Modelled spatial and seasonal distribution of Blue Whiting (Micromesistius poutassou) larvae in the North-East Atlantic (1951 to 2005)

Blue whiting (Micromesistius poutassou, http://www.marinespecies.org/aphia.php?p=taxdetails&id=126439) is a small mesopelagic planktivorous gadoid found throughout the North-East Atlantic. This data contains the results of a model-based analysis of larvae captured by the Continuous Plankton Recorder (CPR) during the period 1951-2005. The observations are analysed using Generalised Additive Models (GAMs) of the the spatial, seasonal and interannual variation in the occurrence of larvae. The best fitting model is chosen using the Aikaike Information Criteria (AIC). The probability of occurrence in the continous plankton recorder is then normalised and converted to a probability distribution function in space (UTM projection Zone 28) and season (day of year). The best fitting model splits the distribution into two separate spawning grounds north and south of a dividing line at 53 N. The probability distribution is therefore normalised in these two regions (ie the space-time integral over each of the two regions is 1). The modelled outputs are on a UTM Zone 28 grid: however, for convenience, the latitude ("lat") and longitude ("lon") of each of these grid points are also included as a variable in the NetCDF file. The assignment of each grid point to either the Northern or Southern component (defined here as north/south of 53 N), is also included as a further variable ("component"). Finally, the day of year ("doy") is stored as the number of days elapsed from and included January 1 (ie doy=1 on January 1) - the year is thereafter divided into 180 grid points.

Seasonal festivals and pageants : spring pantomime /

Music arranged for pianoforte.

Selection of species and provenances for low-rainfall areas: physiological responses of Eucalyptus cloeziana and Eucalyptus argophloia to seasonal conditions in subtropical Queensland

Responses of stomatal conductance (g(s)) and net photosynthesis (A) to changes in soil water availability, photosynthetic photon flux density (Q), air temperature (1) and leaf-to-air vapour pressure deficit (D) were investigated in 4-year-old trees of a dry inland provenance of Eucalyptus argophloia Blakely, and two dry inland provenances (Coominglah and Hungry Hills) and a humid coastal provenance (Wolvi) of Eucalyptus cloeziana F. Muell. between April 2001 and April 2002 in southeast Queensland, Australia. There were minimal differences in A, g, and water relations variables among the coastal and inland provenances of E. cloeziana but large differences between E. argophloia and E. cloeziana. E. argophloia and to a lesser extent the Hungry Hills (inland) provenance of E. cloeziana maintained relatively higher pre-dawn water potential (psi(pd)) during the dry season suggesting possible access to water at depth. Simple phenomenological models of stomatal conductance as a function of Q, T and D explained 60% of variation in gs in E. cloeziana and more than 75% in E. argophloia, when seasonal effect was incorporated in the model. A Ball-Berry model for net photosynthesis explained between 70 and 80% of observed variation in A in both species. These results have implications in matching the dry and humid provenances of E. cloeziana and E. argophloia to suitable sites in subtropical environments. (C) 2004 Elsevier B.V. All rights reserved.

Integrated versus non-integrated management and care for clients with co-occurring mental health and substance use disorders: a qualitative systematic review of randomised controlled trials

The purpose of this paper is to conduct a qualitative review of randomised controlled trials in relation to the treatment of adults with co-occurring mental health and substance use disorder (MH/SUD). In particular, integrated approaches are compared with non-integrated approaches to treatment. Ten articles were identified for inclusion in the review. The findings are equivocal with regard to the superior efficacy of integrated approaches to treatment, although the many limitations of the studies need to be considered in our understanding of this finding. Clearly, this is an extremely challenging client group to engage and maintain in intervention research, and the complexity and variability of the problems render control particularly difficult. The lack of available evidence to support the superiority of integration is discussed in relation to these challenges. Much remains to be investigated with regard to integrated management and care for people with co-occurring and MH/SUD, particularly for specific combinations of dual diagnosis and giving consideration to the level of inter-relatedness between the disorders. (C) 2004 Elsevier Ltd. All rights reserved.

