Processo de importação: enquadramento e análise

Mestrado em Línguas e Relações EmpresariaisO presente relatório de estágio visa, além de uma breve introdução à empresa em que se insere, analisar o enquadramento de um processo de importação realizado na empresa Mário Miranda de Almeida, S.A. Será apresentada uma breve descrição deste processo e posteriormente analisadas as barreiras e conclusões retiradas da sua realização. Todos os dados foram adquiridos na empresa Mário Miranda de Almeida, S.A., também conhecida por Orima. O referido estágio teve a duração de 5 meses, tendo decorrido entre os meses de Fevereiro e Junho do presente ano de 2010. Nomeado orientador do estágio é o Professor António Moreno, sendo a supervisora a Dra. Cecília Almeida. O referido relatório irá consistir na análise de um processo de importação que, como não foi possível concluir, será relacionado e concluído com um processo de importação fictício que realizei anteriormente. Tendo tido a possibilidade de trabalhar directamente no departamento de importação da empresa Orima, e sendo uma área directamente relacionada com o Mestrado em Línguas e Relações Empresariais, considerei que teria particular interesse abordar o assunto no relatório de estágio. Creio que a minha experiência poderá, de futuro, fazer perceber a correlação directa entre a formação académica adquirida ao longo da lincenciatura e posterior mestrado e a experiência prática de estágio. Além do propósito primário da exposição escrita – análise do processo de importação - esta será ainda constituída por uma breve contextualização da empresa Mário Miranda de Almeida, S.A, bem como das funções das quais fui incumbida ao longo dos 5 meses de experiência. Os principais objectivos do estágio, definidos em conjunto com a Dra. Cecília Almeida, consistiram numa inclusão no mundo empresarial, estabelecendo contacto a todos os níveis quer com o comércio internacional como nacional desenvolvido na empresa, e desenvolvendo, autonomamente, tarefas ligadas a estes processos. Por último, irei proceder a uma análise crítica dos resultados obtidos ao longo desta experiência, considerando a avaliação do estágio tanto para a empresa Orima como para mim enquanto estagiária em âmbito empresarial.This report on my training period, besides a brief introduction of the company in which it takes place, aims to analyse the framework of an import procedure which took place in the company Mário Miranda de Almeida S.A. A brief description of this procedure will be presented and subsequently the procedual barriers and conclusions learned from its implementation will be analysed. All the data was obtained at Mário Miranda de Almeida, S.A., also known as Orima. The abovementioned training period lasted 5 months, from February to June of the present year of 2010. The training leader is Professor António Moreno, and the training supervisor is Dr. Cecília Almeida. The report will include the analysis of an import procedure, which because it was not concluded, will be related to and concluded with a fictitious import procedure that had been done before. Having had the possibility of working directly in the import department of Orima and because it is directly related to my Master degree in Languages and Business Communication, I considered it would be of particular interest to address this issue in this report. I believe my experience may, in the future, make people realize the direct co-relation between academic knowledge acquired throughout the course and subsequent Masters degree, and the practical experience gained throughout the training period. Besides the primary purpose of this written report – analysis of an import procedure – a brief contextualization of the company Mário Miranda de Almeida, S.A. will also be included and the tasks I was responsible for during the 5 months of experience I went through. The main objectives of the training period, decided in conjunction with Dr. Cecília Almeida consisted on an inclusion in the business world, establishing contact at all levels with the national, as well as international, trade developed in the company, and accomplishing tasks related with these procedures autonomously. Finally, I will make a critical analysis to the results obtained through this experience, analysing the training period for the company Orima as well as for myself as a trainee in business context

Viral genetic clustering and transmission dynamics of the 2022 mpox outbreak in Portugal

Pathogen genome sequencing during epidemics enhances our ability to identify and understand suspected clusters and investigate their relationships. Here, we combine genomic and epidemiological data of the 2022 mpox outbreak to better understand early viral spread, diversification and transmission dynamics. By sequencing 52% of the confirmed cases in Portugal, we identified the mpox virus sublineages with the highest impact on case numbers and fitted them into a global context, finding evidence that several international sublineages probably emerged or spread early in Portugal. We estimated a 62% infection reporting rate and that 1.3% of the population of men who have sex with men in Portugal were infected. We infer the critical role played by sexual networks and superspreader gatherings, such as sauna attendance, in the dissemination of mpox virus. Overall, our findings highlight genomic epidemiology as a tool for the real-time monitoring and control of mpox epidemics, and can guide future vaccine policy in a highly susceptible population.info:eu-repo/semantics/publishedVersio

Viral genetic clustering and transmission dynamics of the 2022 mpox outbreak in Portugal.

