Healthy Cities to Healthy People: a Grid Application to Assess the Potential of Ecosystems Services of Public Urban Green Spaces in Porto, Portugal

Introduction Contemporary cities face multiple socioenvironmental and health challenges that undermine the efforts to promote healthy environments. The 11th goal – Sustainable cities and communities – of United Nations 2030 Agenda for Sustainable Development states that the presence of nature in cities plays a vital role for its sustainability through public urban green spaces (PUGS) accessible and with quality for all.

Objectives This work describes the application of a grid to evaluate the potential of the ecosystems services (ES) of PUGS.

Methodology The grid was applied in 25 PUGS in the city of Porto, divided into 5 clusters of socioeconomic and environmental deprivation (SED), ranging from very high to very low), and is composed by 6 sections with 37 domains assessed: i) identification; ii) description of the activities; iii) activities that take place; iv) assessment of the environment quality; v) existence of infrastructure and facilities; and vi) security. Dimensions iii, iv, v and vi are filled in the grid by a dichotomous answer: No = 0; Yes = 1. All data calculation and statistical analyses were performed using IBM® SPSS® Statistics vs.25.0. The grid was applied in January 2019 and each PUGS visit lasted 20-25 minutes.

Results The highest total score (33) corresponds to 2 parks located in a low and medium SED clusters. The lowest score (9) corresponds to 2 gardens located in a very high and high SED clusters. The most critical dimension assessed of the PUGS has to do with the activities it offers (Median = 2). On the other hand, the dimension with the highest scores relates to the PUGS environmental quality (Median = 8). Regarding results by SED clusters, it is observed that lowest scores, in all assessed domains, are from PUGS located in high and very high SED clusters.

Conclusion This work presents useful information regarding the importance of promoting PUGS with quality and accessible from all, especially to socioeconomic vulnerable groups, which should be the major goal of public policies designers.

P1497Digoxin in patients with advanced heart failure and sinus rhythm - Is there any benefit?

Background

Digoxin is one of the oldest drugs used in heart failure treatment. It is recommended in patients in sinus rhythm with still symptomatic heart failure with reduced ejection fraction. However, a controversy regarding digoxin use has risen with recent studies demonstrating an increased mortality and arrhythmias rate in patients taking this drug.

Purpose

The purpose of this study is to assess the prognostic impact of digoxin in patients in sinus rhythm with a CRT device, concerning all-cause mortality, hospitalizations due to acute heart failure and rate of ventricular arrhythmias.

Methods

A cohort of 297 consecutive P with advanced HF, sinus rhythm and a CRT device (80% with defibrillator) implanted between February 2004 and January 2016, in a single centre, was included in this retrospective study.

Patients were divided in two groups regarding digoxin prescription (digoxin (DG) and without digoxin (NDG)).  A mean clinical follow-up of 5.3 ± 3.4 years regarding long term outcomes was performed. Cox regression was used to identify independent predictors of outcomes.

Results

Digoxin was prescribed in 104 P (35%). In this cohort 67% of P were males and the mean age was 64 ± 11 years. Patients in DG were younger (60 ± 11 vs 66 ± 10, p < 0.001).  The 2 groups had similar prevalence of comorbidities, with exception of chronic kidney disease (GD 27.5% vs GND 33.3%, p = 0.05). The etiology was similar between the 2 groups (42% ischaemic).

In the qui-square analysis, there was a statically significant association between the use of digoxin and mortality (DG 42.3% vs NDG 25.4%, p= 0.003), and also between digoxin and hospitalization with acute heart failure (DG 36.5% vs NDG 21.4%, p = 0.005). There was no association between digoxin use and the occurrence of ventricular tachycardia (DG 31.7% vs 40.1%, p = 0.155).

In the Cox proportional hazards regression, accounting for the potential confounders, the use of digoxin was an independent predictor for all-cause mortality (HR = 2.80, CI 95 [1.07 – 7.31], p = 0.036) and also for hospitalization with acute heart failure (HR = 5.82, CI 95 [1.54 – 22.06], p = 0.010).

Conclusion

The use of digoxin was an independent predictor of all-cause mortality and hospitalizations due to acute heart failure. Randomized trials are needed to clarify the impact of digoxin and determine if it is only an indicator of disease severity and worse prognosis or if the drug has a direct negative influence in the natural history of P with heart failure.