Moreton Bay, Queensland, Australia: An example of the co-existence of significant marine mammal populations and large-scale coastal development

Recent analyses assert that large marine vertebrates such as marine mammals are now 'functionally or entirely extinct in most coastal ecosystems'. Moreton Bay is a large diverse marine ecosystem bordering the fastest growing area in Australia. The human population is over 1.6 million and increasing yearly by between 10% and 13% with resultant impacts upon the adjoining marine environment. Nonetheless, significant populations of three species of marine mammals are resident within Moreton Bay and a further 14 species are seasonal or occasional visitors. This paper reviews the current and historical distributions and abundance of these species in the context of the current management regime and suggests initiatives to increase the resilience of marine mammal populations to the changes wrought by the burgeoning human population in coastal environments. (C) 2004 Elsevier Ltd. All rights reserved.

Modeling equity market integration using smooth transition analysis:a study of Eastern European stock markets

This paper assesses the extent to which the equity markets of Hungary, Poland the Czech Republic and Russia have become less segmented. Using a variety of tests it is shown there has been a consistent increase in the co-movement of some Eastern European markets and developed markets. Using the variance decompositions from a vector autoregressive representation of returns it is shown that for Poland and Hungary global factors are having an increasing influence on equity returns, suggestive of increased equity market integration. In this paper we model a system of bivariate equity market correlations as a smooth transition logistic trend model in order to establish how rapidly the countries of Eastern Europe are moving away from market segmentation. We find that Hungary is the country which is becoming integrated the most quickly. © 2005 ELsevier Ltd. All rights reserved.

One-stop health centres:What co-location means for pharmacy

This paper examines the potential for the development of patient services that could arise from the co-location of pharmacies with medical practices in the new "one-stop" centres. A review of the pharmacy-specific literature shows limited understanding of influence of location upon service development and highlights a tension between the professional and commercial drives. The aim of the survey of health centre pharmacists was to describe the current patterns of integration in the primary health care team. The study demonstrates that co-location offers opportunities but that there are barriers linked to the loss of traditional commercial activity. © 2003 Elsevier Science Ltd. All rights reserved.

Tissue engineering of co-cultured skin substitutes using biocomposite membranes based on collagen and polycaprolactone

The preparation and characterisation of collagen: PCL, gelatin: PCL and gelatin/collagen:PCL biocomposites for manufacture of tissue engineered skin substitutes are reported. Films of collagen: PLC, gelatin: PCL (1:4, 1:8 and 1:20 w/w) and gelatin/collagen:PCL (1:8 and 1:20 w/w) biocomposites were prepared by impregnation of lyophilised collagen and/or gelatin mats by PCL solutions followed by solvent evaporation. In vitro assays of total protein release of collagen:PCL and gelatin: PCL biocomposite films revealed an expected inverse relationship between the collagen release rate and the content of synthetic polymer in the biocomposite samples that may be exploited for controlled presentation and release of biopharmaceuticals such as growth factors. Good compatibility of all biocomposite groups was proven by interaction with 3T3 fibroblasts, normal human epidermal keratinocytes (NHEK), and primary human epidermal keratinocytes (PHEK) and dermal fibroblasts (PHDF) in vitro respectively. The 1:20 collagen: PCL materials exhibiting good cell growth curves and mechanical characteristics were selected for engineering of skin substitutes in this work. The tissue-engineered skin model based on single-donor PHEK and PHDF with differentiated confluent epidermal layer and fibrous porous dermal layer was then developed successfully in vitro proven by SEM and immunohistochemistry assay. The following in vivo animal study on athymic mice revealed early complete wound healing in 10 days and good integration of co-cultured skin substitutes with adjacent mice skin structures. Thus the co-cultured skin substitutes based on 1:20 collagen: PCL biocomposite membranes was proven in principle. The approach to skin modelling reported here may find application in wound treatment, gene therapy and screening of new pharmaceuticals.

