Latanoprost for open-angle glaucoma (UKGTS): a randomised, multicentre, placebo-controlled trial

Background
Treatments for open-angle glaucoma aim to prevent vision loss through lowering of intraocular pressure, but to our knowledge no placebo-controlled trials have assessed visual function preservation, and the observation periods of previous (unmasked) trials have typically been at least 5 years. We assessed vision preservation in patients given latanoprost compared with those given placebo.

Methods
In this randomised, triple-masked, placebo-controlled trial, we enrolled patients with newly diagnosed open-angle glaucoma at ten UK centres (tertiary referral centres, teaching hospitals, and district general hospitals). Eligible patients were randomly allocated (1:1) with a website-generated randomisation schedule, stratified by centre and with a permuted block design, to receive either latanoprost 0·005% (intervention group) or placebo (control group) eye drops. Drops were administered from identical bottles, once a day, to both eyes. The primary outcome was time to visual field deterioration within 24 months. Analyses were done in all individuals with follow-up data. The Data and Safety Monitoring Committee (DSMC) recommended stopping the trial on Jan 6, 2011 (last patient visit July, 2011), after an interim analysis, and suggested a change in primary outcome from the difference in proportions of patients with incident progression between groups to time to visual field deterioration within 24 months. This trial is registered, number ISRCTN96423140.

Findings
We enrolled 516 individuals between Dec 1, 2006, and March 16, 2010. Baseline mean intraocular pressure was 19·6 mm Hg (SD 4·6) in 258 patients in the latanoprost group and 20·1 mm Hg (4·8) in 258 controls. At 24 months, mean reduction in intraocular pressure was 3·8 mm Hg (4·0) in 231 patients assessed in the latanoprost group and 0·9 mm Hg (3·8) in 230 patients assessed in the placebo group. Visual field preservation was significantly longer in the latanoprost group than in the placebo group: adjusted hazard ratio (HR) 0·44 (95% CI 0·28–0·69; p=0·0003). We noted 18 serious adverse events, none attributable to the study drug.

Interpretation
This is the first randomised placebo-controlled trial to show preservation of the visual field with an intraocular-pressure-lowering drug in patients with open-angle glaucoma. The study design enabled significant differences in vision to be assessed in a relatively short observation period

Do removable dental prosthesis have an impact on tooth loss?

DESIGN: A multi-centre randomised controlled study in 14 dental schools. This report is an interim analysis at 3 years.

INTERVENTION: Patients were allocated to either the Removable dental prosthesis group (RPD)-109 patients or the no prosthesis group (SDA) -106 patients. Patients had to be older than 35 years with no molars in the study jaw. Follow-up visits were scheduled at 4 to 8 wks (baseline), at 6 months, and at 1, 2, 3, 4, and 5 yrs after treatment.

OUTCOME MEASURE: Time to loss of first tooth following intervention or no intervention.

RESULTS: 81 patients received a RDP and 69 patients received no treatment in the end. This is a reduction of 26% and 35% respectively from the time when they were randomised to the two groups. Tooth loss occurred in 13 of the RDP group (16% of those who received the RDP, 12% of those allocated to the group at the start) with 5 of these being in the study jaw and 8 in the opposing jaw. Tooth loss occurred in 9 of the SDA group (13% of those who received SDA, 9% of those who were allocated to the group at the start) with 5 in the study jaw and 4 in the opposing jaw. The respective Kaplan-Meier survival rates at 38 months were 0.83 (95% CI: 0.74-0.91) in the RDP group and 0.86 (95% CI: 0.78-0.95) in the SDA group.

CONCLUSIONS: The difference in tooth loss at three years between patients treated with RDP and those not treated with RDP was not significant.

Precision Teaching in IV Fluid Prescribing and Patient Safety

OBJECTIVES: Precision Teaching (PT) has been shown to be an effective intervention to assess teaching method effectiveness and evaluate learning outcomes. SAFMEDS (Say All Fast Minute Every Day Shuffled) are a practice/assessment procedure within the PT framework to assist learning and fluency. We explored the effects of a brief intervention with PT, to impart high frequency performance in safe intravenous fluid prescription in a group of final year undergraduate medical students.
METHODS: 133 final year undergraduate medical students completed a multiple choice question (MCQ) test on safe IV fluid prescription at the beginning and end of the study. The control group (n= 76) of students were taught using a current standardized teaching method. Students allocated to the intervention arm of the study were additionally instructed on PT and the use of SAFMEDS. The study group (n = 57) received 50 SAFMEDS cards containing information on the principles of IV fluid prescription scenarios. These students were trained/tested twice per day for 1 minute.
RESULTS: Interim analysis showed that the study group displayed an improvement in fluency and accuracy as the study progressed. There was a statistically significant improvement in MCQ performance for the PT group compared with the control group between the beginning and end of the study (35% vs 15%).
CONCLUSION: These results suggest PT employing SAFMEDS is an effective method for improving fluency, accuracy and patient safety in intravenous fluid prescribing amongst undergraduate medical students.

