Predictability of COVID-19 hospitalizations, intensive care unit admissions, and respiratory assistance in Portugal: Longitudinal Cohort study

Funding Information: The authors thank Portuguese Directorate General of Health (DGS) for providing the data. Data are available upon reasonable request. This work was supported by Fundação para a Ciência e a Tecnologia (FCT), through IDMEC, under LAETA project (UIDB/50022/2020), IPOscore (DSAIPA/DS/0042/2018) and Data2Help (DSAIPA/AI/ 0044/2018) projects, the contract CEECIND/01399/2017 to RSC, FCT/MCTES funds for INESC-ID (UIDB/50021/2020) and the Associate Laboratory for Green Chemistry - LAQV (UIDB/50006/2020 and UIDP/50006/2020).Background: In the face of the current COVID-19 pandemic, the timely prediction of upcoming medical needs for infected individuals enables better and quicker care provision when necessary and management decisions within health care systems. Objective: This work aims to predict the medical needs (hospitalizations, intensive care unit admissions, and respiratory assistance) and survivability of individuals testing positive for SARS-CoV-2 infection in Portugal. Methods: A retrospective cohort of 38,545 infected individuals during 2020 was used. Predictions of medical needs were performed using state-of-the-art machine learning approaches at various stages of a patient's cycle, namely, at testing (prehospitalization), at posthospitalization, and during postintensive care. A thorough optimization of state-of-the-art predictors was undertaken to assess the ability to anticipate medical needs and infection outcomes using demographic and comorbidity variables, as well as dates associated with symptom onset, testing, and hospitalization. Results: For the target cohort, 75% of hospitalization needs could be identified at the time of testing for SARS-CoV-2 infection. Over 60% of respiratory needs could be identified at the time of hospitalization. Both predictions had >50% precision. Conclusions: The conducted study pinpoints the relevance of the proposed predictive models as good candidates to support medical decisions in the Portuguese population, including both monitoring and in-hospital care decisions. A clinical decision support system is further provided to this end.publishersversionpublishe

Factorial validity and measurement invariance of the uncertainty response scale

Abstract This study presents the adaptation of the Uncertainty Response Scale (Greco & Roger, Pers. Individ. Differ, 31:519-534, 2001) to Portuguese. This instrument was administered to a non-clinical community sample composed of 1596 students and professionals, allowing a thorough validity and invariance analysis by randomly dividing participants into three subsamples to perform: an exploratory factor analysis (sample one: N = 512); a preliminary confirmatory factor analysis to identify the final solution for the scale (sample two: N = 543); and the confirmatory factor analysis (sample three: N = 541). Samples two and three were also used for multi-group analysis to assess measurement invariance, invariance across gender, sociocultural levels, and students versus active professionals. Results showed the scale reflects the original factorial structure, as well as good internal consistency and overall good psychometric qualities. Invariance results across groups reached structural invariance which provides a confident invariance measurement for this scale, while invariance across gender and sociocultural levels reached metric invariance. Accordingly, differences between these groups were explored, by comparing means with multi-group analysis to establish the scale's sensitivity toward social vulnerability, by demonstrating the existence of statistically significant differences regarding gender and sociocultural levels on how individuals cope with uncertainty, specifically in terms of emotional strategies, as a self-defeating strategy. Thus, females scored higher on emotional uncertainty, as well as low sociocultural levels, compared with higher ones. Therefore, it is proposed that this scale could be a sound alternative to explore strategies for coping with uncertainty, when considering social, economic, or other environmental circumstances that may affect them

Clarifying changes in student empathy throughout medical school: a scoping review