The integration of multi-source data to improve the classification of remotely sensed images

The number of remote sensing platforms and sensors rises almost every year, yet much work on the interpretation of land cover is still carried out using either single images or images from the same source taken at different dates. Two questions could be asked of this proliferation of images: can the information contained in different scenes be used to improve the classification accuracy and, what is the best way to combine the different imagery? Two of these multiple image sources are MODIS on the Terra platform and ETM+ on board Landsat7, which are suitably complementary. Daily MODIS images with 36 spectral bands in 250-1000 m spatial resolution and seven spectral bands of ETM+ with 30m and 16 days spatial and temporal resolution respectively are available. In the UK, cloud cover may mean that only a few ETM+ scenes may be available for any particular year and these may not be at the time of year of most interest. The MODIS data may provide information on land cover over the growing season, such as harvest dates, that is not present in the ETM+ data. Therefore, the primary objective of this work is to develop a methodology for the integration of medium spatial resolution Landsat ETM+ image, with multi-temporal, multi-spectral, low-resolution MODIS \Terra images, with the aim of improving the classification of agricultural land. Additionally other data may also be incorporated such as field boundaries from existing maps. When classifying agricultural land cover of the type seen in the UK, where crops are largely sown in homogenous fields with clear and often mapped boundaries, the classification is greatly improved using the mapped polygons and utilising the classification of the polygon as a whole as an apriori probability in classifying each individual pixel using a Bayesian approach. When dealing with multiple images from different platforms and dates it is highly unlikely that the pixels will be exactly co-registered and these pixels will contain a mixture of different real world land covers. Similarly the different atmospheric conditions prevailing during the different days will mean that the same emission from the ground will give rise to different sensor reception. Therefore, a method is presented with a model of the instantaneous field of view and atmospheric effects to enable different remote sensed data sources to be integrated.

Coal-fired Power Plants with Flexible Amine-based CCS and Co-located Wind Power: Environmental, Economic and Reliability Outcomes

Carbon Capture and Storage (CCS) technologies provide a means to significantly reduce carbon emissions from the existing fleet of fossil-fired plants, and hence can facilitate a gradual transition from conventional to more sustainable sources of electric power. This is especially relevant for coal plants that have a CO2 emission rate that is roughly two times higher than that of natural gas plants. Of the different kinds of CCS technology available, post-combustion amine based CCS is the best developed and hence more suitable for retrofitting an existing coal plant. The high costs from operating CCS could be reduced by enabling flexible operation through amine storage or allowing partial capture of CO2 during high electricity prices. This flexibility is also found to improve the power plant’s ramp capability, enabling it to offset the intermittency of renewable power sources. This thesis proposes a solution to problems associated with two promising technologies for decarbonizing the electric power system: the high costs of the energy penalty of CCS, and the intermittency and non-dispatchability of wind power. It explores the economic and technical feasibility of a hybrid system consisting of a coal plant retrofitted with a post-combustion-amine based CCS system equipped with the option to perform partial capture or amine storage, and a co-located wind farm. A techno-economic assessment of the performance of the hybrid system is carried out both from the perspective of the stakeholders (utility owners, investors, etc.) as well as that of the power system operator.

In order to perform the assessment from the perspective of the facility owners (e.g., electric power utilities, independent power producers), an optimal design and operating strategy of the hybrid system is determined for both the amine storage and partial capture configurations. A linear optimization model is developed to determine the optimal component sizes for the hybrid system and capture rates while meeting constraints on annual average emission targets of CO2, and variability of the combined power output. Results indicate that there are economic benefits of flexible operation relative to conventional CCS, and demonstrate that the hybrid system could operate as an energy storage system: providing an effective pathway for wind power integration as well as a mechanism to mute the variability of intermittent wind power.

In order to assess the performance of the hybrid system from the perspective of the system operator, a modified Unit Commitment/ Economic Dispatch model is built to consider and represent the techno-economic aspects of operation of the hybrid system within a power grid. The hybrid system is found to be effective in helping the power system meet an average CO2 emissions limit equivalent to the CO2 emission rate of a state-of-the-art natural gas plant, and to reduce power system operation costs and number of instances and magnitude of energy and reserve scarcity.