Vosaroxin and vosaroxin plus low-dose Ara-C (LDAC) vs low-dose Ara-C alone in older patients with acute myeloid leukemia

The development of new treatments for older patients with acute myeloid leukemia is an active area, but has met with limited success. Vosaroxin, a quinolone-derived intercalating agent has several properties that could prove beneficial. Initial clinical studies showed it to be well-tolerated in older patients with relapsed/refractory disease. In vitro data suggested synergy with cytarabine (Ara-C). To evaluate vosaroxin, we performed 2 randomized comparisons within the "Pick a Winner" program. A total of 104 patients were randomized to vosaroxin vs low-dose Ara-C (LDAC) and 104 to vosaroxin + LDAC vs LDAC. When comparing vosaroxin with LDAC, neither response rate (complete recovery [CR]/complete recovery with incomplete count recovery [CRi], 26% vs 30%; odds ratio [OR], 1.16 (0.49-2.72); P = .7) nor 12-month survival (12% vs 31%; hazard ratio [HR], 1.94 [1.26-3.00]; P = .003) showed benefit for vosaroxin. Likewise, in the vosaroxin + LDAC vs LDAC comparison, neither response rate (CR/CRi, 38% vs 34%; OR, 0.83 [0.37-1.84]; P = .6) nor survival (33% vs 37%; HR, 1.30 [0.81-2.07]; P = .3) was improved. A major reason for this lack of benefit was excess early mortality in the vosaroxin + LDAC arm, most obviously in the second month following randomization. At its first interim analysis, the Data Monitoring and Ethics Committee recommended closure of the vosaroxin-containing trial arms because a clinically relevant benefit was unlikely.

Efficacy and safety of ivacaftor in patients with cystic fibrosis who have an Arg117His-CFTR mutation: a double-blind, randomised controlled trial

BACKGROUND: Ivacaftor has been previously assessed in patients with cystic fibrosis with Gly551Asp-CFTR or other gating mutations. We assessed ivacaftor in patients with Arg117His-CFTR, a residual function mutation.

METHODS: We did a 24-week, placebo-controlled, double-blind, randomised clinical trial, which enrolled 69 patients with cystic fibrosis aged 6 years and older with Arg117His-CFTR and percentage of predicted forced expiratory volume in 1 s (% predicted FEV1) of at least 40. We randomly assigned eligible patients (1:1) to receive placebo or ivacaftor 150 mg every 12 h for 24 weeks. Randomisation was stratified by age (6-11, 12-17, and ≥18 years) and % predicted FEV1 (<70, ≥70 to ≤90, and >90). The primary outcome was the absolute change from baseline in % predicted FEV1 through week 24. Secondary outcomes included safety and changes in sweat chloride concentrations and Cystic Fibrosis Questionnaire-Revised (CFQ-R) respiratory domain scores. An open-label extension enrolled 65 of the patients after washout; after 12 weeks, we did an interim analysis.

FINDINGS: After 24 weeks, the treatment difference in mean absolute change in % predicted FEV1 between ivacaftor (n=34) and placebo (n=35) was 2·1 percentage points (95% CI -1·13 to 5·35; p=0·20). Ivacaftor treatment resulted in significant treatment differences in sweat chloride (-24·0 mmol/L, 95% CI -28·01 to -19·93; p<0·0001) and CFQ-R respiratory domain (8·4, 2·17 to 14·61; p=0·009). In prespecified subgroup analyses, % predicted FEV1 significantly improved with ivacaftor in patients aged 18 years or older (treatment difference vs placebo: 5·0 percentage points, 95% CI 1·15 to 8·78; p=0·01), but not in patients aged 6-11 years (-6·3 percentage points, -11·96 to -0·71; p=0·03). In the extension study, both placebo-to-ivacaftor and ivacaftor-to-ivacaftor groups showed % predicted FEV1 improvement (absolute change from post-washout baseline at week 12: placebo-to-ivacaftor, 5·0 percentage points [p=0·0005]; ivacaftor-to-ivacaftor, 6·0 percentage points [p=0·006]). We did not identify any new safety concerns. The studies are registered with ClinicalTrials.gov (the randomised, placebo-controlled study, number NCT01614457; the open-label extension study, number NCT01707290).

