The impact of fear and psychopathological symptoms on neural responses to naturalistic stimuli in adolescents

The presentation of real-world images can swiftly engage processing mechanisms within specific brain regions and neural pathways. In this study, we explore the effects of fear and psychopathological symptoms on neural processing of realistic stimuli during a free viewing naturalistic task in a sample of adolescents (11-16y). Thirty-one participants performed an experimental task consisting of the visualization of animal pictures according to three conditions - Snakes, Spiders, and Dogs - during EEG recordings. Dimensions of fear and psychopathological symptoms were previously assessed through The Fear Survey Schedule for Children- Revised and the Brief Symptom Inventory. Earlier and later visual processing was analyzed through ERP components' peak amplitudes. The results show a robust effect of psychopathology-related dimensions in the visual processing of naturalistic images, suggesting an increase of neural activity at later stages of visual processing (at the N200 time window) in symptomatic adolescents, corroborating the role of psychopathological symptoms in modulating neural responses to naturalistic images, and also guiding clinicians by providing additional data on how symptomatic adolescents perceive and process reality.

Differential correlates of fear and anxiety in salience perception: A behavioral and ERP study with adolescents

Anxiety disorders are the most common psychopathologies among adolescents. Their diagnostic criteria include both fear and anxiety symptomatology, although according to the literature, we can find evidence for some distinction between these two emotions. The present study contribute to this distinction, exploring the effects of trait fear and trait anxiety on behavioral and neural correlates. Thirty-two participants (aged 11-16 years) performed two experimental tasks of salient target detection, including visual stimuli that were manipulated to become salient, while reaction times and EEG were recorded. Results of both tasks revealed differential effects of trait fear and trait anxiety assessed through the Fear Survey Schedule for Children-Revised and the Youth Anxiety Measure for DSM-5 on reaction times and ERP components amplitudes. Specifically, higher symptoms from Separation Anxiety Disorder increased early neural visual processing and decreased reaction times for more salient stimuli. Also, trait fear reduced later neural visual processing of salient stimuli. These findings may provide a significant contribution to guiding psychological interventions, especially with adolescents presenting higher levels of anxiety-related symptomatology.

Critical Bias in Critical Care Devices

Critical care data contain information about the most physiologically fragile patients in the hospital, who require a significant level of monitoring. However, medical devices used for patient monitoring suffer from measurement biases that have been largely underreported. This article explores sources of bias in commonly used clinical devices, including pulse oximeters, thermometers, and sphygmomanometers. Further, it provides a framework for mitigating these biases and key principles to achieve more equitable health care delivery.

Clinical standards for diagnosis, treatment and prevention of post-COVID-19 lung disease

BACKGROUND: The aim of these clinical standards is to provide guidance on 'best practice' care for the diagnosis, treatment and prevention of post-COVID-19 lung disease.METHODS: A panel of international experts representing scientific societies, associations and groups active in post-COVID-19 lung disease was identified; 45 completed a Delphi process. A 5-point Likert scale indicated level of agreement with the draft standards. The final version was approved by consensus (with 100% agreement).RESULTS: Four clinical standards were agreed for patients with a previous history of COVID-19: Standard 1, Patients with sequelae not explained by an alternative diagnosis should be evaluated for possible post-COVID-19 lung disease; Standard 2, Patients with lung function impairment, reduced exercise tolerance, reduced quality of life (QoL) or other relevant signs or ongoing symptoms ≥4 weeks after the onset of first symptoms should be evaluated for treatment and pulmonary rehabilitation (PR); Standard 3, The PR programme should be based on feasibility, effectiveness and cost-effectiveness criteria, organised according to local health services and tailored to an individual patient's needs; and Standard 4, Each patient undergoing and completing PR should be evaluated to determine its effectiveness and have access to a counselling/health education session.CONCLUSION: This is the first consensus-based set of clinical standards for the diagnosis, treatment and prevention of post-COVID-19 lung disease. Our aim is to improve patient care and QoL by guiding clinicians, programme managers and public health officers in planning and implementing a PR programme to manage post-COVID-19 lung disease.

