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Determine the influence of sarcopenia on the prognosis of peripheral arterial disease (PAD).A systematic search of the PubMed and Cochrane Library databases was performed with the keywords and medical subject heading (MesH): "muscle, skeletal", "sarcopenia", "prognosis", "duration of stay", "death", "mortality", "patient readmission", "length of stay", "peripheral arterial disease", "intermittent claudication" and "critical limb ischemia". Papers published from January 2010 to October 2020 in English, French, Spanish and Portuguese were eligible for inclusion. The primary outcome was overall survival. Secondary outcomes included post-operative complications, amputation, length of hospital stay and hospital readmission.Of 1071 papers, 8 articles and 1511 patients were included (68.96% male, mean age 71.83 years). Five papers found an inverse relationship between SM area and mortality. Matsubara (2015) found that the 5-year overall survival rates were lower for patients with sarcopenia (23.5% ± 0.18% vs 77.5% ± 0.09% P = 0.001). Matsubara (2016) registered 3-year cardiovascular event-free survival rates of 43.1% and 91.2% for patients with and without sarcopenia (P0.01). Juszczak (2018) found that survival was lower in patients with reduced total psoas area. Taniguchi (2019) found that 3-year overall survival rate was 60% for patients with sarcopenia and 87% for patients without sarcopenia (P0.05). Shimazoe (2019) concluded sarcopenia was a significant predictor of overall survival. Distinctly, Nyers (2017) concluded that higher ratio bilateral psoas area to L4 vertebral body was associated with an increased risk of death. Two other studies analyzed other characteristics of the SM (density and strength). McDermott (2012) and found that lower calf muscle density and strength were associated with an increase in mortality. Sugai (2019) concluded that patients with major cardiovascular and limb events had a lower SM density.Lower SM area and mass seem to be associated with a higher mortality in PAD patients.

© Translational Lung Cancer Research. All rights reserved. This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/., Background: Liquid biopsy allows the identification of targetable cancer mutations in a minimally invasive manner. In patients with advanced non-small cell lung cancer (NSCLC), droplet digital PCR (ddPCR) is increasingly used to genotype the epidermal growth factor receptor (EGFR) gene in circulating cell-free DNA (cfDNA). However, the sensitivity of this method is still under debate. The aim of this study was to implement and assess the performance of a ddPCR assay for detecting the EGFR T790M mutation in liquid biopsies. Methods: A ddPCR assay was optimized to detect the EGFR T790M mutation in plasma samples from 77 patients with NSCLC in progression. Results: Our ddPCR assay enabled the detection and quantification of the EGFR T790M mutation at cfDNA allele frequency as low as 0.5%. The mutation was detected in 40 plasma samples, corresponding to a positivity rate of 52%. The number of mutant molecules per mL of plasma ranged from 1 to 6,000. A re-biopsy was analyzed for 12 patients that had a negative plasma test and the mutation was detected in 2 cases. A second liquid biopsy was performed for 6 patients and the mutation was detected in 3 cases. Conclusions: This study highlights the value of ddPCR to detect and quantify the EGFR T790M mutation in liquid biopsies in a real-world clinical setting. Our results suggest that repeated ddPCR tests in cfDNA may obviate tissue re-biopsy in patients unable to provide a tumor tissue sample suitable for molecular analysis., This work was supported by Fundação para a Ciência e Tecnologia (FCT)/Ministério da Ciência, Tecnologia e Ensino Superior - Fundos do Orçamento de Estado (UID/BIM/50005/2019), and FCT/FEDER/POR Lisboa 2020, Programa Operacional Regional de Lisboa, PORTUGAL 2020 (LISBOA-01-0145-FEDER-016394). C.S. was a recipient of a FCT fellowship (SFRH/BDE/110544/2015).

Light-chain multiple myeloma (LCMM) is a less frequent type of multiple myeloma (MM), with a more aggressive course and poorer prognosis. It is characterized by the inability of the malignant plasma cells to produce heavy chains, resulting in the exclusive production of light chains. Therefore, no M-spike is visible in serum protein electrophoresis. We described the case of a 67-year-old female who presents to the emergency department with anemia, severe renal insufficiency, and multiple lytic bone lesions. After three days, the diagnosis of kappa light chain multiple myeloma was made in a patient with elevated serum and urinary kappa light chains and a bone marrow aspirate with 21.7% of atypical plasma cells. The rapid diagnosis allowed prompt referral to a specialized multiple myeloma center and early initiation of treatment.

Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare systemic vasculitis. This report describes the case of a 68-year-old female that showed up at the emergency department with extensive haemorrhagic bullous lesions, affecting elbows, the dorsal side of hands, feet and knees, with loss of tissue and necrotic areas. The evaluation led to the diagnosis of antineutrophil cytoplasmic antibody-positive EGPA with multisystem involvement: cutaneous, pulmonary, renal, intestinal and peripheral and central nervous system. She received corticosteroids and intravenous immunoglobulin. She developed multiple infectious complications with multidrug-resistant bacteria. Two months after the diagnosis, the patient had no respiratory or gastrointestinal signs or symptoms, and the proteinuria was mild. Yet, she maintained extensive ulcers and was suffering from disabling dysesthesias. After the resolution of all infections, we decided to start rituximab. She was also submitted to excisional debridement and heterologous graft repair and later to autologous graft repair of elbows and feet. She had a good clinical response with complete healing of the wounds. This case intends to illustrate a serious form of EGPA, with severe multisystem involvement that resulted in great morbidity. It was a clinical challenge to balance the need for immunosuppressive therapy with the high infectious risk of the patient. Nonetheless, we considered that disease control was fundamental to skin recovery, better physical rehabilitation and better quality of life.

