Snapshot of macroalgae and fish assemblages in temperate reefs in the Southern European Atlantic Ecoregion

Most of the biodiversity studies in the South European Atlantic Shelf ecoregion are limited to shallow subtidal or intertidal habitats, while deeper reef habitats, also of relevant ecological importance, are particularly understudied. Macroalgal communities, associated fauna, and sea surface temperature were studied in deep reefs (25-30 m) at two locations in this ecoregion: Parcel, North of Portugal (41 degrees N), and Tarifa, Southern Spain (35 degrees N). Specifically, algal assemblages were assessed using biomass collection and associated ichthyofauna was assessed using visual census techniques using scuba. Seawater surface temperature was higher (>3 degrees C) in the southern region-Tarifa, compared to the northern region-Parcel. Our survey revealed 18 fish species and 23 algae species. The highest abundance of cold-water species (both macroalgae and fish species) was recorded in Parcel and warm-water species were dominant in Tarifa. In light of climate global trends, both regions might experience biodiversity shifts towards tropicalization. Current knowledge on their biodiversity is imperative to further evaluate potential shifts.info:eu-repo/semantics/publishedVersio

Pheochromocytomas and paragangliomas in von hippel–lindau disease: Not a needle in a haystack

Objective: Pheochromocytomas are a hallmark feature of von Hippel–Lindau disease (vHL). To our knowledge, this is the first systematic review with meta-analysis evaluating the frequency of pheochromocytomas and/or paragangliomas (PPGLs) in patients with vHL, as well as among patients with different vHL subtypes. Design: Systematic review with meta-analysis. Methods: We searched on MEDLINE, Scopus, and Web of Science. We included primary studies assessing participants with vHL and reporting on the frequency of PPGL. We performed random-effects meta-analysis to quantitatively assess the frequency of PPGL, followed by meta-regression and subgroup analysis. Risk of bias analysis was performed to assess primary studies’ methodological quality. Results: We included 80 primary studies. In 4263 patients with vHL, the pooled frequency of PPGL was 19.4% (95% CI = 15.9–23.6%, I2 = 86.1%). The frequency increased to 60.0% in patients with vHL type 2 (95% CI = 53.4–66.3%, I2 = 54.6%) and was determined to be of 58.2% in patients with vHL type 2A (95% CI = 49.7–66.3%, I2 = 36.2%), compared to 49.8% in vHL type 2B (95% CI = 39.9–59.7%, I2 = 42.7%), and 84.1% in vHL type 2C (95% CI = 75.1–93.1%, I2 = 0%). In meta-regression analysis, more recent studies were associated with a higher frequency of PPGL. All studies had at least one internal validity item classified as 'high risk of bias,' with 13% studies having low risk of bias in all external validity items. Conclusions: PPGLs are a common manifestation of vHL. Despite methodological limitations and differences across primary studies, our results point to the importance of PPGL screening in patients with vHL

What Is the Optimal Bowel Preparation for Capsule Colonoscopy and Pan-intestinal Capsule Endoscopy? A Systematic Review and Meta-Analysis

Background: The rate of adequate cleansing (ACR) and complete examinations (CR) are key quality indicators in capsule colonoscopy (CC) and pan-intestinal capsule endoscopy (PCE). Aims: To evaluate the efficacy of bowel preparation protocols regarding ACR and CR. Methods: We conducted a systematic review and meta-analysis, search terms regarding colon capsule preparation, publication date from 2006/01, and date of search 2021/12, in six bibliographic databases. Multiple steps of the cleansing protocol were assessed: diet, adjunctive laxatives, purgative solution, use of prokinetic agents, and "booster". The meta-analytical frequency of ACR and CR was estimated, and subgroup analyses performed. Strategies associated with higher ACR and CR were explored using meta-analytical univariable and multivariable regression models. Results: Twenty-six observational studies and five RCTs included (n = 4072 patients). The pooled rate of ACR was 72.5% (95% C.I. 67.8-77.5%; I2 = 92.4%), and the pooled rate of CR was 83.0% (95% C.I. 78.7-87.7%; I2 = 96.5%). The highest ACR were obtained using a low-fibre diet [78.5% (95% C.I. 72.0-85.6%); I2 = 57.0%], adjunctive laxatives [74.7% (95% C.I. 69.8-80.1%); I2 = 85.3%], and split dose < 4L polyethylene glycol (PEG) as purgative [77.5% (95% C.I. 68.4-87.8%); I2 = 47.3%]. The highest CR were observed using routine prokinetics prior to capsule ingestion [84.4% (95% C.I. 79.9-89.2%); I2 = 89.8%], and sodium phosphate (NaP) as "booster" [86.2% (95% C.I. 82.3-90.2%); I2 = 86.8%]. In univariable models, adjunctive laxatives were associated with higher ACR [OR 1.81 (95% C.I. 1.13; 2.90); p = 0.014]. CR was higher with routine prokinetics [OR 1.86 (95% C.I. 1.13; 3.05); p = 0.015] and split-dose PEG purgative [OR 2.03 (95% C.I. 1.01; 4.09), p = 0.048]. Conclusions: Main quality outcomes (ACR, CR) remain suboptimal for CC and PCE. Despite considerable heterogeneity, our results support low-fibre diet, use of adjunctive sennosides, split dose < 4L PEG, and routine prokinetics, while NaP remains the most consistent option as booster.info:eu-repo/semantics/publishedVersio