Increased N250 elicited by facial familiarity: An ERP study including the face inversion effect and facial emotion processing

The present study aims to explore how familiarity modulates the neural processing of faces under different conditions: upright or inverted, neutral or emotional. To this purpose, 32 participants (25 female; age: M = 27.7 years, SD = 9.3) performed two face/emotion identification tasks during EEG recording. In the first task, to study facial processing, three different categories of facial stimuli were presented during a target detection task: famous familiar faces, faces of loved ones, and unfamiliar faces. To explore the face inversion effect according to each level of familiarity, these facial stimuli were also presented upside down. In the second task, to study emotional face processing, an emotional identification task on personally familiar and unfamiliar faces was conducted. The behavioural results showed an improved performance in the identification of facial expressions of emotion with the increase of facial familiarity, consistent with the previous literature. Regarding electrophysiological results, we found increased amplitudes of the P100, N170, and N250 for inverted compared to upright faces, independently of their degree of familiarity. Moreover, we did not find familiarity effects at the P100 and N170 time-windows, but we found that N250 amplitude was larger for personally familiar compared to unfamiliar faces. This result supports the reasoning that the facial familiarity increases the neural activity during the N250 time-window, which may be explained by the processing of additional information prompted by the viewing of our loved ones faces, in contrast to what happens with unfamiliar individuals.

Prevention and screening during the COVID-19 pandemic: qualitative findings from the BETTER WISE project

BACKGROUND

The COVID-19 pandemic challenged healthcare systems worldwide and disrupted primary care, particularly prevention, screening, and lifestyle counselling. BETTER WISE is a comprehensive and structured approach that proactively addresses cancer and chronic disease prevention and screening (CCDPS), including cancer survivorship and screening for poverty and lifestyle risks for patients aged 40 to 65. Patients from 13 primary care clinics (urban, rural, and remote) in Alberta, Ontario, and Newfoundland & Labrador, Canada were invited for a 1-hour visit with a prevention practitioner (PP), a member of the primary care team with specialized training in CCDPS to provide patients an overview of eligible screening and assist with lifestyle counselling. This qualitative sub-study describes how the COVID-19 pandemic impacted BETTER WISE in a constantly changing medical landscape.

METHODS

We conducted 17 focus groups and 48 key informant interviews with a total of 132 primary care providers (PPs, physicians, allied health professionals, and clinic staff) over three different time points to better understand their perspectives on the BETTER WISE project. We also received 585 patient feedback forms of the 1005 patients who agreed to participate in the study. We also collected field notes and memos and employed thematic analysis using a constant comparative method focused on the impact of the pandemic on BETTER WISE.

RESULTS

We identified four themes related to how the COVID-19 pandemic impacted the BETTER WISE study: 1) Switch of in-person visits to visits over the phone; 2) Lack of access to preventive care and delays of screening tests; 3) Changes in primary care providers' availability and priorities; 4) Mental health impacts of the pandemic on patients and primary care providers.

CONCLUSIONS

The COVID-19 pandemic had and, at the time of writing, continues to have an impact on primary care, particularly on prevention, screening, and lifestyle counselling. Despite structural, procedural, and personal challenges throughout different waves of the pandemic, the primary care clinics participating in BETTER WISE were able to complete the study. Our results underscore the importance of the role of primary care providers in adapting to changing circumstances and support of patients in these challenging times.

TRIAL REGISTRATION

This qualitative study is a sub-component of the BETTER WISE pragmatic, cRCT, trial registration ISRCTN21333761 (date of registration 19/12/2016).

Could paraprobiotics be a safer alternative to probiotics for managing cancer chemotherapy-induced gastrointestinal toxicities?

Clinical oncology has shown outstanding progress improving patient survival due to the incorporation of new drugs. However, treatment success may be reduced by the emergency of dose-limiting side effects, such as intestinal mucositis and diarrhea. Mucositis and diarrhea management is symptomatic, and there is no preventive therapy. Bacterial and fungal-based compounds have been suggested as an alternative for preventing the development of diarrhea in cancer patients. Using probiotics is safe and effective in immunocompetent individuals, but concerns remain during immunosuppressive conditions. Paraprobiotics, formulations composed of non-viable microorganisms, have been proposed to overcome such limitation. The present literature review discusses current evidence regarding the possible use of paraprobiotics as an alternative to probiotics to prevent gastrointestinal toxicity of cancer chemotherapy.