Treated wastewater has the potential to be a feasible alternative to supply non-potable uses and avoid water scarcity in urban areas, but it is important to understand and compare the associated energy consumption and CO2 emissions. This study presents a comparative analysis of the water–energy nexus associated with the traditional water supply and to the alternative reuse of treated wastewater, both for non-potable purposes. A case study of a Portuguese municipality was considered, regarding golf course irrigation and municipal gardens irrigation. A balance between production and demand was established, and the energy consumption and CO2 emissions were calculated considering the supply with drinking water and with treated wastewater. Three scenarios were defined to analyze the water–energy nexus for different configurations of the potential end-uses: (1) golf course supply, (2) municipal irrigation supply and (3) simultaneous supply to the golf course and to municipal irrigation. A quality analysis was also carried out by comparing the records from discharged wastewater quality parameters with the limits presented in the legislation for each proposed non-potable use. The results show that all scenarios present significant annual savings from using treated wastewater instead of drinking water from the public network, especially scenarios 1 and 3, that consider the golf course irrigation (water costs decrease by about 60,000.00 EUR/year). Regarding the water–energy nexus, this study reveals that treated wastewater spends less energy on its production and supply and produces fewer CO2 emissions. The energy savings can reach an average value of about kWh/year, with 5300 fewer kg of CO2 emitted in the best scenario.

Synchronous tumours are defined as two or more independent primary neoplasms of different origins diagnosed at the same time in 1 individual. Although rare, its incidence is increasing and the proper diagnosis and staging of each tumour is crucial in defining the patient prognosis and the best therapeutic choice. We present a case of a 56-year-old woman presenting with a lung adenocarcinoma and pulmonary metastases initially diagnosed as stage IV and who was started on a tyrosine kinase inhibitor (erlotinib). In the meantime, she was also diagnosed with papillary thyroid carcinoma and was submitted to complete thyroidectomy. After 6 cycles of erlotinib, thoracic CT showed a decrease in the dimensions of the primary pulmonary tumour, but an increase in the size and number of pulmonary metastases while blood tests showed elevated thyroglobulin. This therefore raised the possibility that the metastases could have originated from the thyroid carcinoma. Anatomo-pathological examination of the lung metastases confirmed this hypothesis. In conclusion, it is important to confirm the origin of metastases in synchronous tumours given this can lead to a re-staging of tumours and a different prognosis, along with other therapeutic options. A multidisciplinary team meeting is crucial to define management and therapeutic approaches for these patients. LEARNING POINTS: Although rare, synchronous primary tumours are a possibility and physicians should be aware of this possibility. Papillary thyroid carcinoma may metastasize to the lungs and its differential diagnosis should be made in the presence of lung carcinoma. When in doubt, anatomo-pathological examination of the metastases should be performed for proper staging of both tumours and to decide on the best therapeutic option.

Green roofs and green walls are a potential strategy to increase green spaces in the urban environment. These solutions bring multiple benefits to the cities at the economic and socio-environmental levels. However, from the point of view of private investors, green roofs and green walls often have a negative financial evaluation. Concerning this, the quantification of the benefits according to building use and occupancy could be an important tool to assist the decision-making process and guarantee returns on investment. This study aims to support the decision-making process by managers and owners of youth hostels regarding green roofs and green walls implementation. Using a structured questionnaire, users&rsquo, perceptions were assessed through a five-point Likert scale. The survey was conducted in five youth hostels in Lisbon, Portugal. Analyses were performed in two phases. Firstly, using the original sample (n = 345), and subsequently grouping homogeneous individuals through cluster analysis. The results showed that most respondents support green infrastructure installation in the hostel and consider that these solutions could provide a greater sense of individual well-being and local aesthetic improvement. However, there is no strong evidence that green infrastructure solutions are considered a deciding factor to select local lodging, despite the fact that it can be a tiebreaker factor between two similar options. Furthermore, findings have shown that 90% of the respondents from Cluster 1 and 92% from Cluster 4 are probably not willing to pay higher daily rates for youth hostels that have green infrastructure solutions in place. On the other hand, 67% of the respondents from Cluster 2 were potentially willing to pay an additional amount. For the 345 respondents, the most preferred green infrastructure typologies are indoor living wall and the accessible green roof. Moreover, findings support the gender socialization and identity theory showing that women have a greater environmental concern compared to men.

Dengue fever causes a disease whose symptoms range from asymptomatic to more severe, that may even lead to death. During infection, the non-structural (NS) 1 protein is produced in infected cells and subsequently shed to the circulation. Anti-NS1 antibodies have been implicated in disease pathogenesis as well as in protection against lethal infection. Here we analysed the role of anti-NS1 antibodies elicited when the NS1 protein was specifically targeted to two distinct dendritic cell (DC) subsets by chimeric monoclonal antibodies (mAbs) that bind to the DC surface receptors DEC205 and DCIR2. BALB/c mice received two doses of αDEC-NS1 or αDCIR2-NS1 mAbs in the presence of an adjuvant. We observed that anti-NS1 antibodies induced by immunization with chimeric αDEC-NS1 or αDCIR2-NS1 mAbs did not cause significant pathology or were able to protect BALB/c mice from an intracranial DENV2 NGC strain challenge.

Introduction: Smoking cessation programs offer an effective way to quit smoking. In Portugal these programs receive patients from primary care and all areas of secondary/tertiary care. Objective: to compare patients who attended a smoking cessation program referred from primary care(PC) with those from a hospital facility(HF). Methods: retrospective study conducted among patients who attended a smoking cessation program in a Lisbon central hospital, between 2017-2018. Demographic data, smoking pack-years, nicotine dependence, motivation to quit, anxiety and depression (assessed by Fagerstrom Test, Richmond Test and Hospital Anxiety Depression Scale, respectively) and quit smoking success were collected. Success rate was defined as non-smoking for ≥3 months. Results: total sample of 285 patients, 224(78.6%) from HF and 61(21.4%) from PC. Both had similar mean age. HF patients had a higher mean smoking pack-years (HFvsPC, 41±21.8vs38±21.7) and more respiratory comorbidities (HFvsPC, 43.3%vs34.4%). PC patients had more anxiety (mean score 9.6±4.2vs8.5±4.3) and depression (mean score 6.4±3.7vs6.0±3.7). On average, both groups had a moderate nicotine dependence and motivation to quit, only 6.6% of PC and 8.8% HF patients were highly motivated. The overall success rate was higher in HF patients-14.7%vs4.9% (p-value 0.04), rising to 26%vs8.3% in those who attended ≥3sessions. Conclusion: Patients referred from a HF had more respiratory comorbidities and higher smoking load, probably felling more benefits with smoking cessation. They were less anxious and depressed, allowing an easier intervention. Considering the small percentage of highly motivated patients, it should be a better selection for these programs.