Abstract Figure.

An assessment of a municipal physical activity programme for seniors based on the EFQM model: Integrating the views of internal and external stakeholders

The growing proportion of senior citizens and the importance of encouraging active well-ageing behaviours explain the increasing efforts carried out by governments to develop exercise programmes particularly targeted to this group. The complexity associated with the running of these programmes and the resources committed make their quality assessment essential. The aim of the current paper is to validate and refine the use of the EFQM model in this context. A programme of a medium-sized municipality of the Centre region of Portugal was used as a case study to evaluate the adequacy and relevance of the EFQM model and to identify the strengths and weaknesses of the current programme based on the data collected from service users, instructors, municipal leaders and programme partners. High levels of customer satisfaction and loyalty, together with the clarity of programme mission and strategy emerged as main areas of strength. On the other hand, insufficient attention to the measurement of people satisfaction, as well as the leaders' failure of to show appreciation for the efforts developed by the programme instructors are key areas for improvement.

Correlations Between MRI Biomarkers PDFF and cT1 With Histopathological Features of Non-Alcoholic Steatohepatitis

INTRODUCTION

Late stage clinical trials in non-alcoholic steatohepatitis (NASH) are currently required by the FDA to use liver biopsy as a primary endpoint. The well-reported limitations with biopsy, such as associated risks and sampling error, coupled with patient preference, are driving investigation into non-invasive alternatives. MRI-derived biomarkers proton density fat fraction (PDFF) and iron-corrected T1 mapping (cT1) are gaining traction as emerging alternatives to biopsy for NASH. Our aim was to explore the correlations between cT1 and PDFF (from LiverMultiScan®), with the histological components on the NAFLD-NASH spectrum in a large cohort of cross-sectional data, in order to calibrate the measurement to histology, and to infer what might constitute a clinically meaningful change when related to the FDA's criteria.

MATERIALS AND METHODS

In a retrospective analysis of data combined from three previously published observational NASH studies, in which adult participants who underwent liver biopsy on suspicion of NAFLD or NASH and had an MRI scan measuring cT1 and PDFF (LiverMultiScan®, Perspectum Ltd, UK), associations between imaging biomarkers and histology were tested using Spearman's rank correlation coefficient (r_s), and further exploration of the relationships between the imaging variables and histology were performed using linear regression.

RESULTS

N = 264 patients with mean age of 54 (SD:9.9), 39% female, and 69% with BMI ≥ 30kg.m^-2 were included in the analysis. cT1 and PDFF both correlated with all features of the NAFLD activity score (NAS). cT1 was also positively correlated with Kleiner-Brunt fibrosis. Partial correlations, adjusting for steatosis, revealed cT1 correlated with inflammation and fibrosis, whereas PDFF did not, and both were still associated with the NAS, but correlation was weaker with PDFF than cT1. An estimated difference of 88 ms in cT1, or 21% relative difference in PDFF was related to a two-point difference in overall NAS.

CONCLUSION

The correlations between cT1 and PDFF with the histopathological hallmarks of NASH demonstrate the potential utility of both cT1 and PDFF as non-invasive biomarkers to detect a pharmacodynamic change in NASH, with cT1 showing superiority for detecting changes in inflammation and fibrosis, rather than liver fat alone.

Localized ulcerative nodular amyloidosis presenting as ulcerative panniculitis, an unusual clinical manifestation: A case report

Introduction and objectives:

The main objective of this article is to present and discuss a case of localized ulcerative nodular amyloidosis with deep involvement clinically manifesting as ulcerative panniculitis and discuss its impact on the choice of treatment.

Methods and results:

We present a 73-year-old woman with a history of painful ulcerated nodules on the inferior limbs. Microscopy confirmed amyloid deposits deep in the dermis and subcutaneous fat. No systemic involvement was found. Considering that skin-directed treatments often are not able to reach subcutaneous fat or were contraindicated because of the ulcers, she was successfully treated with cyclophosphamide and prednisone.