Despite the increasing awareness of the relevance of empathy in patient care, some findings suggest that medical schools may be contributing to the deterioration of students' empathy. Therefore, it is important to clarify the magnitude and direction of changes in empathy during medical school. We employed a scoping review to elucidate trends in students' empathy changes/differences throughout medical school and examine potential bias associated with research design. The literature published in English, Spanish, Portuguese and French from 2009 to 2016 was searched. Two-hundred and nine potentially relevant citations were identified. Twenty articles met the inclusion criteria. Effect sizes of empathy scores variations were calculated to assess the practical significance of results. Our results demonstrate that scoped studies differed considerably in their design, measures used, sample sizes and results. Most studies (12 out of 20 studies) reported either positive or non-statistically significant changes/differences in empathy regardless of the measure used. The predominant trend in cross-sectional studies (ten out of 13 studies) was of significantly higher empathy scores in later years or of similar empathy scores across years, while most longitudinal studies presented either mixed-results or empathy declines. There was not a generalized international trend in changes in students' empathy throughout medical school. Although statistically significant changes/differences were detected in 13 out of 20 studies, the calculated effect sizes were small in all but two studies, suggesting little practical significance. At the present moment, the literature does not offer clear conclusions relative to changes in student empathy throughout medical school.info:eu-repo/semantics/publishedVersio

Time-Lagged Correlation Analysis of Shellfish Toxicity Reveals Predictive Links to Adjacent Areas, Species, and Environmental Conditions

This work was funded by the project “MATISSE: A machine learning-based forecasting system for shellfish safety” (DSAIPA/DS/0026/2019). The work was also supported by national funds through Fundação para a Ciência e a Tecnologia (FCT) with references CEECINST/00102/2018, CEECIND/01399/2017, UIDB/04326/2020, UIDP/04326/2020 and LA/P/0101/2020 (CCMAR), UIDB/04516/2020 (NOVA LINCS), UIDB/00297/2020 (NovaMath), and UIDB/50021/2020 (INESC-ID). This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 951970 (OLISSIPO project).Diarrhetic Shellfish Poisoning (DSP) is an acute intoxication caused by the consumption of contaminated shellfish, which is common in many regions of the world. To safeguard human health, most countries implement programs focused on the surveillance of toxic phytoplankton abundance and shellfish toxicity levels, an effort that can be complemented by a deeper understanding of the underlying phenomena. In this work, we identify patterns of seasonality in shellfish toxicity across the Portuguese coast and analyse time-lagged correlations between this toxicity and various potential risk factors. We extend the understanding of these relations through the introduction of temporal lags, allowing the analysis of time series at different points in time and the study of the predictive power of the tested variables. This study confirms previous findings about toxicity seasonality patterns on the Portuguese coast and provides further quantitative data about the relations between shellfish toxicity and geographical location, shellfish species, toxic phytoplankton abundances, and environmental conditions. Furthermore, multiple pairs of areas and shellfish species are identified as having correlations high enough to allow for a predictive analysis. These results represent the first step towards understanding the dynamics of DSP toxicity in Portuguese shellfish producing areas, such as temporal and spatial variability, and towards the development of a shellfish safety forecasting system.publishersversionpublishe

Analysis of a Local HIV-1 Epidemic in Portugal Highlights Established Transmission of non-B and -G Subtypes

The existing data supports Portugal as the Western Europe country with highest HIV-1 subtype diversity. However, detailed phylogenetic studies of Portuguese HIV-1 epidemics are still scarce. Thus, our main goal was to analyze the phylodynamics of a local HIV-1 infection in the Portuguese region of Minho. Molecular epidemiological analysis was applied to data from 289 HIV-1 infected individuals followed in the reference Hospital of the province of Minho, Portugal, in which isolated viruses had been sequenced between 2000 and 2012. Viruses of the G (29.1%) and B (27.0%) subtypes were the most frequent, followed by recombinant forms (17.6%), C (14.5%), F1 (7.3%) and A1 (4.2%) subtypes. Multinomial logistic regression revealed that the odds of being infected with A1 and F1 subtype increased over the years when compared with B, G, C or recombinant viruses. As expected, polyphyletic patterns suggesting multiple and old introductions of subtypes B and G were found. However, transmission clusters of non-B and -G viruses among native individuals were also found with the dates of the most recent common ancestor estimated to the early 2000s. Our study supports that the HIV-1 subtype diversity in the Portuguese region of Minho is high and has been increasing in a manner that is apparently driven by factors other than immigration and international travel. Infections with A1 and F1 viruses in the region of Minho are becoming established and were mainly found in sexually transmitted clusters, reinforcing the need for more efficacious control measures targeting this infection route

Doctor, how much weight will I lose? - a new individualized predictive model for weight loss

