Design of more efficient luminescent solar concentrators by using peripherally dye-doped stacked optical fibers

Ways of improving the optical efficiency of luminescent solar concentrators based on multiple poly(methyl methacrylate) plastic optical fibers peripherally doped with two promising types of dyes are analyzed by means of a Monte-Carlo computational model developed by us. By comparing the performance of optical fibers doped with lumogen red and lumogen yellow, or combinations of them at several concentrations, this work clarifies how to achieve a better compromise between the trapping efficiency of the sunlight and the reabsorption of the light emitted by the mixture in stacked optical fibers connected to a photovoltaic solar cell.

Epigenetic regulation by metabolites from the gut microbiome

The gut microbiome can metabolise food components, such as dietary fibres and various phytochemicals; and the microbiome can also synthesise some nutrients, for example B vitamins. The metabolites produced by bacteria and other micro-organisms in the colon can have implications for health and disease risk. Some of these metabolites are epigenetically active, and can contribute to changes in the chemical modification and structure of chromatin by affecting the activity and expression of epigenetically-active enzymes, for example histone deacetylases and DNA methyltransferases. The epigenetic activity of such gut microbiome metabolites is reviewed herein.

How can policymakers incorporate uncertainty (as modelled through foresight) into policy evaluation?

Background

Using a robust policy evaluation framework is critical to inform policymakers about the relevance of a policy in a structured way, clarifying its implications and providing arguments and criteria to compare competing options and decide which policy should be prioritised. In the current context of complex societal, environmental and public health challenges, decision-makers demand tools that allow a comparative assessment of the effectiveness of multisectoral policies and their comparison under different scenarios.

Methods

This presentation will detail a socio-technical “desirability-doability” framework (2xD). In 2xD, an additive value model is constructed to measure the desirability of public policies, and their doability is appraised under two contrasted scenarios. For these purposes, the MACBETH approach is used in developing the three group modelling phases of 2xD: (I) Structuring facilitated workshops, (II) Evaluation decision conference, and (III) Desirability-doability decision conference. Tailor-made interactive protocols or questioning procedures are used to elicit group judgements, based on which objective-specific value scores are assigned to the policies, and the objectives are weighted (in II). Finally, we elicit doability scores for the policies under each scenario (in III).

Results

We present how the 2xD framework was applied in Lisbon's urban health policymaking setting and discuss case insights regarding the role of scenario analysis in the appraisal and selection of policies.

Conclusions

The 2xD framework advances knowledge on how to assist policymakers in evaluating and selecting policies and contributes to the literature on overall policy formulation and evaluation. Specifically, the framework enabled a group of policymakers to balance (multicriteria) desirability versus doability of policies under the light of two contrasting scenarios, therefore incorporating uncertainty in their decision-making process.

Anorexia nervosa admissions during the COVID-19 pandemic: results from a Department of Psychiatry in northern Portugal

Introduction

Emerging evidence suggests that the COVID-19 pandemic had a negative impact on mental health. In particular, patients with Anorexia nervosa (AN) may have faced increased symptom severity.

Objectives

To compare the clinical characteristics of inpatients with AN admitted amidst the COVID-19 pandemic versus the two previous years.

Methods

Retrospective observational study of inpatients admitted between January 2018 and December 2020 in a psychiatry inpatient unit of a tertiary hospital.

Results

There were 11 admissions of patients with AN in 2020 (8 from March onwards), a 22% increase relative to 2019, which in turn saw a 28% increase in admissions relative to 2018. Most patients had an AN diagnosis previous to the pandemic. The majority were undergoing outpatient treatment for over a year. Two patients were admitted within a month of outpatient treatment. There was an increase in admissions through the emergency service in 2020. The most frequent diagnostic was AN binge-eating/purging type in 2020 and 2019, whereas in 2018 the AN restrictive type was dominant. Mean BMI at admission and average length of stay were similar across the three years. Readmission in a 12-month period was 54,5% in 2020 (22,2% in 2019 and 42,9% in 2018).

Conclusions

Despite the widespread impression of a negative impact of the pandemic on AN patients, in our study the clinical characteristics of AN patients admitted in 2020 were mostly similar to the two previous years. Readmissions were higher in 2020, therefore future analysis of data from 2021 might be more enlightening.

Disclosure

No significant relationships.

POS1232 LONG-TERM OUTCOMES OF COVID-19 VACCINATION IN PATIENTS WITH RARE AND COMPLEX CONNECTIVE TISSUE DISEASES: AN AD-INTERIM ANALYSIS OF ERN-ReCONNET VACCINATE STUDY

Background

Since the COVID-19 vaccination campaign was launched all over Europe, there has been general agreement on how benefits of SARS-CoV2 vaccines outweigh the risks in patients with rare connective tissue diseases (rCTDs). Yet, there is still limited evidence regarding safety and efficacy of such vaccines in these patients, especially in the long-term. For this reason, in the framework of ERN-ReCONNET, an observational long-term study (VACCINATE) was designed in order to explore the long-term outcome of COVID-19 vaccination in rCTDs patients. The consent form was developed thanks to the involvement of the ERN ReCONNET ePAG Advocates (European Patients Advocacy Group).

