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Background Coronary atherosclerosis detected by imaging is a marker of elevated cardiovascular risk. However, imaging involves large resources and exposure to radiation. The aim was, therefore, to test whether nonimaging data, specifically data that can be self‐reported, could be used to identify individuals with moderate to severe coronary atherosclerosis. Methods and Results We used data from the population‐based SCAPIS (Swedish CardioPulmonary BioImage Study) in individuals with coronary computed tomography angiography (n=25 182) and coronary artery calcification score (n=28 701), aged 50 to 64 years without previous ischemic heart disease. We developed a risk prediction tool using variables that could be assessed from home (self‐report tool). For comparison, we also developed a tool using variables from laboratory tests, physical examinations, and self‐report (clinical tool) and evaluated both models using receiver operating characteristic curve analysis, external validation, and benchmarked against factors in the pooled cohort equation. The self‐report tool (n=14 variables) and the clinical tool (n=23 variables) showed high‐to‐excellent discriminative ability to identify a segment involvement score ≥4 (area under the curve 0.79 and 0.80, respectively) and significantly better than the pooled cohort equation (area under the curve 0.76, P

ABSTRACT Mycobacterium bovis causes animal tuberculosis in livestock and wildlife, with an impact on animal health and production, wildlife management, and public health. In this work, we sampled a multi-host tuberculosis community from the official hotspot risk area of Portugal over 16 years, generating the largest available data set in the country. Using phylogenetic and ecological modeling, we aimed to reconstruct the history of circulating lineages across the livestock-wildlife interface to inform intervention and the implementation of genomic surveillance within the official eradication plan. We find evidence for the co-circulation of M. bovis European 1 (Eu1), Eu2, and Eu3 clonal complexes, with Eu3 providing sufficient temporal signal for further phylogenetic investigation. The Eu3 most recent common ancestor (bovine) was dated in the 1990s, subsequently transitioning to wildlife (red deer and wild boar). Isolate clustering based on sample metadata was used to inform phylogenetic inference, unravelng frequent transmission between two clusters that represent an ecological corridor of previously unrecognized importance in Portugal. The latter was associated with transmission at the livestock-wildlife interface toward locations with higher temperature and precipitation, lower agriculture and road density, and lower host densities. This is the first analysis of M. bovis Eu3 complex in Iberia, shedding light on background ecological factors underlying long-term transmission and informing where efforts could be focused within the larger hotspot risk area of Portugal.IMPORTANCEEfforts to strengthen surveillance and control of animal tuberculosis (TB) are ongoing worlwide. Here, we developed an eco-phylodynamic framework based on discrete phylogenetic approaches informed by M. bovis whole-genome sequence data representing a multi-host transmission system at the livestock-wildlife interface, within a rich ecological landscape in Portugal, to understand transmission processes and translate this knowledge into disease management benefits. We find evidence for the co-circulation of several M. bovis clades, with frequent transmission of the Eu3 lineage among cattle and wildlife populations. Most transition events between different ecological settings took place toward host, climate and land use gradients, underscoring animal TB expansion and a potential corridor of unrecognized importance for M. bovis maintenance. Results stress that animal TB is an established wildlife disease without ecological barriers, showing that control measures in place are insufficient to prevent long-distance transmission and spillover across multi-host communities, demanding new interventions targeting livestock-wildlife interactions.

Abstract Cardiovascular magnetic resonance (CMR) can accurately measure left ventricular (LV) mass, and several measures related to LV wall thickness exist. We hypothesized that prognosis can be used to select an optimal measure of wall thickness for characterizing LV hypertrophy. Subjects having undergone CMR were studied (cardiac patients, n = 2543; healthy volunteers, n = 100). A new measure, global wall thickness (GT, GTI if indexed to body surface area) was accurately calculated from LV mass and end-diastolic volume. Among patients with follow-up (n = 1575, median follow-up 5.4 years), the most predictive measure of death or hospitalization for heart failure was LV mass index (LVMI) (hazard ratio (HR)[95% confidence interval] 1.16[1.12–1.20], p

Abstract Large deletions at chromosome 22q11.2 are known to cause severe clinical conditions collectively known as 22q11.2 deletion syndrome. Notwithstanding the pathogenicity of these deletions, affected individuals are typically diagnosed in late childhood or early adolescence, and little is known of the molecular signaling cascades and biological consequences immediately downstream of the deleted genes. Here, we used targeted metabolomics to compare neonatal dried blood spot samples from 203 individuals clinically identified as carriers of a deletion at chromosome 22q11.2 with 203 unaffected individuals. A total of 173 metabolites were successfully identified and used to inform on systemic dysregulation caused by the genomic lesion and to discriminate carriers from non-carriers. We found 84 metabolites to be differentially abundant between carriers and non-carriers of the 22q11.2 deletion. A predictive model based on all 173 metabolites achieved high Accuracy (89%), Area Under the Curve (93%), F1 (88%), Positive Predictive Value (94%), and Negative Predictive Value (84%) with tyrosine and proline having the highest individual contributions to the model as well as the highest interaction strength. Targeted metabolomics provides insight into the molecular consequences possibly contributing to the pathology underlying the clinical manifestations of the 22q11 deletion and is an easily applicable approach to first-pass screening for carrier status of the 22q11 to prompt subsequent verification of the genomic diagnosis.

