Municipalities of higher vulnerability to Sylvatic Yellow Fever occurrence in the S��o Paulo State, Brazil

Until 1999 the endemic cases of Sylvatic Yellow Fever were located in the states of northern, midwestern and pre-Amazon regions. Since then, the disease progressively expanded its territory of occurrence, cases being registered beyond the traditional boundaries of endemism. The S��o Paulo State is considered to be part of this context, since after decades without registration of autochthonous cases of the disease, it reported, in 2000 and 2008-2009, epizootic occurrence in non-human primates and 30 cases in humans. Facts like these, added to the increase in incidences of serious adverse effects resulting from the Yellow Fever vaccination, have highlighted the importance of defining priority municipalities for vaccination against the disease in the state. Two groups of municipalities, some affected and some non-affected by YF, were compared for environmental variables related to the eco-epidemiology of the disease according to literature. The Multiple Correspondence Analysis (MCA) was used to pinpoint the factor able to differentiate the two groups of municipalities and define the levels of risk. The southeast region of the S��o Paulo State was considered to be the area with a higher number of municipalities classified as high risk and should be considered a priority for the application of prevention measures against Yellow Fever.

O acordo de Basileia II

Este trabalho evidencia a gest��o do risco operacional e a import��ncia da implementa����o de uma estrutura adequada de gest��o de risco. De forma a contextualizar o tema foi abordado o conceito de risco e risco operacional e as v��rias categorias de risco e feito o enquadramento nos v��rios Acordos de Basileia. Enfocou-se em Basileia II que inovou tratando do risco operacional, at�� ent��o esquecido. Neste ambito foram abordados os v��rios m��todos de avalia����o de risco: basico, standard e avan��ado. A tem��tica est�� organizada de forma a que haja um fio condutor que culmina na gest��o do risco apresentando as linhas orientadoras do BIS a esse respeito e um modelo de uma estrutura de gest��o de risco. Por fim o exemplo do Banco Comercial Portugu��s que implementou a sua estrutura de gest��o de risco tendo em conta as diretrizes de Basileia considerando m��todos benchmark de gest��o de risco.

Avalia����o das melhores t��cnicas dispon��veis relativas �� refrigera����o industrial e ��s emiss��es resultantes da armazenagem

Esta disserta����o foi realizada em colabora����o com o grupo empresarial Monteiro, Ribas e teve como principais objetivos efetuar uma avalia����o das melhores t��cnicas dispon��veis relativas �� refrigera����o industrial e ��s emiss��es resultantes da armazenagem. O primeiro objetivo teve como alvo todas as instala����es da Monteiro, Ribas enquanto que o segundo objetivo se debru��ou sobre Monteiro, Ribas, Embalagens Flex��veis, S.A.. Para cumprir estes objetivos, inicialmente efetuou-se um levantamento das melhores t��cnicas dispon��veis apresentadas nos respetivos documentos de refer��ncia. Em seguida selecionaram-se as t��cnicas que se adequavam ��s condi����es e ��s instala����es em estudo e procedeu-se a uma avalia����o de forma a verificar o grau de implementa����o das medidas sugeridas no BREF (Best Available Techniques Reference Document). Relativamente aos sistemas de refrigera����o industrial verificou-se que est��o implementadas quase todas as medidas referenciadas no respetivo documento de refer��ncia. Isto prende-se com o facto dos sistemas de refrigera����o existentes no complexo industrial Monteiro, Ribas serem relativamente recentes. Foram implementados no ano de 2012, e s��o caracterizados por apresentarem uma conce����o moderna com elevada efici��ncia. No que diz respeito �� armazenagem de produtos qu��micos perigosos, a instala����o em estudo, apresenta algumas inconformidades, uma vez que a maioria das t��cnicas mencionadas no BREF n��o se encontram implementadas, pelo que foi necess��rio efetuar uma avalia����o de riscos ambientais, com recurso �� metodologia proposta pela Norma Espanhola UNE 150008:2008 ��� An��lise e Avalia����o do Risco Ambiental. Para isso procedeu-se ent��o �� formula����o de v��rios cen��rios de riscos e �� quantifica����o de riscos para �� Monteiro, Ribas Embalagens Flex��veis S.A., tendo-se apurado que os riscos estavam avaliados como moderados a altos. Por fim foram sugeridas algumas medidas de preven����o e de minimiza����o do risco que a instala����o deve aplicar, como por exemplo, o parque de res��duos perigosos deve ser equipado com kits de conten����o de derrames (material absorvente), procedimentos a realizar em caso de emerg��ncia, fichas de dados de seguran��a e o extintor deve ser colocado num local de f��cil visualiza����o. No transporte de res��duos perigosos, para o respetivo parque, �� aconselh��vel utilizar bacias de conten����o de derrames port��teis e kits de conten����o de derrames. Relativamente ao armaz��m de produtos qu��micos perigosos �� recomendado que se proceda a sua reformula����o tendo em conta as MTD apresentadas no subcap��tulo 5.2.3 desta disserta����o.