Objectives

To evaluate the safety profile of COVID-19 vaccination in rCTDs patients and the potential impact on disease activity. Primary endpoints were the prevalence of adverse events (AEs) and of disease exacerbations post-vaccination. Secondary endpoints were the proportion of serious adverse events (SAEs) and adverse events of special interest for COVID-19 (adapted from https://brightoncollaboration.us/wp-content/uploads/2021/01/SO2_D2.1.2_V1.2_COVID-19_AESI-update-23Dec2020-review_final.pdf)

Methods

The first ad-interim analysis of the VACCINATE study involved 9 ERN-ReCONNET Network centres. Patients over 18 years of age with a known rCTD and who received vaccine against COVID-19 were eligible for recruitment. Demographic data and diagnoses were collected at the time of enrolment, while the appearance of AEs and potential disease exacerbations were monitored after one week from each vaccination dose, and then after 4, 12 and 24 weeks from the second dose. A disease exacerbation was defined as at least one of the following: new manifestations attributable to disease activity, hospitalization, increase in PGA from previous evaluation, addition of corticosteroids or immunosuppressants.

Results

A cohort of 300 patients (261 females, mean age 52, range 18-85) was recruited. Systemic lupus erythematosus (44%) and systemic sclerosis (16%) were the most frequent diagnoses, followed by Sjogren’s syndrome (SS,12%), idiopathic inflammatory myositis (IMM,10%), undifferentiated connective tissue disease (UCTD,8%), mixed connective tissue disease (MCTD,4%), Ehlers-Danlos’s syndrome (EDS,4%), antiphospholipid syndrome (APS,2%). AEs appearing 7 days after the first and second doses were reported in 93 (31%) and 96 (32%) patients respectively, mainly represented by fatigue, injection site reaction, headache, fever and myalgia. Otitis, urticaria, Herpes Simplex-related rash, stomatitis, migraine with aura, vertigo, tinnitus and sleepiness were reported with very low frequency. Less than 2% of patients experienced AEs within 24 weeks from the second dose. No SAEs or AEs of special interest were observed in the study period. There were 25 disease exacerbations (8%), 7 of which severe. The highest number of exacerbations was observed after 4 weeks from the second dose (12 within week 4, 6 within week 12 and 7 within week 24). Disease exacerbation was most frequent in patients with EDS (33%) and MCTD (25%).

Conclusion

This preliminary analysis shows that COVID-19 vaccination is safe in rCTDs patients. AEs appear most often early after vaccination and are usually mild. Disease exacerbations are not frequent, but can be potentially severe and tend to occur most frequently within the first month after vaccination. Exacerbations can also occur 3-6 months after vaccination, although a causal relationship with the vaccination remains to be established. Our present data underline the importance of long-term observational studies.

Table 1.

AEs and disease exacerbations per disease

DiagnosisPatients enrolled (%) (n=300)EAs after 1st and 2nd dose (%)Exacerbations (%)APS25714EDS45033IIM10527MCTD44225SS12598SLE44698SSC16492UCTD850-

Acknowledgements

VACCINATE is a study promoted by the European Reference Network on rare and complex connective tissue diseases, ERN ReCONNET. This publication was funded by the European Union’s Health Programme (2014-2020)

Disclosure of Interests

None declared

Addressing the sexual and reproductive health of women with Bipolar Disease

Introduction

Bipolar disorder (BD) is a severe mental illness (SMI) with an estimated lifetime prevalence of around 1%, starting in young adulthood and progressing with acute episodes. Although there is no significant prevalence difference between the sexes, the course of the disorder may be more problematic in women, due to hormonal and reproductive factors. Moreover, hypersexuality and impulsive sexual behaviour can manifest as part of a manic or hypomanic episodes, with devastating effects on the physical and emotional health of these patients.

Objectives

To highlight the pertinent issues related to sexual and reproductive health of women with BD.

Methods

A non systematic review of the literature from the last 10 years was carried out using the electronic databases, Pubmed and Google Scholar. The literature search was confined to papers written in English. The keywords ‘sexual health’, ‘reproductive health’, were combined with ‘bipolar disorder’ and ‘women’.

Results

The literature points to an increased incidence of unsafe sexual practices (unprotected sex, multiple sexual partners, trading sex) as well as poor reproductive and sexual health (increased risk of sexually transmitted diseases, high risk of unwanted pregnancies and abortions, low use of contraceptives, menstrual and fertility problems). Female patients with BD are also more likely to report history of sexual abuse.

Conclusions

Attention and counseling regarding effective contraception, planning a pregnancy and risk of sexually transmitted diseases, among others, should be an integral part of health care received by all women with bipolar disorder.

Disclosure

No significant relationships.

A growing heart: a literary review on clozapine-induced Myocarditis

Introduction

Clozapine, a unique antipsychotics, is well known for its adverse effects. Myocarditis is a rare but life-threatening complication, however not monitored at a global scale.

Objectives

This work aims to review the literature on clozapine-induced myocarditis.

Methods

Pubmed and Google Scholar search using Mesh terms clozapine, myocarditis, clozapine-induced myocarditis.