Schizophrenia is a heterogeneous disorder, exhibiting variability in presentation and outcomes that complicate treatment and recovery. To explore this heterogeneity, we leverage the comprehensive Danish health registries to conduct a prospective, longitudinal study from birth of 5432 individuals who would ultimately be diagnosed with schizophrenia, building individual trajectories that represent sequences of comorbid diagnoses, and describing patterns in the individual-level variability. We show that psychiatric comorbidity is prevalent among individuals with schizophrenia (82%) and multi-morbidity occur more frequently in specific, time-ordered pairs. Three latent factors capture 79% of variation in longitudinal comorbidity and broadly relate to the number of co-occurring diagnoses, the presence of child versus adult comorbidities and substance abuse. Clustering of the factor scores revealed five stable clusters of individuals, associated with specific risk factors and outcomes. The presentation and course of schizophrenia may be associated with heterogeneity in etiological factors including family history of mental disorders.

Epidemiological surveillance of animal tuberculosis (TB) based on whole genome sequencing (WGS) of Mycobacterium bovis has recently gained track due to its high resolution to identify infection sources, characterize the pathogen population structure, and facilitate contact tracing. However, the workflow from bacterial isolation to sequence data analysis has several technical challenges that may severely impact the power to understand the epidemiological scenario and inform outbreak response. While trying to use archived DNA from cultured samples obtained during routine official surveillance of animal TB in Portugal, we struggled against three major challenges: the low amount of M. bovis DNA obtained from routinely processed animal samples; the lack of purity of M. bovis DNA, i.e., high levels of contamination with DNA from other organisms; and the co-occurrence of more than one M. bovis strain per sample (within-host mixed infection). The loss of isolated genomes generates missed links in transmission chain reconstruction, hampering the biological and epidemiological interpretation of data as a whole. Upon identification of these challenges, we implemented an integrated solution framework based on whole genome amplification and a dedicated computational pipeline to minimize their effects and recover as many genomes as possible. With the approaches described herein, we were able to recover 62 out of 100 samples that would have otherwise been lost. Based on these results, we discuss adjustments that should be made in official and research laboratories to facilitate the sequential implementation of bacteriological culture, PCR, downstream genomics, and computational-based methods. All of this in a time frame supporting data-driven intervention.

Salmonella enterica subsp. enterica serovar Enteritidis (S. Enteritidis) is one of the leading causes of foodborne infections associated with broilers and laying hens. Portugal has had the lowest notification rates of salmonellosis in recent years, due to the vaccinations of layer and breeder flocks and strict compliance with biosecurity measures. However, data about the genetic diversity of S. Enteritidis in Portugal are scarce. In this study, 102 S. Enteritidis isolates selected from human (n = 63) and non-human sources (n = 39) were characterized by serotyping, antimicrobial susceptibility, and whole genome sequencing. The S. Enteritidis population was mainly resistant to fluoroquinolones, and a sole isolate showed resistance to extended-spectrum cephalosporins. ST11 was the most frequent sequence type, and three novel STs from human isolates (ST9236, ST4457, and ST9995) were assigned. Several Salmonella pathogenic islands (SPI) and Putative SPI were present in the genomes, namely SPI-1, 2, 3, 4, 5, 9, 10, 12, 13, and 14, C63PI, CS54_island, and 170 virulence genes were identified. The phylogenetic analysis revealed that strains from Portugal are genetically heterogeneous regarding sample type, collection date, and genetic content. This study increases the available data, essential to a better characterization of strains in a global context.

Background Interstitial lung abnormalities (ILA) are incidental findings on chest computed tomography (CT). These patterns can present at an early stage of fibrotic lung disease. Our aim was to estimate the prevalence of ILA in the Swedish population, in particular in never-smokers, and find out its association with demographics, comorbidities and symptoms. Methods Participants were recruited to the Swedish CArdioPulmonary BioImage Study (SCAPIS), a population-based survey including men and women aged 50–64 years performed at six university hospitals in Sweden. CT scan, spirometry and questionnaires were performed. ILA were defined as cysts, ground-glass opacities, reticular abnormality, bronchiectasis and honeycombing. Findings Out of 29 521 participants, 14 487 were never-smokers and 14 380 were men. In the whole population, 2870 (9.7%) had ILA of which 134 (0.5%) were fibrotic. In never-smokers, the prevalence was 7.9% of which 0.3% were fibrotic. In the whole population, age, smoking history, chronic bronchitis, cancer, coronary artery calcium score and high-sensitive C-reactive protein were associated with ILA. Both ILA and fibrotic ILA were associated with restrictive spirometric pattern and impaired diffusing capacity of the lung for carbon monoxide. However, individuals with ILA did not report more symptoms compared with individuals without ILA. Interpretation ILA are common in a middle-aged Swedish population including never-smokers. ILA may be at risk of being underdiagnosed among never-smokers since they are not a target for screening.

The purpose of this study was to examine the perceived impact of a Service-Learning (SL) experience titled “Educating for Sustainable Development Goals (SDGs),” at the Porto campus of Universidade Católica Portuguesa (UCP), in which 15 university students from different programs were challenged to train other students about the SDGs. The main aim of the SL project was to raise awareness about the SDGs among the recipients (200 high school students, 20 students from a University in Angola and 40 from a University in Brazil). Besides the development of soft skills in UCP students, the learning objectives also focused on training socially responsible citizens who can take the SDGs into their future professions and help create a better and more sustainable world. UCP students were asked to reflect on their SL experience in the middle and at the end of the semester, based on structured reflection prompts. Based on these reflections, the present study aimed to understand the perceived impact of the SL experience on UCP students, particularly on their understanding of sustainable development (e.g., knowledge of SDGs), and the recipients (e.g., knowledge of strategies to achieve SDGs). Qualitative analysis was performed through NVIVO software. The results showed an impact not only on the academic learning and the UCP students’ personal and professional domains, but also on their literacy about the SDGs. According to the UCP students’ perceptions, the SL experience was particularly helpful in promoting SDGs awareness in the recipients and predisposing them to change attitudes and behaviors. Therefore, we conclude that the SL project accomplished its purpose of promoting awareness of the SDGs among the recipients. The implications of these findings are discussed in the context of the role of higher education institutions and SL experiences in sustainable development.