Seasonal variations in surface metabolite composition of Fucus vesiculosus and Fucus serratus sampled at outer Kiel Fjord (August 2012 - July 2013)

The chemical composition of surface associated metabolites of two Fucus species (Fucus vesiculosus and Fucus serratus) was analysed by means of gas chromatography-mass spectrometry (GC-MS) to describe temporal patterns in chemical surface composition. Method: The two perennial brown macroalgae F. vesiculosus and F. serratus were sampled monthly at Bülk, outer Kiel Fjord, Germany (54°27'21 N / 10°11'57 E) over an entire year (August 2012 - July 2013). Per month and species six non-fertile Fucus individuals were collected from mixed stands at a depth of 0.5 m under mid water level. For surface extraction approx. 50 g of the upper 5-10 cm apical thalli tips were cut off per species. The surface extraction of Fucus was performed according to the protocol of de Nys and co-workers (1998) with minor modifications (see Rickert et al. 2015). GC/EI-MS measurements were performed with a Waters GCT premier (Waters, Manchester, UK) coupled to an Agilent 6890N GC equipped with a DB-5 ms 30 m column (0.25 mm internal diameter, 0.25 mM film thickness, Agilent, USA). The inlet temperature was maintained at 250°C and samples were injected in split 10 mode. He carrier gas flow was adjusted to 1 ml min-1. Alkanes were used for referencing of retention times. For further details (GC-MS sample preparation and analysis) see the related publication (Rickert et al. submitted to PLOS ONE).

Co-digestion of terrestrial plant biomass with marine macro-algae for biogas production

This paper investigates factors affecting anaerobic degradation of marine macro-algae (or seaweed), when used as a co-substrate with terrestrial plant biomass for the production of biogas. Using Laminaria digitata, a brown marine seaweed species and green peas, results showed that when only 2% of feedstock of a reactor treating the green peas at an organic loading rate (OLR) of 2.67 kg VS.m3.day-1 was replaced with the seaweed, methane production was disrupted, whilst acidogenesis, seemed to be less adversely affected, resulting in excessive volatile acids accumulation. Reactor stability was difficult to achieve thereafter. The experiment was repeated with a lower initial OLR of green peas of 0.70 kg VS.m3.day-1 before the addition of the seaweed. Although similar symptoms as in first trial were observed, process stability was restored through the control of OLR and alkalinity. These measures led to an increase in overall OLR of 1.25 kg VS.m3.day-1 comprising of 35% seaweed. This study has shown that certain seaweed constituents are more inhibitory to the methanogens even at trace concentrations than to the other anaerobic digestion microbial groups. Appropriate adaptation strategy, involving initial low proportion of the seaweed relative to the total OLR, and overall low OLR, is necessary to ensure effective adaptation of the microorganisms to the inhibitory constituents of seaweed. Where there is seasonal availability of seaweed, the results of this study suggest that a fresh adaptation or start-up strategy must be implemented during each cycle of seaweed availability in order to ensure sustainable process stability.

The impacts of environmental and anthropogenic stressors on largemouth bass: an integration of field and laboratory studies

