Prevalence of the prothrombin G20210A mutation in the Irish populations:use of a novel polymerase chain reaction approach

The prothrombin G20210A polymorphism is associated with a threefold-increased risk of venous thrombosis. There is considerable variation in the reported prevalence of this polymorphism within normal populations, ranging from 0 to 6.5%. The prevalence within the Irish population has not been determined. A restriction fragment length polymorphism (RFLP)-based assay is commonly used for the detection of the prothrombin 20210A allele. This assay does not include a control restriction digest fragment and, consequently, failure of the enzyme activity or lack of addition of enzyme to the sample cannot be distinguished from wild-type prothrombin. We developed a RFLP-based assay, which incorporates an invariant digest site, resulting in the generation of a control digest fragment. Furthermore, we developed a nested polymerase chain reaction (PCR) method for the amplification and digestion of poor-quality or low-concentration DNA. In the Irish population studied, five of 385 (1.29%) were heterozygous and one patient was homozygous for the prothrombin 20210A polymorphism. This is the first reported data on an Irish or Celtic population and suggests that the allele frequency is similar to Anglo-Saxon populations. The nested PCR method successfully amplified and digested 100/100 (100%) of the archived samples; none of these samples could be analyzed by the standard single-round PCR method. In conclusion, nested PCR should be considered in the analysis of archived samples. Single-round PCR is appropriate for recently collected samples; however, an invariant control digest site should be incorporated in RFLP-based assays to validate the integrity of the digestion enzyme and limit the risk of false-negative results.

Cancer dormancy: a model of early dissemination and late cancer recurrence

Cancer dormancy is a stage in tumor progression in which residual disease remains occult and asymptomatic for a prolonged period of time. Dormant tumor cells can be present as one of the earliest stages in tumor development, as well as a stage in micrometastases, and/or minimal residual disease left after an apparently successful treatment of the primary tumor. The general mechanisms that regulate the transition of disseminated tumor cells that have lain dormant into a proliferative state remain largely unknown. However, regulation of the growth from dormant tumor cells may be explained in part through the interaction of the tumor cell with its microenvironment, limitations in the blood supply, or an active immune system. An understanding of the regulatory machinery of these processes is essential for identifying early cancer biomarkers and could provide a rationale for the development of novel agents to target dormant tumor cells. This review focuses on the different signaling models responsible for early cancer dissemination and tumor recurrence that are involved in dormancy pathways.

Identification of novel Factor XI mutations in a patient requiring dental extractions

Factor XI is a serine protease that participates in the intrinsic pathway of blood coagulation. Patients deficient in factor XI exhibit varying degrees of post operative bleeding following invasive surgical procedures such as dental extractions. Objectives: The aim of the study was to identify the specific mutations in a patient from a family with known factor XI deficiency. Methods: Samples were obtained from the patient, his mother and his father and subjected to DNA sequencing. Each protein coding exon 2-15 of the factor XI gene was amplified by polymerase chain reaction (PCR) followed by bidirectional sequencing utilizing di-deoxy chain termination chemistry. Results: The patient had a factor XI level of 20% of normal. Initial sequencing of factor XI from the patient identified a point mutation (646G>A) and a putative splice site mutation (1567+4A>T) in intron 13. These are novel previously unreported mutations. DNA sequence analysis of the mother revealed the 1567+4A>T mutation and the father exhibited the 646G>A mutation. As a consequence the treatment proceeded without serious bleeding complication and required administration only of transexamic acid though factor XI was available as haemostatic cover. Conclusion: The two mutations identified in this family are novel; further laboratory investigation of the functional consequences of those mutations is currently underway. Although factor XI deficiency is rare in the Northern Irish population this study highlights the techniques available to sequence and analyse this and similar haematological disorders.

Perceived difficulty of various steps of manual small incision cataract surgery among trainees in rural China

Background: The perceived difficulty of steps of manual small incision cataract surgery among trainees in rural China was assessed. Design: Cohort study. Participants: Fifty-two trainees at the end of a manual small incision cataract surgery training programme. Methods: Participants rated the difficulty of 14 surgical steps using a 5-point scale, 1 (very easy) to 5 (very difficult). Demographic and professional information was recorded for trainees. Main Outcome Measure: Mean ratings for surgical steps. Results: Questionnaires were completed by 49 trainees (94.2%, median age 38 years, 8 [16.3%] women). Twenty six (53.1%) had performed ≤50 independent cataract surgeries prior to training. Trainees rated cortical aspiration (mean score±standard deviation=3.10±1.14) the most difficult step, followed by wound construction (2.76±1.08), nuclear prolapse into the anterior chamber (2.74±1.23) and lens delivery (2.51±1.08). Draping the surgical field (1.06±0.242), anaesthetic block administration (1.14±0.354) and thermal coagulation (1.18±0.441) were rated easiest. In regression models, the score for cortical aspiration was significantly inversely associated with performing >50 independent manual small incision cataract surgery surgeries during training (P=0.01), but not with age, gender, years of experience in an eye department or total number of cataract surgeries performed prior to training. Conclusions: Cortical aspiration, wound construction and nuclear prolapse pose the greatest challenge for trainees learning manual small incision cataract surgery, and should receive emphasis during training. Number of cases performed is the strongest predictor of perceived difficulty of key steps. © 2013 Royal Australian and New Zealand College of Ophthalmologists.