Background: Carotid Arterial Disease (CAD) and peripheral arterial disease (PAD) are atherosclerotic diseases. Adipose tissue (AT) and skeletal muscle (SM) are endocrine organs producing polypeptides with vascular effects. The main objective of this study is to characterize the AT and SM in PAD and CAD. It is also an aim to determine their role in central hemodynamics. Methods: A prospective, observational, case–control study is being conducted. The study group includes patients with PAD/CAD, with and without surgical indication. The control group includes subjects without PAD/CAD, with indication for elective non-vascular surgery, in order to allow access to samples of AT and SM. The quantity, histology and endocrine function of AT and SM are being determined. Results: From December 2018 to August 2019, 47 PAD were studied: 33 with Intermittent Claudication (IC) - (28 male; age: 67.24 ± 9.97 years) and 14 Critical Limb Ischemia (CLI) - (seven male; age: 69.21 ± 8.33 years). CLI patients have a lower quantity of SM and higher quantity of visceral and subcutaneous AT, determined on the CT scan, but these differences were not statistically significant. CLI had significant lower SM strength and density [muscle strength right hand: 22.62 ± 8.20 kgf IC vs. 16.38 ± 7.84 kgf CLI, p = 0,02; SM strength left hand: 21.98 ± 8.98 kgf IC vs. 16.37 ± 8.35 kgf CLI, p = 0.04; SM density: 20.44 ± 11.73 Hounsfield Units (HU) IC vs. 9.04 ± 2.47 HU CLI, p = 0.01]. Conclusion: This preliminary data suggests that CLI patients could have a SM dysfunction, inferred from hand grip strength and SM density. These results would be corroborated with the project development. The novelty of this research is the possibility to study the histology features and endocrine markers of AT and SM and to find an association with artery function, arteriosclerosis an atherosclerosis, in human.

In the domestic segment, various appliances and processes consume great amount of water and, consequently, energy. In this context, the main aim of this study is to analyse the impact of water temperature, flow and bath duration in water and energy consumptions. The impact on CO2 emissions and a simple costs analysis were also carried out. It included a monitoring plan of 197 baths taken under different scenarios of water temperature and flow. It was concluded that increasing water consumption leads to an increase on energy consumption and that both resources consumptions increase with bath duration. Bath temperature had influence not only on energy consumption, as expected, but also in water consumption, what may be explained by the user's satisfaction during baths with higher temperatures. The use of a flow reducing valve is not a guarantee of water saving which can also be related to the user's satisfaction patterns, given that the introduction of a flow reducing valve can lead to a bath duration increase. In what concerns to the CO2 emissions, it was concluded, as expected, that higher values are obtained for baths with higher temperatures given their relation with higher energy consumptions patterns. A simple costs analysis revealed that having flow reducing valves, with a bath temperature of 75 °C, increased the costs with electricity and water in 119% and 32%, respectively, when compared with a temperature of 60 °C.

Green infrastructure, such as green roofs/walls, plays a key role in addressing urban problems. Despite the well-established sustainable mentality, aspects such as aesthetics, recreation, and welfare are still the main drivers for undertaking such investments. Several studies have focused on proving the benefits of green infrastructure, namely, thermal insulation, air quality, and others. However, significant soft benefits have not yet been properly addressed. It is, therefore, important to understand how much citizens are willing to invest in those mitigating measures and list the aspects that influence that value. This study suggests a methodology based on stated preferences to evaluate the willingness-to-pay of owner/tenants for green roofs/walls in residential buildings and determine the influence of multiple factors. Results show that consumers reveal higher willingness-to-pay for accessible green roofs. Knowledge of benefits and the accessibility of green roofs have a great impact on the willingness-to-pay. Recreation benefit is at the forefront of individuals&rsquo, concerns, even more than aesthetics.

The installation of green roof systems is being used as a specific action towards a broader objective of increasing the sustainability of the built environment. Yet, their development is still limited by the absence of a full understanding of their economic value. There is an underlying assumption that these solutions can enhance the value of cities, however contrasting results of past studies do not allow to draw specific conclusions about their real economic contribution.This paper intends to improve the decision-making process by providing an adequate methodology to perform cost-benefit analyses of installing green roofs. The proposed economic evaluation balances costs and benefits at three levels of analysis: financial, economic and socio-environmental. The first level compares construction, maintenance and replacement costs of green roofs with private benefits as discount on fire insurance, energy consumption, improvement of photovoltaic performance and urban rooftop farming. The second level also includes the economic gains from increase of property value, aesthetics, recreation and sound insulation. The third level adds social benefits related to storm water management, noise reduction, air pollution removal, mitigation of the urban heat island effect, public health and ecological preservation. The all-inclusive methodology is successfully applied to Lisbon, Portugal. The study confirmed the economic feasibility of green roofs in the long term at a social level but not at a financial level. The estimated net present value of green roofs implementation in Lisbon is about 320 million euros. A sensitivity analysis is also performed to the costs/benefits included. The results show that aesthetics, recreational value and sound insulation have the highest influence on the economic value.