Aquatic wild meat consumption of cetaceans in São Tomé and Príncipe (Gulf of Guinea)

Relatively little is known about cetaceans in São Tomé and Príncipe and in recent years, some episodes of cetacean bycatch and human consumption have been described. Aiming to provide insight into the reliance upon cetaceans as a source of meat, we present findings from complementary studies conducted in the islands of São Tomé and Príncipe from 2012 to 2021. Based on interviews with local residents, we assessed the prevalence of human consumption of cetaceans and identified potential sociodemographic drivers. This study provides the first comprehensive assessment of harvest (direct remove or incidental take) and consumption of cetaceans (mainly the family Delphinidae) in the country. These findings will be useful in the development of regional conservation measures and contribute to our understanding of anthropogenic activities affecting cetacean populations in the Gulf of Guinea.

The Portuguese observatory on occupational psychosocial factors: contribution for public health

 

To achieve the goal of sustainable employment, considering the profile of the Portuguese working population (PWP), is needed a range of strategies to ensure long, productive, and sustainable careers allied with a better quality of working life, health, and wellbeing, but also with public health policies grounded on scientifically validated and reliable data. This is possible through a comprehensive working system approach that ensures workers will be mentally and physically able to remain at work by the balance between work demands and individual resources allied with public health policies transfer into the workplaces by organizations’ leadership and policy makers. The Portuguese Observatory on Occupational Factors (Popsy@Work) aims at addressing this global challenge by: i) digitally collecting psychosocial data on the PWP; ii) implementing and strengthening of a psychosocial occupational health surveillance digital system; iii) providing reference values for the PWP concerning Psychosocial Health; iv) Transferring to society knowledge and best practices; v) Raising awareness on the importance of psychosocial management in occupational settings based on science. Popsy@work is a digital platform that collects and aggregates psychosocial data analytically and creates a visualization hub adding value to data on the PWP and giving science back to society in a usable way, empowering workers, strengthening organizations and grounding public policies. Pospy@Work considers the development of strategic intelligence on levels and inequalities of psychosocial health and well-being in occupational settings by robust metrics and reference data. Creating opportunities for national policy dialogue on inequalities, including the psychosocial health of the PWP through collaboration with diverse sectors identifying and mapping subgroups of populations whose unmet needs require specific outreach measures.

Key messages

Chest calcifications beyond the lung parenchyma-A review

OBJECTIVE

Thoracic calcifications are frequently found in chest radiographs and CTs, occurring in a wide variety of disorders. Although most calcifications are harmless sequelae of previous disease, they provide important information to establish the diagnosis. This article reviews the different types of calcified lesions found in the chest, focusing on lesions outside the lung parenchyma. A location-based approach to the differential diagnosis is used, while providing the reader with diagnostic pearls and discussing the clinical importance of the different types of calcifications.

CONCLUSION

Chest calcifications are a common finding in routine chest imaging. Understanding the different etiologies and radiologic manifestations provide the radiologist with the necessary tools to elaborate a differential diagnosis, as well as to correctly differentiate the findings that need further work-up from the ones that can be dismissed.

Severity of oEsophageal Anastomotic Leak in patients after oesophagectomy: the SEAL score

Background

Anastomotic leak (AL) is a common but severe complication after oesophagectomy. It is unknown how to determine the severity of AL objectively at diagnosis. Determining leak severity may guide treatment decisions and improve future research. This study aimed to identify leak-related prognostic factors for mortality, and to develop a Severity of oEsophageal Anastomotic Leak (SEAL) score.

Methods

This international, retrospective cohort study in 71 centres worldwide included patients with AL after oesophagectomy between 2011 and 2019. The primary endpoint was 90-day mortality. Leak-related prognostic factors were identified after adjusting for confounders and were included in multivariable logistic regression to develop the SEAL score. Four classes of leak severity (mild, moderate, severe, and critical) were defined based on the risk of 90-day mortality, and the score was validated internally.