Several environmental stressors can impact the physiology and survival of fishes. Fish experience natural fluctuations in temperature and dissolved oxygen, but variations in these parameters due to anthropogenic sources are typically greater in magnitude and duration. Changes in temperature and oxygen of anthropogenic origins may therefore have larger negative impacts on fish than those occurring during natural events. Physiological parameters are sensitive indicators of the impacts of stressors by providing insight into the manner in which fish are disturbed by the stressor. Fish may display cumulative physiological responses to successive stressors, but the concept of synergy among multiple thermal stressors is poorly understood. Further, some fish species can be subjected to competitive angling events, which expose fish to an array of additional stressors that can increase mortality. The impacts of these events may change over seasons as fish display seasonal changes in behavior and physiology. Latitudinal origin may also affect the physiological response and mortality of fish exposed to common environmental stressors as individual populations are adapted to local environmental conditions. This thesis focuses on addressing these potential impacts on physiological parameters and mortality of largemouth bass (Micropterus salmoides) and provides implications for management and conservation. Largemouth bass were relatively robust to abrupt changes in temperature and oxygen, but were perturbed from physiological homeostasis during large (12°C) temperature shocks and low (< 4 mg O2/L) levels of dissolved oxygen. Cumulative physiological impacts of multiple cold shocks were only slightly greater than the disturbances sustained during a single cold shock, suggesting largemouth bass are able to tolerate successive thermal stressors. Largemouth bass exhibited seasonal changes in physiological parameters but the responses of fish to angling tournaments were relatively similar across seasons when compared with seasonal controls. Mortality was low during angling tournaments held during four seasons and no apparent seasonal trends were observed. Lastly, largemouth bass from two latitudinally separated populations exhibited differences in their physiological responses to acute cold stressors and overwinter mortality, characterized by greater mortality and physiological disturbances of southern fish than northern fish. Knowledge gained from this study can be used to make management and conservation decisions regarding a host of environmental factors and provides insight into the mechanisms by which fish species can persist over large latitudinal ranges.

A biochemical analysis into the co-translational folding of a G protein-coupled receptor; GPR35

The folding and targeting of membrane proteins poses a major challenge to the cell, as they must remain insertion competent while their highly hydrophobic transmembrane (TM) domains are transferred from the ribosome, through the aqueous cytosol and into the lipid bilayer. The biogenesis of a mature membrane protein takes place through the insertion and integration into the lipid bilayer. A number of TM proteins have been shown to gain some degree of secondary structure within the ribosome tunnel and to retain this conformation throughout maturation. Although studies into the folding and targeting of a number of membrane proteins have been carried out to date, there is little information on one of the largest class of eukaryotic membrane proteins; the G-protein-coupled receptors (GPCRs). This project studies the early folding events of the human ortholog of GPR35. To analyse the structure of the 1st TM domain, intermediates were generated and assessed by the biochemical method of pegylation (PEG-MAL). A structurally-similar microbial opsin (Bacterioopsin) was also used to investigate the differences in the early protein folding within eukaryotic and prokaryotic translation systems. Results showed that neither the 1st TM domain of GPR35 nor Bacterioopsin were capable of compacting in the ribosome tunnel before their N-terminus reached the ribosome exit point. The results for this assay remained consistent whether the proteins were translated in a eukaryotic or prokaryotic translation system. To examine the communication mechanism between the ribosome, the nascent chain and the protein targeting pathway, crosslinking experiments were carried out using the homobifunctional lysine cross-linker BS3. Specifically, the data generated here show that the nascent chain of GPR35 reaches the ribosomal protein uL23 in an extended conformation and interacts with the SRP protein as it exits the ribosome tunnel. This confirms the role of SRP in the co-translational targeting of GPR35. Using these methods insights into the early folding of GPCRs has been obtained. Further experiments using site-directed mutagenesis to reduce hydrophobicity in the 1st TM domain of GPR35, highlighted the mechanisms by which GPCRs are targeted to the endoplasmic reticulum. Confirming that hydrophobicity within the signal anchor sequence is essential of SRP-dependent targeting. Following the successful interaction of the nascent GPR35 and SRP, GPR35 is successfully targeted to ER membranes, shown here as dog pancreas microsomes (DPMs). Glycosylation of the GPR35 N-terminus was used to determine nascent chain structure as it is inserted into the ER membrane. These glycosylation experiments confirm that TM1 has obtained its compacted state whilst residing in the translocon. Finally, a site-specific cross-linking approach using the homobifunctional cysteine cross-linker, BMH, was used to study the lateral integration of GPR35 into the ER. Cross-linking of GPR35 TM1 and TM2 could be detected adjacent to a protein of ~45kDa, believed to be Sec61α. The loss of this adduct, as the nascent chain extends, showed the lateral movement of GPR35 TM1 from the translocon was dependent on the subsequent synthesis of TM2.