Characteristics, complications, and gaps in evidence-based interventions in rheumatic heart disease: the Global Rheumatic Heart Disease Registry (the REMEDY study)

AIMS: Rheumatic heart disease (RHD) accounts for over a million premature deaths annually; however, there is little contemporary information on presentation, complications, and treatment.

METHODS AND RESULTS: This prospective registry enrolled 3343 patients (median age 28 years, 66.2% female) presenting with RHD at 25 hospitals in 12 African countries, India, and Yemen between January 2010 and November 2012. The majority (63.9%) had moderate-to-severe multivalvular disease complicated by congestive heart failure (33.4%), pulmonary hypertension (28.8%), atrial fibrillation (AF) (21.8%), stroke (7.1%), infective endocarditis (4%), and major bleeding (2.7%). One-quarter of adults and 5.3% of children had decreased left ventricular (LV) systolic function; 23% of adults and 14.1% of children had dilated LVs. Fifty-five percent (n = 1761) of patients were on secondary antibiotic prophylaxis. Oral anti-coagulants were prescribed in 69.5% (n = 946) of patients with mechanical valves (n = 501), AF (n = 397), and high-risk mitral stenosis in sinus rhythm (n = 48). However, only 28.3% (n = 269) had a therapeutic international normalized ratio. Among 1825 women of childbearing age (12-51 years), only 3.6% (n = 65) were on contraception. The utilization of valvuloplasty and valve surgery was higher in upper-middle compared with lower-income countries.

CONCLUSION: Rheumatic heart disease patients were young, predominantly female, and had high prevalence of major cardiovascular complications. There is suboptimal utilization of secondary antibiotic prophylaxis, oral anti-coagulation, and contraception, and variations in the use of percutaneous and surgical interventions by country income level.

Identification of diagnostic biomarkers for infection in premature neonates

Infection is a leading cause of neonatal morbidity and mortality worldwide. Premature neonates are particularly susceptible to infection because of physiologic immaturity, comorbidity, and extraneous medical interventions. Additionally premature infants are at higher risk of progression to sepsis or severe sepsis, adverse outcomes, and antimicrobial toxicity. Currently initial diagnosis is based upon clinical suspicion accompanied by nonspecific clinical signs and is confirmed upon positive microbiologic culture results several days after institution of empiric therapy. There exists a significant need for rapid, objective, in vitro tests for diagnosis of infection in neonates who are experiencing clinical instability. We used immunoassays multiplexed on microarrays to identify differentially expressed serum proteins in clinically infected and non-infected neonates. Immunoassay arrays were effective for measurement of more than 100 cytokines in small volumes of serum available from neonates. Our analyses revealed significant alterations in levels of eight serum proteins in infected neonates that are associated with inflammation, coagulation, and fibrinolysis. Specifically P- and E-selectins, interleukin 2 soluble receptor alpha, interleukin 18, neutrophil elastase, urokinase plasminogen activator and its cognate receptor, and C-reactive protein were observed at statistically significant increased levels. Multivariate classifiers based on combinations of serum analytes exhibited better diagnostic specificity and sensitivity than single analytes. Multiplexed immunoassays of serum cytokines may have clinical utility as an adjunct for rapid diagnosis of infection and differentiation of etiologic agent in neonates with clinical decompensation.

