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Monitoring how different people – as ‘social sensors’ – evaluate and respond to crisis such as pandemics, allows tailoring crisis communication to the social perceptions of the situation, at different moments. To gather such evidence, we proposed a index of social perceptions of systemic risk (SPSR), as an indicator of a situational threat compromising risks to physical health, psychological health, the economy, social relations, health system, and others. This indicator was the core of a social sensing approach applied to crisis situations, implemented during the COVID-19 pandemic through a content analysis of more than 130.000 public comments from Facebook™ users, in COVID-19 related publications. This content coding allowed creating a SPSR index monitored during a one-year descriptive longitudinal analysis. This index correlated with co-occurring events within the social system, namely epidemiological indicators across measurement cycles (e.g. new deaths; cumulative number of infection cases; Intensive Care Unit hospitalizations) and tended to reflect the epidemiological situation severity (e.g. with the highest level registered during the worst pandemic wave). However, discrepancies also occurred, with high SPSR registered in a low severity situation, i.e. low number of hospitalizations and deaths (e.g. school year beginning), or low SPSR in a high severity situation (e.g. 2nd pandemic wave during Christmas), showing other factors beyond the epidemiological situation contributing to the social perceptions. After each ‘crisis period’ with SPSR peaking, there was a ‘restoration period’, consistently decreasing towards average levels of the previous measurement cycle. This can either indicate social resilience (recovery and resources potentiation) or risk attenuation after a high-severity period. This study serves as preliminary proof of concept of a crises social sensing approach, enabling monitoring of social system dynamics for various crisis types, such as health crisis or the climate crisis. Fundação para a Ciência e Tecnologia - FCT info:eu-repo/semantics/publishedVersion

Hepatobiliary manifestations are common in inflammatory bowel disease (IBD), with 30% of patients presenting abnormal liver tests and 5% developing chronic liver disease. They range from asymptomatic elevated liver tests to life-threatening disease and usually follow an independent course from IBD. The pathogenesis of liver manifestations or complications and IBD can be closely related by sharing a common auto-immune background (in primary sclerosing cholangitis, IgG4-related cholangitis, and autoimmune hepatitis), intestinal inflammation (in portal vein thrombosis and granulomatous hepatitis), metabolic impairment (in non-alcoholic fatty liver disease or cholelithiasis), or drug toxicity (in drug induced liver injury or hepatitis B virus infection reactivation). Their evaluation should prompt a full diagnostic workup to identify and readily treat all complications, improving management and outcome.

Background and aims Non-cirrhotic portal hypertension (NCPH) comprise a group of diseases that cause portal hypertension without cirrhosis, leading to a high risk of hemorrhage from esophageal varices. There are no non-invasive predictors of high-risk varices (HRV) described in the literature for NCPH. This study aimed to evaluate whether transient splenic elastography (TSE) can predict HRV in patients with NCPH. Methods Prospective study of patients with NCPH who underwent a single timepoint evaluation with transient liver and spleen elastography, ultrasonography, upper endoscopy, and laboratory tests. The study was performed from January to September 2020. Patients were divided into two groups based on the presence of HRV. The relation between TSE, transient liver elastography (TLE), spleen size, and platelet count to the presence of HRV was evaluated. Results Of 42 patients with NCPH, 50% (21/42) presented HRV. In univariate analysis, TSE (median, 58.4 vs. 28.3, p = 0.009) and spleen size (median, 17.5 vs. 14.5 cm, p = 0.013) were associated with HRV. No statistically significant relationship was found between the presence of HRV and platelet count or TLE. In multivariate analysis, TSE was the only variable related to HRV (OR 1.21, 95% CI 1.02-1.38). TSE had a good performance in predicting HRV in our population (AUROC 0.878; 95% CI 0.751-1000). TSE > 35.4 kPa presents 93.3% sensitivity, 60.0% specificity, and 90.9% negative predictive value. Conclusion In our population of patients with NCPH, TSE is useful in predicting HRV. TLE, spleen size, and platelet count were not related to HRV.

In patients with portal hypertension (PH), the differential diagnosis between porto-sinusoidal vascular disease (PSVD) and cirrhosis is challenging. This study aims to evaluate the diagnostic accuracy of the SSM/LSM index in the diagnosis of PSVD.Prospective study of patients with PH and PSVD or cirrhosis. Transient liver and spleen elastography were performed and the ratio between spleen stiffness measurement (SSM) and liver stiffness measurement (LSM) was calculated. The relation of SSM/LSM with the diagnosis of PSVD was evaluated.Forty-four patients with PSVD and 44 patients with cirrhosis were evaluated. Median age was 57.5 (IQR 49.0-64.5) years, 66.3% were males. In patients with PSVD, median SSM was 59.4 (33.5-77.7) kPa, median LSM was 6.2 (5.2-10.2) kPa and median SSM/LSM was 5.62 (3.15-9.68). In patients with cirrhosis, median SSM was 47.3 (24.3-60.3) kPa, median LSM was 27.8 (17.7-53.9) kPa and median SSM/LSM was 1.55 (1.06-3.24). The SSM/LSM AUROC was 0.940 (p0.001). Using 2 as a cut-off, we obtained good sensitivity (86.5%), specificity (92.7%), and accuracy (89.7%) for the diagnosis of PSVD.The SSM/LSM index is useful in the differential diagnosis between liver cirrhosis and PSVD. Using the cut-off of 2 we achieved a good sensitivity and specificity for diagnosing PSVD.