Bariatric surgery is an effective treatment for weight loss, but the patient’s ability to reach a sustained weight loss depends upon several technical and individual factors. Creating an easy model that adapts bariatric surgery’s weight loss goals for each patient is very important for pre-surgery and follow-up evaluations.info:eu-repo/semantics/publishedVersio

Diversity and patterns of marine non-native species in the archipelagos of Macaronesia

Tiago Marques and Carolina Marques thank partial support by CEAUL (funded by FCT through the project UIDB/00006/2020).Aims The present study is the first attempt to grasp the scale and richness of marine biological invasions in Macaronesia. We pioneered a comprehensive non-native species (NNS), inventory in the region to determine their diversity patterns and native distribution origins. NNS were defined here as the result of both introductions and range expansions. We also used statistical modelling to examine relationships among NNS richness, anthropogenic activities, demographic and geographical variables across Macaronesia. Location Macaronesia. Methods A comprehensive literature search was conducted for marine NNS records in Macaronesia, registering the first record's location and year from 1884 to 2020. We used univariate and multivariate analyses to evaluate differences and similarities in community composition. By applying a Generalized Linear Model (GLM), we tested hypotheses regarding NNS richness as a function of anthropogenic activities, demographic and geographical variables. Results A total of 144 marine non-native species (NNS) were recorded for the whole of Macaronesia. The highest NNS richness was registered in the Canary Islands (76 NNS), followed by the Azores (66 NNS), Madeira (59 NNS) and finally Cabo Verde (18 NNS). Some differences amongst archipelagos were observed, such as the high number of non-native macroalgae in the Azores, fishes in the Canary Islands and tunicates in Cabo Verde. Overall, macroalgae, tunicates and bryozoans were the predominant taxonomic groups in the Macaronesian archipelagos. Madeira and Canary Islands were the archipelagos with more similarity in marine NNS, and Cabo Verde the most divergent. Finally, GLM suggested that non-native richness patterns across Macaronesia were dependent on the considered archipelago and strongly affected by (1) minimum distance to the mainland, (2) the total number of ports and marinas and (3) total marinas area (km2). Conclusions The model results and NNS listing in the present study will likely raise the awareness and response regarding marine NNS in the whole Macaronesia region, serving as a baseline for future research as well as implementing and enforcing regulations related to the introduction of marine NNS in oceanic islands.Publisher PDFPeer reviewe

The advantages of Structural Equation Modelling to address the complexity of spatial reference learning

Background: Cognitive performance is a complex process influenced by multiple factors. Cognitive assessment in experimental animals is often based on longitudinal datasets analyzed using uni- and multi-variate analyses, that do not account for the temporal dimension of cognitive performance and also do not adequately quantify the relative contribution of individual factors onto the overall behavioral outcome. To circumvent these limitations, we applied an Autoregressive Latent Trajectory (ALT) to analyze the Morris water maze (MWM) test in a complex experimental design involving four factors: stress, age, sex, and genotype. Outcomes were compared with a traditional Mixed-Design Factorial ANOVA (MDF ANOVA). Results: In both the MDF ANOVA and ALT models, sex, and stress had a significant effect on learning throughout the 9 days. However, on the ALT approach, the effects of sex were restricted to the learning growth. Unlike the MDF ANOVA, the ALT model revealed the influence of single factors at each specific learning stage and quantified the cross interactions among them. In addition, ALT allows us to consider the influence of baseline performance, a critical and unsolved problem that frequently yields inaccurate interpretations in the classical ANOVA model. Discussion: Our findings suggest the beneficial use of ALT models in the analysis of complex longitudinal datasets offering a better biological interpretation of the interrelationship of the factors that may influence cognitive performance.European Commission (FP7) “SwitchBox” (Contract HEALTH-F2-2010-259772) project and co-financed by the Portuguese North Regional Operational Program (ON.2, O Novo Norte) under the National Strategic Reference Framework (QREN), through the European Regional Development Fund (FEDER), and by Fundação Calouste Gulbenkian—Inovar em Saúde (“Envelhecimento cognitivo saudável—proporcionar saúde mental no processo biológico do envelhecimento,” Contract P-139977). In addition, this study was supported by Portuguese Foundation for Science and Technology (FCT) grant PTDC/SAU-NMC/113934/2009, Canon Foundation and a Grant-in-Aid for Scientific Research on Innovative Areas (Brain Environment) of Ministry of Education, Science, Sports, and Culture of Japan