INTERPRETATION: Although this study did not show a significant improvement in % predicted FEV1, ivacaftor did significantly improve sweat chloride and CFQ-R respiratory domain scores and lung function in adult patients with Arg117His-CFTR, indicating that ivacaftor might benefit patients with Arg117His-CFTR who have established disease.

Whole Genome Sequencing Reveals Local Transmission Patterns of Mycobacterium bovis in Sympatric Cattle and Badger Populations

Whole genome sequencing (WGS) technology holds great promise as a tool for the forensic epidemiology of bacterial pathogens. It is likely to be particularly useful for studying the transmission dynamics of an observed epidemic involving a largely unsampled 'reservoir' host, as for bovine tuberculosis (bTB) in British and Irish cattle and badgers. BTB is caused by Mycobacterium bovis, a member of the M. tuberculosis complex that also includes the aetiological agent for human TB. In this study, we identified a spatio-temporally linked group of 26 cattle and 4 badgers infected with the same Variable Number Tandem Repeat (VNTR) type of M. bovis. Single-nucleotide polymorphisms (SNPs) between sequences identified differences that were consistent with bacterial lineages being persistent on or near farms for several years, despite multiple clear whole herd tests in the interim. Comparing WGS data to mathematical models showed good correlations between genetic divergence and spatial distance, but poor correspondence to the network of cattle movements or within-herd contacts. Badger isolates showed between zero and four SNP differences from the nearest cattle isolate, providing evidence for recent transmissions between the two hosts. This is the first direct genetic evidence of M. bovis persistence on farms over multiple outbreaks with a continued, ongoing interaction with local badgers. However, despite unprecedented resolution, directionality of transmission cannot be inferred at this stage. Despite the often notoriously long timescales between time of infection and time of sampling for TB, our results suggest that WGS data alone can provide insights into TB epidemiology even where detailed contact data are not available, and that more extensive sampling and analysis will allow for quantification of the extent and direction of transmission between cattle and badgers. © 2012 Biek et al.

Wind energy resource modelling in Portugal and its future large-scale alteration due to anthropogenic induced climate changes

The high dependence of Portugal from foreign energy sources (mainly fossil fuels), together with the international commitments assumed by Portugal and the national strategy in terms of energy policy, as well as resources sustainability and climate change issues, inevitably force Portugal to invest in its energetic self-sufficiency. The 20/20/20 Strategy defined by the European Union defines that in 2020 60% of the total electricity consumption must come from renewable energy sources. Wind energy is currently a major source of electricity generation in Portugal, producing about 23% of the national total electricity consumption in 2013. The National Energy Strategy 2020 (ENE2020), which aims to ensure the national compliance of the European Strategy 20/20/20, states that about half of this 60% target will be provided by wind energy. This work aims to implement and optimise a numerical weather prediction model in the simulation and modelling of the wind energy resource in Portugal, both in offshore and onshore areas. The numerical model optimisation consisted in the determination of which initial and boundary conditions and planetary boundary layer physical parameterizations options provide wind power flux (or energy density), wind speed and direction simulations closest to in situ measured wind data. Specifically for offshore areas, it is also intended to evaluate if the numerical model, once optimised, is able to produce power flux, wind speed and direction simulations more consistent with in situ measured data than wind measurements collected by satellites. This work also aims to study and analyse possible impacts that anthropogenic climate changes may have on the future wind energetic resource in Europe. The results show that the ECMWF reanalysis ERA-Interim are those that, among all the forcing databases currently available to drive numerical weather prediction models, allow wind power flux, wind speed and direction simulations more consistent with in situ wind measurements. It was also found that the Pleim-Xiu and ACM2 planetary boundary layer parameterizations are the ones that showed the best performance in terms of wind power flux, wind speed and direction simulations. This model optimisation allowed a significant reduction of the wind power flux, wind speed and direction simulations errors and, specifically for offshore areas, wind power flux, wind speed and direction simulations more consistent with in situ wind measurements than data obtained from satellites, which is a very valuable and interesting achievement. This work also revealed that future anthropogenic climate changes can negatively impact future European wind energy resource, due to tendencies towards a reduction in future wind speeds especially by the end of the current century and under stronger radiative forcing conditions.