Urban population is becoming less likely to contact with nature. Yet, green infrastructure, as green roofs, provide multiple ecosystem services, as promoting citizens physical and psychological well-being. With the Coronavirus 19 world pandemic public spaces, like parks and other recreational areas, were closed and most citizens were confined to their dwellings. In this context, the need for outdoor space in the housing environment became more necessary than ever. This study is based on a survey performed to citizens living in 35 different countries to identify their access and value given to existing green areas in the home environment during and after confinement, and their willingness to pay (WTP) for an accessible green roof. Results indicate that 68% of respondents missed having a garden during the confinement and the outdoor space value increased after the confinement. Most are willing to pay for a medium sized accessible green roof and their WTP increases if the green area is bigger. WTP for medium sized green roofs is higher in other countries than in Portugal but not significantly different for larger green roofs. To promote private investment in green roofs, citizens WTP should be considered when designing new urban green infrastructure incentive policies.

Knowing water and energy consumption patterns sets the baseline for understanding their drivers and assessing the performance of potential measures to increase efficiency and/or reliability. These patterns can vary substantially depending on the building characteristics, on the building users and use, on the cultural, social, economic, environmental context in which the building is located, among many other factors. This article presents a general methodological framework for characterizing water and energy consumption patterns in buildings based on the evaluation of the characteristics of the equipments and appliances, as well as the type of users and the activities developed in each type of room. This allows estimating water and energy use, by end use per square meter and by roomtype. The methodological framework proposed was applied to the buildings of the Paricarana Campus of Federal University of Roraima (UFRR), Brazil, providing one of the few examples in the literature reporting water and energy consumption in university buildings in tropical climates. Universities, in most cases, represent large water and energy consumers with distinctive consumption drivers and patterns which have received limited attention when compared to other types of buildings (e.g., residential). The findings have shown that teaching rooms and administration rooms are the main consumers, representing 48% and 49% of the institution's energy and water consumption, respectively. Air conditioning is the biggest energy consumption (63%), while personal use represents 72% of the total water consumption in a building. The toilets represent a large water consumption in a university building (46.40%). Comparing different building uses, the central library is the highest consumer, due to the longest operating time and the highest occupational density. The methodological proposal intends to be a useful tool to support managers and decision-makers to understand the dynamics of consumption and then propose effective practices to reduce water and energy uses, as well as providing reference data for comparison with other educational institutions., University building; Water and energy consumption; End use of water and energy.

Simple Summary Observation of small ruminants showing differing degrees of leanness or emaciation is a common occurrence at slaughterhouses. Although either condition may result from similar causes, emaciation and cachexia are usually pathological conditions, warranting total condemnation of the carcass during post-mortem inspection. This is done in order to prevent unfit meat from entering the human food chain. Scrapie, a naturally occurring transmissible spongiform encephalopathy in small ruminants, is characterized by loss of body conditioning and a wasting appearance. Since atypical scrapie has been identified as occurring at a low, but very consistent, the prevalence in small ruminant populations, it is advisable to include this disease as a differential diagnosis of wasting conditions detected during meat inspection at the abattoir. Vigilance for detection of putative scrapie in slaughterhouses, and its differential diagnosis from other conditions associated with wasting carcasses, are of paramount importance for post-mortem decisions on the fate of carcasses, offal, as well as animal by-products. Abstract Wasting disease in small ruminants is frequently detected at slaughterhouses. The wasting disorder is manifested by the deterioration of the nutritional and physiological state of the animal indicated by thinness, emaciation, and cachexia. Evidence of emaciation and cachexia, alone, are pathological conditions leading to carcass condemnation during an inspection. Several diseases are associated with a wasting condition, including scrapie, pseudotuberculosis, tuberculosis, paratuberculosis, Maedi Visna, and tumor diseases. On the other hand, parasitic diseases, nutrition disorders, exposure or ingestion of toxins, metabolic conditions, inadequate nutrition due to poor teeth, or poor alimentary diet are conditions contributing to poor body condition. Classical and atypical scrapie is naturally occurring transmissible spongiform encephalopathies in small ruminants. The etiological agent for each one is prions. However, each of these scrapie types is epidemiologically, pathologically, and biochemically different. Though atypical scrapie occurs at low incidence, it is consistently prevalent in the small ruminant population. Hence, it is advisable to include differential diagnosis of this disease, from other possibilities, as a cause of wasting conditions detected during meat inspection at the abattoir. This manuscript is a review of the measures in force at the abattoir for scrapie control, focusing on the differential diagnosis of gross lesions related to wasting conditions detected in small ruminants during meat inspection.

Water is an essential and increasingly scarce resource that should be preserved. The evolution of the human population and communities has contributed to the global decrease of potable water availability and the reduction of its consumption is now compulsory. Rainwater harvesting systems (RWHS) are emerging as a viable alternative source for water consumption in non-potable uses. The present study aims to contribute to the promotion of water efficiency, focusing on the application of rainwater harvesting systems in commercial buildings, and comprises four stages: (i) development of a technical evaluation tool to aid the design of RWHS and support their financial evaluation; (ii) validation of the tool using operational data from an existing RWHS installed at Colombo Shopping Center, in Lisbon, Portugal; (iii) assessment of the sensibility of the technical evaluation tool results to the variation of the inputs, namely the precipitation and consumption, through a parametric analysis for the Colombo Shopping Center; and (iv) comparison of the performance and financial feasibility of hypothetical RWHS in two existing commercial buildings. The technical tool was applied to two Sonae Sierra’s shopping centers, one in Portugal and one in Brazil. The installation of a 200-m3 tank is advised for the first case study, allowing non-potable water savings of 60% but a payback period of about 19 years. In the Brazilian shopping, the implementation of a tank with a capacity ranging from 100 to 400 m3 leads to non-potable savings between 20 and 50%, but with smaller payback period, under 2 years, due to the relatively lower investment costs and higher water fees.

