Implementação de um plano de segurança de águas num hospital

Dissertação de Natureza Científica para obtenção do grau de Mestre em Engenharia CivilO sistema de distribuição predial (SDP) de água de um hospital apresenta determinados componentes, que caso não sejam devidamente instalados, operados e alvo de uma manutenção e monitorização adequada, podem constituir um foco de contaminação da água. A implementação de um plano de segurança de águas (PSA) constitui uma ferramenta importante na avaliação e na gestão de risco de um SDP, que permite garantir uma maior qualidade da água, constituindo um elemento importante das políticas de saúde. O PSA é uma abordagem de avaliação e gestão de risco onde são identificados potenciais riscos microbiológicos (nomeadamente, bactérias e vírus), químicos, radiológicos e físicos. Num SDP o PSA é implementado desde o contador (local onde cessa a responsabilidade da entidade gestora do sistema de distribuição público) até ao dispositivo de utilização. A OMS (2004, 2007 e 2011a)) estende a implementação de PSA’s a hotéis, navios de cruzeiro, urbanizações, entre outros. A implementação de uma avaliação de riscos já é uma recomendação da atual legislação nacional em vigor (Decreto Lei 307/2006, de 27 de agosto) verificando-se a suaimplementação em várias entidades gestoras de sistemas de abastecimento. É importante referir que atualmente já existem PSA em sistemas de abastecimento público de águas. A Diretiva (EU) nº 1787/2015, de 6 Outubro, que altera os anexos II e III da Diretiva 98/83/CE relativa à qualidade da água destinada ao consumo humano, de modo a incorporar o progresso científico e técnico, vem reforçar a importância da implementação de um PSA, recomenda a incorporação de aspetos relativos à avaliação de risco segundo a norma europeia EN 15975-1-2011, Security of drinking water supply – Guidelines for risk and crisis management. A implementação de um PSA num hospital deve ter em conta não só as recomendações por parte da OMS (referenciadas nas Guidelines for DrinkingWater Quality (2004), Legionella and the Prevention of Legionellosis (2007), Water Safety in Buildings (2011) e Water Safety in Distribution Systems (2014)) e a norma europeia (Security of drinking water supply – Guidelines for risk and crisis management (2013)), mas também a legislação portuguesa e outras recomendações nacionais. Para implementar com sucesso um PSA devem-se considerar as seguintes etapas: - etapas preliminares, que engloba a constituição da equipa e a descrição do sistema; - avaliação do sistema, onde são avaliados e caracterizados os riscos; - monitorização do sistema, com o detalhe dos diferentes procedimentos; - elaboração de procedimentos, implementando uma gestão de rotina em condições normais e excecionais, e a documentação e protocolos de comunicação; - validação e verificação do PSA. O objetivo deste trabalho final de mestrado é desenvolver um PSA num hospital, contribuindo para o abastecimento seguro e com qualidade da água para todos os usos e atividades a desenvolver. O hospital selecionado foi o Hospital Beatriz Ângelo (HBA), um hospital recente, com três anos de funcionamento, situado no concelho de Loures.Abstract: The building distribution system (BDS) of water in a hospital presents certain components, if not correctly installed, operated, maintained and monitored, can be a focus of water contamination. The implementation of a water safety plan (WSP) is an important tool to evaluate and manage the risk of a BDS, it allows to guarantee a bigger water quality, allowing to guarantee a better water quality constituting an important element in health politics. A WSP is an assessment and risk management approach where the potentialrisks are identified: microbiologic (such as bacteria and virus), chemical, radiological and physical. In a BDS the WSP is implemented from the counter (local where the responsability of the management entity of the public distribution system ends) to the user device. WHO (2004, 2007 and 2011a)) extends WSPs implementations to hotels, cruise ships, urbanizations, etc. The risk management implementation is currently a recommendation of an existing national legislation (Decreto Lei 307/2006, de 27 de agosto), verifying their implementation in many management companies of supply systems. It is important to note that currently there are already WSP in water for public supply systems. The directive (EU) nº 1787/2015, of October 6th, that changes the annexes II and III of the directiva 98/83/CE related to water quality to human consumption, to incorporate the scientific and technical progress, reinforcing the importance of implementing a WSP, it recommends the incorporation of aspects such as risk assessment in accordance with the European Norm EN 15975-1-2011, Security of drinking water supply – Guidelines for risk and crisis management. The implementation of a WSP in a hospital should have in consideration not only the recommendations by WHO referenced in Guidelines for Drinking-Water Quality (2004), Legionella and the Prevention of Legionellosis (2007), Water Safety in Buildings (2011) and Water Safety in Distribution Systems (2014), but also Portuguese legislation and other national recommendations. To implement a WSP with success the following steps should be considered: • preliminary step, where it is considered the team constitution and the system description; - system evaluation, where the risks are identified and characterized; - system monitorization, with the different procedures; - procedures elaboration, related with routine management procedures in normal and exceptional conditions, and documents and communicationprotocols; - WSP validation and verification. The objective of this final work of master degree is to implement a WSP in a hospital, contributing for a safe supply with a water quality for all uses and activities developed. The selected hospital was Hospital Beatriz Ângelo (HBA), a recent hospital, with three years of operation, located in the municipality of Loures

Allelic expression imbalance of PIK3CA mutations is frequent in breast cancer and prognostically significant.

Funder: EC | EC Seventh Framework Programm | FP7 People: Marie-Curie Actions (FP7-PEOPLE - Specific Programme "People" Implementing the Seventh Framework Programme of the European Community for Research, Technological Development and Demonstration Activities (2007 to 2013)); Grant(s): FP7/2007-2013/303745PIK3CA mutations are the most common in breast cancer, particularly in the estrogen receptor-positive cohort, but the benefit of PI3K inhibitors has had limited success compared with approaches targeting other less common mutations. We found a frequent allelic expression imbalance between the missense mutant and wild-type PIK3CA alleles in breast tumors from the METABRIC (70.2%) and the TCGA (60.1%) projects. When considering the mechanisms controlling allelic expression, 27.7% and 11.8% of tumors showed imbalance due to regulatory variants in cis, in the two studies respectively. Furthermore, preferential expression of the mutant allele due to cis-regulatory variation is associated with poor prognosis in the METABRIC tumors (P = 0.031). Interestingly, ER-, PR-, and HER2+ tumors showed significant preferential expression of the mutated allele in both datasets. Our work provides compelling evidence to support the clinical utility of PIK3CA allelic expression in breast cancer in identifying patients of poorer prognosis, and those with low expression of the mutated allele, who will unlikely benefit from PI3K inhibitors. Furthermore, our work proposes a model of differential regulation of a critical cancer-promoting gene in breast cancer

Characterisation of microbial attack on archaeological bone

As part of an EU funded project to investigate the factors influencing bone preservation in the archaeological record, more than 250 bones from 41 archaeological sites in five countries spanning four climatic regions were studied for diagenetic alteration. Sites were selected to cover a range of environmental conditions and archaeological contexts. Microscopic and physical (mercury intrusion porosimetry) analyses of these bones revealed that the majority (68%) had suffered microbial attack. Furthermore, significant differences were found between animal and human bone in both the state of preservation and the type of microbial attack present. These differences in preservation might result from differences in early taphonomy of the bones. © 2003 Elsevier Science Ltd. All rights reserved