Conclusion:

Localized ulcerative nodular amyloidosis with deep involvement is a rare clinical presentation that can present as ulcerative panniculitis. Such a clinical manifestation might be misleading. Systemic treatment might be necessary to control symptoms when conventional skin-directed therapies are contraindicated.

Early Interaction of Alternaria infectoria Conidia with Macrophages

Fungi of the genus Alternaria are ubiquitous indoor and outdoor airborne agents, and individuals are daily exposed to their spores. Although its importance in human infections and, particularly in respiratory allergies, there are no studies of how Alternaria spp. spores interact with host cells. Our aim was to study the early interaction of Alternaria infectoria spores with macrophages, the first line of immune defense. RAW 264.7 macrophages were infected with A. infectoria conidia, and the internalization and viability of conidia once inside the macrophages were quantified during the first 6 h of interaction. Live cell imaging was used to study the dynamics of this interaction. TNF-α production was quantified by relative gene expression, and the concentration of other cytokines (IL-1α, IL-1β, IL-6, IL-4, IL-10, IL-17, GM-CSF and INF-γ) and a chemokine, MIP-1α, was quantified by ELISA. Conidia were rapidly internalized by macrophages, with approximately half internalized after 30 min of interaction. During the first 6 h of interaction, macrophages retained the ability to mitotically divide while containing internalized conidia. The classical macrophage-activated morphology was absent in macrophages infected with conidia, and TNF-α and other cytokines and chemokines failed to be produced. Thus, macrophages are able to efficiently phagocyte A. infectoria conidia, but, during the first 6 h, no effective antifungal response is triggered, therefore promoting the residence of these fungal conidia inside the macrophages.

Multivariate analysis and modeling of soil quality indicators in long-term management systems

Soil management systems, as well as the long-term application of nitrogen fertilization, might promote changes in soil quality (SQ). The knowledge of how agronomic practices influence SQ is the main factor in the development of most sustainable management systems. Thus, the aim of this study was to evaluate the influence of long-term management systems on SQ through the analysis of 10 soil quality indicators (SQIs), to select the most sensitive SQIs through principal components analysis (PCA) and to propose a mathematical model that could estimate the activities of enzymes based on SQI values with simple and low-cost procedures in relation to enzyme measurement. Soil samples were collected from three experiments in which soils were used for this purpose over more than two decades. The first experiment consisted of winter fallow and maize seeding as a summer crop in a conventional tillage system (CT) that received nitrogen fertilization at doses of 0, 90 and 180 kg ha^-1. The second and third experiments consisted of no-tillage (NT) using maize/maize (NT M/M) and legume/maize (NT L/M) crop rotation, respectively, both using nitrogen fertilization at the same doses as in the first experiment. The no-tillage system with legume/maize crop rotation favored the development of microorganisms and improved the soil quality. The effects of nitrogen fertilization on SQIs varied according to the management system. The microbial respiration (MR), the metabolic quotient (q CO₂), total organic carbon (TOC), nitrogen microbial biomass (NMC), urease enzyme activity (UEA), dehydrogenase activity (DA) and amylase activity (AA) were the most efficient SQIs. The adjusted mathematical models presented a good predictive capacity to estimate the urease activity in CT and NT M/M and the amylase activity in the CT system.

Age-related changes in social decision-making: An electrophysiological analysis of unfairness evaluation in the Ultimatum Game

This study examines age-related differences in behavioral and neural responses to unfairness. Our sample was composed of younger, middle-aged, and older adults, who performed the Ultimatum Game in the proposer role, and in the respondent role during an EEG recording. We administered neurocognitive tests to identify whether patterns in decision-making are associated with age-related changes in cognition. Despite the worse performance in measures of executive functioning, older adults had the best economic strategy by accepting more unfair offers than younger and middle-aged adults. Regarding electrophysiological results, while younger adults showed higher medial frontal negativity (MFN) amplitudes after unfair than after fair offers, middle-aged and older adults had similar amplitudes after both conditions. Our results suggest that aging may be accompanied by an insensitivity to unfairness, which may underlie their higher rates of unfair offers acceptance.