Background: Peripheral arterial disease (PAD) is a manifestation of atherosclerosis. Adipose tissue (AT) and skeletal muscle (SM) are endocrine organs with vascular effects. The objective is to compare the quantity and function of AT and SM between two groups: intermittent claudication (IC) and critical limb ischemia (CLI). Methods: A prospective observational study is being performed. A transverse CT image at lower border the third lumbar vertebra was used to quantify the SM, visceral and subcutaneous AT. The SM function was inferred with the determination of hand strength using a Jamar® hydraulic hand dynamometer. Results: From December 2018 to May 2019, 44 PAD were studied: 31 with IC (24 male; age: 67 10, 29 years) and 13 CLI (7 male; age: 70, 62 6, 74 years). CLI have a lower quantity of subcutaneous AT and higher quantity of visceral and total AT, determined on the CT scan (subcutaneous AT: 16564,75 7600,00 cm2 IC versus 16067,42 10187,33 cm2 CLI p = 0.03; visceral AT: 17212,20 10096, 30 cm2 IC versus 18904,85 10189,04 cm2 CLI p = 0,03; Total AT: 33222,08 15459,33 cm2 IC versus 57320,00 52538,78 cm2 CLI p = 0.03). CLI had lower SM strength and density (muscle strength right hand: 22,62 8,20 Kgf IC versus 16,38 7,84 Kgf CLI p = 0,02; SM strength left hand: 21,98 8,98 Kgf IC versus 16,37 8,35 Kgf CLI p = 0,04; SM density: 20,44 11,73 HU IC versus 9,04 28,47 HU CLI p = 0,01) No differences were found in the SM quantity (15120,87 3199,35 cm2 IC versus 15322,57 5315,31 cm2 CLI p = 0.44). Conclusion: CLI have a higher quantity of visceral, total AT and lower quantity of subcutaneous AT, SM function and density.

Introduction: A Primary Spontaneous Pneumothorax (PSP) is defined as the presence of air in the pleural space, without a precipitating event and in the absence of lung disease. An important risk factor that has been shown to predispose patients to PSP is cigarette smoking. Objectives: Analyse the impact of smoking status in hospitalized patients with a diagnosis of PSP, in the last 8 years, at a central hospital. Methods: The Light Index was used to assess the size of the pneumothorax. Patients with no chest x-ray available or with pleural effusion were excluded from this study. Statistical analysis was used to compare the differences between smokers vs non-smokers. Results: This study evaluated 35 patients with PSP, 23 of them corresponding to smokers and former smokers, and the remaining 12 corresponding to non-smokers. Those with smoking habits, had an average of 11 pack-years, with the majority being male. A large pneumothorax was noticed in 88% of patients and 17% were surgically intervened due to persistent pneumothorax. Respiratory failure (RF) was not noticed in any of the patients and the mean time with a chest tube was 5,8 days. As to the non-smokers, a male prevalence was still observed. However, the percentages of patients with a large pneumothorax, a persistent pneumothorax with surgical indication and RF, as well as the mean time with a chest tube were very similar in both groups (75%, 17%, 8% and 6,1 days, respectively). As such, no statistically significant difference was found between the two groups in the above parameters. Conclusion: Although smoking is a known risk factor for PSP, it appeared to have no prognostic influence during hospitalization in our study, in terms of therapeutic failure, RF and mean time with chest tube.

Introduction: Despite the associated benefits, smoking cessation(SC) is particularly difficult to achieve among smokers with respiratory diseases. It is crucial to identify factors affecting SC in these patients. Objectives: Identify factors reported by patients with respiratory diseases that hinder their SC attempts. Methods: Cross-sectional study carried out among patients followed in a pulmonology outpatient clinic of a central hospital. Data was collected through a self-reported questionnaire. Descriptive analysis was conducted to identify reported barriers to SC. Results: 136patients enrolled the study (57%males, mean age 66y). Main diagnosis were lung cancer, chronic obstructive pulmonary disease(COPD), asthma and obstructive sleep apnea. The majority were non-smokers (30%) or former smokers (49%). Among active smokers (n=28; 53%males, mean age 65y), the main diagnosis were COPD(60%), lung cancer(30%) and asthma(10%). 59% had previous failed attempts to quit smoking. Main reported barriers to SC were: expensive SC medication (89%), easy access to cigarettes (53%), stress/anxiety (41%) and major family or professional problems at the time they attempt to quit (29%). Cheaper drugs (67%), strategies to restrict access to tobacco (37%), easier access to SC programs (29%) and to get in touch with SC program physician by email(6%) were the most cited facilitators for SC. Conclusions: In our sample, expensive SC medication was one of the main barriers, since in Portugal varenicline is the only reimbursed prescription drug to SC. Higher levels of anxiety and choosing the wrong time to quit hindered the success of SC. Handing out self-reported questionnaires is a possible way to identify barriers to SC and improve the success of SC programs.

Introduction: Smoking is the main avoidable health risk factor in Europe. The number of people who are covered by tobacco control measures has increased. Objectives: Compare clinical practice and knowledge about smoking cessation between physicians and nurses of a central hospital. Methods: Cross-sectional study carried out among physicians and nurses of a central hospital. A questionnaire was used to collect data about brief intervention, motivational assessment, withdrawal syndrome recognition and pharmacological treatment. Statistical analysis was conducted to compare the differences between physicians and nurses. Results: 96 health professionals enrolled the study, 49% were physicians. Both groups often asked patients about their smoking habits (94% and 96%). Compared to nurses, physicians addressed more frequently the risks associated with smoking (79% vs 69%) as well as the benefits associated with smoking cessation (79% vs 71%), although these differences were not statistically significant. Only 36% of physicians and 19% of nurses assessed the motivation to quit smoking. Nicotine withdrawal symptoms were mainly evaluated by nurses (73% vs 28%, p Conclusions: Both groups present important gaps in the evaluation of the withdrawal syndrome and the motivational degree. This is probably due to the fact that both groups are sparsely trained, although they recognize the importance of the topic.

