Sydney Swallow Questionnaire: European Portuguese translation

Objectives: Dysphagia is a swallowing disorder commonly diagnosed after stroke. Due to its serious consequences, an early diagnosis is fundamental. The patients with an early diagnosis should be referred for further clinical assessment. These assessments should include several evaluation techniques, including the use of self-administered Functional Health Status inventories. In Portugal, there is a lack of validated assessment scales and/or questionnaires related to dysphagia. The aim of this project is the translation and cultural adaptation of the Sidney Swallow Questionnaire (SSQ) to European Portuguese (EP). Methods: The English version of the SSQ was translated into EP by two independent bilingual translators, fluent in both languages, with EP as their mother tongue. A common version was agreed. A bilingual translator fluent in both languages, and whose mother tongue is English, completed back translation. A panel of experts composed of several health professionals with experience in the area, analysed this version and classified all its items in terms of their semantic, idiomatic, experiential and conceptual equivalence (phase I). Some modifications were then suggested and incorporated. The new version was re-examined by the same group (phase II). The data resulting from both phases were statistically analysed using the Content Validity Index (CVI). Results: The CVI values obtained for phase I were: 0.97, 0.98, 0.96 and 0.95, showing very good agreement between experts for semantic, idiomatic, experiential and conceptual domains. The CVI values for phase II were identical to the ones presented in phase I. Conclusions: The SSQ-EP version presented very good CVI values for semantic, idiomatic, experiential and conceptual domains. The SSQ is a quick and simple self-filling questionnaire and allows quantifying the symptomatic severity of oropharyngeal dysphagia as experienced by the patient. Further studies are needed in order to analyse its psychometric characteristics.publishe

On the relevance of thrombomodulin variants in atypical hemolytic uremic syndrome

5 p.-1 fig.-1 tab.This project was funded by the Instituto de Salud Carlos III: REDinREN (RD016/009/009) and Instituto de Investigacion Puerta de Hierro-Segovia Arana (IDIPHISA) to AH and by grants from the Spanish Ministerio de Economía y Competitividad–FEDER (European Regional Development Fund) (PID2019-104912RB-I00) and the Autonomous Region of Madrid (S2017/BMD-3673 and S2022/BMD-7278) to SRdC. TC was supported by grant from National Health Institute Carlos III (RETIC ISCIII RD21/0005. RICORS),Peer reviewe

Energy Management in High-Value Buildings: tensions and challeges

Dissertação de Mestrado em Reabilitação de Edifícios apresentada à Faculdade de Ciências e TecnologiaA eficiência energética do parque imobiliário é um tema que tem ganho expressão nos últimos anos. O Sistema de Certificação Energética, que surge na sequência da implementação da diretiva europeia EPBD, permitiu estabelecer medidas para atingir os requisitos mínimos relativos à eficiência energética nos edifícios. Porém, existe um grupo de imóveis que estão excluídos deste sistema de certificação como é o caso dos Edifícios de Elevado Valor Patrimonial.Este trabalho teve como objetivo analisar as implicações da adoção de medidas de eficiência energética em intervenções que devem salvaguardar os valores existentes. Para esta análise foi necessário avaliar as Orientações, Cartas e publicações da UNESCO a fim de investigar quais as orientações relacionadas com a salvaguarda dos valores culturais, arquitetónicos e construtivos, assim como a existência ou não de linhas orientadoras quanto ao desempenho e eficiência dos edifícios classificados; a legislação europeia a fim de perceber quais as metas e considerações estabelecidas pela Europa para a diminuição do CO2; e a legislação portuguesa esclarecendo o que é que está abrangido pelo Sistema de Certificação Energética. Foram também estudadas algumas boas práticas de intervenções em edifícios europeus com valor cultural reconhecido.O caso de estudo utilizado para este trabalho foi o Real Colégio das Artes, pertencente ao conjunto Universidade de Coimbra – Alta e Sofia, inserido na Lista de Património Mundial da UNESCO em 2013. Com base na legislação europeia, nacional e orientações da UNESCO, foram traçadas algumas medidas de intervenção que pretendem melhorar a gestão energética do edifício fazendo um equilíbrio entre a preservação dos valores culturais e a eficiência energética.Foi possível constatar que, no caso do Real Colégio das Artes, existem várias opções projetuais passíveis de serem aplicadas para cada um dos elementos construtivos equacionados, com maior ou menor impacto nos valores culturais e arquitetónicos e com maior ou menor resultados ao nível do desempenho térmico. Para este caso específico, é possível afirmar que pode existir uma correlação entre o grau de desempenho energético que se pretende atingir e o seu impacto nos valores culturais e arquitetónicos do edifício.The energy efficienncy of the building stock is a theme that has been developed in recente years. The Energy Certification System, wich follow on from the implementation of the European Directive EPBD, has enabled the establishment of measures to meet the minimum requirements for energy efficiency in Buildings. However, there is a group of buildings that are excluded from this certification system: High-Value Buildings.This paper aimed to analyze the impact of energy efficiency measures in interventions that should safeguard existing values. For this analysis it was necessary to study the UNESCO Guidelines, Letters and Publications in order to know wich guidelines are related to the safeguarding of cultural, architectural and constructive values, as well as the existence or not of guidelines regarding the performance and efficiency of classified buildings. It was necessary to study also European legislation to understand the goals and considerations set by Europe for the reduction of CO2 and Portuguese legislation clarifying what is covered by the Energy Certification System. Some good practices of interventions in European buildings with recognized cultural value were also studied.The case study used in this project was the Royal College of Arts, belonging to the plot Universidade de Coimbra – Alta e Sofia, included in the UNESCO World Heritage List in 2013. Based on European National and UNESCO guidelines, some intervention measures were proposed to improve the energy management of the building by balancing the preservation of cultural values and Energy efficiency.It was possible to realized that in Royal College of Arts, there are several design options that can be applied, with more or less impact on cultural and architectural values and with more or less results in terms of termal performance. For this particular case, it’s possible to say that can exist a correlation between the degree of Energy performance to be achieved and its impact oh the building’s cultural and architectural values