Adenosine Deaminase Two and Immunoglobulin M Accurately Differentiate Adult Sneddon’s Syndrome of Unknown Cause

Background: The association that exists between livedo reticularis (LR) and stroke is known as Sneddon’s syndrome (SnS). The disorder is classified as primary SnS (PSnS), if the cause remains unknown and secondary SnS. The condition is rare and it occurs mainly sporadically. In 2014, 2 independent teams described a new genetic disorder with childhood-onset, which was called deficiency of adenosine deaminase 2 (DADA2), characterized by recurrent fevers and vascular pathologic features that included LR and stroke. All the patients carried recessively inherited mutations in cat eye syndrome chromosome region candidate 1 gene (CECR1), encoding the adenosine deaminase 2 (ADA2) protein. Genetic testing is the standard for the diagnosis of DADA2. However, the diagnostic accuracy of more affordable laboratorial analysis in CECR1-mutated individuals remains to be established. We aim to determine whether plasma ADA2 activity and serum immunoglobulin M (IgM) levels can distinguish (1) DADA2 from other adult patients within the SnS spectrum, and (2) healthy CECR1 heterozygous (HHZ) from healthy controls (HC). Methods: ADA2 activity in plasma and serum IgM concentrations was measured in adult patients within the SnS spectrum, healthy first-degree relatives and HC. Genetic results were used as the reference standard. The primary outcome measures were sensitivity and specificity derived from receiver operating curve analysis. Results: A total of 73 participants were included in the study: 26 patients with PSnS with no CECR1 mutation (PSnS), 6 bi-allelic (DADA2 patients) and 7 HHZ CECR1 mutations and 34 HC. Plasma ADA2 activity and serum IgM levels were significantly lower in DADA2 patients than in PSnS. With the use of the best indexes, plasma ADA2 activity differentiated PSnS from DADA2 with a sensitivity and specificity of 100.0% and HHZ from HC with a sensitivity of 97.1% and specificity of 85.7%. Serum IgM levels also differentiated PSnS from DADA2 with a sensitivity of 85.2% and specificity of 83.3%. Conclusion: Serum IgM levels might be used as a triage tool and plasma ADA2 activity performs perfectly as a diagnostic test for DADA2 in adult patients within the SnS spectrum. ADA2 activity in plasma also reliably distinguishes HHZ from HC.

Linear and whorled nevoid hypermelanosis and Joubert syndrome: a novel association: A case report and literature review

This report discusses a case of linear and whorled nevoid hypermelanosis associated with cerebellar atrophy, ocular and developmental anomalies compatible with Joubert syndrome. Linear and whorled nevoid hypermelanosis is a rare disorder of skin pigmentation characterized by swirls and whorls of hyperpigmented macules in a reticulate pattern along Blaschko’s lines. Neurologic, cardiac, skeletal and developmental anomalies have been reported. We present a case of linear and whorled nevoid hypermelanosis on an 18-year-old woman who also presented with cerebellar atrophy, jerk nystagmus, macrocephaly and developmental delay. Those symptoms were compatible with Joubert syndrome. A complete work-up failed to reveal other systemic or skeletal anomalies. No chromosomal alteration was found on karyotyping carried out on a skin specimen. Much remains to be known about linear and whorled nevoid hypermelanosis. It is generally a benign condition but association with various congenital anomalies have been reported. Proper work-up is advised in order to exclude congenital anomalies.

Fish diversification at the pace of geomorphological changes: evolutionary history of western Iberian Leuciscinae (Teleostei: Leuciscidae) inferred from multilocus sequence data