Results

Clozapine-induced Myocarditis (CIM) is potentially fatal, with mortality rates environ 21%. According to the World Health Organization Monitoring Program, notification rate is 0,93%, nonetheless incidence found in literature varies dramatically. Highest rates are reported in Australia, where this relationship was first established and a complete monitoring protocol is compulsory in all patients starting clozapine, which causes some authors to defend this condition is generally undernotified. Underlying mechanisms are not fully understood, but an imunomediated hypersensitive reaction occurring in the first 3-4 weeks after treatment is suggested. CIM is rare after 6 weeks. Risk factors include age, cardiac disease, initial high dose, rapid titration and simultaneous valproate or other antipsychotics use. The most common symptoms, fever, tachycardia, dyspnea and malaise, are non-specific and can be indistinguishable from other clozapine benign adverse effects. Analytically, C-reactive protein and Troponine elevation are the most specific diagnostic markers, therefore the most suitable for monitoring. Prompt cardiological observation for further evaluation should be seeked whenever CIM is suspected.

Conclusions

Diagnosis of CIM can be challenging. Systematic monitoring is not consensual but may increase detection, prevent severe outcomes and help clinicians decide whether to keep or suspend therapy. Clozapine is beneficial and shouldn’t be avoided or unjustifiably discontinued.

Disclosure

No significant relationships.

What is the Pisa Syndrome? A review

Introduction

Pisa syndrome (PS) is a type of dystonia of rare occurrence, first described in 1972 as an adverse effect of neuroleptic agents. It is used to describe a postural abnormality that includes trunk flexion in the coronal plane and axial rotation, which improves in the supine position.

Objectives

In this work, we aim to conduct a brief review of Pisa Syndrome aetiology, pathophysiology and treatment.

Methods

A non-systematic search was conducted through the PubMed database for “pisa syndrome”. Articles were screened for relevant information on PS aetiology, pathophysiology and treatment.

Results

Pisa syndrome has been associated as an adverse effect of multiple drugs from different classes, mainly antipsychotics, dopaminergic agents and cholinesterase inhibitors. The underlying mechanisms are not yet fully understood. Nevertheless, one of the most consensual hypothesis considers PS as a consequence of a cholinergic-dopaminergic imbalance that can be caused by antipsychotic treatment. Some factors have been associated with increased risk for developing PS such as old age and polypharmacy. PS appears to be better treated with the reduction or interruption of the agent(s) associated with its onset.

Conclusions

Despite its low incidence, Pisa syndrome can occur as a side effect of a number of different medications and the identification of the trigger-drug is fundamental so it can be reduced or interrupted in order to treat this condition.

Disclosure

No significant relationships.

OP0041-PARE SJÖGREN EUROPE: REVIEW OF ITS FIRST THREE YEARS OF ACTIVITY

Background

Sjögren Europe was founded on 23 February 2019 by several European patient organisations representing Sjögren’s patient to help to address the lack of visibility, attention, and solutions for Sjögren’s.

Objectives

To show the first achievements and contributions of the federation.

Methods

Sjögren Europe’s purpose is to promote the advancement of knowledge, research, information, treatment, and care, to foster patient involvement and participation in research and any other relevant area, to increase awareness, identify the different unmet needs and articulate patient voices throughout Europe.

Results

Finding one’s bearings and the right rhythm during the first years of an organisation’s life is a challenge in itself. The Covid-19 pandemic has made this process even more difficult. Our first goal was to organise a first face-to-face European patient conference. This meeting had to be postponed. However, we were able to adapt and develop a range of activities.

We organised a series of informative webinars on different topics by leading European experts for patients and others interested in the subject. We have organised various awareness campaigns such as a campaign for Sjögren Awareness Month in 2021 for which we have created 2 awareness videos and published several testimonials. We also created a 3-axis campaign about fatigue for World Sjögren’s Day 2021 which won the Best Practice Award at the 2021 PARE Conference, and during which we shared the patients’ perspective on fatigue in publications in 13 languages on social media. We published a booklet about fatigue developed by a specialist and produced 3 informative leaflets for patients. We also subtitled 2 videos made by one of our members in 10 European languages to disseminate quality information that many patients miss. We have been involved in various research projects, working groups and patient panels and have been able to bring the patient perspective to various stakeholders on many occasions.

Conclusion

Despite the limited contacts, we were able to create strong links and rich discussions that stimulated our creativity. Sjögren Europe has become a privileged partner, recognised, and appreciated by the various stakeholders. Patients with Sjögren’s are better represented at the supranational level. It is our members, the national patient organisations, who by their trust give us our legitimacy. In return, Sjögren Europe has been able to inject a new energy and dynamism that can be felt at the different national levels and that opens up many perspectives and opportunities. We have been able to strengthen our presence and visibility with patients on social networks, where our audience is constantly growing, as well as in the rheumatology field with researchers, clinicians, industry, and associations such as EULAR. The resumption of face-to-face contacts is eagerly awaited to consolidate the links already created and to feed the richness, relevance, originality and diversity of our discussions and activities.

Disclosure of Interests

None declared.

POS0013 MUSCULOSKELETAL MANIFESTATIONS IN PATIENTS WITH ENDOCRINE DISEASES IN TERTIARY SERVICE

Background:

Musculoskeletal diseases represent about 50 to 70% of the frequency of chronic diseases according to previous studies (SOUZA, OLIVEIRA, 2015). Chronic pain is often associated with these diseases and is an important cause of care in the health service. Thus, medical professionals are required to adequately manage their patients. Despite the lack of knowledge of some, endocrine diseases are basic diseases linked to musculoskeletal manifestations.