Inflammatory bowel disease (IBD) may be associated with a wide range of hepatobiliary manifestations. This study aimed to characterize the spectrum of hepatobiliary disorders in patients with IBD who underwent liver biopsy for sustained abnormal liver function tests (LFT).A retrospective study was performed of all patients with IBD who underwent liver biopsy between January 2010 and December 2020 for sustained abnormal LFT (at least 6-month duration).A total of 101 patients were included, mostly male (62.4%), with a mean age of 44.4±13.3 years. The most common IBD type was Crohn's disease (61.4%). Median time interval between abnormal LFT and biopsy was 14 (7-36) months. Abnormal LFT was predominantly hepatocellular in 40 patients (39.6%), cholestatic in 26 (25.7%) and mixed in 35 (34.7%). The most frequent diseases were nonalcoholic fatty liver disease (NAFLD) in 33 patients (32.7%), drug-induced liver disease (DILI) in 30 (29.7%), autoimmune hepatitis (AIH) in 13 (12.9%) and primary sclerosing cholangitis (PSC) in 13 (12.9%). Three patients had primary biliary cholangitis. Remarkably, 70 patients (69.3%) already had fibrosis by the time of liver biopsy and in 6 (5.9%) liver disease was already detected in the stage of cirrhosis.Abnormal LFT in IBD patients had a wide range of etiologies and histology was often essential for reaching a correct diagnosis. NAFLD, DILI, AIH and PSC were the most common diagnoses and patients often presented in cirrhotic stage. Therefore, liver biopsy must be considered early in IBD patients with unexplained sustained abnormal LFT.

Do crisis evolve linearly through sequential one-directional stages that end with their resolution? Or are crisis, a set of nonlinear events with somewhat a chaotic nature, better represented as multilayer relapse cycles, that is, a series of dynamic processes and templates that evolve at different levels of analysis and can either go forward—achievement—or go back—relapses? Moreover, should crisis always move forward to reach their resolution or should we strive to achieve social systems resilience, grounded on learning and adaptation processes, that is, moving forward and backwards, until achieving it? To argument in favor of achieving crisis resilience, we propose a theoretical model—the crisis layers and thresholds (CLT) model grounded on the following assumptions: (a) individuals' evaluations and responses should be the basis/core of crisis management and crisis communication activities;(b) different concurrent psychosocial and organizational processes occur at different levels of analysis of a crisis, from a microindividual level to a macro organization level;and (c) rather than striving for crisis resolution, we should strive for crisis resilience, preparing the social system for current and future emerging risks and crisis To implement effective evidence-based crisis management and crisis communication in line with such assumptions, we also propose the CLT-ResiliScence approach, an Information and Communication Technology-mediated crisis sensing approach This is based on monitoring “social sensors” data, particularly from social media, as an important source of information Examples of this will be provided based on research on the current COVID-19 pandemic © 2020 Wiley Periodicals LLC

Background In the last few years we have witnessed a revolution in the treatment of hepatitis C virus (HCV) infection. With the introduction of direct-acting antiviral agents (DAAs), sustained virological response (SVR) is achieved in more than 95% of the patients. The focus is now being turned to the global targets set by the World Health Organization, with the aim of achieving HCV elimination by 2030. Prison inmates constitute one of the high-risk groups, and receive treatment less frequently due to several barriers in access to health care. Aim To describe the management and follow-up of a cohort of HCV monoinfected patients treated with DAA in the prison setting, where tertial referral liver center specialists locally provide, on-site assessment and treatment for the prisoners. Methods A prospective observational study was conducted from April 2017 to March 2020, which included all HCV monoinfected prison inmates in the largest Northern Portugal prison. Demographic, clinical, and laboratory data, as well as transient elastography measurements, were collected onsite by the medical team and prospectively recorded. Patients were treated with DAA according to international guidelines. The primary endpoint was SVR at post-treatment week 12. Results There were 98 monoinfected HCV male inmates (mean age, 42.7 ± 8.6 years) included in the analysis. Injecting drugs or tattooing were reported in 74.5%, with 38.8% of the latter being done in prison. Alcohol consumption of more than 30 g/d was referred in 69.4%. The most prevalent genotype was 1a (54.1%), followed by 3 (27.6%), 4 (9.2%) and 1b (6.1%). Pretreatment fibrosis degree was mild-to-moderate (F0-F2) in 77.6% and severe in 22.4% (F3-F4). Treatment regimens chosen were: 45.9% elbasvir/grazoprevir, 29.6% sofosbuvir/velpatasvir, and 12.2% sofosbuvir/ledispavir and glecaprevir/pibrentasvir. No major adverse events were observed. SVR at post-treatment week 12 was 99%. Conclusion In a population considered to be both hard-to-access and a cornerstone for HCV elimination, the onsite evaluation and treatment of HCV-infected prisoners, achieved an exceptional highly effective success rate. This type of collaborative program should be considered to be expanded, to support hepatitis C elimination efforts.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the least deadly but most infectious coronavirus strain transmitted from wild animals. It may affect many organ systems. Aim of the current guideline is to delineate the effects of SARS-CoV-2 on the liver. Asymptomatic aminotransferase elevations are common in coronavirus disease 2019 (COVID-19) disease. Its pathogenesis may be multifactorial. It may involve primary liver injury and indirect effects such as "bystander hepatitis," myositis, toxic liver injury, hypoxia, and preexisting liver disease. Higher aminotransferase elevations, lower albumin, and platelets have been reported in severe compared with mild COVID-19. Despite the dominance of respiratory disease, acute on chronic liver disease/acute hepatic decompensation have been reported in patients with COVID-19 and preexisting liver disease, in particular cirrhosis. Metabolic dysfunction-associated fatty liver disease (MAFLD) has a higher risk of respiratory disease progression than those without MAFLD. Alcohol-associated liver disease may be severely affected by COVID-19-such patients frequently have comorbidities including metabolic syndrome and smoking-induced chronic lung disease. World Gastroenterology Organization (WGO) recommends that interventional procedures such as endoscopy and endoscopic retrograde cholangiopancreatography should be performed in emergency cases or when they are considered strictly necessary such as high risk varices or cholangitis. Hepatocellular cancer surveillance may be postponed by 2 to 3 months. A short delay in treatment initiation and non-surgical approaches should be considered. Liver transplantation should be restricted to patients with high MELD scores, acute liver failure and hepatocellular cancer within Milan criteria. Donors and recipients should be tested for SARS-CoV-2 and if found positive donors should be excluded and liver transplantation postponed until recovery from infection., NA