The evolutionary history of western Iberian Leuciscinae, obligatory freshwater fish, is directly linked to the evolution of the hydrographic network of the Iberian Peninsula after its isolation from the rest of Europe, which involved dramatic rearrangements such as the transition from endorheic lakes to open basins draining to the Atlantic. Previous phylogenetic research on western Iberian leuciscines, using mainly mitochondrial DNA and more recently one or two nuclear genes, has found contradictory results and there remain many unresolved issues regarding species relationships, taxonomy, and evolutionary history. Moreover, there is a lack of integration between phylogenetic and divergence time estimates and information on the timing of geomorphological changes and paleobasin rearrangements in the Iberian Peninsula. This study presents the first comprehensive fossil-calibrated multilocus coalescent species tree of western Iberian Leuciscinae (including 14 species of Achondrostoma, Iberochondrostoma, Pseudochondrostoma and Squalius endemic to the Iberian Peninsula, seven of which endemic to Portugal) based on seven nuclear genes, and from which we infer their biogeographic history by comparing divergence time estimates to known dated geological events. The phylogenetic pattern suggests slow-paced evolution of leuciscines during the Early-Middle Miocene endorheic phase of the main Iberian river basins, with the shift to exorheism in the late Neogene-Quaternary allowing westward dispersals that resulted in many cladogenetic events and a high rate of endemism in western Iberia. The results of this study also: (i) confirm the paraphyly of S. pyrenaicus with respect to S. carolitertii, and thus the possible presence of a new taxon in the Portuguese Tagus currently assigned to S. pyrenaicus; (ii) support the taxonomic separation of the Guadiana and Sado populations of S. pyrenaicus; (iii) show the need for further population sampling and taxonomic research to clarify the phylogenetic status of A. arcasii from the Minho basin and of the I. lusitanicum populations in the Sado and Tagus basins; and (iv) indicate that A. occidentale, I. olisiponensis and P. duriensis are the most ancient lineages within their respective genera.

The BETTER WISE protocol: building on existing tools to improve cancer and chronic disease prevention and screening in primary care for wellness of cancer survivors and patients - a cluster randomized controlled trial embedded in a mixed methods design

Background

There is a pressing need to reduce the burden of chronic disease and improve healthcare system sustainability through improved cancer and chronic disease prevention and screening (CCDPS) in primary care. We aim to create an integrated approach that addresses the needs of the general population and the special concerns of cancer survivors. Building on previous research, we will develop, implement, and test the effectiveness of an approach that proactively targets patients to attend an individualized CCDPS intervention delivered by a Prevention Practitioner (PP). The objective is to determine if patients randomized to receive an individualized PP visit (vs standard care) have improved cancer surveillance and CCDPS outcomes. Implementation frameworks will help identify and address facilitators and barriers to the approach and inform future dissemination and uptake.

Methods/design

The BETTER WISE project is a pragmatic two-arm cluster randomized controlled trial embedded in a mixed methods design, including a qualitative evaluation and an economic assessment. The intervention, informed by the expanded chronic care model and previous research, will be refined by engaging researchers, practitioners, policy makers, and patients. The BETTER WISE tool kit includes blended care pathways for cancer survivors (breast, colorectal, prostate) and CCDPS including lifestyle risk factors and screening for poverty. Patients aged 40–65, including both cancer survivors and general population patients, will be randomized at the physician level to an intervention group or to a wait-list control group. Once the intervention is completed, patients randomized to wait-list control will be invited to receive a prevention visit. The main outcome, calculated at 12-months follow-up, will be an individual patient-level summary composite index, defined as the proportion of CCDPS actions achieved relative to those for which the patient was eligible at baseline. A qualitative evaluation will capture information related to program outcome, implementation (facilitators and barriers), and sustainability. An economic assessment will examine the projected cost-benefit impact of investing in the BETTER WISE approach.

Discussion

This project builds on existing work and engages end users throughout the process to develop, implement, and determine the effectiveness of a multi-faceted intervention that addresses CCDPS and cancer survivorship in primary care settings.

Trial registration

ISRCTN21333761. Registered on December 19, 2016

A systematic review and meta-analysis of the survival rate of implants placed in previously failed sites

The aim of this study was to conduct a systematic review and meta-analysis to assess the clinical outcomes of dental implants placed in previously early and late implant failed sites. An electronic literature search was conducted in several databases for articles published up to February 2018. Human clinical trials that received at least one implant in a previously failed site were included. Hence, the PICO question that was aimed to be addressed was: Do patients undergoing implant replacement (second and third attempts) in previous failed sites have survival rates similar to implants placed at first attempts? A random effects model was used to calculate survival weighted means and corresponding 95% Confidence Intervals (CI) among studies. Eleven studies of low to moderate methodological quality were included in this review. Implants placed in sites with history of one and two implant failures had a weighted survival rate (SR) of 88.7% (95%CI 81.7-93.3) and 67.1% (95%CI 51.1-79.9), respectively. Implants placed in sites with a previous early failure revealed a weighted SR of 91.8% (95%CI 85.1-95.6). First implants presented higher SR than implants placed in sites with one or two previous implant failures. In contrast, implants placed in sites with one and two implant failures had similar SR. Within its limitations, this review suggests that replacement implants have moderate SR. Larger prospective studies with well-defined criteria for early and late implant failure are necessary to confirm and expand on these results.