Thus, secondary arthropathies of the non-rheumatologic origin or osteoarticular complaints that simulate or show rheumatic diseases can be seen in patients with endocrine diseases during their evolution or in the initial phase along with other systemic symptoms.

Based on this concept, the musculoskeletal manifestations presented by patients with endocrine disorders in tertiary health service were monitored and evaluated.

Objectives:

The objective of this study is to characterize the musculoskeletal manifestations in patients with endocrine diseases: type 1 and type 2 diabetes mellitus; hypothyroidism; hyperthyroidism and pituitary diseases and to clinically classify the patients based on physical and imaging findings.

Methods:

A cross-sectional and descriptive study, where clinical screening was performed at the endocrinology outpatient clinic, in which patients with musculoskeletal complaints were identified. These patients were referred for evaluation with a rheumatologist with clinical, laboratory and imaging investigation for the diagnosis of rheumatic disease. A questionnaire with epidemiological and clinical data was applied.

Results:

In this study, 325 patients with endocrine diseases were interviewed, 53 ± 16.4 years old, 258 (80%) were female and 64 (20%) males. Of the interviewed patients, 236 (72.8%) reported musculoskeletal pain, being that 196 (75.9%) of the women and 33% of the men indicated this type of symptom. Regarding endocrine diseases, the most frequent was Diabetes Mellitus type 2 with 158 patients (48.6%), and 75% of these people have chronic musculoskeletal pain, most 5 to 7 times a week, showing an intrinsic character of this disease with pain complaints from a large part of this population. It was also identified the prevalence of 25% of Hypothyroidism, 12% of Diabetes type 1, 9% of Hyperthyroidism and less expressive amounts of other endocrine diseases such as Acromegaly (2.1%), Gigantism (0.3%) and similar. About 63% of those who have pain are not followed up in the service of rheumatology, 42% of these have already indicated these pains to their endocrinologist, however they have not had their complaint properly flagged. Of these patients, 94 (29%) use Antihypertensives and 25% Oral Antidiabetics. The most notable diagnoses in rheumatology are: Rheumatoid Arthritis (29%); Osteoarthritis (27%); Osteoporosis and Fibromyalgia both with 20.6% of diagnoses and Psoriatic Arthritis and GOUT with 6%. The main regions that are subject to pain are the Hands (52%); Knees (40%); Spine and feet with 30% each.

Conclusion:

Although there is a demand of more confirmatory studies, our preliminary results showed the mutuality between endocrine diseases and musculoskeletal manifestations and, therefore, that rheumatological findings are increasingly frequent in this population. The high prevalence of these symptoms secondary to endocrine diseases raises serious questions in order to improve the quality of life of these patients, and also to increase the number of researches in this field, because the pathophysiological mechanisms of this association are not well elucidated and, from this, expand this information to professionals who may not be aware of this relationship.

References:

[1]SOUZA, Cesario da Silva; OLIVEIRA, Anamaria Siriani. Prevalência de encaminhamentos às doenças musculoesqueléticas segundo a classificação estatística internacional de doenças (CID-10): reflexões para formação do fisioterapeuta na área de musculoesquelética. Fisioterapia e Pesquisa v. 22, n. 1, p. 48–53, 2015.

Disclosure of Interests:

None declared.

Modelling of polymer optical fiber-based solar concentrators

A comprehensive model for the theoretical simulation of luminescent solar concentrators (LSCs) has been developed and examined. It can simulate the interdependent effects of multiple dopants having two main electronic energy states, which are incorporated simultaneously into the fiber core, as well as the effect of the cladding. The available experimental results appear to confirm the accuracy of the model, which is a valuable tool for gaining insight into the behavior of LSC prototypes, since it may guide the designers at the early stages of optimization processes.

Bipolar mania with psychosis vs without psychosis: A clinical characterization with indirect measures of severity

Introduction

The presence of psychotic symptoms is highest during acute episodes of bipolar mania. There is no evidence base regarding the implications of psychosis in the prognosis of bipolar disorder, despite common assumption that their occurrence reflects greater disease severity.

Objectives

We aim to compare sociodemographic and clinical characteristics of inpatients admitted for bipolar mania with and without psychotic features.

Methods

Retrospective observational study of inpatients admitted between January 1^st 2017 and 31 October 2020 in a psychiatry inpatient unit of a tertiary hospital. Descriptive analysis of the results was performed using the SPSS software, version 26.0.

Results

Between 2017 and October 2020 there were 103 admissions due to mania bipolar I disorder, 53.4% (n=55) with psychotic symptoms. When compared with mania without psychosis, psychotic mania was associated to male gender (71.1% to 39.7%; c²(1, N = 103) = 10,06; p = 0.02) and younger age (t(103) = -2.43; p = 0.017). The proportion of compulsory admissions and average length of stay were similar between mania with psychosis and mania without psychosis. Also, having a manic bipolar episode with psychotic symptoms was not associated to being prescribed a long-acting injectable antipsychotic.

Conclusions

The presence of psychotic symptoms in bipolar manic episodes were associated to male gender and younger age but not to indirect measures of illness severity.

Disclosure

No significant relationships.

Follie a deux: Psychopathology in a pandemic

Introduction

Follie a deux is a rare syndrome characterized by the transference of delusions from a primary subject to a secondary one. This rare condition, and frequently forgotten in psychiatry pratice, is more frequent in feedlots, particularly in situations alike we face nowadays because of the pandemic.