ObjectiveAlpha-1 antitrypsin deficiency (AATD) is a common, potentially lethal inborn disorder caused by mutations in alpha-1 antitrypsin (AAT). Homozygosity for the ‘Pi*Z’ variant of AAT (Pi*ZZ genotype) causes lung and liver disease, whereas heterozygous ‘Pi*Z’ carriage (Pi*MZ genotype) predisposes to gallstones and liver fibrosis. The clinical significance of the more common ‘Pi*S’ variant remains largely undefined and no robust data exist on the prevalence of liver tumours in AATD.DesignBaseline phenotypes of AATD individuals and non-carriers were analysed in 482 380 participants in the UK Biobank. 1104 participants of a multinational cohort (586 Pi*ZZ, 239 Pi*SZ, 279 non-carriers) underwent a comprehensive clinical assessment. Associations were adjusted for age, sex, body mass index, diabetes and alcohol consumption.ResultsAmong UK Biobank participants, Pi*ZZ individuals displayed the highest liver enzyme values, the highest occurrence of liver fibrosis/cirrhosis (adjusted OR (aOR)=21.7 (8.8–53.7)) and primary liver cancer (aOR=44.5 (10.8–183.6)). Subjects with Pi*MZ genotype had slightly elevated liver enzymes and moderately increased odds for liver fibrosis/cirrhosis (aOR=1.7 (1.2–2.2)) and cholelithiasis (aOR=1.3 (1.2–1.4)). Individuals with homozygous Pi*S mutation (Pi*SS genotype) harboured minimally elevated alanine aminotransferase values, but no other hepatobiliary abnormalities. Pi*SZ participants displayed higher liver enzymes, more frequent liver fibrosis/cirrhosis (aOR=3.1 (1.1–8.2)) and primary liver cancer (aOR=6.6 (1.6–26.9)). The higher fibrosis burden was confirmed in a multinational cohort. Male sex, age ≥50 years, obesity and the presence of diabetes were associated with significant liver fibrosis.ConclusionOur study defines the hepatobiliary phenotype of individuals with the most relevant AATD genotypes including their predisposition to liver tumours, thereby allowing evidence-based advice and individualised hepatological surveillance.

The clinical implications of the biopsy findings in cases of drug-induced liver injury (DILI) are not fully elucidated. The aim of this study was to evaluate the histopathological findings of cases diagnosed as DILI and to correlate them with clinical and biochemical findings (such as causality assessment algorithms). We searched our department database for all cases of liver biopsy with findings consistent with toxic liver disease and selected those with a clinical diagnosis of DILI. The causative relationships were established according to Roussel Uclaf Causality Assessment Method (RUCAM). A total of 53 cases of DILI were reviewed, most of them diagnosed in hospitalized patients (83%). The analytical toxicity profile was hepatocellular (R > 5) in 60% of the cases and cholestatic (R