An Open-Source Framework for the Computer Aided Design of Complex Profile Extrusion Dies

This work presents a new design procedure for improving the flow distribution in complex profile extrusion dies. The proposed approach is based on open source software and aims to motivate both academics and industrials to consider numerical methodologies in their future developments. A new solver was implemented in OpenFOAM computational library in order to model the steady non-isothermal flow of inelastic fluids. The developed code was verified with the Method of Manufactured Solutions. The capability of the proposed design procedure was experimentally assessed with an industrial case study, and the results obtained suggest that the computational based design aid is an excellent alternative to the usual experimental trial-and-error procedure used in industry.

Calciphylaxis in a Patient With Non-Hodgkin Lymphoma: Case Report and Literature Review

BACKGROUND

Calciphylaxis is a well-known entity in end-stage kidney disease and after renal transplant. Cases of nonuremic calciphylaxis (NUC) have also been reported, but data on this rare condition are mainly empirical.

OBJECTIVE

We discuss a case of NUC secondary to spontaneous tumour lysis syndrome in a patient who had chemotherapy for non-Hodgkin lymphoma and present a review of the literature to better characterize malignancy-associated NUC.

METHODS

We identified 12 published cases of malignancy-associated NUC.

RESULTS

This systematic review of malignancy-associated NUC did not show a relationship between the type of malignancy, the distribution of skin lesions, or mortality. However, distal more than proximal involvement seems to be more frequently associated with calcium phosphate imbalance.

CONCLUSION

Clinicians must maintain a high index of suspicion for calciphylaxis when evaluating patients with cutaneous lesions developed in the setting of malignancy.

Technetium-99m Labelling of the IOR CEA 1 Monoclonal Antibody: Evaluation of Different Methods

Aim: The aim of this study was to investigate the in vivo and in vitro properties of 99mTc labelled monoclonal antibody, IOR CEA 1 when radio-labelled by different methods. Methods: To achieve that purpose IOR CEA was directly radiolabeled via 2-mercaptoethanol (2-Me) and stannous ion (SnCI2) reduction and indirectly via the 2-iminothiolane (2-lm) conjugation. The resulting 99mTc-MoAbs were analysed for number of free sulfhydryl groups, chemical and radiochemical purity (checked by HPLC and SDS PAGE), immunoreactivity and biological distribution in mice. Results: Experimental results indicated a similar radiochemical purity and immunoreactivity for direct labelling methods and a decrease of both for 2-lm method. 2-Me antibody reduction led to a high antibody fragmentation as indicated by non-denaturing SDS PAGE analysis. Nevertheless SnCI2 and 2-lm labels revealed lower in vivo stability. Conclusion: 99mTc-(2-Me) IOR CEA presented favorable in vitro and in vivo properties. Therefore this label was compared to 99mTc-monoclonal antibody BW 431/26. Similar characteristics were found. Clinical studies also revealed identical biodistribution profile.

The effect of aging on the (mis)perception of intentionality - an ERP study

Despite the accumulated knowledge on moral decision-making in the early stages of development, empirical evidence is still limited in the old-aged adults. The current study contributes to unveil the neural correlates of judgments of moral transgressions as a function of aging, by examining the temporal dynamics of neural activation elicited by intentional and accidental harmful actions in three groups of healthy participants: young adults (18-35), adults (40-55), and older adults (60-75). Older adults were slower and less accurate in rating intentionality, compared to the younger groups. In ERP analysis, the older group showed increased P2 amplitude, which was predicted by poorer performance on neuropsychological tests. Reduced amplitudes were found on critical ERP components to moral cognition (N2 and LPP), namely while processing intentional harmful scenarios. Older adults seem to allocate more attentional resources (P2) to the task, probably to compensate the age-related decline in executive functioning, while younger groups show a pronounced negativity while detecting harm (N2) and increased neural activation to encode the intentions behind the acts (LPP).