Rehabilitate for Tourism: Analysis of an Intervention with a focus on improving Energy Efficiency

Dissertação de Mestrado Integrado em Arquitetura apresentada à Faculdade de Ciências e TecnologiaThe construction of buildings is now one of the activities with the largest ecological footprint and part of the existing building stock is unused, it is therefore essential to rehabilitate the existing building, introducing the necessary conditions to meet the current lifestyles and comfort parameters. This rehabilitation has to safeguard the preservation of the buildings' architectural identity and culture without forgetting the need for them to ensure energy efficiency. Rehabilitation is a priority and, although for different reasons, so is tourism, and both have been mutually stimulating. If the act of rehabilitating is a challenge, rehabilitating for tourism can be an even bigger challenge, since the latter has specific energy needs. Having said this, this dissertation aimed to understand how the rehabilitation of buildings can improve their energy efficiency taking into account hotel energy needs. For this it was necessary to clarify a number of concepts related to the rehabilitation of buildings, to the particularities of their use for tourism purposes, and to the energy efficiency of buildings. Since energy efficiency is a very present issue in the European context, it was crucial to know the European and national guidelines concerning the goals to be achieved in order to find specific guidelines for both rehabilitation and tourism.As far as rehabilitation is concerned, the compatibility of rehabilitation and reuse of buildings with the spatial needs of tourism was explored in order to promote energy efficiency in this activity. To do this analysis, a recently rehabilitated building was selected as the object of study. We then proceeded to the study of the rehabilitation project and its current situation and finally and based on this analysis we present a reflection and a proposal for a set of improvement actions that could further contribute to the energy efficiency of the building.A construção de edificos é hoje uma das atividades com maior pegada ecológica e parte do parque edificado existente encontra-se sem utilização, torna-se por isso fundamental reabilitar o edificado existente, introduzindo as condições necessárias para satisfazer os modos de vida e parâmetros de conforto atuais. Esta reabilitação tem de salvaguardar a preservação da identididade e a cultura arquitetónica dos edifícios sem esquecer a necessidade que os mesmos têm de garantir a eficiência energética.. Reabilitar é uma prioridade e, ainda que por razões distintas, também o turismo o é sendo que ambos se têm impulsionado mutuamente. Se o acto de reabilitar é um desafio, reabiltiar para o turismo pode ser um desafio ainda maior, uma vez que este último tem necessidades energéticas específicos. Posto isto, esta dissertação pretendeu entender de que forma a reabilitação dos edifícios pode melhorar a sua eficiência energética tendo em conta as necessidades energéticas hotelerias. Para isso foi necessário clarificar um conjunto de conceitos relacionados com a reabilitação de edificios, com as particularidades utilização para fins turísticos e com a eficiência energéticas dos edificos. Sendo que a eficiência energética é uma questão bastante presente no contexto europeu, foi crucial conhecer as diretrizes europeiras e nacionais relativas às metas que se querem atingir na expectativa de encontrar diretrizes específicas quer para a reabilitação quer para o turismo.No que diz respeito à reabilitação, procurou explorar-se a compatibilidade da reabilitação e do reuso dos edifícios com as necessidades espaciais do turismo de modo a promover a eficiência energética nesta atividade. Para fazer esta análise selecionou-se um edifício recentemente reabilitado para albergar uma Pousada de Juventude como objeto de estudo. Procedeu-se depois ao estudo do projeto de reabilitação e da sua situação atual e por fim e com base nesta análise apresenta-se uma reflexão e a proposta de um conjunto de ações de melhoria que poderiam contribuir ainda mais para a eficiência energética do edifício