Summary Background & Aims Inflammatory bowel diseases (IBD) are associated with various hepatobiliary disorders. There is a strong association for primary sclerosing cholangitis (PSC). Primary biliary cholangitis (PBC), another autoimmune cholestatic liver disease, is not usually associated with IBD. The aim of this study is to report cases of PBC-associated IBD, their clinical features, response to therapy, and long-term outcome. Methods Retrospective analysis of a prospectively collated database identified patients presenting with PBC-associated IBD from 2006 to 2016. PBC has been diagnosed according to accepted criteria, and staged according to Ludwig classification. A magnetic resonance cholangiopancreatography (MRCP) was performed to rule out PSC. Response to ursodeoxycholic acid (UDCA) therapy has been assessed by using the Paris II criteria. Results A total of six patients (five females) with PBC-associated IBD were identified. Median age at IBD diagnosis was 44.7 years (range 22.5–48.8). Three had Crohn's disease and three ulcerative colitis. PBC was diagnosed in all after IBD had been diagnosed. All patients presented with cholestasis, all were positive for anti-mitochondrial antibodies. MRCP was normal in all. Liver biopsy was consistent with PBC (stage I in one, stage II in five). One year after initiation of UDCA, all patients responded to therapy. Conclusion Herein we describe the largest series reported to date of PBC-associated IBD. Although the coexistence of the two conditions is rare, PBC should be considered during the work-up of abnormal liver function tests in patients with IBD.

Introduction: Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder with an inexorably progressive course which leads to a progressive neuromuscular weakness. Weight loss is one of the major bad prognostic factors in ALS. The placement of percutaneous endoscopic gastrostomy (PEG) is of paramount importance in patients with dysphagia to improve the disease outcomes, although some fear exists regarding the possible ventilatory complications during the procedure. The aim of this study was to evaluate the safety and effectiveness of PEG tube insertion under non-invasive ventilation (NIV) in patients with ALS and severe ventilatory impairment. Methods: A retrospective study of all consecutive PEGs placed in our department from May 2011 to January 2018 in patients with ALS was performed. The procedure was performed under non-invasive positive-pressure ventilation for ventilatory support. Results: We included 59 patients with ALS with severe ventilatory impairment, 58% were female, with a mean age of 67.2 ± 10.1 years and a median follow-up of 6 [2–15] months. The main indication for PEG placement was dysphagia (98%). The median time for PEG tube insertion since the established diagnosis of ALS was 12 [6–25] months and 4 [2–18] months since the beginning of bulbar symptoms. The majority of the patients had placed a 20-Fr PEG (63%) and under mild sedation with midazolam (80%), all under NIV. There were no immediate complications during and after the procedure (no episodes of aspiration or orotracheal intubation) and mortality. Conclusion: The placement of PEG is a very important procedure in patients with ALS and severe ventilatory impairment. The interdisciplinary department collaboration permitted the placement of PEG under NIV, in a safe and effective procedure in this special population.

International audience; Islands are often considered excellent socio-ecological laboratories for testing the rapidity of global change since they experience the climate effects of sea-level rise faster than other areas. The Azores are a Portuguese volcanic archipelago located on the junction of the three tectonic plates: the Eurasian, the African and the North American plates. São Miguel, the main island of the Azores archipelago, hosts three active volcanoes, but the last significant volcanic eruption was the Capelinhos volcano on the island of Faial in 1957. Hence, the Azores offers the opportunity to assess insular risk awareness, facing both telluric and climate-related hazards. The key research question emerges from their natural situation: how does the local population perceive the threat of the natural hazards that occur in Azores? Because risks are socially constructed and depend on the uniqueness of territories, risk mitigation strategies must focus on the individual experiences of local dwellers, as a relationship between risk awareness and such strategies may be expected. To analyze this relationship, a web-based survey with a questionnaire including these variables was administered to a sample of Azoreans. The study aimed to assess risk awareness of the Azorean population and find a relationship between this and reported mitigation strategies. The results gave a preliminary insight into Azorean risk awareness of natural hazards and showed a significant positive relationship between risk awareness-raising activities and reported mitigation strategies. This is relevant information for municipalities and regional governments of areas with similar risk exposures, showing that, although risk awareness alone is not enough for measures to be implemented, it may be an important motivational first step for this to occur.

The global pandemic of coronavirus disease 2019 (COVID-19) changed dramatically all priorities on medical society and created several challenges for clinicians caring for patients with liver diseases. We performed a comprehensive review about how COVID-19 can affect the liver, the influence of liver diseases on the risk of developing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and COVID-19 severity and also some strategies to overcome all the challenges clinicians have to face in the management of patients with liver diseases in a period of time when all the focus turned on COVID-19. We analyze the relationship between COVID-19 and non-alcoholic fatty liver disease, alcoholic liver disease, viral hepatitis, autoimmune liver disease, cirrhosis, hepatocellular carcinoma and liver transplantation, as well as the approach to SARS-CoV-2 vaccination.

Human enhancement aims at improving individual human performance through science-based or technology-based interventions in the human body. For various decades, associated research and applications/interventions were performed in conventional settings (e.g., research institutes) through conventional regulated and controlled procedures (e.g., clinical trials). In the last decade there has been an emergence of science activities grounded on emerging technologies used in unconventional settings (e.g., households; community labs), often through unconventional unregulated and uncontrolled procedures (e.g., self-administration of substances). The Do-It-Yourself Biology or Biohacking movement is an example of communities supportive of such activities, which use emerging technologies such as the CRISPR technique. Among others, these can have other or self-enhancement goals. Because such activities are anticipated to increase in the future, and due to the methods novelty, lack of regulation, quality, and safety control, there is uncertainty regarding personal and social consequences. Thus, these can be considered to present an emerging risk to human health and the environment. A first step in risk regulation is considering ethical aspects of emerging technologies use, which has been implemented. A second step to sustain subsequent evidence-based risk management and risk communication to citizen scientists, is necessary. It should involve risk assessment by experts and an understanding of public views on human enhancement technologies. Due to the scarce literature, gathering information to support this step was the goal of a non-systematic literature review. This focused on internal enhancements through substances intake and human body manipulations, specifically DIY biology/biohacking activities with this goal.