Abstract Background Physical activity is a major determinant of physical and mental health. International recommendations identify health professionals as pivotal agents to tackle physical inactivity. This study sought to characterize medical doctors’ clinical practices concerning the promotion of patients’ physical activity, while also exploring potential predictors of the frequency and content of these practices, including doctors’ physical activity level and sedentary behaviours. Methods A cross-sectional study assessed physical activity promotion in clinical practice with a self-report questionnaire delivered through the national medical prescription software (naturalistic survey). Physical activity and sedentary behaviours were estimated using the International Physical Activity Questionnaire (short form). Indicators of medical doctors’ attitudes, knowledge, confidence, barriers, and previous training concerning physical activity promotion targeting their patients were also assessed. Multiple regression analysis was performed to identify predictors of physical activity promotion frequency by medical doctors, including sociodemographic, attitudes and knowledge-related variables, and physical activity behaviours as independent variables. Results A total of 961 medical doctors working in the Portuguese National Health System participated (59% women, mean age 44 ± 13 years) in the study. The majority of the participants (84.6%) reported to frequently promote patients’ physical activity. Five predictors of physical activity promotion frequency emerged from the multiple regression analysis, explaining 17.4% of the dependent variable (p

The current study analyzed university students’ purpose in life in the context of service-learning (SL) courses developed in a university in Portugal. Briefly, 112 graduation and master students, from different areas, involved in 15 SL courses (82 female; 73.2%; age ranging from 18 to 51; M = 23; SD = 6.51) participated in this study. Questionnaires included an open-ended question about students’ purpose in life. Four closed-ended questions were included to understand student’s perceptions of change in their purpose in life arising from the SL courses and other perceptions about their SL course. Qualitative data were analyzed via content analysis with NVivo. Results indicated that students’ purpose in life ranged from social-related goals, such as helping or caring for others, to personal-related goals, including personal growth and well-being. Most of the students (71.4%) reported that their purpose in life changed moderately or a lot after participating in a SL course. Findings are discussed in light of the literature, identifying implications for the development of SL courses in higher education, considering the contribution of this pedagogic methodology to the definition and reconfiguration of young people’s purpose in life.

Resumo: Vivemos em uma sociedade em que hábitos, costumes, valores e crenças foram modificados em decorrência da globalização e das tecnologias de informação e comunicação, que entraram e ocuparam os espaços públicos e privados, de maneira intensa e significativa. A educação, por sua vez, mesmo com alguns avanços pertinentes, ainda presentifica, nas salas de aula brasileiras, o ensino fragmentado, um modelo tradicional descontextualizado da vida cotidiana dos educandos. Ao considerar que é na e pela linguagem que o ser humano interage, este artigo objetiva apresentar uma ação crítico-formativa desenvolvida junto a formadores de língua portuguesa, da Secretaria da Educação do Estado do Acre, na discussão de conceitos de gêneros discursivos, sequência didática e multiletramentos, como possibilidade de transformação dos sujeitos envolvidos. Metodologicamente, ancoramo-nos na Pesquisa Crítica de Colaboração (PCCol), a qual todos os envolvidos atuam, de modo crítico, colaborativo e reflexivo, nas atividades desenvolvidas, de modo a intervir e transformar a realidade existente. Nos resultados encontrados, verificaramos a necessidade de revisão em: a) conceitos considerados internalizados e, b) no papel do formador como alguém que precisa articular teoria-prática de modo mais colaborativo, crítico e efetivo para com os docentes.

To provide meat safety and consumer protection, appropriate hygiene control measures at an abattoir are required. This study aimed to evaluate the influence of visual fecal contamination level (VFCL) and lairage time (LT) on pig skin (PS) and external (ECS) and internal (ICS) carcass surfaces. The presence of Enterobacteriaceae, Escherichia coli (E. coli) and Salmonella in PS, ECS, and ICS were evaluated. A total of 300 paired samples were collected from 100 pigs. Results underlined the importance of the skin (Enterobacteriaceae: 3.27 ± 0.68 log CFU/cm2; E. coli: 3.15 ± 0.63 log CFU/cm2; Salmonella: 21% of samples) as a direct or indirect source of carcass contamination. Although VFCL revealed no significant effect (p > 0.05), the increase of LT had a significant impact (p < 0.001) on Enterobacteriaceae and E. coli levels across all analysed surfaces, and Salmonella presence on ICS (p < 0.01), demanding attention to LT. Also, the ICS showed a higher level of these bacteria compared to ECS. These results highlight the need of food business operators to consider ICS as an alternative area to sample for Salmonella, as a criterion for process hygiene based on EC Regulation No. 2073/2005, and as a potential contamination source to be integrated in the hazard analysis critical control point (HACCP) plans.

Schizophrenia is a complex disorder where individuals experience different symptoms and outcomes that can be captured by patterns in other diagnoses. Here the authors use computational approaches to summarize these patterns and suggest they are associated with genetic and environmental exposure.

Este artigo, apoiado na perspectiva teórica sócio-histórica-cultural, promove uma discussão crítica acerca da inclusão de crianças com deficiência sob a perspectiva de docentes e estagiários do curso de Pedagogia. Objetiva desencadear reflexão sobre os sentidos e significados atribuídos a presença de um estagiário em uma sala de aula inclusiva. Utiliza exemplos selecionados de um corpus de pesquisa coletado em uma escola municipal de São Paulo, extraídos de uma dissertação de mestrado de 2019, que subsidiarão a discussão apoiada em Vygotsky ([1924] 1997; 1930; [1930] 2008; [1930] 2010; [1934] 2001). Os resultados apontam para uma revisão e reflexão crítica sobre o papel do estagiário em uma sala de aula inclusiva.