C-reactive protein at 24 hours after hospital admission may have relevant prognostic accuracy in acute pancreatitis: a retrospective cohort study

Introduction: C-reactive protein (CRP) and Bedside Index for Severity in Acute Pancreatitis (BISAP) have been used in early risk assessment of patients with AP. Objectives: We evaluated prognostic accuracy of CRP at 24 hours after hospital admission (CRP24) for in-hospital mortality (IM) in AP individually and with BISAP. Materials and Methods: This retrospective cohort study included 134 patients with AP from a Portuguese hospital in 2009---2010. Prognostic accuracy assessment used area under receiver---operating characteristic curve (AUC), continuous net reclassi���cation improvement (NRI), and integrated discrimination improvement (IDI). Results: Thirteen percent of patients had severe AP, 26% developed pancreatic necrosis, and 7% died during index hospital stay. AUCs for CRP24 and BISAP individually were 0.80 (95% con���dence interval (CI) 0.65---0.95) and 0.77 (95% CI 0.59---0.95), respectively. No patients with CRP24 <60 mg/l died (P = 0.027; negative predictive value 100% (95% CI 92.3---100%)). AUC for BISAP plus CRP24 was 0.81 (95% CI 0.65---0.97). Change in NRI nonevents (42.4%; 95% CI, 24.9---59.9%) resulted in positive overall NRI (31.3%; 95% CI, ��� 36.4% to 98.9%), but IDI nonevents was negligible (0.004; 95% CI, ��� 0.007 to 0.014). Conclusions: CRP24 revealed good prognostic accuracy for IM in AP; its main role may be the selection of lowest risk patients.

Environmental Decision-making utilizing a Web GIS to Monitor Hazardous Industrial Emissions in the Valencian community of Spain

Dissertation submitted in partial fulfillment of the requirements for the Degree of Master of Science in Geospatial Technologies.

Genomic Signatures and Antiviral Drug Susceptibility Profile of A(H1N1)pdm09

Background: Genetic changes in influenza surface and internal genes can alter viral fitness and virulence. Mutation trend analysis and antiviral drug susceptibility profiling of A(H1N1)pdm09 viruses is essential for risk assessment of emergent strains and disease management. Objective: To profile genomic signatures and antiviral drug resistance of A(H1N1)pdm09 viruses and to discuss the potential role of mutated residues in human host adaptation and virulence. Study design: A(H1N1)pdm09 viruses circulating in Portugal during pandemic and post-pandemic periods and 2009/2010 season. Viruses were isolated in MDCK-SIAT1 cell culture and subjected to mutation analysis of surface and internal proteins, and to antiviral drug susceptibility profiling. Results: The A(H1N1)pdm09 strains circulating during the epidemic period in Portugal were resistant to amantadine. The majority of the strains were found to be susceptible to oseltamivir and zanamivir, with five outliers to neuraminidase inhibitors (NAIs) identified. Specific mutation patterns were detected within the functional domains of internal proteins PB2, PB1, PA, NP, NS1, M1 and NS2/NEP, which were common to all isolates and also some cluster-specific. Discussion: Modification of viral genome transcription, replication and apoptosis kinetics, changes in antigenicity and antiviral drug susceptibility are known determinants of virulence. We report several point mutations with putative roles in viral fitness and virulence, and discuss their potential to result in more virulent phenotypes. Monitoring of specific mutations and genetic patterns in influenza viral genes is essential for risk assessing emergent strains, disease epidemiology and public health implications.