Body hacking through self-implantation of electronic devices (e.g., insideables and prostheses) is an emerging risky behavior with potential negative health and safety consequences, despite the claimed potential benefits. Risks become higher in unconventional settings where self-implantations are performed without experts' risk assessment and preventive measures. To understand such behavior, it is important to identify what are the motivational factors that underlie intentions to practice body-hacking. Given the scarce literature on the subject to date, this paper presents a theoretical framework of potential motivational drivers underlying the intention towards practicing body hacking in order to help setting up priorities for future research. The potential theoretical associations between intention to practice body hacking and existential, identity, ideological, cognitive, epistemic, social affiliation, and affective drivers are discussed.

Introduction Complications of cirrhosis are one the major causes of hospital admission associated with high morbimortality rates and social and economic charges. The aims of this study were to evaluate hospital readmission and mortality rates and predictive factors for hospital readmission and mortality. Methods Patients with decompensated cirrhosis admitted to our institution between 2008–2014 were retrospectively analyzed. Results Included 427 admissions from 177 patients with cirrhosis with mean age of 59.0 ± 12.3 years. The major cause was alcoholic-related liver disease and the median duration of admission was 9.0 days (IQR 6.0–14.0). During the follow-up period,there were 250 readmissions from 95 patients, with a median of 58 (IQR27-134) days for readmission, representing 58.5% of the total number of admissions.The 180-day mortality rate was 35.0%. In the multivariate analysis, ascites, smoking and MELD Na were associated with 180-day mortality. Creatinine, albumin, esophageal variceal bleeding, previous variceal banding, lactulose, rifaximin and proton pump inhibitors use were independently associated with need of readmission. Based on regression analysis, two models were calculated to predict 180-day mortality (AUROC 0.74 (0.682−0.794)) and need for readmission(AUROC 0.821 (0.781−0.861)), p Conclusion The readmission rate and mortality of cirrhotic patients are still very high and it is a priority to determine preventable risk factors to improve patient outcome. Two models were created to predict 180-day mortality(AUROC 0.74) and need for readmission(AUROC 0.821), that could guide the management of the patients at the time of admission.

With the increased frequency, intensity and duration of extreme weather events potentiated by climate change, a better understanding of social systems’ resilience and adaptation strategies to these...

Continental Portugal and its two archipelagos (Azores Islands and Madeira Islands) present a very interesting and diverse seaweed community. Its great diversity results for example from different environmental conditions such as the latitudinal gradients that affect the continental Portugal coastal shoreline in unique ways. The first Portuguese phycological studies published date from the end of the 18th century and seaweeds have been harvested to be used as fertilizer since at least the 14th century. However, Portuguese seaweeds are still a natural and valuable resource that is relatively under explored or studied, particularly regarding its economic potential. Although Portugal was one of the world’s main agar producers in the past, the sustainability of its seaweed exploitation was overlooked. Contemporary awareness of this valuable resource might bring together role players such as researchers and industries towards innovative and sustainable practices (such as to make use of non-indigenous species that have been registered in the country). Nowadays, almost all Portuguese higher education institutions currently have research groups dedicated to studies related to seaweeds (ranging from ecological and environmental assessment studies to seaweed aquaculture, uses and applications). This work addresses the diversity of Portuguese seaweeds and its main economic aspects.

This study was funded by Fundaçao ˜ para a Ciˆencia e a Tecnologia (FCT) through the Strategic Project UID/MAR/04292/2019, project MARINE INVADERS – The impact and mechanisms of success of the invasive seaweed Asparagopsis armata on coastal environments (POCI01-0145-FEDER-031144), and the grants awarded to Carla Silva (SFRH/ BD/87030/2012). The project was also partially funded by European Union through EASME Blue Labs project AMALIA—Algae-to-MArket Lab IdeAs (EASME/EMFF/2016/1.2.1.4/03/SI2.750419), and the Integrated Programme of SR&TD “SmartBioR” (reference Centro-01-0145- FEDER-000018) cofunded by Centro 2020 program, Portugal2020, European Union, through the European Regional Development Fund. Authors are also thankful to all the team members for the help during field work Biological invasions represent a threat to ecosystems, through competition and habitat destruction, which may result in significant changes of the invaded community. Asparagopsis armata Harvey 1855 is a red macroalgae (Rodophyta) globally recognized as an invasive species. It is found from the intertidal to shallow subtidal areas, on rock or epiphytic, forming natural vegetation belts on exposed coasts. This study evaluated the variations on native intertidal seaweed and macroinvertebrate assemblages inhabiting rock pools with and without the presence of the invasive macroalgae A. armata. To achieve this, manipulation experiments on Atlantic (Portugal) rock pools were done. Three rock pools were maintained without A. armata by manual removal of macroalgae, and three others were not experimentally manipulated during the study period and A. armata was freely present. In this study the variations between different rock pools were assessed. Results showed different patterns in the macroalgae composition of assemblages but not for the macrobenthic communities. Ellisolandia elongata (J. Ellis & Solander) K.R. Hind & G.W. Saunders 2013 was the main algal species affected by the invasion of A. armata. Invaded pools tended to show less macroalgal species richness, showing a more constant and conservative structure, with lower variation of its taxonomic composition than the pools not containing A. armata, where the variability between samples was always higher. Despite the importance of the achieved results, further data based on observation of long-term series are needed, in order to further understand more severe effects of the invader A. armata on native macroalgal assemblage. info:eu-repo/semantics/publishedVersion