Abstract Background Both ischemic and non-ischemic heart disease can cause disturbances in the myocardial blood volume (MBV), myocardial perfusion and the myocardial extracellular volume fraction (ECV). Recent studies suggest that native myocardial T1 mapping can detect changes in MBV during adenosine stress without the use of contrast agents. Furthermore, native T2 mapping could also potentially be used to quantify changes in myocardial perfusion and/or MBV. Therefore, the aim of this study was to explore the relative contributions of myocardial perfusion, MBV and ECV to native T1 and native T2 at rest and during adenosine stress in normal physiology. Methods Healthy subjects (n = 41, 26 ± 5 years, 51% females) underwent 1.5 T cardiovascular magnetic resonance (CMR) scanning. Quantitative myocardial perfusion [ml/min/g] and MBV [%] maps were computed from first pass perfusion imaging at adenosine stress (140 microg/kg/min infusion) and rest following an intravenous contrast bolus (0.05 mmol/kg, gadobutrol). Native T1 and T2 maps were acquired before and during adenosine stress. T1 maps at rest and stress were also acquired following a 0.2 mmol/kg cumulative intravenous contrast dose, rendering rest and stress ECV maps [%]. Myocardial T1, T2, perfusion, MBV and ECV values were measured by delineating a region of interest in the midmural third of the myocardium. Results During adenosine stress, there was an increase in myocardial native T1, native T2, perfusion, MBV, and ECV (p ≤ 0.001 for all). Myocardial perfusion, MBV and ECV all correlated with both native T1 and native T2, respectively (R2 = 0.35 to 0.61, p

This study focuses on the application of a multi-analytical approach combining image processing techniques, imaging studies and material characterisation of a French late fifteen-early sixteen century incunabulum – the BPE, Inc.438. The first study goal was to verify the potential of computational methods in NIR imaging to retrieve accurate reconstructions of the engraving printings by Germain Hardouyn. For this aspect, two representative scenes were chosen: Trinity, f.8r; Saint Anthony the Abbot, f.61v. The applied methodology allowed faster creation of digital reconstructions while the material analysis proved the use of azurite, malachite, vermilion, lead white and ochres, and their NIR response was assessed in the context of the digital processing. The second goal was to make a comparison between chosen illuminations and engraved references of the same representations from two incunabula of the British Library, unravelling the illuminator’s intentional iconographic alteration based on visual and theological criteria.

The skin is a multi-layered organ, often displaying associated structures, that establishes a protective interface between the organism and the surrounding environment. In mammals, the skin provides a physical and immune barrier, while contributing to thermoregulation and water balance. Within cetaceans, the archetypal mammalian skin was drastically reshaped and remodeled, emerging as a striking feature of their successful adaptation to a fully aquatic lifestyle. In fact, cetacean skin is extremely thick, displays a high cellular turnover rate, and lacks typical mammalian pelages, as well as sebaceous glands, resulting in a smooth and drag-reducing skin. Curiously, at the genome level, the majority of cetacean skin-related innovations resulted from episodes of gene loss: spanning diverse processes such as skin keratinization and cornification, immunity and inflammation or lubrication. Here, we review how the cetacean skin was shaped by such an evolutionary mechanism, by describing the full set of genes with inactivating mutations in the various functional compartments of the skin.

Abstract Background Quantification of myocardial blood flow requires knowledge of the amount of contrast agent in the myocardial tissue and the arterial input function (AIF) driving the delivery of this contrast agent. Accurate quantification is challenged by the lack of linearity between the measured signal and contrast agent concentration. This work characterizes sources of non-linearity and presents a systematic approach to accurate measurements of contrast agent concentration in both blood and myocardium. Methods A dual sequence approach with separate pulse sequences for AIF and myocardial tissue allowed separate optimization of parameters for blood and myocardium. A systems approach to the overall design was taken to achieve linearity between signal and contrast agent concentration. Conversion of signal intensity values to contrast agent concentration was achieved through a combination of surface coil sensitivity correction, Bloch simulation based look-up table correction, and in the case of the AIF measurement, correction of T2* losses. Validation of signal correction was performed in phantoms, and values for peak AIF concentration and myocardial flow are provided for 29 normal subjects for rest and adenosine stress. Results For phantoms, the measured fits were within 5% for both AIF and myocardium. In healthy volunteers the peak [Gd] was 3.5 ± 1.2 for stress and 4.4 ± 1.2 mmol/L for rest. The T2* in the left ventricle blood pool at peak AIF was approximately 10 ms. The peak-to-valley ratio was 5.6 for the raw signal intensities without correction, and was 8.3 for the look-up-table (LUT) corrected AIF which represents approximately 48% correction. Without T2* correction the myocardial blood flow estimates are overestimated by approximately 10%. The signal-to-noise ratio of the myocardial signal at peak enhancement (1.5 T) was 17.7 ± 6.6 at stress and the peak [Gd] was 0.49 ± 0.15 mmol/L. The estimated perfusion flow was 3.9 ± 0.38 and 1.03 ± 0.19 ml/min/g using the BTEX model and 3.4 ± 0.39 and 0.95 ± 0.16 using a Fermi model, for stress and rest, respectively. Conclusions A dual sequence for myocardial perfusion cardiovascular magnetic resonance and AIF measurement has been optimized for quantification of myocardial blood flow. A validation in phantoms was performed to confirm that the signal conversion to gadolinium concentration was linear. The proposed sequence was integrated with a fully automatic in-line solution for pixel-wise mapping of myocardial blood flow and evaluated in adenosine stress and rest studies on N = 29 normal healthy subjects. Reliable perfusion mapping was demonstrated and produced estimates with low variability.