Contribution of biomass combustion to air pollutant emissions

In Portugal, it was estimated that around 1.95 Mton/year of wood is used in residential wood burning for heating and cooking. Additionally, in the last decades, burnt forest area has also been increasing. These combustions result in high levels of toxic air pollutants and a large perturbation of atmospheric chemistry, interfere with climate and have adverse effects on health. Accurate quantification of the amounts of trace gases and particulate matter emitted from residential wood burning, agriculture and garden waste burning and forest fires on a regional and global basis is essential for various purposes, including: the investigation of several atmospheric processes, the reporting of greenhouse gas emissions, and quantification of the air pollution sources that affect human health at regional scales. In Southern Europe, data on detailed emission factors from biomass burning are rather inexistent. Emission inventories and source apportionment, photochemical and climate change models use default values obtained for US and Northern Europe biofuels. Thus, it is desirable to use more specific locally available data. The objective of this study is to characterise and quantify the contribution of biomass combustion sources to atmospheric trace gases and aerosol concentrations more representative of the national reality. Laboratory (residential wood combustion) and field (agriculture/garden waste burning and experimental wildland fires) sampling experiments were carried out. In the laboratory, after the selection of the most representative wood species and combustion equipment in Portugal, a sampling program to determine gaseous and particulate matter emission rates was set up, including organic and inorganic aerosol composition. In the field, the smoke plumes from agriculture/garden waste and experimental wildland fires were sampled. The results of this study show that the combustion equipment and biofuel type used have an important role in the emission levels and composition. Significant differences between the use of traditional combustion equipment versus modern equipments were also observed. These differences are due to higher combustion efficiency of modern equipment, reflecting the smallest amount of particulate matter, organic carbon and carbon monoxide released. With regard to experimental wildland fires in shrub dominated areas, it was observed that the largest organic fraction in the samples studied was mainly composed by vegetation pyrolysis products. The major organic components in the smoke samples were pyrolysates of vegetation cuticles, mainly comprising steradienes and sterol derivatives, carbohydrates from the breakdown of cellulose, aliphatic lipids from vegetation waxes and methoxyphenols from the lignin thermal degradation. Despite being a banned practice in our country, agriculture/garden waste burning is actually quite common. To assess the particulate matter composition, the smoke from three different agriculture/garden residues have been sampled into 3 different size fractions (PM2.5, PM2.5-10 and PM>10). Despite distribution patterns of organic compounds in particulate matter varied among residues, the amounts of phenolics (polyphenol and guaiacyl derivatives) and organic acids were always predominant over other organic compounds in the organosoluble fraction of smoke. Among biomarkers, levoglucosan, β-sitosterol and phytol were detected in appreciable amounts in the smoke of all agriculture/garden residues. In addition, inositol may be considered as an eventual tracer for the smoke from potato haulm burning. It was shown that the prevailing ambient conditions (such as high humidity in the atmosphere) likely contributed to atmospheric processes (e.g. coagulation and hygroscopic growth), which influenced the particle size characteristics of the smoke tracers, shifting their distribution to larger diameters. An assessment of household biomass consumption was also made through a national scale survey. The information obtained with the survey combined with the databases on emission factors from the laboratory and field tests allowed us to estimate the pollutant amounts emitted in each Portuguese district. In addition to a likely contribution to the improvement of emission inventories, emission factors obtained for tracer compounds in this study can be applied in receptor models to assess the contribution of biomass burning to the levels of atmospheric aerosols and their constituents obtained in monitoring campaigns in Mediterranean Europe.

Comunidades de prática online: contributos para a prática letiva: um estudo de caso no âmbito da educação em ciência envolvendo professores e investigadores