Programa Nacional de Vigilância da Gripe: relatório da época 2015/2016

O vírus da gripe é uma das maiores causas de morbilidade e mortalidade em todo o mundo, afetando um elevado número de indivíduos em cada ano. Em Portugal a vigilância epidemiológica da gripe é assegurada pelo Programa Nacional de Vigilância da Gripe (PNVG), através da integração da informação das componentes clínica e virológica, gerando informação detalhada relativamente à atividade gripal. A componente clínica é suportada pela Rede Médicos-Sentinela e tem um papel especialmente relevante por possibilitar o cálculo de taxas de incidência permitindo descrever a intensidade e evolução da epidemia de gripe. A componente virológica tem por base o diagnóstico laboratorial do vírus da gripe e tem como objetivos a deteção e caraterização dos vírus da gripe em circulação. Para o estudo mais completo da etiologia da síndrome gripal foi efectuado o diagnóstico diferencial de outros vírus respiratórios: vírus sincicial respiratório tipo A (RSV A) e B (RSV B), o rhinovírus humano (hRV), o vírus parainfluenza humano tipo 1 (PIV1), 2 (PIV2) e 3 (PIV3), o coronavírus humano (hCoV), o adenovírus (AdV) e o metapneumovirus humano (hMPV). Desde 2009 a vigilância da gripe conta também com a Rede Portuguesa de Laboratórios para o Diagnóstico da Gripe que atualmente é constituída por 15 hospitais onde se realiza o diagnóstico laboratorial da gripe. A informação obtida nesta Rede Laboratorial adiciona ao PNVG dados relativos a casos de doença respiratória mais severa com necessidade de internamento. Em 2011/2012, foi lançado um estudo piloto para vigiar os casos graves de gripe admitidos em Unidades de Cuidados Intensivos (UCI) que deu origem à atual Rede de vigilância da gripe em UCI constituída em 2015/2016 por 31 UCI (324 camas). Esta componente tem como objetivo a monitorização de novos casos de gripe confirmados laboratorialmente e admitidos em UCI, permitindo a avaliação da gravidade da doença associada à infeção pelo vírus da gripe. O Sistema da Vigilância Diária da Mortalidade constitui uma componente do PNVG que permite monitorizar a mortalidade semanal por “todas as causas” durante a época de gripe. É um sistema de vigilância epidemiológica que pretende detetar e estimar de forma rápida os impactos de eventos ambientais ou epidémicos relacionados com excessos de mortalidade. A notificação de casos de Síndrome Gripal (SG) e a colheita de amostras biológicas foi realizada em diferentes redes participantes do PNVG: Rede de Médicos-Sentinela, Rede de Serviços de Urgência/Obstetrícia, médicos do Projeto EuroEVA, Rede Portuguesa de Laboratórios para o Diagnóstico da Gripe e Rede vigilância da gripe em UCI. Na época de vigilância da gripe de 2015/2016 foram notificados 1.273 casos de SG, 87% dos quais acompanhados de um exsudado da nasofaringe para diagnóstico laboratorial. No inverno de 2015/2016 observou-se uma atividade gripal de baixa intensidade. O período epidémico ocorreu entre a semana 53/2015 e a semana 8/2016 e o valor mais elevado da taxa de incidência semanal de SG (72,0/100000) foi observado na semana 53/2015. De acordo com os casos notificados à Rede Médicos-Sentinela, o grupo etário dos 15 aos 64 anos foi o que apresentou uma incidência cumulativa mais elevada. O vírus da gripe foi detetado em 41,0% dos exsudados da nasofaringe recebidos tendo sido detetados outros vírus respiratórios em 24% destes. O vírus da gripe A(H1)pdm09 foi o predominantemente detetado em 90,4% dos casos de gripe. Foram também detetados outros vírus da gripe, o vírus B - linhagem Victoria (8%), o vírus A(H3) (1,3%) e o vírus B- linhagem Yamagata (0,5%). A análise antigénica dos vírus da gripe A(H1)pdm09 mostrou a sua semelhança