Esquizofrenia e direção veicular: uma revisão sistemática da literatura

Introdução: O diagnóstico de esquizofrenia vem, ao longo dos anos, carregado de um processo histórico de transformações sob o olhar da sociedade. Nesse âmbito, a esquizofrenia é vista atualmente como doença degenerativa, de caráter demencial progressivo, com prejuízo global de suas funções e declínio cognitivo, gerando muito comumente, uma vida marcada por preconceito e exclusão, inclusive no âmbito de mobilidade no que se diz respeito à direção veicular. Concomitante a esses dados, existe uma escassez de trabalhos de investigação sobre acidentes de automóveis em condutores portadores de esquizofrenia, apesar de alguns estudos apontarem no sentido de maior potencial fator de risco. Objetivo: O objetivo desta revisão bibliográfica foi levantar estudos na literatura que tragam informações acerca do paciente portador de esquizofrenia e direção veicular, buscando responder se podem ou não ser liberados através do exame mental/psicológico. Método: Realizou-se uma revisão sistemática da literatura científica sobre a relação entre esquizofrenia e direção veicular. Resultados: Existem estudos que sugerem um maior número de infrações às regras de trânsito e acidentes de viação em pacientes esquizofrênicos, porém esta diferença não fora observada por outros autores. Houve uma tendência de distorção de feedback visual nos pacientes em relação à população geral, além de erros de processamento sensorial. Esquizofrênicos que dirigiam apresentaram-se melhores no exame do estado mental que esquizofrênicos não motoristas. As taxas de acidente encontradas foram quase idênticas nos grupos de pacientes com transtornos psicóticos e controle, e que além disso, taxas de acidentes com lesões podem ser equiparadas com as da população geral. Conclusão: Diante dos dados expostos, fica evidente a relação entre esquizofrenia e prejuízo cognitivo. Porém os estudos traçados não permitiram exercer com solidez a aferição destas perdas mentais, e tampouco demonstrar o impacto na direção veicular. Em suma, torna-se de extrema importância investigação mais apurada destes pacientes, para que não sejam indevidamente impedidos de exercer o ato da direção veicular. À medida que mais estudos surgirem, os profissionais da Medicina de Tráfego obterão mais embasamento teórico em sua avaliação mental.

Time to endoscopic intervention in patients with upper gastrointestinal patients can be improved with pathway provision

Background

Patients with upper gastrointestinal malignancy often require admission to hospital with dysphagia or jaundice requiring therapeutic endoscopy. Endoscopic intervention is often effective permitting rapid discharge. An efficient service would permit rapid discharge for patients who are often at the end of life. We noted that a majority of patients in hospital under the gastroenterological oncology were admitted with symptoms requiring therapeutic endoscopy.

Methods

We conducted an audit cycle of the inpatient days before and after pathway implementation.

A wait of 1 day was set as acceptable for patients with bleeding as defined by NICE guidance and we set an arbitrary standard of 2 days for patients without bleeding but requiring therapeutic endoscopy. Between the audit cycles, a pathway was built to accommodate these patients.

Results

Inpatient waits improved from a median of 3 days to 1 day. There was no difference in outcome between those presenting with bleeding and other symptoms or any difference in patients requiring different procedures.

Conclusions

Waiting times for endoscopy can be improved with the introduction of a targeted pathway of cancer patients. Further issues including cost, quality of life and nutrition require further intervention.

Electronic supplementary material

The online version of this article (doi:10.1186/s12885-017-3335-0) contains supplementary material, which is available to authorized users.

Guidelines for balancing the flow in extrusion dies: the influence of the material rheology

In this work we present improved design guidelines to support the die designer activity, when searching for the flow channel geometry that allows the achievement of a balanced flow distribution, in complex profile extrusion dies. The proposed methodology relies on surrogate models, obtained through a detailed and extensive numerical study, carried out with the open source computational library OpenFOAM®, in which an appropriate numerical solver for the problems under study was implemented. The main contribution of this work is to further enlarge the applicability of the simplified design methodology (Rajkumar A, Ferrás LL, Fernandes C, Carneiro OS, Becker M, Nóbrega JM. Int. Polym. Proc. 2017, 32, 58–71.) previously proposed by this group for similar purposes, by considering the effect of processing parameters and material rheology. The sensitivity analyses performed showed that, among the studied parameters, the power-law exponent was the only one that affected the system behavior. Thus, the previous proposed surrogate models were modified to include the effect of this parameter. Verification studies performed for three geometries and different rheological and process parameters evidenced the effectiveness of the proposed simplified design methodology.