Smoking is a major risk factor (RF) for the development of cardiovascular disease (CVD). Acute myocardial infarction (AMI) and stroke are the leading cause of mortality and morbidity worldwide. Tobacco is also associated with insulin resistance and hypertension (HBP). Current lifestyles, dominated by stress, anxiety, precarious socioeconomic factors facilitate and perpetuate smoking. The objective was to determine the impact of smoking in the development of different CVD. Methods: A retrospective cohort study was performed in smokers and non-smokers followed up at the Pulmonology Clinics. The incidence of AMI, stroke, type 2 diabetes mellitus (DM2) and HBP was analyzed in these groups. Descriptive analysis and logistic regression was performed. Results: Of the 150 patients (mean age 75 years, 63% male, mean body mass index (BMI) 28.3), 61.3% (n = 92) were smokers. In the group of smokers (mean age 72y, 68% male, mean BMI 31, mean pack year (PY) 35), 19.5% (n = 18) had a stroke, 11.9% (n = 11) had an AMI, 27.1% (n = 25) had DM2 and 72.8% (N = 67) had HBP. It was observed that smokers with cardiovascular events had higher PY values (40 vs 28). In the non-smoking group (mean age 63y, 54% male, mean BMI 26.2), 8.6% (n = 5) had a stroke, 6.8% (n = 4) had an AMI, 29.3% (n= 17) had DM2 and 58.6% (n=34) had HBP. Conclusion: This study suggests that smoking may have a greater impact on the development of stroke (p = 0.012) and HBP (p = 0.025). Smoking also has an impact on the development of AMI, but on a smaller scale (p=0.042). Higher PY values are also influencing the development of CVD (p = 0.035). There was no statistically significant variation between the two groups in the development of DM2.

University buildings may contribute significantly to the urban demand of potable water, particularly in small and medium communities with large universities. In this regard, alternative sources of water supply contribute to minimizing the pressure on natural resources. This paper investigates the applicability of rainwater harvesting (RWH) systems to partially compensate the daily non-potable water demand in university buildings. The traditional daily water balance model was improved to enhance the accuracy of the performance analysis and design optimization of the RWH system by accounting for consumption and runoff variability. The novel algorithm was tested using real daily water consumption data for two university buildings located in Portugal. In addition, different scenarios were evaluated combing RWH systems with extensive green roofs and different runoff distributions over time. The findings indicate that the use of real daily water consumption data instead of average values influences the final results, especially in buildings with fluctuating water consumption patterns over time up to 11%. Regarding the runoff coefficient, it was verified that variable values are recommended compared to the average values. Runoff variability associated with the installation of green roofs was found to decrease RWH system performance due to reduced stormwater runoff. However, the scenario with 50% of the catchment area covered by extensive green roofs showed promising results, decreasing the potential water saving less than 6% and increasing the volume of retained water by almost 15%.

Fetal and neonatal alloimmune thrombocytopenia is a rare disorder in which maternal alloantibodies cross the placenta and cause fetal thrombocytopenia. Most cases are mild but can be potentially fatal if there is an intracranial haemorrhage. Usually, the mother is asymptomatic during pregnancy and no screening is routinely recommended unless there is obstetric or family history. After birth, prompt identification is crucial so that the newborn is closely monitored and treatment is given, if needed, to prevent serious complications. In this article we present two clinical cases of fetal and neonatal alloimmune thrombocytopenia in first-born children, after uneventful pregnancies, with different outcomes and discuss the obstetric management and follow-up in future pregnancies.

Urban planners, policy makers and transport operators constantly search for ways to improve the environment of transport infrastructures. “Greening” solutions, such as green roofs and walls, are among the potential measures to achieve the Sustainable Development Goals. The integration of greenery in the urban environment, including transport infrastructures, is shown to provide positive Net Present Values and to have several environmental, economic, and social benefits. Since users are forced to walk and wait in urban interfaces for a certain time, “greening” solutions may contribute to improve their psychological well-being and comfort. However, there is little evidence on the perceptions and the value attributed by users to these solutions. This paper intends to provide a unique perspective on users’ perception and willingness-to-pay for comfort and “greening” solutions in transport interfaces. The proposed methodology aims to evaluate the feasibility of several scenarios, based on a questionnaire survey taken amongst railway users. The process starts with a pilot survey and preliminary interviews, followed by the definition of the target population and with both “in-situ” and online survey campaigns. The case-study is developed at Entrecampos Station, Lisbon, Portugal, where the survey was taken by 146 users. Results have shown that although users might attribute some value to having greener spaces in public transport interfaces, their willingness-to-pay is low and they show a preference for improvements such as more seats or safe and comfortable waiting areas. These conclusions may assist decision-making processes regarding infrastructure systems and urban greening.

In the context of an increasing commitment to water efficiency in the EU policy, a different approach for eco-efficiency assessment in the agricultural sector, at the meso level, was applied to the Monte Novo irrigation perimeter, located in the southern region of Portugal, targeting the new agricultural paradigm being implemented in the Alentejo region, focusing on the assessment of the environmental and economic impacts and the eco-efficiency performance associated with the water value chain for both the baseline scenario and a set of potential eco-efficiency agricultural improvements. These improvements would be resource efficient or pollution preventing. The agricultural eco-efficiency improvements which promote the efficiency of water use, like the Regulated Deficit Irrigation, allow the reduction of water and energy consumptions, whereas those promoting pollution prevention as the use of sludge from waste water treatment plants or the use of organic fertilizers, make it possible to reduce pollution caused by the use of chemical fertilizers. The selection of the agricultural eco-efficiency improvements to be tested was based on stakeholders' involvement and perceptions; the chosen methodology highlights the impacts of the application of each of those eco-efficiency improvements and the potential investments required, in order to facilitate stakeholders' decisions. The results to be presented focus on the relative performance of the scenarios corresponding to the application of each of the proposed eco-efficiency improvements compared to a baseline scenario. The set of eco-efficiency indicators evaluated is complemented with an economic performance assessment, allowing to present some policy recommendations on technology uptake.