Coronary Revascularization Induces a Shift From Cardiac Toward Noncardiac Mortality Without Improving Survival in Vascular Surgery Patient

OBJECTIVE: Although evidence has shown that ischemic heart disease (IHD) in vascular surgery patients has a negative impact on the prognosis after surgery, it is unclear whether directed treatment of IHD may influence cause-specific and overall mortality. The objective of this study was to determine the prognostic implication of coronary revascularization (CR) on overall and cause-specific mortality in vascular surgery patients. METHODS: Patients undergoing surgery for abdominal aortic aneurysm, carotid artery stenosis, or peripheral artery disease in a university hospital in The Netherlands between January 2003 and December 2011 were retrospectively included. Survival estimates were obtained by Kaplan-Meier and Cox regression analysis. RESULTS: A total of 1104 patients were included. Adjusted survival analyses showed that IHD significantly increased the risk of overall mortality (hazard ratio [HR], 1.50; 95% confidence interval, 1.21-1.87) and cardiovascular death (HR, 1.93; 95% confidence interval, 1.35-2.76). Compared with those without CR, patients previously undergoing CR had similar overall mortality (HR, 1.38 vs 1.62; P = .274) and cardiovascular mortality (HR, 1.83 vs 2.02; P = .656). Nonrevascularized IHD patients were more likely to die of IHD (6.9% vs 35.7%), whereas revascularized IHD patients more frequently died of cardiovascular causes unrelated to IHD (39.1% vs 64.3%; P = .018). CONCLUSIONS: This study confirms the significance of IHD for postoperative survival of vascular surgery patients. CR was associated with lower IHD-related death rates. However, it failed to provide an overall survival benefit because of an increased rate of cardiovascular mortality unrelated to IHD. Intensification of secondary prevention regimens may be required to prevent this shift toward non-IHD-related death and thereby improve life expectancy.

Long-Term Recurrence of Nonmelanoma Skin Cancer after Topical Methylaminolevulinate Photodynamic Therapy in a Dermato-Oncology Department

BACKGROUND: Most available studies on the efficacy of topical photodynamic therapy focus on short-to medium-term results. Long-term data are scarce. OBJECTIVE: To evaluate the long-term efficacy of photodynamic therapy with topical methylaminolevulinate to treat Bowen's disease and basal cell carcinoma in the clinical practice setting of a dermato-oncology department. METHODS: The study included patients diagnosed with Bowen's disease or basal cell carcinoma, and who received photodynamic therapy from 2004 to 2008. Treatment protocol and clinical follow-up were standardized. The primary endpoint was clinically observed recurrence in a previous photodynamic therapy-treated area. Descriptive and survival analyses were performed. RESULTS: A total of 31 Bowen's disease lesions and 44 superficial basal cell carcinoma were treated, with a median follow-up of 43.5 months. Recurrence was observed in 14 Bowen's disease lesions (53.8%) and in 11 superficial basal cell carcinoma (33.3%). Significantly higher estimates for recurrence rates were found in patients with Bowen's disease (p=0.0036) or those aged under 58 years (p=0.039). The risk of recurrence was higher in patients with Bowen's disease than in those with superficial basal cell carcinoma and younger patients. CONCLUSIONS: Recurrence should be considered when choosing to treat non-melanoma skin cancer with photodynamic therapy. Younger age and Bowen's disease were independent predictors for long-term recurrence, suggesting the need to establish an extended period of follow-up for this subset of patients.