Invasive macroalgae represent one of the major threats to marine biodiversity, ecosystem functioning and structure, as well as being important drivers of ecosystem services depletion. Many such species have become well established along the west coast of the Iberian Peninsula. However, the lack of information about the distribution of the invaders and the factors determining their occurrence make bioinvasions a difficult issue to manage. Such information is key to enabling the design and implementation of effective management plans. The present study aimed to map the current probability of presence of six invasive macroalgae: Grateloupia turuturu, Asparagopsis armata, Colpomenia peregrina, Sargassum muticum, Undaria pinnatifida, and Codium fragile ssp. fragile. For this purpose, an extensive field survey was carried out along the coast of the north-western Iberian Peninsula. Species distribution models (SDMs) were then used to map the presence probability of these invasive species throughout the study region on the basis of environmental and anthropogenic predictor variables. The southern Galician rias were identified as the main hotspots of macroalgal invasion, with a high probability of occurrence for most of the species considered. Conversely, the probability of presence on the Portuguese coast was generally low. Physico-chemical variables were the most important factors for predicting the distribution of invasive macroalgae contributing between 57.27 and 85.24% to the ensemble models. However, anthropogenic factors (including size of vessels, number of shipping lines, distance from ports, population density, etc.) considerably improved the estimates of the probability of occurrence for most of the target species. This study is one of the few to include anthropogenic factors in SDMs for invasive macroalgae. The findings suggest that management actions aimed at controlling these species should strengthen control and surveillance at ports, particularly in southern Galician rias. Early detection should be of main concern for risk assessment plans on the Portuguese coast., A. B. was supported by the Axencia Galega de Innovación (GAIN), Xunta de Galicia (grant ED481B 2018/68). This work was supported by the European Union through EASME Blue Labs project AMALIA—Algae-to-MArket Lab IdeAs (EASME/EMFF/2016/ 1.2.1.4/03/SI2.750419). The authors acknowledge financial support provided by the Portuguese Foundation for Science and Technology (FCT) through Strategic Project UID/MAR/04292/2019 granted to MARE – Marine and Environmental Sciences Centre, through MARINE INVADERS Project (PTDC/BIA-CBI/31144/2017), co-financed by COMPETE (POCI-01-0145-FEDER-031144), and the Integrated Programme of SR&TD “Smart Valorization of Endogenous Marine Biological Resources Under a Changing Climate” (reference Centro-01-0145- FEDER-000018), co-funded by Centro 2020 program, Portugal 2020, European Union, through the European Regional Development Fund.

The introduction of exotic organisms in marine ecosystems can lead to economic and ecological losses. Globally, seaweeds represent a significant part of these non-indigenous species (NIS), with 407 introduced algal species. Furthermore, the presence of NIS seaweeds has been reported as a major concern worldwide since the patterns of their potential invasion mechanisms and vectors are not yet fully understood. Currently, in the Iberian Peninsula, around 50 NIS seaweeds have been recorded. Some of these are also considered invasive due to their overgrowth characteristic and competition with other species. However, invasive seaweeds are suitable for industrial applications due to their high feedstock. Hence, seaweeds’ historical use in daily food diet, allied to research findings, showed that macroalgae are a source of nutrients and bioactive compounds with nutraceutical properties. The main goal of this review is to evaluate the records of NIS seaweeds in the Iberian Peninsula and critically analyze the potential of invasive seaweeds application in the food industry.

Biological invasions represent a threat to ecosystems, through competition and habitat destruction, which may result in significant changes of the invaded community. Asparagopsis armata Harvey 1855 is a red macroalgae (Rodophyta) globally recognized as an invasive species. It is found from the intertidal to shallow subtidal areas, on rock or epiphytic, forming natural vegetation belts on exposed coasts. This study evaluated the variations on native intertidal seaweed and macroinvertebrate assemblages inhabiting rock pools with and without the presence of the invasive macroalgae A. armata. To achieve this, manipulation experiments on Atlantic (Portugal) rock pools were done. Three rock pools were maintained without A. armata by manual removal of macroalgae, and three others were not experimentally manipulated during the study period and A. armata was freely present. In this study the variations between different rock pools were assessed. Results showed different patterns in the macroalgae composition of assemblages but not for the macrobenthic communities. Ellisolandia elongata (J. Ellis & Solander) K.R. Hind & G.W. Saunders 2013 was the main algal species affected by the invasion of A. armata. Invaded pools tended to show less macroalgal species richness, showing a more constant and conservative structure, with lower variation of its taxonomic composition than the pools not containing A. armata, where the variability between samples was always higher. Despite the importance of the achieved results, further data based on observation of long-term series are needed, in order to further understand more severe effects of the invader A. armata on native macroalgal assemblage.