Rabbit haemorrhagic disease virus 2 (RHDV2) emerged recently in several European countries, leading to extensive economic losses in the industry. In response to this new infection, specific inactivated vaccines were developed in Europe and full and rapid setup of protective immunity induced by vaccination was reported. However, data on the efficacy of these vaccines in an ongoing-infection scenario is unavailable. In this study we investigated an infected RHDV2 indoor industrial meat rabbitry, where fatalities continued to occur after the implementation of the RHDV2 vaccination, introduced to control the disease. The aim of this study was to understand if these mortalities were RHDV2-related, to discover if the dead animals showed any common features such as age or time distance from vaccination, and to identify the source of the outbreak. Anatomo-pathological analysis of vaccinated animals with the virus showed lesions compatible with systemic haemorrhagic disease and RHDV2-RNA was detected in 85.7% of the animals tested. Sequencing of the vp60 gene amplified from liver samples led to the recognition of RHDV2 field strains demonstrating that after the implementation of vaccination, RHDV2 continued to circulate in the premises and to cause sporadic deaths. A nearby, semi-intensive, RHDV2 infected farm belonging to the same owner was identified as the most probable source of the virus. The main risk factors for virus introduction in these two industries were identified. Despite the virus being able to infect a few of the vaccinated rabbits, the significant decrease in mortality rate observed in vaccinated adult rabbits clearly reflects the efficacy of the vaccination. Nonetheless, the time taken to control the infection also highlights the importance of RHDV2 vaccination prior to the first contact with the virus, highly recommendable in endemic areas, to mitigate the infection’s impact on the industry.

Gastrointestinal infections caused by nontyphoidal Salmonella (NTS) remain one of the main causes of foodborne illness worldwide. Within the multiple existing Salmonella enterica serovars, the serovar Rissen is rarely reported, particularly as a cause of human salmonellosis. Between 2015 and 2017, the Portuguese National Reference Laboratory of Gastrointestinal Infections observed an increase in the number of clinical cases caused by multidrug-resistant (MDR) S. enterica serovar Rissen, particularly from the Azores archipelago. In the present study, we analyzed by whole genome sequencing (WGS) all clinical, animal, food, and environmental isolates received up to 2017 in the Portuguese Reference Laboratories. As such, through a wgMLST-based gene-by-gene analysis, we aimed to identify potential epidemiological clusters linking clinical and samples from multiple sources, while gaining insight into the genetic diversity of S. enterica serovar Rissen. We also investigated the genetic basis driving the observed multidrug resistance. By integrating 60 novel genomes with all publicly available serovar Rissen genomes, we observed a low degree of genetic diversity within this serovar. Nevertheless, the majority of Portuguese isolates showed high degree of genetic relatedness and a potential link to pork production. An in-depth analysis of these isolates revealed the existence of two major clusters from the Azores archipelago composed of MDR isolates, most of which were resistant to at least five antimicrobials. Considering the well-known spread of MDR between gastrointestinal bacteria, the identification of MDR circulating clones should constitute an alert to public health authorities. Finally, this study constitutes the starting point for the implementation of the “One Health” approach for Salmonella surveillance in Portugal.

Abstract Objective To apply, in Brazil, the T-cell receptor excision circles (TRECs) quantification technique using real-time polymerase chain reaction in newborn screening for severe combined immunodeficiency and assess the feasibility of implementing it on a large scale in Brazil. Methods 8715 newborn blood samples were collected on filter paper and, after DNA elution, TRECs were quantified by real-time polymerase chain reaction. The cutoff value to determine whether a sample was abnormal was determined by ROC curve analysis, using SSPS. Results The concentration of TRECs in 8,682 samples ranged from 2 to 2,181 TRECs/µL of blood, with mean and median of 324 and 259 TRECs/µL, respectively. Forty-nine (0.56%) samples were below the cutoff (30 TRECs/µL) and were reanalyzed. Four (0.05%) samples had abnormal results (between 16 and 29 TRECs/µL). Samples from patients previously identified as having severe combined immunodeficiency or DiGeorge syndrome were used to validate the assay and all of them showed TRECs below the cutoff. Preterm infants had lower levels of TRECs than full-term neonates. The ROC curve showed a cutoff of 26 TRECs/µL, with 100% sensitivity for detecting severe combined immunodeficiency. Using this value, retest and referral rates were 0.43% (37 samples) and 0.03% (3 samples), respectively. Conclusion The technique is reliable and can be applied on a large scale after the training of technical teams throughout Brazil.

Objectives: Physical fitness is related to all-cause mortality, quality of life and risk of falls in patients with type 2 diabetes. This study aimed to analyse the impact of a long-term community-based combined exercise program (aerobic + resistance + agility/balance + flexibility) developed with minimum and low-cost material resources on physical fitness in middle-aged and older patients with type 2 diabetes. Methods: This was a non-experimental pre-post evaluation study. Participants (N = 43; 62.92 ± 5.92 years old) were engaged in a community-based supervised exercise programme (consisting of combined aerobic, resistance, agility/balance and flexibility exercises; three sessions per week; 70 min per session) of 9 months’ duration. Aerobic fitness (6-Minute Walk Test), muscle strength (30-Second Chair Stand Test), agility/balance (Timed Up and Go Test) and flexibility (Chair Sit and Reach Test) were assessed before (baseline) and after the exercise intervention. Results: Significant improvements in the performance of the 6-Minute Walk Test (Δ = 8.20%, p

Rhabdomyosarcoma is one of the most common soft-tissue sarcomas in children. The therapy for this condition has evolved significantly over recent decades, as has survival rates. Nevertheless, multiagent chemotherapy, radiation therapy, surgical resection or a combination of these modalities still have to be performed. This case report presents a 16-year-old boy with oral and dental effects after rhabdomyosarcoma treatment, diagnosed at the age of 4 years old. This report highlights the key role of dentists in the clinical management of rhabdomyosarcoma cases before, during and after treatment, and its potential side effects.