The Intensive Care Global Study on Severe Acute Respiratory Infection (IC-GLOSSARI): a Multicenter, Multinational, 14-Day Inception Cohort Study

PURPOSE: In this prospective, multicenter, 14-day inception cohort study, we investigated the epidemiology, patterns of infections, and outcome in patients admitted to the intensive care unit (ICU) as a result of severe acute respiratory infections (SARIs). METHODS: All patients admitted to one of 206 participating ICUs during two study weeks, one in November 2013 and the other in January 2014, were screened. SARI was defined as possible, probable, or microbiologically confirmed respiratory tract infection with recent onset dyspnea and/or fever. The primary outcome parameter was in-hospital mortality within 60 days of admission to the ICU. RESULTS: Among the 5550 patients admitted during the study periods, 663 (11.9 %) had SARI. On admission to the ICU, Gram-positive and Gram-negative bacteria were found in 29.6 and 26.2 % of SARI patients but rarely atypical bacteria (1.0 %); viruses were present in 7.7 % of patients. Organ failure occurred in 74.7 % of patients in the ICU, mostly respiratory (53.8 %), cardiovascular (44.5 %), and renal (44.6 %). ICU and in-hospital mortality rates in patients with SARI were 20.2 and 27.2 %, respectively. In multivariable analysis, older age, greater severity scores at ICU admission, and hematologic malignancy or liver disease were independently associated with an increased risk of in-hospital death, whereas influenza vaccination prior to ICU admission and adequate antibiotic administration on ICU admission were associated with a lower risk. CONCLUSIONS: Admission to the ICU for SARI is common and associated with high morbidity and mortality rates. We identified several risk factors for in-hospital death that may be useful for risk stratification in these patients.

Comparative effects of sediments contaminated by carcinogenic and non-carcinogenic PAHs in Dicentrarchus labrax: a semi-quantitative histopathological approach

Disserta����o para obten����o do Grau de Mestre em Engenharia do Ambiente

Can the complex mixture of sediment contaminants cause endocrine disruption on a benthic fish? A case study with Solea senegalensis

Pollution in coastal ecosystems is a serious threat to the biota and human populations there residing. Anthropogenic activities in these ecosystems are the main cause of contamination by endocrine disruption compounds (EDCs), which can interfere with hormonal regulation and cause adverse effects to growth, stress response and reproduction. Although the chemical nature of many EDCs is unknown, it is believed that most are organic contaminants. Under an environmental risk assessment for a contaminated estuary (the Sado, SW Portugal), the present work intended to detect endocrine disruption in a flatsfish, Solea senegalensis Kaup, 1858, and its potential relationship to organic toxicants. Animals were collected from two areas in the estuary with distinct influences (industrial and rural) and from an external reference area. To evaluate endocrine disruption, hepatic vitellogenin (VTG) concentrations in males and gonad histology were analysed. As biomarkers of exposure to organic contaminants, cytochrome P450 (CYP1A) induction and the ethoxyresorufin-O-deethylase (EROD) activity were determined. The results were contrasted to sediment contamination levels, which are overall considered low, although the area presents a complex mixture of toxicants. Either males or females were found sexually immature and showed no significant evidence of degenerative pathologies. However, hepatic VTG concentrations in males from the industrial area in estuary were superior than those from the Reference, even reaching levels comparable to those in females, which may indicate an oestrogenic effect resulting from the complex contaminant mixture. These individuals also presented higher levels of CYP1A induction and EROD activity, which is consistent with contamination by organic substances. The combination of the results suggest that the exposure of flatfish to an environment contaminated by mixed toxicants, even at low levels, may cause endocrine disruption, therefore affecting populations, which implies the need for further research in identification of potential EDCs, their sources and risks at ecosystem scale.