Results

Some 1509 patients with AL were included and the 90-day mortality rate was 11.7 per cent. Twelve leak-related prognostic factors were included in the SEAL score. The score showed good calibration and discrimination (c-index 0.77, 95 per cent c.i. 0.73 to 0.81). Higher classes of leak severity graded by the SEAL score were associated with a significant increase in duration of ICU stay, healing time, Comprehensive Complication Index score, and Esophagectomy Complications Consensus Group classification.

Conclusion

The SEAL score grades leak severity into four classes by combining 12 leak-related predictors and can be used to the assess severity of AL after oesophagectomy.

What is a prevention visit? A qualitative study of a structured approach to prevention and screening - the BETTER WISE project

BACKGROUND

This qualitative study is a sub-component of BETTER WISE, a comprehensive and structured approach that proactively addresses chronic disease prevention, screening, and cancer survivorship, including screening for poverty and addressing lifestyle risks for patients aged 40 to 65. Patients (n = 527) from 13 primary care clinics (urban, rural, and remote) in Alberta, Ontario, and Newfoundland & Labrador, Canada agreed to participate in the study and were invited to a one-hour prevention visit delivered by a Prevention Practitioner (PP) as part of BETTER WISE. We identified the key components of a BETTER WISE prevention visit based on patients' and primary care providers' perspectives.

METHODS

Primary care providers (PPs, physicians and their staff) participated in 14 focus groups and 19 key informant interviews to share their perspectives on the BETTER WISE project. Of 527 patients who agreed to participate in the study and were invited for a BETTER WISE prevention visit with a PP, we received 356 patient feedback forms. We also collected field notes and memos and employed thematic analysis using a constant comparative method focusing on the BETTER WISE prevention visit.

RESULTS

We identified four key themes related to a BETTER WISE prevention visit: 1) Creating a safe environment and building trust with patients: PPs provided sufficient time and a safe space for patients to share what was important to them, including their concerns related to poverty, alcohol consumption, and mental health, topics that were often not shared with physicians; 2) Providing personalized health education: PPs used the BETTER WISE tools to provide patients with a personalized overview of their health status and eligible screening; 3) Non-judgmental empowering of patients: Instead of directing patients on what to do, PPs evoked patients' preferences and helped them to set goals (if desired); and 4) Integrating care for patients: PPs clarified information from patients' charts and surveys with physicians and helped patients to navigate resources within and outside of the primary care team.

CONCLUSIONS

The results of this study underscore the importance of personalized, trusting, non-judgmental, and integrated relationships between primary care providers and patients to effectively address chronic disease prevention, screening, and cancer survivorship as demonstrated by the BETTER WISE prevention visits.

TRIAL REGISTRATION

This qualitative study is a sub-component of the BETTER WISE pragmatic, cRCT, trial registration ISRCTN21333761 (date of registration 19/12/2016).

Antitumoral synergism between a copper(II) complex and cisplatin improves in vitro and in vivo anticancer activity against melanoma, lung and breast cancer cells

BACKGROUND

Intrinsic resistance of cancer cells is a major concern for the success of chemotherapy, and this undesirable feature stimulates further research into the design of new compounds and/or alternative multiple drug chemotherapy protocols.

METHODS

In this study, we investigated the antitumoral potential of the coordination compounds [Cu(HPClNOL)Cl]Cl (1), [Fe(HPClNOL)Cl₂]NO₃(2) and [Mn(HPClNOL)Cl₂] (3). Using the human, MCF-7 and A549, and the murine melanoma, B16-F10, cell lines, we determined the cytotoxicity, DCFH oxidation, disruption of mitochondrial membrane potential (ΔΨm), Sub-G1 and TUNEL positive cells, and caspase 8 and 9 activities. Fractional inhibitory concentration (FIC) and xenograft models were also assessed to evaluate the efficacy of antitumoral potential.

