Study of the performance of TBM in the excavation of granite rock masses of the north of Portugal using the Qtbm system

O sistema QTBM é uma metodologia empírica para a previsão dos rendimentos esperados na escavação de túneis com tuneladoras TBM, nomeadamente, as velocidades de penetração (PR) e de avanço (AR). Neste trabalho, esta metodologia é aplicada a uma base de dados geotécnica coligida durante as obras de construção de uma obra subterrânea hidroeléctrica na zona Norte de Portugal, com o objectivo de avaliar a adequabilidade de utilização de TBM na escavação de túneis em maciços graníticos típicos dessa região. Esta base de dados continha 1230 determinações de vários dos parâmetros necessários. Para os parâmetros em falta foram estabelecidos intervalos de confiança e realizadas análises de sensibilidade à sua variação. Deste estudo verificou-se que o maciço em questão apresenta boas características para ser escavado com recurso a tuneladora já que são expectáveis rendimentos bastante aceitáveis.The QTBM system is an empirical methodology for the performance prediction in tunnels excavated with TBM, namely the penetration and advance rates. In this work this methodology is applied to a database collected during the construction of a hydroelectric underground work built in the North of Portugal to evaluate the adequacy of using TBM in the excavation of tunnels in granite rock masses typical from that region. This database contained 1230 determinations of several parameters. For the ones missing, confidence intervals were set and sensitivity analysis was carried to evaluate the impact to their variation. From this study it was concluded that the analysed rock mass presents good characteristics to be excavated using TBM since the expected performance is rather acceptable

Long-term maintenance strategies after pulmonary rehabilitation: perspectives of people with chronic respiratory diseases, informal carers and healthcare professionals

No abstract available.publishe

Access to pulmonary rehabilitation: perspectives of patients, loved ones and healthcare professionals

Introduction: Improving access to pulmonary rehabilitation (PR) is an international priority, but due to several constraints, healthcare professionals are often faced with the challenge of having to prioritise patients. Evidence from quantitative research suggests that symptoms, functional and health status and not lung function should guide referrals to pulmonary rehabilitation (PR). Whether these criteria are corroborated by the opinions of different stakeholders remains unknown. This qualitative study explored criteria, barriers and facilitators to access PR from the perspectives of people with chronic respiratory disease (CRD), loved ones and healthcare professionals. Methods: An exploratory, cross-sectional qualitative study was carried out. Focus groups were conducted separately with people with CRD, loved ones and healthcare professionals; transcribed verbatim and analysed thematically. All participants had previous experience with PR. Results: Seven focus groups were conducted: four with people with CRD (24 with chronic obstructive pulmonary disease and 5 with interstitial lung disease, 75.9% male, 68.4 ± 7.5 years); one with loved ones (n = 5, 100% female, 66.6 ± 7.7 years) and two with healthcare professionals (n = 16, 25% male, 38 ± 9.2 years). Perspectives among stakeholders were mostly consensual and organised in three themes: all people with CRD should have access to PR and as early as possible “Universal access”; if prioritisation is needed then priority should be given to those motivated, with high symptom burden and impaired functional status “Priority to those struggling and motivated”; and education about PR and continuity and communication between care settings and professionals are lacking to improve access to PR “Communication, dissemination and organisation as main keys”. Conclusions: Our findings corroborate previous evidence and provide new and complementary in-depth understanding to design interventions to improve access to PR in line with the perspectives of different stakeholders.publishe

Treatable traits and its responsiveness to pulmonary rehabilitation in people with chronic obstructive pulmonary disease and interstitial lung disease

No abstract available.publishe

Presence of extra-pulmonary treatable traits in people with COPD increases the likelihood of responding to pulmonary rehabilitation