Acknowledgements: We gratefully acknowledge the engagement and willingness of all participants to share information critical to the investigation. We are grateful to the authors and laboratories that originated and submitted the genetic sequences released in GenBank. The acquisition of equipment associated with whole-genome sequencing used in this study (including the Illumina NextSeq 2000) was funded by the HERA (Human and Environmental Risk Assessment) project (Grant/2021/PHF/23776), supported by the European Commission through the European Centre for Disease Prevention and Control (ECDC), and partially funded by the GenomePT project (POCI-01-0145-FEDER-022184), supported by COMPETE 2020 (Operational Programme for Competitiveness and Internationalisation (POCI)), Lisboa Portugal Regional Operational Programme (Lisboa2020), Algarve Portugal Regional Operational Programme (CRESC Algarve2020) under the PORTUGAL 2020 Partnership Agreement through the European Regional Development Fund (ERDF), and by the Portuguese Science and Technology Foundation (FCT). This study was also supported by the ERINHA-Advance project (funded by the European Union’s Horizon 2020 Research & Innovation program, grant agreement no. 824061) and benefited from co-funding from the European Union’s Horizon 2020 Research and Innovation programme under grant agreement no. 773830 (One Health European Joint Programme), in particular by the co-funding of the post-doctoral fellowships of J.S.D. and V.M. and the development of INSaFLU. We also thank M. Pinheiro (iBiMED at the Universidade de Aveiro) for his continuous support in updating the INSaFLU platform and the Infraestrutura Nacional de Computação Distribuída (INCD) for providing computational resources for testing it. INCD was funded by the FCT and FEDER under the project 22153-01/SAICT/2016. M.P.D. is funded by the Gates Cambridge Scholarship (no. OPP1144). The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript. The GAT-Intendente team also thanks A. Vasques, L. Fortuna, J. Moreira, I. Correia and Á. Baginha.Pathogen genome sequencing during epidemics enhances our ability to identify and understand suspected clusters and investigate their relationships. Here, we combine genomic and epidemiological data of the 2022 mpox outbreak to better understand early viral spread, diversification and transmission dynamics. By sequencing 52% of the confirmed cases in Portugal, we identified the mpox virus sublineages with the highest impact on case numbers and fitted them into a global context, finding evidence that several international sublineages probably emerged or spread early in Portugal. We estimated a 62% infection reporting rate and that 1.3% of the population of men who have sex with men in Portugal were infected. We infer the critical role played by sexual networks and superspreader gatherings, such as sauna attendance, in the dissemination of mpox virus. Overall, our findings highlight genomic epidemiology as a tool for the real-time monitoring and control of mpox epidemics, and can guide future vaccine policy in a highly susceptible population

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)

Management of coronary disease in patients with advanced kidney disease

BACKGROUND Clinical trials that have assessed the effect of revascularization in patients with stable coronary disease have routinely excluded those with advanced chronic kidney disease. METHODS We randomly assigned 777 patients with advanced kidney disease and moderate or severe ischemia on stress testing to be treated with an initial invasive strategy consisting of coronary angiography and revascularization (if appropriate) added to medical therapy or an initial conservative strategy consisting of medical therapy alone and angiography reserved for those in whom medical therapy had failed. The primary outcome was a composite of death or nonfatal myocardial infarction. A key secondary outcome was a composite of death, nonfatal myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. RESULTS At a median follow-up of 2.2 years, a primary outcome event had occurred in 123 patients in the invasive-strategy group and in 129 patients in the conservative-strategy group (estimated 3-year event rate, 36.4% vs. 36.7%; adjusted hazard ratio, 1.01; 95% confidence interval [CI], 0.79 to 1.29; P=0.95). Results for the key secondary outcome were similar (38.5% vs. 39.7%; hazard ratio, 1.01; 95% CI, 0.79 to 1.29). The invasive strategy was associated with a higher incidence of stroke than the conservative strategy (hazard ratio, 3.76; 95% CI, 1.52 to 9.32; P=0.004) and with a higher incidence of death or initiation of dialysis (hazard ratio, 1.48; 95% CI, 1.04 to 2.11; P=0.03). CONCLUSIONS Among patients with stable coronary disease, advanced chronic kidney disease, and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of death or nonfatal myocardial infarction

Health status after invasive or conservative care in coronary and advanced kidney disease