Arquitectura para gestão de actividades em plataformas distribuídas de e-Learning

Doutoramento em Ciências e Tecnologia da ComunicaçãoO desenvolvimento de LMSs bem como dos conteúdos a serem utilizados nos cursos que os mesmos suportam, tem sido feito pelos produtores de software e de conteúdos, sem atender a quaisquer normas, fazendo com que não seja possível a compatibilização dos diferentes sistemas existentes. Preocupações de reuso e interoperabilidade estão na base de diversos projectos de normalização nesta área, levados a cabo por organizações e consórcios internacionais, envolvendo organismos governamentais, empresariais e académicos de todo o mundo. Até ao momento, os principais esforços têm sido canalizados para a questão da construção de unidades de aprendizagem (conteúdos) que possam ser reutilizáveis, estando em curso trabalhos relacionados com a normalização dos LMSs, por forma a que estes possam gerar, utilizar e trocar entre si, conteúdos com as mais diversas amplitudes, indo do simples texto até ao curso completo. Algumas das organizações e consórcios que mais se têm evidenciado neste tipo de trabalho incluem a ADL (Advanced Distributed Learning), o IMS Global Learning Consortium, Inc., o AICC (Aviation Industry Computer Based Training Committee), e o IEEE LTSC (Institute of Electriical and Electronic Engineers Learning Technologies Standard Committee), entre outros. O projecto SCORM (Sharable Content Object Reference Model) da ADL é talvez aquele que neste momento melhor representa o esforço que tem sido feito no sentido da normalização referida. Contudo, até à data, nenhum dos projectos conhecidos se preocupou com questões de gestão operacional dos cursos, deixando por cobrir aspectos achados importantes para o aumento da probabilidade de sucesso dos processos de ensino/aprendizagem. A presente tese pretende descrever o trabalho de obtenção de um referencial para a camada de gestão on-line dos processos de e-learning suportados por LMSs. Tal camada é proposta de forma a poder integrar-se no todo que constiui uma plataforma de ensino/aprendizagem desenvolvida de acordo com as recomendações SCORM e, para além da proposta de uma camada de metadados de gestão, apresenta a forma como a referida integração poderá ser realizada.The development of the LMSs as well as the development of the contents to be used inside the courses that the LMSs support has been done without any standard guidelines. This fact addresses the problem of the existence of non compatible systems in the e-learning market. So, interoperability and reuse are the concerns of several organizations and consortia involving governmental and corporate members. Till now, the main efforts of those organizations and consortia are focused on the building and delivering of contents that could be reused. Simultaneously there are some works running towards a standardized process of LMSs development, so that it could be possible to create courses and generate, use and interchange contents among them. Those contents could have different levels of granularity, beginning on a simple text and ending in a complete course. Some of the most important organizations and consortia working in the area are ADL (Advanced Distributed Learning), IMS Global Learning Consortium, Inc, AICC (Aviation Industry Computer Based Training Committee, IEEE LTSC (Institute of Electrical and Electronic Engineers Learning Technologies Standard Committee) and others. The ADL SCORM (Sharable Content Object Reference Model) project is perhaps the one that, at this moment, better represents the efforts made in the standardization works referred. However, till today, there isn’t any known project covering the on-line management of activities execution during a course operationalization. We believe that such such management capabilities could allow better results in what concerns the success of the teaching/learning process. This thesis describes the work done towards a proposal of a referential for an on-line management layer to be integrated in the global architecture of a LMS. Doing this work, we had in mind the need of integration of the proposed new layer with the existent SCORM recommendations for the LMSs development. The integration process and the management metadata are also presented and described

Comparison of short-term outcomes between minimal invasive superpath approach and conventional posterior approach in total hip arthroplasty: a randomized controlled trial