Comparative analysis of multicriteria decision making methods

Disserta����o para obten����o do Grau de Mestre em Engenharia Electrot��cnica e de Computadores

Fatores individuais de risco de infe����o hospitalar : conhecer para prevenir

RESUMO - Medidas efetivas de preven����o e controlo de infe����o, assim como a sua aplica����o di��ria e consistente, devem fazer parte da cultura de seguran��a dos profissionais de sa��de para promover a excel��ncia da presta����o de cuidados. Tamb��m a identifica����o dos fatores de riscos individuais de infe����o �� crucial e indispens��vel para a ado����o de medidas para a gest��o desses mesmos riscos. A avalia����o do risco pretende determinar a probabilidade que um doente tem de adquirir ou disseminar uma infe����o hospitalar (IH) (WIRRAL, 2008) nas unidades de sa��de. A avalia����o deve ser efetuada na admiss��o do doente e, de forma peri��dica durante o internamento, usando uma grelha de avalia����o, integrada no processo global de cuidados do doente. Efetuada a avalia����o de risco individual, que pressup��e a identifica����o dos fatores de risco do doente (fatores de risco intr��nsecos e extr��nsecos) pode ser implementado um plano de cuidados individualizado para os gerir. Pretendeu-se com este estudo identificar os fatores de risco de infe����o hospitalar do doente que est��o presentes na admiss��o e/ou que podem surgir durante o seu internamento, para que posteriormente seja poss��vel determinar as medidas de preven����o (gest��o do risco) a aplicar individualmente. Foi realizado um estudo de caso-controlo com os doentes internados no Hospital dos Lus��adas em 2011 com o objetivo de, por um lado, determinar os fatores de risco individuais que contribuem para a aquisi����o da IH e, por outro, caraterizar os fatores de risco para uma futura identifica����o de poss��veis medidas de preven����o e controlo da aquisi����o e transmiss��o cruzada da infe����o hospitalar. A popula����o em estudo foi constitu��da pelos doentes que foram internados, entre 1 de Janeiro e 31 de Dezembro de 2011 sendo os casos os doentes em que foi identificada a presen��a de infe����o hospitalar atrav��s do programa institucional de vigil��ncia epidemiol��gica das infe����es, tendo os controlos sido selecionados numa raz��o de 3:1 caso. Foi utilizado um suporte estruturado para a colheita de dados, com a listagem de fatores de risco identificados na revis��o bibliogr��fica e de todos os fatores de risco apresentados pelos doentes em estudo. Os fatores de risco identificados que apresentaram um maior significado estat��stico foram: a idade acima dos 50 anos, o g��nero masculino, a administra����o de antimicrobianos nas tr��s semanas anteriores ao internamento, a coloca����o de cateter venoso central, a algalia����o e, no caso dos doentes cir��rgicos, a cirurgia de urg��ncia e a classifica����o ASA 3. Ap��s a identifica����o dos fatores de risco da popula����o estudada neste hospital, �� agora poss��vel utilizar a informa����o obtida e delinear investiga����es adicionais, objetivando a constru����o de instrumentos para a identifica����o de doentes com risco aumentado de infe����o.

Business model: What should be the strategy used by Smart Galp to implement and potentiate its value proposition in the Portuguese market?

A Work Project, presented as part of the requirements for the Award of a Masters Degree in Management from the NOVA ��� School of Business and Economics

Exposi����o profissional a subst��ncias qu��micas : diagn��stico das situa����es de risco

A abordagem das rela����es trabalho/sa��de(doen��a) implica um conhecimento adequado das vari��veis (factores) profissionais em jogo e das respectivas repercuss��es, positivas ou negativas, sobre a sa��de dos trabalhadores. Tal conhecimento adquire-se mediante an��lise das (sempre complexas) situa����es reais de trabalho. As subst��ncias qu��micas constituem o mais extenso dos grupos de factores de risco de natureza profissional. O n��mero de subst��ncias qu��micas a que se encontram expostos os trabalhadores aumenta dia a dia, sendo actualmente conhecidas mais de 100 000. Os autores procedem �� revis��o de alguns conceitos que, numa perspectiva de preven����o, s��o essenciais para o diagn��stico das situa����es profissionais de risco.