Introduction: Evidence suggests that people with chronic obstructive pulmonary disease (COPD) who have worse clinical status (e.g., higher symptom burden) at baseline respond better to pulmonary rehabilitation. Identification of treatable traits in this population might help to better distinguish responders from non-responders, which could aid optimisation of the intervention in the future. This study aimed to explore the impact of pulmonary rehabilitation on extra-pulmonary traits of people with COPD and whether the presence of these treatable traits at baseline influences the type of response (responder or non-responder) to pulmonary rehabilitation. Methods: An observational retrospective study was conducted. A comprehensive extra-pulmonary treatable traits’ assessment including symptoms (dyspnoea, fatigue, anxiety, and depression), functional status, balance, impact of the disease and healthrelated quality of life, was conducted before and after a 12-week com-munity-based pulmonary rehabilitation programme. Pre-post differences between people with or without each TT were compared with independent samples t-tests or Mann-Whitney U tests. The proportion of responders between groups (with or without treatable traits) were explored with chi-square tests and odds ratio. Results: A total of 102 people with COPD (70 [65; 75] years old, 78% male, FEV1 47 [36; 60]% predicted) were included. People with COPD had a median [min-max] of 3 [0-7] treatable traits per person and each responded on average to 5 [0-9] outcomes of pulmonary rehabilitation. People with identified treatable traits at baseline were more responsive than those without them in all outcomes (p < 0.05) except for the 1-minute sit-to-stand test. The presence of treatable traits increased the likelihood of being a good responder in all outcomes (OR: 1.72-19.95) except for the 1-minute sit-to-stand test (p = 0.175).Conclusions: Identification of extra-pulmonary treatable traits in people with COPD showed potential to inform on pulmonary rehabilitation responsiveness and might therefore be an important strategy for patient selection, treatment personalisation and optimisation.publishe

Pulmonary rehabilitation changes the oral microbiota of people with COPD

Pulmonary rehabilitation (PR) is one of the most beneficial therapies for COPD, generally improving symptoms, exercise tolerance and functionality. Here, we investigated for the first time the effects of PR in the oral microbiota and immune mediators of people with COPD. 456 samples from 76 patients, 38 (72±9y, 76%♂, FEV1pp 49±16) integrating a 12-week community-based PR program, and 38 (70±8y, 82%♂, FEV1pp 52±20) not attending PR, were followed for 6 months and characterised based on sociodemographic, anthropometric, clinical data, oral microbiota, and oral inflammatory profile. PR modulated patients’ microbiota composition and dynamics (Fig1A). Specifically, an enrichment of Proteobacteria (Haemophilus) and a depletion in Bacteroidetes, previously associated with increased severity (Melo-Dias et al, Respir Res 2022), were observed upon PR (Fig1B-C). We also observed a peak of IL-1β one month after the beginning of PR, and a significant increase in TNF-α in the third month of intervention (Fig1D). Additionally, IL-10 also increased in response to PR (Fig1D), and no significant differences were found in IL-6, IL-8, IL-17, and IL-23. Remarkably, our data suggest that PR modulates oral microbiota towards more severe states of the disease and increases both pro and anti-inflammatory markers. Future studies should address the implications and stability of these microbiota modifications and their correlation with inflammation.publishe

Anxiety and depression symptoms after pulmonary rehabilitation in people with interstitial lung disease: responders and non-responders

Pulmonary rehabilitation (PR) is an effective intervention for people with interstitial lung disease (ILD), as it improvesexercise capacity, quality of life and dyspnoea. Less is, however, known about other important and frequentsymptoms, such as anxiety and depression. This study explored the response of anxiety and depression symptomsto PR in people with ILD. Participants undertook a 12-week community-based PR programme. Anxiety and depression symptoms wereevaluated before and after PR with the hospital anxiety and depression scale (HADS). The sample was stratified into2 groups according to the HADS score: ≥8 probable anxiety (PA) or depression (PD) and score <8 normal symptoms(NS). Responders were classified using the HADS minimal clinical important difference (≥1.5 points). 46 people with ILD (62±13 years; 63%♀; 75±20 FVC%; 56±18 DLCO%) participated. Number of responders inanxiety symptoms (73% PA; HADS-A pre: 12±3; mean change: 4±2; p<0.001 vs 25% NS; HADS-A pre: 6±2; meanchange: 2±0; p<0.001) was much higher than in depression symptoms (27% PD; HADS-D pre: 11±3; mean change:3±1; p=0.014 vs 13% NS; HADS-D pre: 5±2; mean change: 2±1; p=0.003). PR seems to improve anxiety symptoms, but it might not be as effective for depression symptoms in people with ILD.Future studies are needed to investigate the role of PR in the psychological health of people with ILD.publishe

Clusters of functional status in COPD: an exploratory analysis

Functional status is highly meaningful to the daily life of people with COPD but is often overlooked by treatmentoptions. Understanding its heterogeneity, might contribute to better personalised care. We aimed to explore clustersof functional status in people with COPD. Lung function, impact of the disease, activity-related dyspnoea and functional status were collected cross-sectionally.The 6-minute walk test, 1-minute sit-to-stand test, quadriceps maximum voluntary contraction and handgrip musclestrength were used to group individuals to clusters (K-means clustering). Total within cluster sum of squares wascomputed for different values of k and the optimum number of clusters was defined as the inflexion point on thecurve. Differences between clusters were explored using ANOVA and post-hoc multiple pairwise comparisons. 127 people with COPD (82% male, 68±8 years, FEV1 56±20 %pred) were included in the analysis. 4 clusters werefound (Fig. 1): ‘over-achievers’ (Cluster 2, n=30); ‘achievers’ (Cluster 1, n=28); ‘partial-achievers’ (Cluster 4, n=39);‘non-achievers’ (Cluster 3, n=29). Our 4 clusters of functional status may guide tailored treatment regimens to improve this highly meaningful outcome.Cluster validity, their behaviour over time and differential response to treatment needs further investigation.publishe