Grounded on the conceptual framework of Bakhtin's architectonic form, we seek to demonstrate that the dimensions of a genre practiced in a virtual learning environment (VLE) are directly related to its design (conception, idealization, and form), that is, to its architectonic form as the design of a VLE, which can foster (new) multiliteracies, provide flexibility or not for multisemiotic genre practices in the contemporary world. To achieve this aim, we observed the design of two tools from two distinct VLEs; in one of them we found the influence of traditional school relationships of time and space (and power), generating an architectonic form of the traditional school characterized by its genres and literacies. In the other VLE, considering its architectonic form, we concluded that the design tends to favor the use of different modes of language - textual, graphic, sound, with static and dynamic images with easy communication/interaction in the contemporary technological media.

BackgroundThe prevalence of hypo‐attenuated leaflet thickening (HALT) and reduced leaflet motion (RLM) is unknown in surgically implanted bioprostheses because systematic investigation of HALT and/or RLM is limited to a few catheter‐based valves. The aim of this study was to investigate the prevalence of HALT and RLM by cardiac computed tomography in patients who underwent surgical aortic valve replacement and received a Perceval sutureless aortic valve bioprosthesis. Methods and ResultsThis was a single‐center prospective observational study that included 47 patients (83.5% of the total number of implantations) who underwent surgical aortic valve replacement with implantation of the Perceval sutureless bioprosthesis (LivaNova PLC, London, UK) at Karolinska University Hospital in Stockholm, Sweden from 2012 to 2016 and were studied by cardiac computed tomography. Cardiac computed tomography was performed at a median of 491 days (range 36–1247 days) postoperatively. HALT was found in 18 (38%) patients and RLM in 13 (28%) patients. All patients with RLM had HALT. Among patients with HALT, 5 out of 18 patients (28%) were treated with anticoagulation (warfarin or any novel oral anticoagulant) at the time of cardiac computed tomography. Among patients with RLM, 3 out of 13 patients (23%) were treated with anticoagulation. ConclusionsHALT and RLM were prevalent in the surgically implanted Perceval sutureless aortic valve bioprosthesis. Both HALT and RLM were found in patients with ongoing anticoagulation treatment. Whether these findings are associated with adverse events needs further study. Clinical Trial RegistrationURL: http://www.clinicaltrials.gov. Unique identifier: NCT02671474.

This article, based on the socio-cultural-historical theoretical perspective, discusses the activity in which individuals engage as constitutive of the social roles they occupy. It aims to trigger discussion of discursive dynamics in the context of critical-collaborative teacher education, focusing on internally persuasive and authoritative discourse (BAKHTIN, 1981) and their co-occurrence in situations of negotiation of meanings. This distinction is relevant because it is possible to understand different argumentative enunciations or not, conducted by educators in training, which approach or distance themselves from those cast by their trainers or isolated voices of theoretical practice, indicating possibilities of creation or reduction of dialogic expansion. From the emphasis on internally persuasive discourse, this article highlights the critical - collaborative argumentation role in training educators. Examples selected from a corpus of research collected in public school in São Paulo subsidize the discussion supported by Bakhtin (1981) and Vygotsky (1998; 2001).

Este artigo, apoiado na perspectiva teórica sócio-histórico-cultural, discute a atividade na qual sujeitos se envolvem como constitutiva dos papeis sociais que exercem. Objetiva desencadear discussão acerca da dinâmica discursiva em contextos de formação crítico-colaborativa de professores, focalizando os discursos de autoridade e internamente persuasivo (BAKHTIN, 2010) e sua coocorrência nas situações de negociação de significados. Tal distinção constitui-se relevante por permitir compreender diferentes enunciados argumentativos ou não, proferidos por educadores em formação, que se proximam ou se distanciam daqueles proferidos por seus formadores ou por vozes teóricas isoladas da prática, indicando possibilidades de criação ou diminuição da expansão dialógica. A partir da ênfase no discurso internamente persuasivo, procura-se destacar o papel crítico-colaborativo da argumentação na formação de educadores. Exemplos selecionados de um corpus de pesquisa coletado em escola pública de São Paulo subsidiará a discussão, por sua vez, apoiada em Bakhtin (2010) e Vygotsky (1998; 2001).