Introduction: Endoscopic retrograde cholangiopancreatography (ERCP) is a technically demanding procedure with a high risk for adverse events (AEs). Aim: evaluate patient- and procedure-related risk factors for ERCP-related AEs and develop an online app to estimate risk of AEs. Methods: retrospective study of 1,491 consecutive patients who underwent 1,991 ERCPs between 2012 and 2017 was conducted. AEs definition and severity were classified according to most recent ESGE guidelines. Each variable was tested for association with occurrence of overall AEs, post-ERCP pancreatitis (PEP) and cholangitis. For each outcome, 2 regression models were built, from which an online Shiny-based app was created. Results: Overall AE rate was 15.3%; in 19 procedures, >1 AE occurred. Main post-ERCP AE was PEP (7.5%), followed by cholangitis (4.9%), bleeding (1.3%), perforation (1%), cardiopulmonary events (0.9%), and cholecystitis (0.3%). Seventy-eight percent of AEs were mild/moderate; of severe (n = 55) and fatal (n = 20) AEs, more than half were related to infection, cardiac/pulmonary AEs, and perforation. AE-related mortality rate was 1%. When testing precannulation, procedural covariates, and ERCP findings, AE occurrence was associated with age (odds ratio [OR] 0.991), previous PEP (OR 2.198), ERCP complexity grade III/IV (OR 1.924), standard bile duct cannulation (OR 0.501), sphincterotomy (OR 1.441), metal biliary stent placement (OR 2.014), periprocedural bleeding (OR 3.024), and biliary duct lithiasis (OR 0.673). Conclusion: Our app may allow an optimization of the patients’ care, by helping in the process of decision-making, not only regarding patient or endoscopist’s selection but also definition of an adequate and tailored surveillance plan after the procedure.

Background During events that involve health risks, people may feel the need personal and social resources to cope with the demands posed by event. Depending on their individual characteristics, people may perceive their resources as sufficient or as insufficient to face the situation. Risk perception analysis was conducted in Portugal during the COVID-19 outbreak, to develop communication strategies, customized to the changing needs, helping people make informed decisions. Methods Citizens messages on social networks of 3 official information sources, and 8 media sources were analyzed between 26th January and 5th March 2020. A sample of comments to publications related to COVID-19 were analyzed in 4-days periods and categorized. A qualitative theory-driven thematic analysis was carried out based on two global categories: Demands and Resources. From this analysis, the threat level ratio (Demands/Resources) was calculated. Results A total of 8,251 comments were analysed in 10 periods of 4 days of data collection, from 26th January to 5th March. The threat level ratio increased during the first 15 days of analysis, having its maximum (6.80) in the period between the 7th and 14th of February, mostly associated with the perceived danger associated with the lack of airports arrivals control from China. After the announcement of the first confirmed case of COVID-19 in a Portuguese citizen outside Portugal, on 23rd February, the risk perception increased 1,4% compared to the previous period of analysis. On the contrary, after announcing the first confirmed case in Portugal, on the 1st March, the risk perception decreased 1,6%, which is inferred to be associated with a shift in the media discourse and to the use of humour. Conclusions Awareness of risks is a necessary condition for people to adhere to the necessary recommendations to mitigate the crisis. During an epidemic, an effective communication strategy can become an opportunity to promote health literacy. Key messages Risk perception is essential to define effective communication strategies to promote health literacy and best practices among targeted populations. effective communication strategies customized to people’s needs and priorities help people making informed decisions during a public health emergency.

BACKGROUND In the last few years we have witnessed a revolution in the treatment of hepatitis C virus (HCV) infection. With the introduction of direct-acting antiviral agents (DAAs), sustained virological response (SVR) is achieved in more than 95% of the patients. The focus is now being turned to the global targets set by the World Health Organization, with the aim of achieving HCV elimination by 2030. Prison inmates constitute one of the high-risk groups, and receive treatment less frequently due to several barriers in access to health care. AIM To describe the management and follow-up of a cohort of HCV monoinfected patients treated with DAA in the prison setting, where tertial referral liver center specialists locally provide, on-site assessment and treatment for the prisoners. METHODS A prospective observational study was conducted from April 2017 to March 2020, which included all HCV monoinfected prison inmates in the largest Northern Portugal prison. Demographic, clinical, and laboratory data, as well as transient elastography measurements, were collected onsite by the medical team and prospectively recorded. Patients were treated with DAA according to international guidelines. The primary endpoint was SVR at post-treatment week 12. RESULTS There were 98 monoinfected HCV male inmates (mean age, 42.7 ± 8.6 years) included in the analysis. Injecting drugs or tattooing were reported in 74.5%, with 38.8% of the latter being done in prison. Alcohol consumption of more than 30 g/d was referred in 69.4%. The most prevalent genotype was 1a (54.1%), followed by 3 (27.6%), 4 (9.2%) and 1b (6.1%). Pretreatment fibrosis degree was mild-to-moderate (F0-F2) in 77.6% and severe in 22.4% (F3-F4). Treatment regimens chosen were: 45.9% elbasvir/grazoprevir, 29.6% sofosbuvir/velpatasvir, and 12.2% sofosbuvir/ledispavir and glecaprevir/pibrentasvir. No major adverse events were observed. SVR at post-treatment week 12 was 99%. CONCLUSION In a population considered to be both hard-to-access and a cornerstone for HCV elimination, the onsite evaluation and treatment of HCV-infected prisoners, achieved an exceptional highly effective success rate. This type of collaborative program should be considered to be expanded, to support hepatitis C elimination efforts.