Objectives: To question and to describe the headache prevalence in a population undergone admissive evaluation. Methods: 607 individuals were undergone admissive evaluation, whose data were catalogued by the examiner neurologist. The questions "Do you have headache? Does headache interfere in your life quality?" were made to all patients, and the prevalence was compared with the literature. Results: The sample was composed of individuals from 17 to 66 years old (27.72 on average), in which 98.35% were male. About 5% of the individuals answered YES to both questions, 0.65% answered YES to only the first question, and no female answered YES to both questions. Conclusions: The observed headache prevalence is smaller than in other studies of healthy populations. It is possible that the hopeful applicant omit this information during the admissive evaluation by fearing that this information would interfere negatively in their hiring.

This paper quantifies green roofs energy savings which is a challenging topic, namely in Mediterranean climate with distinct heating and cooling seasons. The thermal behavior of a green roof case study in Lisbon, Portugal, was assessed through an experimental campaign during heating and cooling periods of the year of 2013. These experimental results were then used to calibrate a building energy simulation in EnergyPlus. After validation, the numerical model was used to compare the energy performance of intensive, semi-intensive and extensive green roofs. The three green roof types lead to similar heating energy needs but extensive green roof solution shows higher cooling energy needs than semi-intensive and intensive ones, of 2.8 and 5.9 times more, respectively. Furthermore, the performance of each type of green roof and different insulation properties was compared to traditional roof solutions. With no thermal insulation, extensive green roofs require 20% less energy use than black roofs and show a similar annual behavior than white roofs. Semi-intensive and intensive green roofs energy use is 60–70% and 45–60% lower than black and white roofs, respectively. Well insulated roofs do not take full advantage of evapotranspiration cooling effects, which is particularly noticeable when comparing with high reflective white roofs.

Greening the urban environment can be an important strategy to tackle the problems of urban densification and meet the United Nations Sustainable Development Goals. Green infrastructures, like green roofs and green walls, have multiple associated environmental, social and economic benefits that improve buildings performance and the urban environment. Yet, the implementation of green roofs and green walls is still limited, as these systems often have additional costs when compared to conventional solutions. Recent studies have been comparing these greening systems to other solutions, balancing the long-term benefits and costs. Also, there is significant research on green roofs and green walls benefits. Although, green roofs and green walls economic analyses don't include all benefits due to measuring difficulties. The associated uncertainty regarding the quantification of the benefit makes it difficult to compare the research outcomes. This paper aims to provide a research review of existing benefits and costs of different types of green roofs and green walls. These were divided between building scale benefits, urban scale benefits and life cycle costs, focusing on the identification of results variability and assessment of their average quantification. The analysis shows that in general, there are few data regarding intangible benefits, as the promotion of quality of life and well-being. Also, there are still few studies quantifying green walls benefits and costs. High variability in data is mostly related to the different characteristics of systems, buildings envelope, surrounding environment and local weather conditions.

Worldwide, green infrastructure is increasingly used to mitigate the impacts of dense urban areas, contributing towards the naturalization of the built environment. However, for investors, these systems often emerge as requiring substantial upfront cost (high installation costs) and, depending on the solution, might also have significant maintenance costs. On the other hand, policymakers are placing green infrastructure on the agenda, as a solution to consider in urban planning and design. There is a mismatch between the economic/social/environmental value of green infrastructure and their financial analysis. As the quantified benefits of these solutions may not compensate the high implementation costs, discouraging building owners to invest in them. The alignment of both expectations, public and private agents, regarding the development of green infrastructure, is done through the use of incentives, with distinct configurations and nature, that promote and facilitate the adoption of green infrastructure by private investors. This research aims to identify and analyse the incentive policies used by several municipalities to promote the installation of green roofs and/or green walls. The data set includes 113 cities in 19 countries. The incentive policies were classified into six different categories: tax reductions, financing, construction permit, sustainability certification, obligations by law and agile administrative process. The results show that incentive policies are mainly concentrated in Europe and North America, and most incentive policies focus on the promotion of green roofs, as no exclusive incentive policies for the promotion of green walls were found. From all incentive policies studied, financial subsidies and obligations by law are the most used ways to promote green infrastructure worldwide.

Green infrastructure have been widely spread to counter the negative effects of urbanization. However, their economic feasibility still generates discussion between researchers, investors and suppliers, leading to the need for more accurate and case-specific cost-benefit analysis. This study pretends to analyze the economic feasibility of greening transport infrastructures, in particular road tunnels. The proposed methodology includes the life-cycle costs and benefits of green systems. Its incremental approach considers economic appraisal components (financial, economic and socioenvironmental) and transport infrastructures dimensions (infrastructure, user and surroundings). This study simulates five green case studies in underground passages of a roadway with high traffic intensity in Lisbon, Portugal. Four out of five scenarios are economically feasible using a life-cycle of 40–50 years and a discount rate of 4,8 %. The final net present values range from 33.961 to 5.079.356 €. Discount and inflation rates, financial costs, reduction of the noise inside the tunnels, creation of new functional areas and aesthetical improvements have great significant impact on projects’ economic return.

Background: Arterial stiffening measured by Pulse Wave Velocity (PWV) predicts cardiovascular events and mortality in adults. It advances with age and seems accelerated in children with certain disease conditions such as chronic kidney disease or diabetes. The aim of this study was to determine factors that influence PWV in children. Methods: PWV was captured in 285 children aged 10–14 years attending a Portuguese school. The effects of sex, age, height, weight, body mass index, waist circumference, blood pressure, heart rate and sodium excretion in 24-h urinary samples in PWV were tested. Results: PWV correlated positively with age, height, systolic blood pressure, diastolic blood pressure and heart rate in males and females (p < 0.05) and with weight in males (p < 0.05). Major predictors for PWV in a multivariate regression analysis were gender, height, weight, diastolic blood pressure, heart rate and body mass index. Conclusion: Our study found several determinants of PWV in children, some of them modifiable and interfering with cardiovascular outcomes. Future research may provide clarity to the association between PWV in children and cardiovascular events in adulthood.