com a estirpe vacinal 2015/2016 (A/California/7/2009), a maioria dos vírus pertencem ao novo grupo genético 6B.1, que foi o predominantemente detetado em circulação na Europa. Os vírus do tipo B apesar de detetados em número bastante mais reduzido comparativamente com o subtipo A(H1)pdm09, foram na sua maioria da linhagem Victoria que antigenicamente se distinguem da estirpe vacinal de 2015/2016 (B/Phuket/3073/2013). Esta situação foi igualmente verificada nos restantes países da Europa, Estados Unidos da América e Canadá. Os vírus do subtipo A(H3) assemelham-se antigenicamente à estirpe selecionada para a vacina de 2016/2017 (A/Hong Kong/4801/2014). Geneticamente a maioria dos vírus caraterizados pertencem ao grupo 3C.2a, e são semelhantes à estirpe vacinal para a época de 2016/2017. A avaliação da resistência aos antivirais inibidores da neuraminidase, não revelou a circulação de estirpes com diminuição da suscetibilidade aos inibidores da neuraminidase (oseltamivir e zanamivir). A situação verificada em Portugal é semelhante à observada a nível europeu. A percentagem mais elevada de casos de gripe foi verificada nos indivíduos com idade inferior a 45 anos. A febre, as cefaleias, o mal-estar geral, as mialgias, a tosse e os calafrios mostraram apresentar uma forte associação à confirmação laboratorial de um caso de gripe. Foi nos doentes com imunodeficiência congénita ou adquirida que a proporção de casos de gripe foi mais elevada, seguidos dos doentes com diabetes e obesidade. A percentagem total de casos de gripe em mulheres grávidas foi semelhante à observada nas mulheres em idade fértil não grávidas. No entanto, o vírus da gripe do tipo A(H1)pdm09 foi detetado em maior proporção nas mulheres grávidas quando comparado as mulheres não grávidas. A vacina como a principal forma de prevenção da gripe é especialmente recomendada em indivíduos com idade igual ou superior a 65 anos, doentes crónicos e imunodeprimidos, grávidas e profissionais de saúde. A vacinação antigripal foi referida em 13% dos casos notificados. A deteção do vírus da gripe ocorreu em 25% dos casos vacinados e sujeitos a diagnóstico laboratorial estando essencialmente associados ao vírus da gripe A(H1)pdm09, o predominante na época de 2015/2016. Esta situação foi mais frequentemente verificada em indivíduos com idade compreendida entre os 15 e 45 anos. A confirmação de gripe em indivíduos vacinados poderá estar relacionada com uma moderada efetividade da vacina antigripal na população em geral. A informação relativa à terapêutica antiviral foi indicada em 67% casos de SG notificados, proporção superior ao verificado em anos anteriores. Os antivirais foram prescritos a um número reduzido de doentes (9,0%) dos quais 45.0% referiam pelo menos a presença de uma doença crónica ou gravidez. O antiviral mais prescrito foi o oseltamivir. A pesquisa de outros vírus respiratórios nos casos de SG negativos para o vírus da gripe, veio revelar a circulação e o envolvimento de outros agentes virais respiratórios em casos de SG. Os vírus respiratórios foram detetados durante todo o período de vigilância da gripe, entre a semana 40/2015 e a semana 20/2016. O hRV, o hCoV e o RSV foram os agentes mais frequentemente detetados, para além do vírus da gripe, estando o RSV essencialmente associado a crianças com idade inferior a 4 anos de idade e o hRV e o hCoV aos adultos e população mais idosa (≥ 65 anos). A Rede Portuguesa de Laboratórios para o Diagnóstico da Gripe, efetuou o diagnóstico da gripe em 7443 casos de infeção respiratória sendo o vírus da gripe detetado em 1458 destes casos. Em 71% dos casos de gripe foi detetado o vírus da gripe A(H1)pdm09. Os vírus da gripe do tipo A(H3) foram detetados esporadicamente e em