Proinflammatory and anti-inflammatory cytokines in the CSF of patients with Alzheimer's disease and their correlation with cognitive decline

Cumulative data suggest that neuroinflammation plays a prominent role in Alzheimer's disease (AD) pathogenesis. The purpose of this work was to assess if patients with AD present a specific cerebrospinal fluid (CSF) cytokine profile and if it correlates to disease progression. We determined the levels of 27 cytokines in CSF of patients with AD and compared them with patients with frontotemporal dementia and nondemented controls. In addition, we correlated the cytokine levels with cognitive status and disease progression after 12 months. Patients with AD had higher levels of proinflammatory and anti-inflammatory cytokines (eotaxin, interleukin [IL]-1ra, IL-4, IL-7, IL-8, IL-9, IL-10, IL-15, granulocyte colony-stimulating factor, monocyte chemotactic protein 1, platelet-derived growth factor, tumor necrosis factor alfa) compared to nondemented controls. There was a negative correlation between the disease progression and the levels of several cytokines (IL-1β, IL-4, IL-6, IL-9, IL-17A, basic fibroblast growth factor, granulocyte colony-stimulating factor, granulocyte-macrophage colony-stimulating factor, interferon gamma, macrophage inflammatory proteins-1β). To the best of our knowledge, this is the first study reporting a "protective" role of the upregulation of specific intrathecal cytokine levels in AD. This finding supports that a fine "rebalancing" of the immune system represents a new target in AD therapeutic approach.The work at ICVS/3B's has been developed under the scope of the project NORTE-01-0145-FEDER-000013, supported by the Northern Portugal Regional Operational Program (NORTE, 2020), under the Portugal 2020 Partnership Agreement, through the European Regional Development Fund (FEDER) and funded by FEDER funds through the Competitiveness Factors Operational Program (COMPETE) and by National funds, through the Foundation for Science and Technology (FCT), under the scope of the project POCI-01-0145-FEDER-007038. The work at Centro Hospitalar do Porto (CHP) work was funded by "Bolsa para Investigacao" of Departamento de Ensino Formacao e Investigacao (DEFI) do CHP. S.P. das Neves is a recipient of a PhD fellowship with the reference PD/BD/114120/2015, from POCH through FCT National Funds

Do critical thinkers drink too much alcohol, forget to do class assignments, or cheat on exams? Using a critical thinking measure to predict college students’ real-world outcomes

Critical thinking is a higher-order way of reasoning composed of the skill and will to use cognitive abilities and knowledge on a daily basis. It is identified as essential by higher education institutions, corporations, and society in general. To analyze whether college students are critical thinkers in their daily lives, the Halpern Critical Thinking Assessment (HCTA; Halpern in Halpern Critical Thinking Assessment (Measurement instrument), Schuhfried, Mödling, 2012) and the real-world outcomes inventory (RWO; Butler in Appl Cogn Psychol 26(5):721–729, 2012) were administered to 238 students. We performed a cluster analysis (K-means-constrained clustering method), and ANOVAs for each cluster solution tested to identify the most suitable clustering solution, taking the RWO inventory dimensions as dependent variables and cluster membership as an independent variable. Four separate clusters emerged, each representing a different profile related to students’ everyday negative outcomes resulting from a lack of critical thinking. We performed multinomial logistic regression to examine which dimensions of the HCTA test, as well as gender, age, and disciplinary area, predicted the four singular groups of students that emerged: “Mature,” “Risk-taking,” “Lost in translation,” and “Reflective.” Results indicate that: (1) age is a relevant predictor of slackness, rashness, and health neglect, all characteristics of “Mature” students; (2) students who are particularly skilled in hypothesis testing tend to be “Risk-taking,” while it is less likely that students who are specifically competent in argument analysis will be in this group; (3) gender is relevant to predict “Lost in translation” students, while argument analysis is negatively related to the chances of being in this group. Our study supports the relevance of critical thinking in daily decisions and everyday outcomes.FCT -Fundação para a Ciência e a Tecnologia(Advanced Training)info:eu-repo/semantics/publishedVersio