RESULTS

We observed that only complex 1 was cytotoxic. The treatment of cancer cells with complex 1 triggered ROS generation and promoted the disruption of ΔΨm. Complex 1 increased the number of Sub-G1 and TUNEL positive cells, and the measurement of caspase 8 and 9 activity confirmed that apoptosis was triggered by the intrinsic pathway. FIC demonstrated that the combination of complex 1 with cisplatin was additive for the A549 cells whilst it was synergic for MCF-7 and B16-F10. Treatment with complex 1, either alone or combined with cisplatin, reduced tumor growth on xenograft models.

CONCLUSIONS

The present study brings new clues regarding the mechanism of action of [Cu(HPClNOL)Cl]Cl, either alone or in combination with cisplatin.

GENERAL SIGNIFICANCE

These results indicate that complex 1, administered either singly or in combination with current drugs, has real potential for use in cancer therapy.

Driftage: a multi-agent system framework for concept drift detection

BACKGROUND

The amount of data and behavior changes in society happens at a swift pace in this interconnected world. Consequently, machine learning algorithms lose accuracy because they do not know these new patterns. This change in the data pattern is known as concept drift. There exist many approaches for dealing with these drifts. Usually, these methods are costly to implement because they require (i) knowledge of drift detection algorithms, (ii) software engineering strategies, and (iii) continuous maintenance concerning new drifts.

RESULTS

This article proposes to create Driftage: a new framework using multi-agent systems to simplify the implementation of concept drift detectors considerably and divide concept drift detection responsibilities between agents, enhancing explainability of each part of drift detection. As a case study, we illustrate our strategy using a muscle activity monitor of electromyography. We show a reduction in the number of false-positive drifts detected, improving detection interpretability, and enabling concept drift detectors' interactivity with other knowledge bases.

CONCLUSION

We conclude that using Driftage, arises a new paradigm to implement concept drift algorithms with multi-agent architecture that contributes to split drift detection responsability, algorithms interpretability and more dynamic algorithms adaptation.

Lymphogranuloma venereum: a retrospective analysis of an emerging sexually transmitted disease in a Lisbon Tertiary Center

BACKGROUND

Lymphogranuloma venereum (LGV) is a sexual transmitted infection (STI), currently endemic within the population of men who have sex with men (MSM) of Western Countries. L2B variant has been reported as the predominant strain in the current LGV epidemics, although a shift towards L2-434 has been observed in some European countries.

OBJECTIVES

To evaluate and characterize the population with LGV infection diagnosed in Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal.

METHODS

A retrospective analysis of all LGV diagnoses between 2016 and 2019 was performed. The diagnosis was established through ompA-genotyping of samples yielding a positive result to Chlamydia trachomatis (CT). All considered samples were retrieved from the clinician activity, through swabbing and urine analysis and CT infection diagnosis was obtained using real-time PCR.

RESULTS

During the period studied 16 279 CT diagnostics tests were employed, with a striking increase from 2016 (n = 467) to 2019 (n = 9362). A total of 1602 diagnoses of CT were established, from which 168 (10.5%) corresponded to LGV, with both infections showing a rising evolution, between 2016 and 2019, of 2.9 and 2.7 times, respectively. The majority of the LGV strains were genotyped as L2/434 (67.3%; n = 113). LGV predominantly affected MSM and men who have sex with men and women (97.0%; n = 163). Anorectal infection was the most prevalent one (90.5%; n = 152), being proctitis the main clinical presentation (76.2%; n = 128). Absence of symptoms was reported in almost 15% of the cases (n = 24). The presence of concomitant infection with human immunodeficiency virus was dominant (73.2%; n = 123) and the prevalence of one or more STI co-infections was about 60.1% (n = 99).

CONCLUSIONS

An increasing evolution of CT and LGV testing and diagnosing was observable throughout the studied period. Characteristics of the population are similar with those described within LGV epidemics. In accordance with recent European studies, predominance towards L2 genotype was identified.

Does shift work affect blood pressure values and hypertension risk? a systematic review and meta-analysis

Funding Acknowledgements

Type of funding sources: Public grant(s) – EU funding. Main funding source(s): Fundação para a Ciência e Tecnologia (FCT) and Fundo Social Europeu (FSE)

Introduction

Modern societies function 24h/day which accounts for shift work (SW) encompassing already more than 20% of the European workforce. While the relationship between blood pressure (BP) and cardiovascular events is a continuous, hypertension (HTN) remains the major preventable cause of cardiovascular disease (CVD) in our continent. SW has been associated with sleep disturbances, circadian misalignment and unhealthy behaviours, possibly conducting to several chronic diseases. Therefore, we aimed to determine if shift workers have higher BP values and/or HTN risk.