Objectives

To describe a clinical case and to discuss and highlight some clinical aspects of this entity.

Methods

Present a clinical case report and respective non systematic literature review

Results

This clinical vignete describes a case of shared delusion between a mother and a son. The son suffers from an intelectual disability and shared with his mother a persecutory and prejudice delusion. Both live in the same house and because of the pandemic they spend all the time together. This situation was probably the main factor influencing the course of the symptoms.

Conclusions

It is highlighted the importance of a social isolation and close contact between the pair mother/son, more important in context of a global pandemic, viewed as an obstacle to promote the separation of both.

Inpatient psychiatry care during coronavirus 2019 pandemic lockdown: Results from a department of psychiatry in northern Portugal

Introduction

COVID-19 pandemic and the consequent containment measures have a negative impact on mental health. Simultaneously, the fear of infection can discourage patients from seeking necessary care.

Objectives

We aim to compare sociodemographic and clinical characteristics of inpatients admitted during the COVID-19 confinement period in Portugal vs. inpatients admitted in the same period the previous year.

Methods

Retrospective observational study of inpatients admitted between March 19^th 2020 and May 1^st 2020 and the analog period of 2019 in a psychiatry inpatient unit of a tertiary hospital. Descriptive analysis of the results was performed using the SPSS software, version 26.0.

Results

During the lockdown period, there were 30 admissions to the psychiatry inpatient unit, 55.2% less than the same period last year (n=67). The proportion of compulsory admissions and the average length of stay did not differ between the two periods. Regarding sociodemographic characteristics, in the confinement period inpatients were similar to the ones in the same period of 2019. In both periods, the majority of patients had previous psychiatric history (lockdown vs. same period last year: 95.5% and 90.0%) and a similar proportion of readmissions rate (previous year) was similar in the two groups (49.9% vs 47.6%). At discharge, the most frequent diagnostic groups were mood disorders (33.3% (n=10) and 34.3% (n=23)) and schizophrenia, schizotypal and delusional disorders (26,7% (n=8) and 31.3% (n=21)).

Conclusions

Although there was an expressive reduction of admissions to the psychiatry inpatient unit during lockdown, the clinical characteristics of these patients were analogous to the same period in the previous year.

[Response to perampanel in a patient with chronic post-hypoxic myoclonus]

INTRODUCTION

Chronic post-hypoxic myoclonus is a condition in which the predominant clinical picture is myoclonus following hypoxic brain damage, usually due to cardiorespiratory arrest. It is a condition that is usually treated with antiepileptic drugs, in most cases with a modest clinical response.

CASE REPORT

We report the case of a patient who started with jerking movements, compatible with myoclonus in the four limbs and the face the day after recovering from a cardiorespiratory arrest. An electroencephalogram was performed during which the myoclonias were recorded with no electrical correlates. During admission, and in successive visits after discharge, different antiepileptic treatments were tried for the myoclonias, which were refractory and affected the patient's quality of life. Two years after onset, treatment with perampanel up to a dose of 4 mg was initiated and the patient reported a significant clinical improvement, as evidenced in the visits.

CONCLUSIONS

Perampanel may be an effective alternative for the treatment of myoclonias in patients with chronic post-hypoxic myoclonus.

Wildfires in the wildland-urban interface: Key concepts and evaluation methodologies

Over the last decades, the different issues regarding the expansion of the wildland-urban interface (WUI) - particularly those related to fires - have spread around the world with particular exposure in the USA, Canada, Australia, and, more recently, in southern European countries (e.g. Portugal and Greece). It has been receiving even more attention from the scientific community particularly due to the ecological and sociological implications on the management of natural resources and decisions associated with spatial planning. Consequently, throughout the extensive research conducted on wildfires, there has been a growing interest and body of literature on wildfires in the WUI worldwide. Although there are many articles published in English, in indexed journals, there is an excellent body of literature published in other languages (e.g. French, Spanish, Portuguese), which is not very well known and rarely cited. In this body of literature, whether in English or other languages, concepts and definitions are not always consensual. In this sense, this paper aims at reviewing the key concepts regarding intrinsic characteristics of the WUI and wildfires in the WUI, presenting evaluation methodologies that have been applied to WUI and analyzing several risk prevention and reduction programs developed in WUI affected by forest fires in different parts of the world. Through our analysis we found that the work developed by researchers worldwide on this subject is significant, considering the increasing relevance of this environmental problem. However, it is fundamental to define standardized methodologies in order to facilitate the transfer of knowledge and promote cooperation, interdisciplinarity. The implementation of a collaborative approach is needed, especially in the development of strategies to prevent and reduce fire risk in these areas.