Responsiveness to pulmonary rehabilitation is related with changes in oral microbiota of people with COPD

Introduction: Pulmonary Rehabilitation (PR) is one of the most cost-effective therapies for chronic obstructive pulmonary disease (COPD), with proven benefits in domains such as exercise capacity and quality of life. Despite its clear benefits, patients are not equal-ly responsive to PR. Reasons behind that as well as the role of the airway microbiota in PR effectiveness are currently unknown.Objectives: Here, we explored for the first time, the effects of PR on oral microbiota and inflammatory markers and the link with responsiveness to PR. Study design: 76 participants were enrolled in this prospective cohort study, half of whom integrated a 12-week PR program. During the 6-month follow-up, a total of 417 saliva samples, and data on dyspnoea during exercise (mBorg), exercise capacity (6MWT) and impact of the disease (CAT) were collected. PR responsiveness was defined as overcoming the published minimal clinically important difference for mBorg (-1 point), 6MWT (25m) and CAT (-2 points).Results: PR modulated patients’ microbiota composition and dy-namics. Specifically, an enrichment of Proteobacteria (Haemophi-lus) and a depletion in Bacteroidetes (Prevotella), previously as-sociated with increased severity (Melo-Dias et al, Respir Res 2022), were observed upon PR. We also observed changes in the levels of IL-1b, TNF-a and IL-10. When separating patients in responders (R) and non-responders (NR), distinct patterns of bacteria/bacteria and bacteria/inflammatory marker longitudinal correlation were ob-served among the groups. In R, the increase in Prevotella nega-tively correlated with Lautropia (enriched in most severe cases of COPD (Melo-Dias et al., Respir Res 2022)). The opposite trend was observed in NR, with Lautropia showing a positive correlation with several pro-inflammatory markers. Conversely, in all groups of R, Rothia and Gemellaceae presented negative correlations with sev-eral pro-inflammatory markers. Conclusions: Overall, despite responsiveness to PR being multidi-mensional and heterogeneous, giving rise to a moderate overlap across domains in individual response, PR-induced changes in mi-crobiota revealed surprisingly consistent patterns among R and NR. Future studies should address the implications and stability of these findings.publishe

Influência de espécies de leguminosas arbóreas na qualidade e produção de pastagem de capim Marandu (Brachiaria brizantha).

The silvopastures systems promote the production and environment protection, several benefits should to be reached. However, to that benefits result in the tree-grass association, it is necessary that the trees provide, mainly, increase production and quality grass grown below their tops. The objetive was, evaluate the influence of four leguminous arboreal species in seventeen variables of Brachiaria brizantha cv. Marandu growing at different distances (D) from the trunk of leguminous of these trees: Dl = 50 cm from the trunk; D2= half of the radius of the projection of the top; D3= the radius of the projection of the top; D4= one and half the radius of the projection of the top; and D5= twice the radius of the projection of the top. Distances (D4 e D5) corresponding to the areas out of the tops and considered as controls. The used species were Samanea guachapele (albizia), Acacia holosericea (olosericea), Mimosa tenuiflora Gurema preta) e Mimosa artemisiana Gurema branca). Were evaluates the variables in grass: tenor crude protein, digestibility in vitro of dry matter, neutral detergent fiber, acid detergent fiber, lignin in sulfuric acid, lignin in permanganate of potassium, cellulose, silica and dry matter production. To analyse the datas utilized a multivariate analysis method, the factor analysis. The rotative factor Fl, wich explained the highest variance percentage of datas, associated to the results of the factorial scores, showed that the leguminous arboreal specie A. holosericeaproporcioned the majors accumulation of dry matter, protein, digestibility in vitro of dry matter in aereal part of Marandu grass, growing in distances more next of the trunk. The rotative factor Fl also showed that the lowest values for these variables were found in grass growing out of the influence of cup is specie Mimosa tenuiflora in the area no tree. The partial results indicate that the arboreal leguminous Acacia holosericea (olosericea) proportioned the higher quality and quantity in Marandu grass, when it growed under influence of its top.Parceria: UFRRJ; PESAGRO; Embrapa Gado de Corte