Gerir tensões na complexidade organizacional de um agrupamento de escolas : testemunho da sua diretora

Trabalho de projeto de mestrado, Ciências da Educação (Administração Educacional), Universidade de Lisboa, Instituto de Educação, 2013

Dynamics and variability of the alongshore flows on the northwestern iberian margin

Tese de doutoramento, Ciências Geofísicas e da Geoinformação (Oceanografia), Universidade de Lisboa, Faculdade de Ciências, 2014

Application of the WRF-Chem Model for a High Ozone Episode in SW Poland – Preliminary Results

The Weather Research and Forecasting model, integrated online with chemistry module, is a multi-scale model suitable for both research and operational forecasts of meteorology and air quality. It is used by many institutions for a variety of applications. In this study, the WRF v3.5 with chemistry (WRF-Chem) is applied to the area of Poland, for a period of 3-20 July 2006, when high concentrations of ground level ozone were observed. The meteorological and chemistry simulations were initiated with ERA-Interim reanalysis and TNO MACC II emissions database, respectively. The model physical parameterization includes RRTM shortwave radiation, Kain-Fritsch cumulus scheme, Purdue Lin microphysics and ACM2 PBL, established previously as the optimal configuration. Chemical mechanism used for the study was RADM2 with MADE/SORGAM aerosols. Simulations were performed for three one-way nested domains covering Europe (36 km x 36 km), Central Europe (12 km x 12 km) and Poland (4 km x 4 km). The results from the innermost domain were analyzed and compared to measurements of ozone concentration at three stations in different environments. The results show underestimation of observed values and daily amplitude of ozone concentrations.

Mudanças climáticas nas regiões insulares

Tese de Doutoramento, Física, 27 de Novembro de 2013, Universidade dos Açores.

Climatology of the Iberia coastal low-level wind jet: weather research forecasting model high-resolution results

Coastal low-level jets (CLLJ) are a low-tropospheric wind feature driven by the pressure gradient produced by a sharp contrast between high temperatures over land and lower temperatures over the sea. This contrast between the cold ocean and the warm land in the summer is intensified by the impact of the coastal parallel winds on the ocean generating upwelling currents, sharpening the temperature gradient close to the coast and giving rise to strong baroclinic structures at the coast. During summertime, the Iberian Peninsula is often under the effect of the Azores High and of a thermal low pressure system inland, leading to a seasonal wind, in the west coast, called the Nortada (northerly wind). This study presents a regional climatology of the CLLJ off the west coast of the Iberian Peninsula, based on a 9km resolution downscaling dataset, produced using the Weather Research and Forecasting (WRF) mesoscale model, forced by 19 years of ERA-Interim reanalysis (1989-2007). The simulation results show that the jet hourly frequency of occurrence in the summer is above 30% and decreases to about 10% during spring and autumn. The monthly frequencies of occurrence can reach higher values, around 40% in summer months, and reveal large inter-annual variability in all three seasons. In the summer, at a daily base, the CLLJ is present in almost 70% of the days. The CLLJ wind direction is mostly from north-northeasterly and occurs more persistently in three areas where the interaction of the jet flow with local capes and headlands is more pronounced. The coastal jets in this area occur at heights between 300 and 400 m, and its speed has a mean around 15 m/s, reaching maximum speeds of 25 m/s.

Estudo da aplicação de adesivos de cura UV em conservação e restauro de vidro e vitral

Do presente trabalho resultou a submissão de um artigo, com o título UV Curing Adhesives for Conservation of Glass- Chemical and Mechanical Stability, para comunicação oral em conferência internacional intitulada Recent Advances in Glass and Ceramics Conservation, a ocorrer em Wroclaw, Polónia, de 25 a 29 de Maio de 2016, no âmbito do ICOM-CC Glass and Ceramics Working Group Interim Meeting.