BACKGROUND In the ISCHEMIA-CKD trial, the primary analysis showed no significant difference in the risk of death or myocardial infarction with initial angiography and revascularization plus guideline-based medical therapy (invasive strategy) as compared with guideline-based medical therapy alone (conservative strategy) in participants with stable ischemic heart disease, moderate or severe ischemia, and advanced chronic kidney disease (an estimated glomerular filtration rate of <30 ml per minute per 1.73 m2 or receipt of dialysis). A secondary objective of the trial was to assess angina-related health status. METHODS We assessed health status with the Seattle Angina Questionnaire (SAQ) before randomization and at 1.5, 3, and 6 months and every 6 months thereafter. The primary outcome of this analysis was the SAQ Summary score (ranging from 0 to 100, with higher scores indicating less frequent angina and better function and quality of life). Mixed-effects cumulative probability models within a Bayesian framework were used to estimate the treatment effect with the invasive strategy. RESULTS Health status was assessed in 705 of 777 participants. Nearly half the participants (49%) had had no angina during the month before randomization. At 3 months, the estimated mean difference between the invasive-strategy group and the conservative-strategy group in the SAQ Summary score was 2.1 points (95% credible interval, 120.4 to 4.6), a result that favored the invasive strategy. The mean difference in score at 3 months was largest among participants with daily or weekly angina at baseline (10.1 points; 95% credible interval, 0.0 to 19.9), smaller among those with monthly angina at baseline (2.2 points; 95% credible interval, 122.0 to 6.2), and nearly absent among those without angina at baseline (0.6 points; 95% credible interval, 121.9 to 3.3). By 6 months, the between-group difference in the overall trial population was attenuated (0.5 points; 95% credible interval, 122.2 to 3.4). CONCLUSIONS Participants with stable ischemic heart disease, moderate or severe ischemia, and advanced chronic kidney disease did not have substantial or sustained benefits with regard to angina-related health status with an initially invasive strategy as compared with a conservative strategy

Health-status outcomes with invasive or conservative care in coronary disease

BACKGROUND In the ISCHEMIA trial, an invasive strategy with angiographic assessment and revascularization did not reduce clinical events among patients with stable ischemic heart disease and moderate or severe ischemia. A secondary objective of the trial was to assess angina-related health status among these patients. METHODS We assessed angina-related symptoms, function, and quality of life with the Seattle Angina Questionnaire (SAQ) at randomization, at months 1.5, 3, and 6, and every 6 months thereafter in participants who had been randomly assigned to an invasive treatment strategy (2295 participants) or a conservative strategy (2322). Mixed-effects cumulative probability models within a Bayesian framework were used to estimate differences between the treatment groups. The primary outcome of this health-status analysis was the SAQ summary score (scores range from 0 to 100, with higher scores indicating better health status). All analyses were performed in the overall population and according to baseline angina frequency. RESULTS At baseline, 35% of patients reported having no angina in the previous month. SAQ summary scores increased in both treatment groups, with increases at 3, 12, and 36 months that were 4.1 points (95% credible interval, 3.2 to 5.0), 4.2 points (95% credible interval, 3.3 to 5.1), and 2.9 points (95% credible interval, 2.2 to 3.7) higher with the invasive strategy than with the conservative strategy. Differences were larger among participants who had more frequent angina at baseline (8.5 vs. 0.1 points at 3 months and 5.3 vs. 1.2 points at 36 months among participants with daily or weekly angina as compared with no angina). CONCLUSIONS In the overall trial population with moderate or severe ischemia, which included 35% of participants without angina at baseline, patients randomly assigned to the invasive strategy had greater improvement in angina-related health status than those assigned to the conservative strategy. The modest mean differences favoring the invasive strategy in the overall group reflected minimal differences among asymptomatic patients and larger differences among patients who had had angina at baseline

Initial invasive or conservative strategy for stable coronary disease

BACKGROUND Among patients with stable coronary disease and moderate or severe ischemia, whether clinical outcomes are better in those who receive an invasive intervention plus medical therapy than in those who receive medical therapy alone is uncertain. METHODS We randomly assigned 5179 patients with moderate or severe ischemia to an initial invasive strategy (angiography and revascularization when feasible) and medical therapy or to an initial conservative strategy of medical therapy alone and angiography if medical therapy failed. The primary outcome was a composite of death from cardiovascular causes, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. A key secondary outcome was death from cardiovascular causes or myocardial infarction. RESULTS Over a median of 3.2 years, 318 primary outcome events occurred in the invasive-strategy group and 352 occurred in the conservative-strategy group. At 6 months, the cumulative event rate was 5.3% in the invasive-strategy group and 3.4% in the conservative-strategy group (difference, 1.9 percentage points; 95% confidence interval [CI], 0.8 to 3.0); at 5 years, the cumulative event rate was 16.4% and 18.2%, respectively (difference, 121.8 percentage points; 95% CI, 124.7 to 1.0). Results were similar with respect to the key secondary outcome. The incidence of the primary outcome was sensitive to the definition of myocardial infarction; a secondary analysis yielded more procedural myocardial infarctions of uncertain clinical importance. There were 145 deaths in the invasive-strategy group and 144 deaths in the conservative-strategy group (hazard ratio, 1.05; 95% CI, 0.83 to 1.32). CONCLUSIONS Among patients with stable coronary disease and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of ischemic cardiovascular events or death from any cause over a median of 3.2 years. The trial findings were sensitive to the definition of myocardial infarction that was used