Summary Background Most patients with autoimmune hepatitis (AIH) respond to a combination of prednisolone and azathioprine. For patients who are intolerant or refractory to azathioprine, proposed alternative therapies are based on scarce data, limited to transplant centres and with short-term follow-up periods. Objective To evaluate the long-term efficacy and safety of MMF as a second-line therapy in patients with AIH managed at a tertiary non-transplant centre. Methods Retrospective analysis of a prospectively collated database identified AIH patients who received MMF from 2006 to 2015. Clinical, biochemical and immunological parameters were assessed at 3-, 6- and 12-months, and at last follow-up. Biochemical response (BR) was defined as improvement of transaminases, complete remission (CR) as normalisation of transaminases and IgG, while others were considered non-responders (NR). Results Eighteen out of 151 (12%) AIH patients received MMF. Nine received MMF due to azathioprine-intolerance (group 1), while nine due to refractory disease (group 2). In group 1, CR and BR was achieved in six (67%) and two (22%) patients respectively. In group 2, CR and BR was achieved in one (11%) and five (56%) patients respectively. Adverse events occurred in eight patients (44%), with one patient requiring drug discontinuation. After a medium follow-up of 78 (31–116) months, there was a significant decrease in transaminase levels, mirrored by decrease in prednisolone dose from 25 to 6.25 mg/day (P Conclusion Long-term therapy with MMF is safe and effective in AIH patients requiring second-line therapies, and these patients can be effectively managed at tertiary non-liver transplant centres.

Background: videocapsule endoscopy (VCE) is currently the most sensitive diagnostic tool to detect early small bowel inflammation. A Lewis score (LS) of ≥ 135 as the cutoff value for the presence of significant inflammatory activity in patients undergoing VCE for suspected Crohn’s disease (CD) has been suggested as a useful tool for the diagnosis of CD. The aim of this study was to evaluate the diagnostic and prognostic accuracy of the LS in patients with suspected CD undergoing VCE. Methods: a retrospective single-center study was performed that included patients who underwent VCE for suspected CD between January 2010 and December 2015. Inflammatory activity was assessed with the LS. Patients were grouped according to the criteria of the International Conference on Capsule Endoscopy (ICCE) for the definition of suspected CD; group 1: patients not fulfilling ICCE and group 2: patients with ≥ 2 ICCE criteria. Results: one hundred and ninety-one patients were included, 61% were female and the mean age was 39 ± 14 years. VCE detected significant inflammatory activity (LS ≥ 135) in 81 patients (42%); 24 patients from group 1 (32%) and 57 patients from group 2 (50%) (p = 0.014). During a mean follow-up period of 41 ± 21 months (12-79), a CD diagnosis was determined in 60 patients (31%); 55 patients with LS ≥ 135 (92%) and five patients with LS < 135 (5%) (p < 0.001). The LS showed a good diagnostic accuracy with an AUROC of 0.93 (p < 0.001). During the first year after diagnosis, there was a significant association between a higher LS and the need for immunomodulatory therapy, biological therapy, bowel resection surgery or hospital admission due to a CD flare-up. Conclusions: the LS (cutoff ≥ 135) is very useful in the diagnosis of CD in patients undergoing VCE. Moreover, higher values of this score was associated with prognostic variables.

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AIMS AND BACKGROUND For consumers to make healthy informed decisions (e.g. choose a low nutritional risk food product), they need to receive and exchange information with experts, health authorities, health and risk communicators and other interest groups. However, communicators often face the challenge that consumers avoid such information and have a low engagement with health and risk communication activities. This often results from a lack of consideration of consumers' characteristics and communications customization to them. METHODS A potential approach to increase engagement with communications is providing information that fits consumers' need and goals, particularly their regulatory orientation. We propose that such customization can be applied within a Mental Models' Approach operationalized through a recently patented Mental Modeling Technology PlatformTM (US9262725B2). RESULTS Drawing results from psychological science and particularly Regulatory Focus Theory, communications can be customized to two global individual's goal orientation: 1) Promotion focus; 2) Prevention Focus. Communications customized into a promotion orientation (vs. prevention orientation) should make salient gains/positive consequences (vs. losses/negative consequences). Regulatory orientation should be measured in Mental Models Approach step two and message customization in step three (communication design). CONCLUSION The role of individual psychological factors which influence food perception and choice should be considered in future studies/interventions to promote healthier decisions. Those responsible for designing mass dissemination messages and/or public health interventions, may benefit from using regulatory fit to facilitate behavior change, particularly when cost-effective personalized bidirectional communications are not possible.