Numerical simulation of the deadliest flood event of Portugal: Unravelling the causes of the disaster

The flood event of November 25 and 26, 1967 corresponds to the deadliest storm affecting Portugal in recent centuries being responsible for >500 fatalities. The main trigger was the heavy rain that fell in just a few hours, provoking a rapid increase in river flows, although other concurrent circumstances had to occur to reach the dramatic water levels estimated in some affected places. However, even today, several important uncertainties related to water levels achieved and timing of floods remain. Here we aim to clarify some of the pending issues by applying suitable high performance numerical tools to elucidate the main conditioning factors that played a key role in the intensification of this dramatic flood. In particular, the analysis has been focused on Quintas village, the location most affected, where >100 fatalities were recorded, close to 2/3 of its total population at the time. The main conclusion provided by the numerical simulations was that a plugging of water flow downstream of Quintas village, favoured by a poor terrain maintenance coupled with the bottleneck created by topographic features, caused the critical over-elevation of water levels. Simulations also corroborate the rapid increase in water levels in Quintas village, with an estimated rise of >2 m in just two hours, as well as the occurrence of the flood during the night, preventing many people to be aware of the extreme danger they were facing and safeguarding themselves.

Using green to cool the grey: Modelling the cooling effect of green spaces with a high spatial resolution

The urban heat island effect creates warmer and drier conditions in urban areas than in their surrounding rural areas. This effect is predicted to be exacerbated in the future, under a climate change scenario. One way to mitigate this effect is to use the urban green infrastructure as a way to promote the cooling island effect. In this study we aimed to model, with a high spatial resolution, how Mediterranean urban parks can be maximized to be used as cooling islands, by answering the following questions: i) which factors influence the cooling effect and when?; ii) what type of green spaces contributes the most to the cooling effect?; iii) what is the cooling distance of influence? To answer these questions we established a sampling design where temperature and relative humidity were measured in different seasons, in locations with contrasting characteristics of green and grey cover. We were able to model the effect of green and grey spaces in the cooling island effect and build high spatial resolution predicting maps for temperature and relative humidity. Our study showed that even green spaces with reduced areas can regulate microclimate, alleviating temperature by 1-3 °C and increasing moisture by 2-8%, on average. Green spaces with a higher density of trees were more efficient in delivering the cooling effect. The morphology, aspect and level of exposure of grey surfaces to the solar radiation were also important features included in the models. Green spaces influenced temperature and relative humidity up to 60 m away from the parks' limits, whereas grey areas influenced in a much lesser range, from 5 m up to 10 m. These models can now be used by citizens and stakeholders for green spaces management and human well-being impact assessment.

GO-DACT: a phase 3b randomised, double-blind, placebo-controlled trial of GOlimumab plus methotrexate (MTX) versus placebo plus MTX in improving DACTylitis in MTX-naive patients with psoriatic arthritis

Objectives

To assess the efficacy of golimumab in combination with methotrexate (MTX) versus MTX monotherapy in psoriatic arthritis (PsA) dactylitis.

Methods

Multicentre, investigator-initiated, randomised, double-blind, placebo-controlled, parallel-design phase 3b trial in 11 Portuguese rheumatology centres. Patients with PsA along with active dactylitis and naive to MTX and biologic disease-modifying antirheumatic drugs (bDMARDs) were randomly assigned to golimumab or placebo, both in combination with MTX. The primary endpoint was Dactylitis Severity Score (DSS) change from baseline to week 24. Key secondary endpoints included DSS and Leeds Dactylitis Index (LDI) response, and changes from baseline in the LDI and MRI dactylitis score. Analysis was by intention-to-treat for the primary endpoint.

Results

Twenty-one patients received golimumab plus MTX and 23 MTX monotherapy for 24 weeks. One patient from each arm discontinued. Patient inclusion was halted at 50% planned recruitment due to a favourable interim analysis. Median baseline DSS was 6 in both arms. By week 24, patients treated with golimumab plus MTX exhibited significantly greater improvements in DSS relative to MTX monotherapy (median change of 5 vs 2 points, respectively; p=0.026). In the golimumab plus MTX arm, significantly higher proportions of patients achieved at least 50% or 70% improvement in DSS and 20%, 50% or 70% improvement in LDI in comparison to MTX monotherapy.

Conclusions

The combination of golimumab and MTX as first-line bDMARD therapy is superior to MTX monotherapy for the treatment of PsA dactylitis.

Trial registration number

NCT02065713

The GO-DACT protocol: a multicentre, randomized, double-blind, parallel-group study to compare the efficacy of golimumab in combination with methotrexate (MTX) versus MTX monotherapy

The GO-DACT is an investigator-initiated, national, multicentric randomized placebo-controlled double-blinded trial, that assesses dactylitis as primary endpoint. Psoriatic arthritis patients naïve to methotrexate and biologic disease modifying anti-rheumatic drugs, with at least one active dactylitis, were assigned to golimumab in combination with methotrexate or placebo in combination with methotrexate, for 24 weeks. Both clinical (dactylitis severity score and the Leeds dactylitis index) and imaging (high resolution magnetic resonance imaging), among others, were assessed as outcomes. The main objective of GO-DACT is to provide evidence to improve the treatment algorithm and care of psoriatic arthritis patients with active dactylitis. In this manuscript we describe the GO-DACT protocol and general concepts of the methodology of this trial.

Temporal relationship between environmental factors and the occurrence of dengue fever

To determine the time-lag effect of meteorological factors on the relative risk (RR) of dengue incidence in Coronel Fabriciano city, Brazil, we applied a distributed lag nonlinear model, a modeling framework that can simultaneously represent nonlinear exposure-response dependencies and delayed effects, to establish the association between dengue incidence and weather predictors. The weekly number of notified dengue cases during the period 2004-2010 was used for analysis. When considering the rainfall, the highest RR (1.2) was observed for lag 10. Observing the cumulative effect of the precipitation, the RR for 12th and 13th week was RR = 4. The highest risk, 1.25, was observed at 25 °C, denoting that the risk of dengue transmission increases with temperature. Climate-based models that take into account the time lag between rainfall, temperature, and dengue can be useful in dengue control programs to be applied in tropical countries.

2011 Portuguese recommendations for the use of biological therapies in patients with psoriatic arthritis

OBJECTIVE

To develop recommendations for the treatment of psoriatic arthritis (PsA) with biological therapies, endorsed by the Portuguese Society of Rheumatology.

METHODS

These treatment recommendations were formulated by Portuguese rheumatologists based on literature evidence and consensus opinion. A draft of the recommendations was first circulated to all Portuguese rheumatologists and their suggestions were incorporated in the draft. At a national meeting the recommendations were discussed and all attending rheumatologists voted on the level of agreement for each recommendation. A second draft was again circulated before publication.

RESULTS

A consensus was achieved regarding the initiation, assessment of response and switching biological therapies in patients with PsA. Specific recommendations were developed for several disease domains: peripheral arthritis, axial disease, enthesitis and dactylitis.

CONCLUSION

These recommendations may be used for guidance in deciding which patients with PsA should be treated with biological therapies. They cover a rapidly evolving area of therapeutic intervention. As more evidence becomes available and more biological therapies are licensed, these recommendations will have to be updated.