The link between nitrous oxide emissions, microbial community profile and function from three full-scale WWTPs

Few attempts have been made in previous studies to link the microbial community structure and function with nitrous oxide (N₂O) emissions at full-scale wastewater treatment plants (WWTPs). In this work, high-throughput sequencing and reverse transcriptase-qPCR (RT-qPCR) was applied to activated sludge samples from three WWTPs for two seasonal periods (winter and summer) and linked with the N₂O emissions and wastewater characteristics. The total N₂O emissions ranged from 7.2 to 937.0 g N-N₂O/day, which corresponds to an emission factor of 0.001 to 0.280% of the influent NH₄-N being emitted as N₂O. Those emissions were related to the abundance of Nitrotoga, Candidatus Microthrix and Rhodobacter genera, which were favored by higher dissolved oxygen (DO) and nitrate (NO₃^-) concentrations in the activated sludge tanks. Furthermore, a relationship between the nirK gene expression and N₂O emissions was verified. Detected N₂O emission peaks were associated with different process events, related to aeration transition periods, that occurred during the regular operation of the plants, which could be potentially associated to increased emissions of the WWTP. The design of mitigation strategies, such as optimizing the aeration regime, is therefore important to avoid process events that lead to those N₂O emissions peaks. Furthermore, this study also demonstrates the importance of assessing the gene expression of nosZ clade II, since its high abundance in WWTPs could be an important key to reduce the N₂O emissions.

Organizing pneumonia revisited: insights and uncertainties from a series of 67 patients

Background: Organizing pneumonia (OP) is classified as an acute/subacute pneumonia according to the American Thoracic Society/European Respiratory Society statement (2013 update). Although its clinical presentation, radiologic and histologic features are well established, data on the relevance of potential causes, corticosteroid doses and length, or management of relapses are based on heterogeneous series of patients. Objectives: The aims of this study were to describe clinical presentation, diagnosis and treatment of OP, explore potential causes, discuss strategies for managing relapses, and analyze prognostic factors. We also discuss our findings in relation to relevant data in the literature. Methods: We performed a cross-sectional study of all patients diagnosed with OP at a tertiary referral center in northern Portugal between 2008 and 2015. Results: Sixty-seven patients were diagnosed with OP over the 7-year study period. Dyspnea and cough were the most common presenting symptoms and approximately 30% of patients were hospitalized at the time of diagnosis. Approximately half of the patients were receiving drugs described as potential causes of OP. Microorganisms were isolated in approximately one-third of patients. Other potential causes identified were hematologic disorders, neoplasms, connective tissue diseases, myelodysplastic syndromes, immunodeficiencies, radiotherapy, and bird exposure. Cryptogenic OP was diagnosed in just 16 patients (23.8%). Corticosteroids were the most common treatment and 11 patients (16.4%) experienced relapse. Conclusions: The findings for this series of patients confirm the extreme variability of the contexts in which OP can occur and suggest that rather than a distinct, homogeneous clinicopathologic entity, OP is a non-specific reaction whose outcomes are dependent on the cause. (Sarcoidosis Vasc Diffuse Lung Dis 2018; 35: 129-138).

How Does Fluoride Concentration in the Tooth Affect Apatite Crystal Size?

Despite fluoride’s (F) well-documented ability to prevent caries, the effects of F concentrations on enamel and dentin apatite crystals are unknown. The present study examined the hypothesis that tooth F concentration and tooth crystallite size correlate. One hundred human unerupted third molars were studied—53 from Fortaleza-Brazil (F water 0.7 ppm), 23 from Toronto (1.0 ppm), and 24 from Montreal (0.2 ppm). F concentration was analyzed by Neutron Activation Analysis and apatite crystal size by powder x-ray diffraction. A positive correlation between dentin F concentration and enamel crystallite length and width was found. Enamel crystallite length was significantly greater in teeth from Fortaleza than in teeth from Toronto (p = 0.011) and Montreal (p = 0.003). Enamel crystallite widths were significantly greater in Fortaleza teeth compared with those from Toronto (p = 0.020) and Montreal (p < 0.001). No difference in the dentin crystallite size was seen in the 3 regions. Thus, tooth F concentration and crystallite size correlate.

How Does Fluoride Affect Dentin Microhardness and Mineralization?

Fluoride (F) has been a useful instrument in caries prevention. However, only limted data exist on the effect of its long-term use on dentin mineralization patterns and microhardness. The objective of this study was to evaluate the influence of tooth F concentration ([F]) and dental fluorosis (DF) severity on dentin microhardness and mineralization. We collected 137 teeth in Montreal and Toronto, Canada, and Fortaleza, Brazil, where optimum or suboptimum levels of water F were 0.2 ppm, 1 ppm, and 0.7 ppm, respectively. Teeth were analyzed for DF severity, dentin [F], enamel [F], dentin microhardness, and dentin mineralization. Dentin [F] correlated with DF severity; enamel [F] correlated with dentin microhardness and dentin mineralization; DF severity correlated with dentin microhardness. Genetic factors ( e.g., DF severity) and environmental factors ( e.g., tooth [F]) influenced the mechanical properties (microhardness) of the teeth, while only the environmental factors influenced their material properties ( e.g., mineralization). Fortaleza teeth were harder and less mineralized and presented higher dentin [F] values. Montreal teeth presented lower levels of DF when compared with both Toronto and Fortaleza teeth.

β-Cell replacement as a treatment for type 1 diabetes: an overview of possible cell sources and current axes of research

To efficiently treat type 1 diabetes, exogenous insulin injections currently represent the main approach to counter chronic hyperglycaemia. Unfortunately, such a therapeutic approach does not allow for perfectly maintained glucose homeostasis and, in time, cardiovascular complications may arise. Therefore, seeking alternative/improved treatments has become a major health concern as an increasing proportion of type 2 diabetes patients also require insulin supplementation. Towards this goal, numerous laboratories have focused their research on β-cell replacement therapies. Herein, we will review the current state of this research area and describe the cell sources that could potentially be used to replenish the depleted β-cell mass in diabetic patients.