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Resumo: Sustentado conceptualmente na teoria da auto-determinação (TAD) e no corpo de estratégias oferecidas pela entrevista motivacional (EM), este artigo procura enquadrar o fenómeno da resistência à mudança comportamental e à adopção de estilos de vida activos enquanto expressão de baixa qualidade (e não só baixa quantidade) motivacional. Neste sentido, pretende-se apresentar uma abordagem qualitativa ao entendimento e intervenção na área da motivação e auto-regulação dos comportamentos de actividade física, apresentando evidência científica para o seu uso. Estratégias práticas para a promoção de um contexto de suporte à autonomia e ao desenvolvimento de competências, focadas na pessoa e no seu desenvolvimento e passíveis de serem usadas pelo profissional de saúde em contextos clínicos, serão também apresentadas e ilustradas com exemplos.Defende-se que a sustentação das estratégias motivacionais num racional sólido e testado (tal como o oferecido pela TAD) em conjugação com o conjunto de linhas de acção nascidas no contexto clínico da EM são uma importante mais-valia para a promoção de uma motivação mais autónoma no utente, qualidade considerada necessária para a integração de comportamentos de exercício no longo prazo e bem-estar associado. A filosofia de acção, princípios e estratégias apresentados neste artigo podem ser incorporados na prática clínica actual de aconselhamento em saúde. Abstract: Pulling from self-determination theory (SDT) and motivational interviewing (MI), this article sought to present contemporary frameworks for understanding and promoting human motivation as useful tools for health professionals aiming to facilitate adoption and adherence to physical activity, presenting empirical evidence for its use. Practical strategies that may be used by a health professional to create an autonomy-supportive, well-structured, and interpersonally involved exercise counseling environment, more likely to support selfdetermined motivation, also are presented.Combining the strong theoretical underpinnings of SDT and the strong clinical base of MI should allow for much progress in developing the kind of motivation required to initiate and maintain exercise behaviors over the long term. These relatively simple and straightforward principles can be incorporated into existing approaches currently used by professionals who desire to improve their effectiveness, enhancing positive outcomes in terms of exercise adoption, adherence, and well-being; Palavras-chave: Motivação para o exercício, Adesão, Teoria da autodeterminação, Entrevista motivacional, Estratégias de intervenção motivacional, Resistência, Keywords: Exercise motivation, Adherence, Self-determination theory, Motivational interviewing, Motivational strategies, Resistance

Resumo: Um dos obstáculos a uma utilização mais frequente e apropriada da ressonância magnética cardíaca (RMC) em Portugal tem sido a ausência de códigos específicos que descrevam adequadamente os exames tal como são efetuados actualmente. Este documento de consenso fornece recomendações para a atualização e uniformização dos códigos empregues na RMC. São igualmente feitas recomendações quanto às técnicas e códigos a utilizar nas indicações clínicas mais frequentes. Abstract: One of the obstacles to more frequent and appropriate use of cardiac magnetic resonance (CMR) in Portugal has been the lack of specific codes that accurately describe these examinations as they are currently performed. In this consensus document, recommendations are made for updating and standardizing CMR codes in Portugal. Guidance on which techniques and codes should be used in the most common clinical scenarios is also provided. Palavras-chave: Ressonância magnética cardíaca, Codificação, Consenso, Keywords: Cardiac magnetic resonance, Coding, Consensus

Considering the increasing challenges of the current cities, the urban tourism has been proposed as a solution for solving or minimizing different problems. Including economic, social and environmental aspects, this approach can lead to the fulfillment of sustainable development theory. Accordingly, there is no doubt about the successful results of the urban tourism development and all urban managers and authorities agree on this point. Meanwhile, what threatens the success of the urban tourism development plans is to ignore the all effective factors that make effect on the quality of travel experience. In their best, the cities are projected in their public spaces, and any tourist spent a considerable part of his travel in such spaces. Thus the quality of urban spaces is an important factor on the successfulness of urban tourism development plans and hence their environmental desirability must be studied and evaluated more precise under a comprehensive approach. The main objective of this research is to answer the main question of how the effective spatial qualities on tourism are explain with regard to the social factors. Since the man and his activities are the base of the urban studies, this article uses an urban-strategic approach based on the descriptive-analytical method using library resources to study the social factors that are effective on the qualities of urban spaces. The analytical model of the research will be presented based on the theoretical studies. The results show that some qualities such as flexibility, functional diversity, physical diversity, vegetation, safety, lightening, landscape attractiveness, identity, and memorability in relation to the urban space, and social and arbitrary activities based on Gehl theory can make effect as the complementary factors of the urban tourism attraction and make effect on social factors such as vitality, sense of security, arbitrary activity, social activity and tourists sense of peace. Emphasizing on the social exchange theory, such factors can pave the way for the sustainability of urban tourism industry. The results of this research can be used in identifying and reinforcing the spatial qualities relating to the social factors that are effective on tourism in Iran. Consequently, they can be useful in the tourism development. The essential value of this article is its simultaneous focus on both spatial qualities (physical dimension) and social factors (human dimension) in relation to the tourism development. In this regard, the unidimensional attitude is rejected and the adaptation of a holistic approach to the urban tourism is highlighted.

During the last half century scientific data have been accumulated, through epidemiological and clinical studies that clearly document the significant health benefits associated with regular physical activity. This paper will analyse the latest recommendations for prescribing exercise in all age groups in healthy subjects and to individuals with chronic non-communicable diseases such as overweight, obesity, diabetes, hypertension, atherosclerotic cardiovascular disease and cancer, that contribute to the leading causes of global mortality. A search in the Pubmed database was performed and were also searched the recommendations of the World Health Organization and scientific organizations in Portugal. Most health benefits occur with at least 150 minutes of aerobic exercise of moderate intensity, accumulated over the week, which can be split into periods of at least 10 minutes. Brisk walking seems to be the preferred aerobic exercise. Vigorous intensity aerobic exercise and resistance exercises for muscle strengthening, at least two days a week are also recommended. Children, youth, older adults and people with overweight have particular needs for physical activity. Additional benefits occur with increasing quantity and quality of physical activity through the proper manipulation of the exercise density (intensity, frequency and duration). However, some physical activity is better than none. The role of health professionals in prescribing appropriate exercise to their patients is fundamental to their involvement in increasing their physical activity levels and thus contributing to their health promotion and prevention and treatment of major non-communicable chronic diseases.