As comunidades de prática (CoP), bem como a investigação-ação, têm vindo a ser apontadas na literatura como formas de promover o desenvolvimento profissional de professores, potenciando a melhoria das suas práticas letivas. Contudo, as evidências empíricas relativas às práticas letivas desenvolvidas por professores no âmbito dessas configurações sociais são escassas. Neste estudo procura-se contribuir para colmatar essa lacuna ao analisar uma CoP online, que envolveu professores de ciências e investigadores em Educação em Ciência (EC) e se constituiu no âmbito do projeto “Investigação e práticas lectivas em Educação em Ciência: Dinâmicas de interacção” (IPEC), com enfoques distintos, a que se alude abaixo. A investigação realizada envolveu uma metodologia de natureza predominantemente qualitativa, descritiva, exploratória e do tipo estudo de caso único, sendo o caso as práticas letivas desenvolvidas pelos membros da CoP referida e as dinâmicas de interação entre os mesmos. Como técnicas de recolha de dados, recorreu-se principalmente à observação mediada pela plataforma online de apoio ao desenvolvimento do projeto (dados estatísticos e as mensagens registadas automaticamente) e recolha de documentos. Quanto às técnicas de análise de dados, optou-se principalmente pela análise de conteúdo e análise documental interna, tendo-se triangulado dados de diferentes fontes. Com base no Interconnected Model of Teacher Professional Growth, que Clarke e Hollingsworth propuseram em 2002, e em instrumentos de análise resultantes da revisão de literatura, adaptados aos enfoques definidos, a análise da CoP selecionada incidiu sobre: a) os domínios externo e das práticas de desenvolvimento curricular (DC), ou seja, as suas dinâmicas de interação durante dois anos letivos; b) o domínio das consequências nas práticas letivas, no que concerne às estratégias de ensino de ciências desenvolvidas; c) a evidências do seu carater inovador; e d) aos princípios de DC operacionalizados através do módulo curricular desenhado, implementado, avaliado e disseminado pelos membros da CoP. Os resultados indicam que a) a participação dos membros variou ao longo do período de interação e que a sua dinâmica se enquadra numa adaptação das fases de desenvolvimento de CoP proposta por Wenger e colegas em 2002, com dois ciclos de investigação-ação; b) a CoP desenvolveu estratégias de ensino diversificadas, pouco exploradas por professores e coerentes com diversas recomendações da literatura, de forma consistente; c) as práticas letivas são inovadoras, do tipo challenging, tendo incluído o envolvimento de professores que lecionavam nas escolas dos professores membros da CoP; e d) a CoP operacionalizou vários princípios de DC recomendados na literatura, nomeadamente a flexibilidade e diferenciação. Os resultados empíricos permitiram ainda validar as dimensões do modelo de Clarke e Hollingsworth, assim como adaptar à especificidade do caso analisado.Pelo acima referido, embora reconhecendo as limitações do estudo, nomeadamente relativas às opções metodológicas efetuadas, foi possível inferir que o trabalho realizado no seio desta CoP online de professores e investigadores contribuiu para a inovação e melhoria de práticas letivas de EC. Do estudo resultam ainda instrumentos de análise que se consideram relevantes, dado poderem vir a ser usados em investigações futuras, assim como poderem vir a orientar professores de ciências que desejem alinhar as suas práticas de ensino com recomendações da investigação em EC. Por fim, são apresentadas recomendações relativamente ao envolvimento de professores e investigadores em CoP online, no âmbito da EC, assim como relativamente a possibilidades ao nível de investigações futuras, nomeadamente a validação dos instrumentos e das recomendações apresentadas em contextos mais abrangentes e transversais.

International cooperation for development in tourism destinations

The main goal of this thesis is to propose a conceptual theoretical model of critical success factors of International Development Cooperation programmes that are based in knowledge transfer approaches in the context of tourism development. The research was structured around three main theoretical pillars: international development cooperation (IDC), tourism as a tool for development, and knowledge transfer (KT). By exploring these pillars´ main interrelations, it was possible to gather the necessary background to develop the theoretical model and apply it to a real context. It was adopted a qualitative research approach using as a case study an IDC programme in tourism - the UNWTO.Volunteers programme. The key contribution of this thesis in the theoretical realm is the bridging of fields of study that are insufficiently covered in the scientific literature. The resulting model proposal applied to a real context of an IDC programme implementation permitted to test it partially providing useful insights for future research. It is postulated that IDC programmes in these contexts constitute a process rather than an end in itself. Therefore, they should be seen as a way of changing the state of the art of the tourism system in a sustainable manner so that it potentially generates positive development changes. This study suggested that it is not possible to achieve positive results if, instead of encouraging a KT and learning environment, it is simply disseminated knowledge in a linear, static, north-south approach. The characteristics of these interventions should be reviewed in that it was found that it is very difficult to guarantee the maintenance of the development changes induced by them if it is not safeguarded the necessary conditions and accountability to implement the recommended actions. While it was perceived a great potential for development changes to be induced by some IDC programmes in tourism destinations, it was concluded that these processes are too much dependent on the local political systems and existing power relations, as well as on the level of tourism development of the destination. However, more research is needed to examine the ability to generalise the findings to other IDC programmes and different destinations of developing countries.

Insights into molecular and cellular events involved in normal and pathological vertebral development and fusion using zebrafish as model organism