Methods

This systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A literature search was performed on MEDLINE, EMBASE and Cochrane electronic databases. Included studies reported HTN diagnosis using current thresholds and/or BP values, in both shift workers and in a control group of day workers. SW was categorized in 4 subgroups, focused mostly on night work. Pooled mean difference and 95% Confidence Intervals (95%IC) were estimated for continuous outcomes, Systolic BP (SBP) and diastolic BP (DBP), and pooled Odds Ratio and 95%IC were determined for HTN risk. The Newcastle-Ottawa Quality Assessment Scale was used for quality evaluation of included studies.

Results

Forty-five independent studies were included engaging 117252 workers. Of these, 41 studies were included in the meta-analysis for SBP, 39 for DBP and 14 for HTN. Most studies provided cross-sectional data (n = 42), were developed in Asia (n = 21), in an industrial setting (n = 25) and included only men (n = 26). Most studies were rated as satisfactory quality (n = 23) with confounder adjustment being the weakest parameter.

We found a statically significant increase for both systolic and diastolic BP among permanent night workers, 2.52mmHg [0.75–4.29] and 1.77mmHg [0.39–3.15] respectively. Amongst rotational shift workers, both with and without night work, we found a significant increase only for SBP, namely 1.28 mmHg [0.18–2.39] and 0.65 mmHg [0.07–1.22]. For HTN risk, none of SW types showed significant differences.

Conclusions

Certain groups of shift workers may be at special risk for increased BP. This is the first review assessing the impact of SW specifically on BP values. Although the increases were generally modest, these may play an important role among already susceptible individuals exposed overtime. The effect of SW was more consistent for SBP, which has a major impact on CVD risk. Hence, occupational health services should embrace a holistic CVD preventive approach including atypical risk factors such as SW, with active monitoring across the lifespan of more vulnerable workers.

Sleep and personality in college students: A preliminary study

Introduction

Sleep represents an important process in the stable behavioural and emotional functioning of the individual and is an important health indicator. Personality is related with academic and occupational achievement, quality of interpersonal relationships, but also with sleep. Concerning personality, individuals with lower emotional stability have greater sensitivity to stress and maladaptive sleep-related behaviour.

Objectives

The main goal of this study is to analyze the relation between sleep quality and personality in college students.

Methods

This study employed a correlational design. A sample of 220 Portuguese students (84.9% females), with mean age of 19.5 years (sd=3.4), from different health courses, filled in the Pittsburgh Sleep Quality Questionnaire and HEXACO-60, during a single individual session. A descriptive statistical analysis, a Pearson correlation analyses and the t Student test, for independent samples, were performed.

Results

The results showed a predominance of poor sleep quality among students (96.3%). The more prevalent HEXACO dimensions are: Conscientiousness (X=32.6; sd=4.2) and Emotionality (X=31.2; sd=5.2). When exploring personality differences between sleep groups (GSG=Good Sleep Group; PSG=Poor Sleep Group) a significant difference was found in mean scores of the dimension Emotionality. It was observed that the PSG revealed higher levels of Emotionality than the GSG (PSG=31.5; sd=5.1; PSG=26.3; sd=4.0; p<.05).

Conclusions

College students self-report a poor sleep and the prevalent personality dimensions are Conscientiousness and Emotionality. Students with higher levels of Emotionality (fearfulness, anxiety, dependence and sentimentality) presented a poor sleep. To conclude, mediation studies are needed in order to better understanding the link between personality and sleep.