High blood pressure is a major risk factor of cardiovascular diseases and has a high prevalence in the older individuals becoming in a risk factor associated with high cardiovascular mortality and morbidity among these population. This study has the objective to analyze the changes in the cardiovascular system inherent to the aging process, that provoke the increase of blood pressure levels with the advance of age and that can origin hypertension. With the aging process, changes in the anatomy and cardiovascular physiology occur, even in the absence of illness. High blood pressure is characterized as a systemic condition that involves the presence of structural changes of the arteries and the myocardium, associated to an endotelial and baroreceptors dysfunction.

Introdução: Vários organismos internacionais têm recomendado o exercício aeróbio como medida de prevenção, tratamento e controlo da hipertensão arterial na população em geral. No entanto, o efeito do exercício aeróbio na pressão arterial da população idosa ainda é uma área pouco estudada e os resultados dos estudos nem sempre são consistentes. Objectivo: Este estudo de revisão tem como objectivo analisar a influência crónica e aguda do exercício aeróbio nos valores da pressão arterial da população idosa. Metodologia: Foi realizada uma pesquisa nas bases de dados Pubmed e Highwire Press. Foram também pesquisadas as recomendações de várias organizações internacionais na área da cardiologia. Incluíram-se no estudo 67 artigos. Conclusões: O exercício aeróbio, quer de forma aguda ou crónica, parece diminuir tanto os níveis de pressão arterial clínica, como de pressão arterial ambulatória, dos sujeitos idosos, especialmente dos hipertensos. Parece assim existirem evidências para considerar o exercício aeróbio como estratégia terapêutica não farmacológica e de modificação do estilo de vida, essencial para a prevenção, tratamento e controlo da hipertensão nos indivíduos idosos. Os profissionais de saúde devem ter um papel activo no aconselhamento de exercício à população idosa, contribuindo assim para a prevenção e controlo das doenças cardiovasculares.

OBJETIVO: Avaliar o conhecimento médico sobre as imunodeficiências primárias na cidade de São Paulo (SP). MÉTODOS: Um questionário de 14 questões sobre as imunodeficiências primárias foi aplicado a médicos que trabalhavam em hospitais gerais. Uma das questões apresentava 25 situações clínicas que poderiam ou não estar associadas às imunodeficiências primárias, e a porcentagem de respostas apropriadas gerou um indicador de conhecimento. RESULTADOS: Participaram do estudo 746 médicos, dentre os quais 215 pediatras (28,8%), 244 cirurgiões (32,7%) e 287 clínicos (38,5%). Cerca de 70% dos médicos responderam ter aprendido sobre as imunodeficiências primárias na graduação ou na residência médica. O atendimento a pacientes que usam antibióticos com frequência foi relatado por 75% dos médicos, mas apenas 34,1% já haviam investigado algum paciente e 77,8% não conheciam os dez sinais de alerta para as imunodeficiências primárias. O indicador de conhecimento obtido apresentou uma média de 45,72% (±17,87). Apenas 26,6% dos pediatras e 6,6% tanto dos clínicos quanto dos cirurgiões apresentaram indicador de conhecimento de pelo menos 67% (equivalente à resposta apropriada em dois terços das situações clínicas). CONCLUSÃO: Há uma deficiência no conhecimento médico das imunodeficiências primárias na cidade de São Paulo, mesmo entre os pediatras, a despeito do maior contato com o tema nos últimos anos. A melhora da informação sobre as imunodeficiências primárias entre a comunidade médica é um importante passo para o diagnóstico e o tratamento precoces dessas doenças.

RESUMO Objetivo: Validar a quantificação de T-cell receptor excision circles (TRECs) e kappa-deleting recombination circles (KRECs) por reação em cadeia de polimerase (polymerase chain reaction, PCR) em tempo real (qRT-PCR), para triagem neonatal de imunodeficiências primárias que cursam com defeitos nas células T e/ou B no Brasil. Métodos: Amostras de sangue de recém-nascidos (RN) e controles foram coletadas em papel-filtro. O DNA foi extraído e os TRECs e KRECs foram quantificados por reação duplex de qRT-PCR. O valor de corte foi determinado pela análise de Receiver Operating Characteristics Curve, utilizando-se o programa Statistical Package for the Social Sciences (SSPS) (IBM®, Armonk, NY, EUA). Resultados: 6.881 amostras de RN foram analisadas quanto à concentração de TRECs e KRECs. Os valores de TRECs variaram entre 1 e 1.006 TRECs/µL, com média e mediana de 160 e 139 TRECs/µL, respectivamente. Três amostras de pacientes diagnosticados com imunodeficiência grave combinada (severe combined immunodeficiency, SCID) apresentaram valores de TRECs abaixo de 4/µL e um paciente com Síndrome de DiGeorge apresentou TRECs indetectáveis. Os valores de KRECs encontraram-se entre 10 e 1.097 KRECs/µL, com média e mediana de 130 e 108 KRECs/µL, e quatro pacientes com diagnóstico de agamaglobulinemia tiveram resultados abaixo de 4 KRECs/µL. Os valores de corte encontrados foram 15 TRECs/µL e 14 KRECs/µL, e foram estabelecidos de acordo com a análise da Receiver Operating Characteristics Curve, com sensibilidade de 100% para detecção de SCID e agamaglobulinemia, respectivamente. Conclusões: A quantificação de TRECs e KRECs foi capaz de diagnosticar crianças com linfopenias T e/ou B em nosso estudo, validando a técnica e dando o primeiro passo para a implementação da triagem neonatal em grande escala no Brasil.