Pulmonary Anti-inflammatory Effects of Chitosan Microparticles Containing Betamethasone

Chitosan microparticles (CMs) are of potential interest for controlled delivery of therapeutic agents to cells and tissues, especially to mucosal-epithelial surfaces in the body. CM incorporation efficiency and release kinetics for betamethasone (B), an epimeric synthetic glucocorticoid, were investigated. Evidence for mild but significant inflammatory reactions in rat lung exposed to high CM concentrations was observed. Inflammation in the rat lung was significantly decreased by inhalation of B-loaded CMs (BCMs). Decreases in bronchoalveolar lavage fluid protein, content of polymorphonuclear neutrophils, lactate dehydrogenase (LDH) activity, lung tissue myeloperoxidase (MPO) activity, and leukocyte infiltration were observed. For all biochemical parameters tested, CMs loaded with 1.0-1.2mg/kg B decrease the inflammation by 1.63±0.14 fold, to near air-inhalation control levels. Thus, the drug was efficiently delivered and active in the pulmonary tissues by this technique.

Development and validation of a visual body condition scoring system for dairy goats with picture-based training

Body condition scoring (BCS) is the most widely used method to assess changes in body fat reserves, which reflects its high potential to be included in on-farm welfare assessment protocols. Currently used scoring systems in dairy goats require animal restraint for body palpation. In this study, the Animal Welfare Indicators project (AWIN) proposes to overcome this constraint by developing a scoring system based only on visual assessment. The AWIN visual body condition scoring system highlights representative animals from 3 categories: very thin, normal, and very fat, and was built from data sets with photographs of animals scored by a commonly used 6-point scoring system that requires palpation in 2 anatomical regions. Development of the AWIN scoring system required 3 steps: (1) identification and validation of a body region of interest; (2) sketching the region from photographs; and (3) creation of training material. The scoring system's reliability was statistically confirmed. An initial study identified features in the rump region from which we could compute a set of body measurements (i.e., measures based on anatomical references of the rump region) that showed a strong correlation with the assigned BCS. To validate the result, we collected a final data set from 171 goats. To account for variability in animal size and camera position, we mapped a subset of features to a standard template and aligned all the rump images before computing the body measurements. Scientific illustrations were created from the aligned images of animals identified as representative of each category to increase clarity and reproducibility. For training material, we created sketches representing the threshold between consecutive categories. Finally, we conducted 2 field reliability studies. In the first test, no training was given to 4 observers, whereas in the second, training using the threshold images was delivered to the same observers. In the first experiment, interobserver results was substantial, showing that the visual scoring system is clear and unambiguous. Moreover, results improved after training, reaching almost perfect agreement for the very fat category. The visual body condition scoring system is not only a practical tool for BCS in dairy goats but also shows potential to be fully automated, which would enhance its use in welfare assessment schemes and farm management.

Effects of Rest Interval on Strength Recovery in Breast Cancer Survivors

The purpose of this study was to compare the acute effect of 2 different resting intervals (RI) between sets of isokinetic knee extension exercise on peak torque (PT) and total work (TW) in breast cancer survivors (BCS) and control group (CNT). 16 BCS (52±4 years) and 14 CNT (53±6 years) performed 3 sets of 10 unilateral isokinetic knee extension repetitions at 60°.s(- 1) on 2 separate days with 2 different RI between sets (1 and 2 min). There was a significant interaction between groups vs. exercise sets (p=0.03) and RI vs. exercise sets (p<0.001) for PT. PT was greater in CNT at 1(st) and 2(nd) sets compared to BCS group (CNT, 133.4±20.8 and BCS 107.6±19.9 Nm, p=0.012 and CNT, 118.9±19.6 and BCS, 97.1±15.9  Nm, p=0.045, respectively). The TW of the knee extensor was significant greater in CNT than BCS group for all 3 knee extension exercise sets. In conclusion, the present study suggests that Breast Cancer Survivors women may need a longer rest interval (longer than 2 min) to be able to fully recover during a 3 sets of isokinetic knee extension exercise training session.

Effects of chronic resveratrol supplementation in military firefighters undergo a physical fitness test--a placebo-controlled, double blind study

PURPOSE

The purpose of this study was to determine the plasma metabolic response and certain indicators of oxidative stress (antioxidant system and oxidative stress biomarkers) in plasma and erythrocytes of Brazilian military firefighters supplemented or not with resveratrol (RES) for 90 days (100 mg/day). The analyses were performed before and after a typical physical fitness test (FT) used to induce oxidative stress.

METHODS/RESULTS

In this placebo-controlled double-blinded study, we observed that RES supplementation did not present hepatic consequences compared with the placebo group following analysis of AST, ALT and GGT plasma activities. Plasma glucose and triglycerides levels were increased after the FT in firefighters supplemented with RES but were not elevated at baseline. Neither total nor cholesterol fractions were modified by RES supplementation. CK levels were increased after the firefighters performed the FT; however, no differences were determined between the placebo and RES groups. Ferric-reducing ability of plasma as well as uric acid was increased after the FT, but was not modified by RES supplementation. Plasma oxidative stress biomarkers, such as thiol content, 8-isoprostane and 8OHdG, showed no modifications, while IL-6 and TNF-α were decreased in the RES group after the FT. Among antioxidant enzyme activities determined in erythrocytes from the firefighters, only GPx activity was reduced by RES supplementation both before and after the FT.