Background: Pulse Wave Velocity (PWV) is a measure of arterial stiffness and vascular aging and an important parameter for cardiovascular risk stratification. A previous study showed high prevalence rates of early vascular aging in an adult population from the North of Portugal. The aim of this study was to characterize children from the same region regarding PWV and its relationship with central adiposity indices and blood pressure. Methods: A convenience sample of 285 children aged 10–14 years attending a Northern Portuguese school was used. PWV, height, weight, body mass index (BMI), waist circumference e blood pressure (BP) were measured. Collected data was distributed by gender, age and height specific percentiles. Results: Mean PWV values were 5.4 ± 1.0 for males and 5.1 ± 0.7 for females. We only found statistically significant differences between males and females PWV in the 13’ years old group (p = 0.02). 27.4% of the children (N = 78) had PWV ≥ 90th percentile, 64.1% of which were males (N = 50) and 15.3% (N = 12) were overweight/obese. PWV was significantly higher in children with systolic BP ≥ 90th percentile (p = 0.004). No differences were found in PWV between overweight/obese (BMI ≥ 85th percentile) and healthy weight children. Conclusion: Our study found a high prevalence rate of elevated PWV in children. This is a concerning aspect, taking into account the highly recognized relationship of PWV and cardiovascular outcomes, indicating that healthy policy measures need to be implemented early in life. Future research is needed to establish PWV reference percentile curves specific for Portuguese children.

Introduction: Knowledge regarding tobacco interventions is essential for the effectiveness of smoking cessation programs. Objectives: Compare general knowledge, attitudes and experience in smoking cessation between junior doctors (JD) and senior doctors (SD) prior a one-day training intervention, aimed at physicians interested in this subject. Methods: Cross-sectional study where data were collected using a questionnaire on demographic characteristics, knowledge and attitudes regarding smoking cessation. Statistical analyses were conducted to compare JD and SD. Results: A total of 69 physicians answered our questionnaire, 68% JD and 32% SD. In both groups, the great majority were general practitioners or pulmonologists (91% of JD and 100% of SD). SD had a higher experience in motivational (73%) and pharmacological (45%) interventions compared to JD (53% and 26%, respectively). However, both groups lacked training, with 72% of JD and 50% of SD lacking pre-graduate training and 49% of JD and 41% of SD lacking post-graduate training. Even though the majority didn’t have an individual smoking cessation consult (85% of JD and 86% of SD), they frequently asked their patients about their smoking status (96% of JD and 100% of SD) and considered them important (96% of JD and 91% of SD). Conclusions: Both groups recognized the importance of their patients’ smoking habits. Even though SD had a higher experience in smoking cessation, the difference wasn’t statistically significant and lack of training was evident in both groups. Therefore, it is crucial to provide them training, to increase knowledge and skills in smoking cessation interventions.

This research evaluates which is the most cost-efficient rainwater harvesting (RWH) system in a new commercial building located in the north of Portugal, in Braga. Based on the economic analysis, the cost-efficiency of the presented RWH strategies may be considered for the case studied. The results of this research indicate that RWH scenarios proposed are cost-efficient. Considering a 10 % discount rate, the water price charge in the municipally of Braga and the cost of the infrastructures would be enough to make RWH cost-efficient for this option. At this discount rate, the payback period ranges from 2 to 6 years and the internal rate of return would range from 23 to 76 %. If a discount rate of 5 % were considered, the payback periods would be reduced by approximately 1 year.

Because water is a key at-risk resource, improved water management is essential. In terms of quantity, the two major alternatives in water management can be grouped into: (i) improving efficiency in water use; and (ii) exploring alternative water sources. Rainwater harvesting (RWH) is one of the most promising alternative water sources, since rainwater can easily be collected and used without significant treatment for non-potable purposes. However, the economical viability of these systems is not always assured. This paper examines the most relevant technical and economical issues in designing domestic RWH systems, evaluating the technical feasibility and economical viability of this technology in the particular weather and water use in Portugal. The evaluation is performed for a single-family residence, where the water use pattern was monitored. The precipitation pattern is characterized for two locations in Portugal, Porto and Almada, since they represent two different scenarios for RWH. The RWH and water savings efficiency were assessed and payback period estimated for both cities. It was found that, for an optimum rainwater tank, the water savings potential are similar for both locations, despite the differences in the average annual precipitation. A simple rule for estimating the optimum tank capacity for single-family households in Portugal is proposed. A sensitivity analysis shows an important influence of water fees on the economical viability of RWH systems in single-family houses in Portugal, namely when compared to changes in the consumption pattern.

Introduction: Smoking is a highly addictive behaviour. It is crucial to identify and address factors that may hinder the attempts to quit smoking. Objectives: Evaluate the success rate of a central hospital smoking cessation program and identify factors that may contribute to failing the quit attempt. Methods: Retrospective study conducted among patients who attended ≥3sessions of a smoking cessation program of a central hospital between 2008-2016. Medical records were reviewed to collect data on demographic characteristics, smoking pack-years, nicotine dependence, motivation to quit and mood disorders (assessed by Fagerstrom Test, Richmond Test and Hospital Anxiety and Depression Scale respectively). The sample was divided into two groups: successful and unsuccessful quitters. Statistical analyses were conducted to compare the differences between the two groups. Results: 335 patients enrolled the study (50.5%males; mean age 50.9±11.5y), 56.1% successfully quitted smoking. Unsuccessful quitters were heavier smokers (mean pack-years: 49.3 vs 41.0, p Conclusions: In our smoking cessation program higher nicotine addiction and depression levels had a negative effect in smoking cessation success. These patients are likely to need more intensive and multidisciplinary support in order to succeed in their attempts to quit.