As Comissões Parlamentares de Inquérito no Portugal democrático, 1976-2015

As transformações operadas no mundo contemporâneo, em especial no que respeita às estruturas do poder, à sua maior autonomização e diferenciação, tiveram particulares reflexos ao nível dos Parlamentos e das funções que prosseguem. Desde a sua origem, no passado século XIII, à atualidade, grandes acontecimentos, clivagens e factos históricos estão presentes na sua linha evolutiva. A democratização do regime parlamentar e a legitimidade outorgada através de eleições democráticas e concorrenciais são um marco ímpar na sua história. A complexidade das sociedades hodiernas catapultou o Poder Executivo em detrimento do Parlamento, enquanto órgão legislativo por excelência. Tal circunstancialismo levou, não ao proclamado declínio dos Parlamentos, mas a reformas estruturantes. Outras e mais importantes funções seriam prosseguidas. Se as iniciativas legislativas e a definição das políticas públicas passaram a ser quase um exclusivo do Governo, havia que desenvolver e ampliar, por parte dos Parlamentos, os instrumentos de controlo, fiscalização e escrutínio da ação governativa. Entre os clássicos instrumentos de controlo avulta o Inquérito Parlamentar, materializado em Comissões Parlamentares de Inquérito, dotadas de poderes especiais para recolha de informação e para investigação. No seu percurso parlamentar, também as Comissões de Inquérito foram sendo alvo de constantes aperfeiçoamentos, de ordem constitucional, legal e regimental. A excessiva partidarização da atividade parlamentar de outrora e sobretudo a confusão entre o governo e o partido que o sustentava a nível parlamentar, o confronto desequilibrado de meios entre as maiorias e as minorias, levaram a um reposicionamento do inquérito parlamentar enquanto garante do direito das minorias. Não sendo expectável que as grandes iniciativas de controlo sejam tomadas pelo partido maioritário, cabe à oposição esse papel. Em Portugal, diminuta era a tradição do instituto do inquérito parlamentar, razão porque foi efémera e sem resultado a sua utilização no tempo da monarquia constitucional. O regime democrático, abraçado com o 25 de abril de 1974, relançou o órgão de soberania Parlamento e estabeleceu prioridades. Até ao amadurecimento da democracia viveram-se tempos mais conturbados mas de grande aprendizagem. O inquérito Parlamentar, a partir da revisão constitucional de 1982, passou conceptualmente a integrar um dos meios mais relevantes da fiscalização política. É, pois, o levantamento exaustivo e a análise das Comissões Parlamentares de Inquérito no Portugal democrático, período de 1976-2015, o objetivo a que nos propomos neste estudo.

A Multicenter Randomized Clinical Trial of Primary Anastomosis or Hartmann's Procedure for Perforated Left Colonic Diverticulitis With Purulent or Fecal Peritonitis.

OBJECTIVES: : To evaluate the outcome after Hartmann's procedure (HP) versus primary anastomosis (PA) with diverting ileostomy for perforated left-sided diverticulitis. BACKGROUND: : The surgical management of left-sided colonic perforation with purulent or fecal peritonitis remains controversial. PA with ileostomy seems to be superior to HP; however, results in the literature are affected by a significant selection bias. No randomized clinical trial has yet compared the 2 procedures. METHODS: : Sixty-two patients with acute left-sided colonic perforation (Hinchey III and IV) from 4 centers were randomized to HP (n = 30) and to PA (with diverting ileostomy, n = 32), with a planned stoma reversal operation after 3 months in both groups. Data were analyzed on an intention-to-treat basis. The primary end point was the overall complication rate. The study was discontinued following an interim analysis that found significant differences of relevant secondary end points as well as a decreasing accrual rate (NCT01233713). RESULTS: : Patient demographics were equally distributed in both groups (Hinchey III: 76% vs 75% and Hinchey IV: 24% vs 25%, for HP vs PA, respectively). The overall complication rate for both resection and stoma reversal operations was comparable (80% vs 84%, P = 0.813). Although the outcome after the initial colon resection did not show any significant differences (mortality 13% vs 9% and morbidity 67% vs 75% in HP vs PA), the stoma reversal rate after PA with diverting ileostomy was higher (90% vs 57%, P = 0.005) and serious complications (Grades IIIb-IV: 0% vs 20%, P = 0.046), operating time (73 minutes vs 183 minutes, P < 0.001), hospital stay (6 days vs 9 days, P = 0.016), and lower in-hospital costs (US $16,717 vs US $24,014) were significantly reduced in the PA group. CONCLUSIONS: : This is the first randomized clinical trial favoring PA with diverting ileostomy over HP in patients with perforated diverticulitis.