants, serologies, autoantibodies, radiographs, magnetic resonance imaging and ultrasound, genetic markers and synovial biopsy), one recommendation highlighted predictors of persistence (chronicity), one addressed monitoring of clinical disease activity in UPIA, one aimed to find an useful method/score to predict a definitive diagnosis and the last one was related to treatment. Conclusion: Portuguese evidence-based recommendations for the management of UPIA in everyday practice were developed. Their dissemination and implementation in daily clinical practice should help to improve practice uniformity and optimize the management of UPIA patients.publishersversionpublishe
Immunocompromised patients with acute respiratory distress syndrome: Secondary analysis of the LUNG SAFE database
Background: The aim of this study was to describe data on epidemiology, ventilatory management, and outcome of acute respiratory distress syndrome (ARDS) in immunocompromised patients. Methods: We performed a post hoc analysis on the cohort of immunocompromised patients enrolled in the Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE) study. The LUNG SAFE study was an international, prospective study including hypoxemic patients in 459 ICUs from 50 countries across 5 continents. Results: Of 2813 patients with ARDS, 584 (20.8%) were immunocompromised, 38.9% of whom had an unspecified cause. Pneumonia, nonpulmonary sepsis, and noncardiogenic shock were their most common risk factors for ARDS. Hospital mortality was higher in immunocompromised than in immunocompetent patients (52.4% vs 36.2%; p < 0.0001), despite similar severity of ARDS. Decisions regarding limiting life-sustaining measures were significantly more frequent in immunocompromised patients (27.1% vs 18.6%; p < 0.0001). Use of noninvasive ventilation (NIV) as first-line treatment was higher in immunocompromised patients (20.9% vs 15.9%; p = 0.0048), and immunodeficiency remained independently associated with the use of NIV after adjustment for confounders. Forty-eight percent of the patients treated with NIV were intubated, and their mortality was not different from that of the patients invasively ventilated ab initio. Conclusions: Immunosuppression is frequent in patients with ARDS, and infections are the main risk factors for ARDS in these immunocompromised patients. Their management differs from that of immunocompetent patients, particularly the greater use of NIV as first-line ventilation strategy. Compared with immunocompetent subjects, they have higher mortality regardless of ARDS severity as well as a higher frequency of limitation of life-sustaining measures. Nonetheless, nearly half of these patients survive to hospital discharge. Trial registration: ClinicalTrials.gov, NCT02010073. Registered on 12 December 2013
- …