Percepciones sobre el impacto de ProSavana en Mozambique, y estrategias de afrontamiento sociales y campesinas.

El artículo presenta un estudio sobre el potencial impacto de ProSavana en el Corredor de Nacala, norte de Mozambique. ProSavana es un proyecto agroindustrial, originado en la cooperación trilateral entre Japón, Brasil y Mozambique, con el que se pretende transformar parte del norte del país. El potencial impacto en la población del Corredor de Nacala y la previsión de posibles vulneraciones a los derechos humanos ha provocado una respuesta social y académica importante dentro y fuera del país. De vocación interdisciplinar, el artículo enmarca ProSavana en base a diversos estudios y documentos, y aborda la problemática del impacto desde el análisis de los discursos de líderes de organizaciones sociales, campesinas y de derechos humanos mozambiqueñas. De igual modo, se abordan las estrategias de afrontamiento que está llevando a cabo la oposición social crítica con el proyecto. En el estudio se recogen 35 testimonios de líderes sociales y campesinos mediante entrevistas y grupos focales. Los resultados muestran que ProSavana puede tener graves impactos económicos, socioculturales y medioambientales en el Corredor de Nacala, destacándose una posible usurpación de tierras al campesinado, el desplazamiento de población, y la ruptura de las formas de vida tradicionales, representando graves vulneraciones a los derechos humanos

Percepciones sobre el impacto de ProSavana en Mozambique, y estrategias de afrontamiento sociales y campesinas.

El artículo presenta un estudio sobre el potencial impacto de ProSavana en el Corredor de Nacala, norte de Mozambique. ProSavana es un proyecto agroindustrial, originado en la cooperación trilateral entre Japón, Brasil y Mozambique, con el que se pretende transformar parte del norte del país. El potencial impacto en la población del Corredor de Nacala y la previsión de posibles vulneraciones a los derechos humanos ha provocado una respuesta social y académica importante dentro y fuera del país. De vocación interdisciplinar, el artículo enmarca ProSavana en base a diversos estudios y documentos, y aborda la problemática del impacto desde el análisis de los discursos de líderes de organizaciones sociales, campesinas y de derechos humanos mozambiqueñas. De igual modo, se abordan las estrategias de afrontamiento que está llevando a cabo la oposición social crítica con el proyecto. En el estudio se recogen 35 testimonios de líderes sociales y campesinos mediante entrevistas y grupos focales. Los resultados muestran que ProSavana puede tener graves impactos económicos, socioculturales y medioambientales en el Corredor de Nacala, destacándose una posible usurpación de tierras al campesinado, el desplazamiento de población, y la ruptura de las formas de vida tradicionales, representando graves vulneraciones a los derechos humanos

Electronic and Functional Scope of Boronic Acid Derived Salicylidenehydrazone (BASHY) Complexes as Fluorescent Dyes

A series of boronic acid derived salicylidenehydrazone (BASHY) complexes was prepared and photophysically characterized. The dye platform can be modified by (a) electronic tuning along the cyanine-type axis via modification of the donor–acceptor pair and (b) functional tuning via the boronic acid residue. On the one hand, approach (a) allows the control of photophysical parameters such as Stokes shift, emission color, and two-photon-absorption (2PA) cross section. The resulting dyes show emission light-up behavior in nonpolar media and are characterized by high fluorescence quantum yields (ca. 0.5–0.7) and brightness (ca. 35000–40000 M^–1 cm^–1). Moreover, the 2PA cross sections reach values in the order of 200–300 GM. On the other hand, the variation of the dye structure through the boronic acid derived moiety (approach (b)) enables the functionalization of the BASHY platform for a broad spectrum of potential applications, ranging from biorelevant contexts to optoelectronic materials. Importantly, this functionalization is generally electronically orthogonal with respect to the dye’s photophysical properties, which are only determined by the electronic structure of the cyanine-type backbone (approach (a)). Rare exceptions to this generalization are the presence of redox-active residues (such a triphenylamine or pyrene). Finally, the advantageous photophysics is complemented by a significant photostability