Depletion of adult neurogenesis using the chemotherapy drug temozolomide in mice induces behavioural and biological changes relevant to depression

Numerous studies have examined links between postnatal neurogenesis and depression using a range of experimental methods to deplete neurogenesis. The antimitotic drug temozolomide (TMZ) has previously been used successfully as an experimental tool in animals to deplete adult neurogenesis and is used regularly on human patients as a standard chemotherapy for brain cancer. In this study, we wanted to evaluate whether TMZ as a model for chemotherapy treatment could affect parameters related to depression in an animal model. Prevalence rates of depression in patients is thought to be highly underdiagnosed, with some studies reporting rates as high as 90%. Results from this study in mice, treated with a regimen of TMZ similar to humans, exhibited behavioural and biochemical changes that have relevance to the development of depression. In particular, behavioural results demonstrated robust deficits in processing novelty and a significant increase in the corticosterone response. Quantification of neurogenesis using a novel sectioning method, which clearly evaluates dorsal and ventral neurogenesis separately, showed a significant correlation between the level of ventral neurogenesis and the corticosterone response. Depression is a complex disorder with discoveries regarding its neurobiology and how it relates to behaviour being only in their infancy. The findings presented in this study demonstrate that chemotherapy-induced decreases in neurogenesis results in previously unreported behavioural and biochemical consequences. These results, we argue, are indicative of a biological mechanism, which may contribute to the development of depression in patients being treated with chemotherapy and is separate from the mental distress resulting from a cancer diagnosis.

Design Guidelines to Balance the Flow Distribution in Complex Profile Extrusion Dies

In this work a novel methodology to balance the flow distribution in complex extrusion dies is proposed. For this purpose, the profile cross section geometry is divided into simpler geometries (L and T shaped profiles), which are balanced with a surrogate model obtained by a detailed numerical study. The numerical simulations are performed considering the non-isothermal flow of Bird-Carreau inelastic fluids, and the numerical computations are performed with a solver implemented in OpenFOAM computational library. The proposed methodology is assessed with some case studies.

Advanced paternal age effects in neurodevelopmental disorders-review of potential underlying mechanisms

Multiple epidemiological studies suggest a relationship between advanced paternal age (APA) at conception and adverse neurodevelopmental outcomes in offspring, particularly with regard to increased risk for autism and schizophrenia. Conclusive evidence about how age-related changes in paternal gametes, or age-independent behavioral traits affect neural development is still lacking. Recent evidence suggests that the origins of APA effects are likely to be multidimensional, involving both inherited predisposition and de novo events. Here we provide a review of the epidemiological and molecular findings to date. Focusing on the latter, we present the evidence for genetic and epigenetic mechanisms underpinning the association between late fatherhood and disorder in offspring. We also discuss the limitations of the APA literature. We propose that different hypotheses relating to the origins of the APA effects are not mutually exclusive. Instead, multiple mechanisms likely contribute, reflecting the etiological complexity of neurodevelopmental disorders.

Zooplankton community in the Upper Parnaíba River (Northeastern, Brazil)

The objective of the present work is to evaluate the seasonal patterns of species richness and abundance of the zooplankton community in a semi-arid river, Northeastern of Brazil. Zooplankton samples were taken in four hydrological periods along the Upper Parnaíba River: April (low), August (dry), November (rising) 2013 and January (flood) 2014. The zooplankton community consisted of 125 species; the testate amoebae was the most species-rich (56 species) and the most abundant group (71.5%) of total zooplankton abundance. Season-specific differences were highly significant. The overall zooplankton richness and abundance was significantly higher during the low (71 species) and flood (878.47 ind.m-3) period, respectively. The hydrological regime was important in structuring the zooplankton community, emphasising the importance of the Parnaíba River and its seasonal variation for biodiversity conservation in the Brazilian semi-arid region.