CONCLUSION

In summary, the most pronounced effect of RES supplementation is its anti-inflammatory effect, which reduced IL-6 and TNF-α level. The FT applied to Brazilian military firefighters was not sufficient to challenge the antioxidant defense systems, and, therefore, 100mg of RES for three months did not induce significant effects.

IMPLANTAÇÃO DO CERTIFICADO ISO 9001 EM UMA EMPRESA NO SETOR DE PAPELÃO: AVALIANDO SEUS IMPACTOS ORGANIZACIONAIS

O presente trabalho visa apresentar a avaliação dos impactos internos e externos de uma empresa que adotou um sistema de gestão da qualidade total: a certificação ISO 9001. Baseado em um estudo de caso, apoiado paralelamente em referenciais bibliográficos da literatura, em uma empresa do setor de papelão. A pesquisa visa mensurar e avaliar os conceitos básicos de qualidade e os benefícios da certificação. Ao concluir este estudo verificou-se que realmente a obtenção de um certificado ISO 9001 traz diversos impactos organizacionais e conduz à melhoria global da empresa, como a capacidade de gestão e avaliação geral dos relacionamentos, aumento no número de clientes e fornecedores e a melhoria da imagem da empresa diante do mercado.

A Randomized, blinded assessor study to Evaluate the efFIcacy and safety of etanercept 50 mg once weekly plus as Needed topical agent vs. Etanercept 50 mg twice weekly in patients with moderate to severe plaque psoriasis (REFINE)

BACKGROUND

Topical corticosteroids are used with systemic therapies for treatment of plaque psoriasis, but data from randomized clinical trials to document efficacy of combination therapy are lacking.

OBJECTIVE

To evaluate efficacy and safety of adding topical corticosteroid therapy from the time that etanercept dosage is reduced from initial label dose [50 mg twice weekly (BIW)] to maintenance dose [50 mg once weekly (QW)].

METHODS

In this phase 3b, multicentre, randomized, open-label study, patients with moderate-to-severe plaque psoriasis received etanercept 50 mg BIW for 12 weeks, and then were randomized to etanercept 50 mg BIW or 50 mg QW plus topical agent as needed to achieve static physician global assessment (sPGA) status of clear for 12 weeks. Endpoints included percentage change in Psoriasis Area and Severity Index (PASI) score from week 12 to week 24 (primary endpoint); proportion of patients achieving 50% improvement in (PASI 50), PASI 75 and PASI 90; patients achieving sPGA of clear/almost clear; and change in affected body surface area (BSA).

RESULTS

Mean difference [95% confidence interval (CI)] between etanercept arm (n = 140) and etanercept plus topical arm (n = 142) in change in PASI score from week 12 to week 24 was 16.2% (-3.5%, 35.8%). PASI response rates were similar between groups. Percentage (95% CI) of patients achieving sPGA status of clear/almost clear was 40.6% (32.5%, 48.6%) and 45.8% (37.6%, 54.0%) at week 12 for patients in etanercept and etanercept plus topical arms, respectively, and 53.5% (45.3%, 61.7%) and 45.4% (37.2%, 53.6%) at week 24. Difference (95% CI) between groups in change in affected BSA from week 12 to week 24 was 4.9% (-23.4%, 33.2%).

CONCLUSION

Patients who received etanercept 50 mg QW at week 12 plus as-needed topical therapy and those who stayed on etanercept 50 mg BIW maintained clinical response through week 24 with no notable differences in PASI responses.

Cold modalities with different thermodynamic properties have similar effects on muscular performance and activation

Although tissue cooling is widely used in the treatment of musculoskeletal injuries there is still controversy about its effects on muscular performance. The combination of cooling and exercise justifies the study of this topic. The aim was to compare the effects of ice pack and cold-water immersion on the muscular performance parameters of plantar flexors and muscular activation of the triceps surae. 41 healthy men (mean age: 22.1 years, SD: 2.9) were randomly assigned to cooling with either ice pack (n=20) or cold-water immersion (n=21). Independent variables were cold modality (ice pack or cold-water immersion) and pre- and post-cooling measurement time. Dependent variables were muscular performance (measured during isometric and concentric contractions of plantar flexors) and electromyography parameters of the triceps surae (median frequency and root mean square amplitude). Dependent-samples t-tests were used to compare pre- and post-cooling data and independent-samples t-tests were used to compare the difference (pre- and post-cooling) between groups. Ice pack increased isometric peak torque (mean: 9.00 Nm, P=0.01) and both cold modalities reduced muscular activation in triceps surae (P<0.0001); Cold-water immersion and ice pack reduced peak torque and total work during dynamic isokinetic contraction at both velocities (mean: -11,00 Nm, P<0.05) and affected muscular activation in different ways. In conclusion, ice pack increases isometric torque, while both ice pack and cold-water immersion decrease concentric muscular performance. These results indicate that these cooling methods should be chosen with caution, considering the type of task required during training or rehabilitation. New studies investigating other muscle groups and joints are necessary.