Head and neck cancer surgery during the COVID-19 pandemic: An international, multicenter, observational cohort study

Background: The aims of this study were to provide data on the safety of head and neck cancer surgery currently being undertaken during the coronavirus disease 2019 (COVID-19) pandemic. Methods: This international, observational cohort study comprised 1137 consecutive patients with head and neck cancer undergoing primary surgery with curative intent in 26 countries. Factors associated with severe pulmonary complications in COVID-19–positive patients and infections in the surgical team were determined by univariate analysis. Results: Among the 1137 patients, the commonest sites were the oral cavity (38%) and the thyroid (21%). For oropharynx and larynx tumors, nonsurgical therapy was favored in most cases. There was evidence of surgical de-escalation of neck management and reconstruction. Overall 30-day mortality was 1.2%. Twenty-nine patients (3%) tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) within 30 days of surgery; 13 of these patients (44.8%) developed severe respiratory complications, and 3.51 (10.3%) died. There were significant correlations with an advanced tumor stage and admission to critical care. Members of the surgical team tested positive within 30 days of surgery in 40 cases (3%). There were significant associations with operations in which the patients also tested positive for SARS-CoV-2 within 30 days, with a high community incidence of SARS-CoV-2, with screened patients, with oral tumor sites, and with tracheostomy. Conclusions: Head and neck cancer surgery in the COVID-19 era appears safe even when surgery is prolonged and complex. The overlap in COVID-19 between patients and members of the surgical team raises the suspicion of failures in cross-infection measures or the use of personal protective equipment. Lay Summary: Head and neck surgery is safe for patients during the coronavirus disease 2019 pandemic even when it is lengthy and complex. This is significant because concerns over patient safety raised in many guidelines appear not to be reflected by outcomes, even for those who have other serious illnesses or require complex reconstructions. Patients subjected to suboptimal or nonstandard treatments should be carefully followed up to optimize their cancer outcomes. The overlap between patients and surgeons testing positive for severe acute respiratory syndrome coronavirus 2 is notable and emphasizes the need for fastidious cross-infection controls and effective personal protective equipment

Outcomes from elective colorectal cancer surgery during the SARS‐CoV‐2 pandemic

Aim This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic. Method This was an international cohort study of patients undergoing elective resection of colon or rectal cancer without preoperative suspicion of SARS-CoV-2. Centres entered data from their first recorded case of COVID-19 until 19 April 2020. The primary outcome was 30-day mortality. Secondary outcomes included anastomotic leak, postoperative SARS-CoV-2 and a comparison with prepandemic European Society of Coloproctology cohort data. Results From 2073 patients in 40 countries, 1.3% (27/2073) had a defunctioning stoma and 3.0% (63/2073) had an end stoma instead of an anastomosis only. Thirty-day mortality was 1.8% (38/2073), the incidence of postoperative SARS-CoV-2 was 3.8% (78/2073) and the anastomotic leak rate was 4.9% (86/1738). Mortality was lowest in patients without a leak or SARS-CoV-2 (14/1601, 0.9%) and highest in patients with both a leak and SARS-CoV-2 (5/13, 38.5%). Mortality was independently associated with anastomotic leak (adjusted odds ratio 6.01, 95% confidence interval 2.58–14.06), postoperative SARS-CoV-2 (16.90, 7.86–36.38), male sex (2.46, 1.01–5.93), age >70 years (2.87, 1.32–6.20) and advanced cancer stage (3.43, 1.16–10.21). Compared with prepandemic data, there were fewer anastomotic leaks (4.9% versus 7.7%) and an overall shorter length of stay (6 versus 7 days) but higher mortality (1.7% versus 1.1%). Conclusion Surgeons need to further mitigate against both SARS-CoV-2 and anastomotic leak when offering surgery during current and future COVID-19 waves based on patient, operative and organizational risks

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Background: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods: The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results: NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion: As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population