The vertebral column and its units, the vertebrae, are fundamental features, characteristic of all vertebrates. Developmental segregation of the vertebral bodies as articulated units is an intrinsic requirement to guarantee the proper function of the spine. Whenever these units become fused either during development or postsegmentation, movement is affected in a more or less severe manner, depending on the number of vertebrae affected. Nevertheless, fusion may occur as part of regular development and as a physiological requirement, like in the tetrapod sacrum or in fish posterior vertebrae forming the urostyle. In order to meet the main objective of this PhD project, which aimed to better understand the molecular and cellular events underlying vertebral fusion under physiological and pathological conditions, a detailed characterization of the vertebral fusion occurring in zebrafish caudal fin region was conducted. This showed that fusion in the caudal fin region comprised 5 vertebral bodies, from which, only fusion between [PU1++U1] and ural2 [U2+] was still traceable during development. This involved bone deposition around the notochord sheath while fusion within the remaining vertebral bodies occur at the level of the notochord sheath, as during the early establishment of the vertebral bodies. A comparison approach between the caudal fin vertebrae and the remaining vertebral column showed conserved features such as the presence of mineralization related proteins as Osteocalcin were identified throughout the vertebral column, independently on the mineralization patterns. This unexpected presence of Osteocalcin in notochord sheath, here identified as Oc1, suggested that this gene, opposing to Oc2, generally associated with bone formation and mature osteoblast activity, is potentially associated with early mineralization events including chordacentrum formation. Nevertheless, major differences between caudal fin region and anterior vertebral bodies considering arch histology and mineralization patterns, led us to use RA as an inductive factor for vertebral fusion, allowing a direct comparison of equivalent structures under normal and fusion events. This fusion phenotype was associated with notochord sheath ectopic mineralization instead of ectopic perichordal bone formation related with increased osteoblast activity, as suggested in previous reports. Additionally, alterations in ECM content, cell adhesion and blood coagulation were discussed as potentially related with the fusion phenotype. Finally, Matrix gla protein, upregulated upon RA treatment and shown to be associated with chordacentrum mineralization sites in regular development, was further described considering its potential function in vertebral formation and pathological fusion. Therefore with this work we propose zebrafish caudal fin vertebral fusion as a potential model to study both congenital and postsegmentation fusion and we present candidate factors and genes that may be further explored in order to clarify whether we can prevent vertebral fusion.

Effects of vitamin K deficiency and its mechanisms in vertebrate's early development: zebrafish as a model

Disertação de mestrado, Ciências Biomédicas, Departamento de Ciências Biomédicas e Medicina, Universidade do Algarve, 2015

Using genomics for drug discovery in medulloblastoma

Tese de doutoramento, Medicina (Neurocirurgia), Universidade de Lisboa, Faculdade de Medicina, 2014

Prevalence of Artemisia Species Pollinosis in Western Poland: Impact of Climate Change on Aerobiological Trends, 1995-2004

Background: Artemisia species pollen represents a major cause of allergy in Central Europe. Variations in the pollen season, the influence of climate variables and the prevalence of pollinosis to it were analyzed in Poznan, in western Poland between 1995 and 2004. Methods: A Hirst volumetric spore trap was used for atmospheric sampling. Pollination date trend analysis and Spearman correlation tests were performed. Skin prick tests (SPT) and allergen specific immunoglobulin (Ig)E antibody measurements were performed in 676 and 524 patients, respectively. Results: The Artemisia species pollen season grew longer due to a clear advance in the starting day and only a slightly earlier end point; the peak day also came slightly earlier. Rainfall in the fi rst fortnight of July highly influenced pollen season severity. Temperature was directly correlated with daily Artemisia species pollen levels; relative humidity was inversely correlated. Twelve percent of patients had a positive SPT reaction to Artemisia species. Their symptoms were rhinitis and conjunctivitis (15%), atopic dermatitis (15%), chronic urticaria (14.3%), bronchial asthma (2.4%), and facial and disseminated dermatitis (1.3%). Elevated specifi c IgE concentrations were detected in the sera of 10.1% of patients. Conclusions: Artemisia species pollen is an important cause of pollinosis in western Poland. Pollen season intensity is highly influenced by rainfall in the previous weeks. Trends towards earlier season starts and longer duration, possibly caused by climate change, may have an impact on the allergic population.

Analysing the results of UK urban freight studies

The paper is based on work carried out as part of the Green Logistics project1. The paper provides a review of urban freight studies that have taken place in the UK over approximately a thirty year period from the early 1970 s to the present (this is the first attempt at such a review in the UK as far as the authors are aware). Coverage of both goods collection and delivery vehicle activity and service vehicle activity is included. This review covers the survey techniques used, as well as the survey results obtained. Comparisons are made between the results of studies from the 1970 s and those carried out in the last decade in order to gain insight to changes in urban freight transport operations. The data provided in the studies reviewed is extremely important as it provides insight into urban freight operations that is unavailable from any other data source, including national freight surveys conducted by government. However, until now, the results of these studies have not been widely disseminated or compared.

A Implementação de um sistema de gestão da qualidadena Junta de Freguesia de Gandra

Trabalho de Projeto apresentado ao Instituto Superior de Contabilidade e Administração do Porto para obtenção do grau de Mestre em Auditoria Orientado por: Doutora Alcina Augusta de Sena Portugal Dias