Background: The objective of current study was to compare the short-term outcomes between a cohort of patients that undergone total hip replacement by a superpath technique at the beginning of the surgeon's learning curve, and a cohort of patients that undergone a total hip replacement by a conventional posterior approach.Methods: A cohort of 22 patients was prospectively and randomly selected for being part of a superpath approach group or a conventional posterior approach group. Clinical evaluation was performed in two primary end-points - the third post-operative day and the first month after surgery - using physical exams as the “20 meter walking test” and the “30 seconds sit to stand test”, the Harris hip score, the visual analogue scale for pain. Radiological evaluation was also performed.Results: 11 patients underwent the superpath approach and 11 patients underwent the conventional posterior approach. The surgery time was 78.2 min in the superpath group and 59.4 min in the posterior group. The average hospital stay was 3.4 days in the superpath group and 5.3 days in the posterior group. When assessing pain improvement through VAS, it was found that both on the third postoperative day and on the first postoperative month, patients in the superpath group showed greater improvement. There were no differences in functional results with statistical significance. No complications were seen in both groups.Conclusions: Despite the longer surgical time seen with the superpath approach, it managed to significantly decrease the length of hospital stay and obtained better results in improving pain in the short term

Stevens-Johnson syndrome/toxic epidermal necrolysis and erythema multiforme drug-related hospitalisations in a national administrative database

BACKGROUND: Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) and erythema multiforme (EM) are immunologically-mediated dermatological disorders commonly triggered by drug exposure and/or other external agents. We aimed to characterise SJS/TEN- and EM-drug-related hospitalisations in a nationwide administrative database, focusing on demographic and clinical characteristics, and in the most frequently implicated drug classes. METHODS: We analysed all drug-related hospitalisations with associated diagnosis of SJS/TEN or EM in Portuguese hospitals between 2009 and 2014. We compared gender, age, comorbidities, length of stay, and in-hospital mortality and estimated the number of episodes per million packages sold of drug classes. Predictors of in-hospital mortality were investigated in both conditions by logistic regression. RESULTS: There were 132 SJS/TEN-related and 122 EM-related hospitalisations. Incidence and in-hospital mortality of SJS/TEN episodes (24.2%) were consistent with previous studies. HIV co-infection was more common among SJS/TEN hospitalisations (9 vs. 2% with EM; P = 0.009). Liver disease, advanced age, and a TEN diagnosis, were significantly associated with higher risk of mortality in patients with SJS/TEN. The highest numbers of SJS/TEN and EM episodes per million drug packages sold were observed for antivirals (8.7 and 1.5, respectively), antineoplastic/immunosuppressive drugs (5.6 and 3.9, respectively) and hypouricaemic drugs (5.0 and 2.4, respectively). CONCLUSIONS: SJS/TEN in-hospital mortality is high, and its risk factors include advanced age, liver disease, and TEN diagnosis. The drug classes most frequently associated with these conditions include antivirals, hypouricaemic drugs and antineoplastic/immunosuppressive drugs. Administrative databases seem useful in the study of SJS/TEN drug-related hospitalisations, yielding results consistent with previous studies and on a nationwide basis.info:eu-repo/semantics/publishedVersio

Cost effectiveness of outpatient lumbar discectomy

Background: Microdiscectomy is the most commonly performed spine surgery and the first transitioning for outpatient settings. However, this transition was never studied, in what comes to cost-utility assessment. Accordingly, this economic study aims to access the cost-effectiveness of outpatient lumbar microdiscectomy when compared with the inpatient procedure. Methods: This is a cost utility study, adopting the hospital perspective. Direct medical costs were retrieved from the assessment of 20 patients undergoing outpatient lumbar microdiscectomy and 20 undergoing inpatient lumbar microdiscectomy Quality-adjusted life-years were calculated from Oswestry Disability Index values (ODI). ODI was prospectively assessed in outpatients in pre and 3- and 6-month post-operative evaluations. Inpatient ODI data were estimated from a meta-analysis. A probabilistic sensitivity analysis was performed and incremental cost-effectiveness ratio (ICER) calculated. Results: Outpatient procedure was cost-saving in all models tested. At 3-month assessment ICER ranged from €135,753 to €345,755/QALY, higher than the predefined threshold of €60,000/QALY gained. At 6-month costs were lower and utilities were higher in outpatient, overpowering the inpatient procedure. Probabilistic sensitivity analysis showed that in 65% to 73% of simulations outpatient was the better option. The savings with outpatient were about 55% of inpatient values, with similar utility scores. No 30-day readmissions were recorded in either group. Conclusion: This is the first economic study on cost-effectiveness of outpatient lumbar microdiscectomy, showing a significant reduction in costs, with a similar clinical outcome, proving it cost-effective