The novel Mechanical Ventilator Milano for the COVID-19 pandemic

This paper presents the Mechanical Ventilator Milano (MVM), a novel intensive therapy mechanical ventilator designed for rapid, large-scale, low-cost production for the COVID-19 pandemic. Free of moving mechanical parts and requiring only a source of compressed oxygen and medical air to operate, the MVM is designed to support the long-term invasive ventilation often required for COVID-19 patients and operates in pressure-regulated ventilation modes, which minimize the risk of furthering lung trauma. The MVM was extensively tested against ISO standards in the laboratory using a breathing simulator, with good agreement between input and measured breathing parameters and performing correctly in response to fault conditions and stability tests. The MVM has obtained Emergency Use Authorization by U.S. Food and Drug Administration (FDA) for use in healthcare settings during the COVID-19 pandemic and Health Canada Medical Device Authorization for Importation or Sale, under Interim Order for Use in Relation to COVID-19. Following these certifications, mass production is ongoing and distribution is under way in several countries. The MVM was designed, tested, prepared for certification, and mass produced in the space of a few months by a unique collaboration of respiratory healthcare professionals and experimental physicists, working with industrial partners, and is an excellent ventilator candidate for this pandemic anywhere in the world.

Zooplankton communities and their relationship with water quality in eight reservoirs from the midwestern and southeastern regions of Brazil

Zooplankton are widely recognised as being regulated primarily by predators and food availability. In reservoirs, the quantity and quality of food resources are generally affected by the characteristics of the water, which in turn are controlled by the flow pulse generated by operation of the dams. In this study, we investigated the relationship between zooplankton, water quality and food availability (phytoplankton) in eight hydroelectric reservoirs located in Brazil. Samples were collected during the rainy and dry periods between 2008 and 2009. In general, the reservoirs exhibited mesotrophic conditions and Cyanobacteria were the predominant phytoplankton. The results showed that the rotifers Kellicottia bostoniensis, Hexarthra mira, Keratella spp., and Polyarthra vulgaris were present, indicating nutrient-rich environments. In addition, the copepod Thermocyclops decipiens occurred in eutrophic environments. In contrast, the cladoceran Daphnia gessneri and copepod Notodiaptomus henseni were considered indicators of more desirable water quality, owing to their relationship with waters with lower levels of nutrients and suspended solids. The results support the use of these organisms as a useful tool for understanding changes in water quality and in the ecosystem processes involved.

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 &lt; 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.

Detecting False Alarms by Analyzing Alarm-Context Information: Algorithm Development and Validation

Background

Although alarm safety is a critical issue that needs to be addressed to improve patient care, hospitals have not given serious consideration about how their staff should be using, setting, and responding to clinical alarms. Studies have indicated that 80%-99% of alarms in hospital units are false or clinically insignificant and do not represent real danger for patients, leading caregivers to miss relevant alarms that might indicate significant harmful events. The lack of use of any intelligent filter to detect recurrent, irrelevant, and/or false alarms before alerting health providers can culminate in a complex and overwhelming scenario of sensory overload for the medical team, known as alarm fatigue.

Objective

This paper’s main goal is to propose a solution to mitigate alarm fatigue by using an automatic reasoning mechanism to decide how to calculate false alarm probability (FAP) for alarms and whether to include an indication of the FAP (ie, FAP_LABEL) with a notification to be visualized by health care team members designed to help them prioritize which alerts they should respond to next.

Methods

We present a new approach to cope with the alarm fatigue problem that uses an automatic reasoner to decide how to notify caregivers with an indication of FAP. Our reasoning algorithm calculates FAP for alerts triggered by sensors and multiparametric monitors based on statistical analysis of false alarm indicators (FAIs) in a simulated environment of an intensive care unit (ICU), where a large number of warnings can lead to alarm fatigue.

Results

The main contributions described are as follows: (1) a list of FAIs we defined that can be utilized and possibly extended by other researchers, (2) a novel approach to assess the probability of a false alarm using statistical analysis of multiple inputs representing alarm-context information, and (3) a reasoning algorithm that uses alarm-context information to detect false alarms in order to decide whether to notify caregivers with an indication of FAP (ie, FAP_LABEL) to avoid alarm fatigue.

Conclusions

Experiments were conducted to demonstrate that by providing an intelligent notification system, we could decide how to identify false alarms by analyzing alarm-context information. The reasoner entity we described in this paper was able to attribute FAP values to alarms based on FAIs and to notify caregivers with a FAP_LABEL indication without compromising patient safety.

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.