número muito reduzido (2%), e em 11% o vírus da gripe A (não subtipado). O vírus da gripe do tipo B foi detetado em 16% dos casos. A frequência de cada tipo e subtipo do vírus da gripe identificados na Rede Hospitalar assemelha-se ao observado nos cuidados de saúde primários (Rede Médicos-Sentinela e Serviços de Urgência). Foi nos indivíduos adultos, entre os 45-64 anos, que o vírus A(H1)pdm09 representou uma maior proporção dos casos de gripe incluindo igualmente a maior proporção de doentes que necessitaram de internamento hospitalar em unidades de cuidados intensivos. O vírus da gripe do tipo B esteve associado a casos de gripe confirmados nas crianças entre os 5 e 14 anos. Outros vírus respiratórios foram igualmente detetados sendo o RSV e os picornavírus (hRV, hEV e picornavírus) os mais frequentes e em co circulação com o vírus da gripe. Durante a época de vigilância da gripe, 2015/2016, não se observaram excessos de mortalidade semanais. Nas UCI verificou-se uma franca dominância do vírus da gripe A(H1)pdm09 (90%) e a circulação simultânea do vírus da gripe B (3%). A taxa de admissão em UCI oscilou entre 5,8% e 4,7% entre as semanas 53 e 12 tendo o valor máximo sido registado na semana 8 de 2016 (8,1%). Cerca de metade dos doentes tinha entre 45 e 64 anos. Os mais idosos (65+ anos) foram apenas 20% dos casos, o que não será de estranhar, considerando que o vírus da gripe A(H1)pdm09 circulou como vírus dominante. Aproximadamente 70% dos doentes tinham doença crónica subjacente, tendo a obesidade sido a mais frequente (37%). Comparativamente com a pandemia, em que circulou também o A(H1)pdm09, a obesidade, em 2015/2016, foi cerca de 4 vezes mais frequente (9,8%). Apenas 8% dos doentes tinha feito a vacina contra a gripe sazonal, apesar de mais de 70% ter doença crónica subjacente e de haver recomendações da DGS nesse sentido. A taxa de letalidade foi estimada em 29,3%, mais elevada do que na época anterior (23,7%). Cerca de 80% dos óbitos ocorreram em indivíduos com doença crónica subjacente que poderá ter agravado o quadro e contribuído para o óbito. Salienta-se a ausência de dados históricos publicados sobre letalidade em UCI, para comparação. Note-se que esta estimativa se refere a óbitos ocorridos apenas durante a hospitalização na UCI e que poderão ter ocorrido mais óbitos após a alta da UCI para outros serviços/enfermarias. Este sistema de vigilância da gripe sazonal em UCI poderá ser aperfeiçoado nas próximas épocas reduzindo a subnotificação e melhorando o preenchimento dos campos necessários ao estudo da doença. A época de vigilância da gripe 2015/2016 foi em muitas caraterísticas comparável ao descrito na maioria dos países europeus. A situação em Portugal destacou-se pela baixa intensidade da atividade gripal, pelo predomínio do vírus da gripe do subtipo A(H1)pdm09 acompanhada pela deteção de vírus do tipo B (linhagem Victoria) essencialmente no final da época gripal. A mortalidade por todas as causas durante a epidemia da gripe manteve-se dentro do esperado, não tendo sido observados excessos de mortalidade. Os vírus da gripe do subtipo predominante na época 2015/2016, A(H1)pdm09, revelaram-se antigénicamente semelhantes à estirpe vacinal. Os vírus da gripe do tipo B detetados distinguem-se da estirpe vacinal de 2015/2016. Este facto conduziu à atualização da composição da vacina antigripal para a época 2016/2017. A monitorização contínua da epidemia da gripe a nível nacional e mundial permite a cada inverno avaliar o impacto da gripe na saúde da população, monitorizar a evolução dos vírus da gripe e atuar de forma a prevenir e implementar medidas eficazes de tratamento da doença, especialmente quando esta se apresenta acompanhada de complicações graves.