Managing indoor air quality in nursery and primary schools with low-cost solutions

This study aimed to evaluate the feasibility of using low-cost solutions to monitor and mitigate PM2.5 and PM10 concentrations in nursery and primary schools in Porto (Portugal). Three periods were considered: i) early 2020 (before COVID-19 pandemic), ii) early 2021 (during COVID-19 pandemic, with mitigation measures to prevent SARS-CoV-2 spread);and iii) in the middle of 2021 (additionally using a low-cost portable air cleaner). PM2.5 and PM10 were continuously monitored with a low-cost sensing device for at least two consecutive days in five classrooms. In general, the lowest PM concentrations were observed in the third period. Concentrations reduced up to 63% from the second to the third period. The application of low-cost solutions for monitoring and mitigating PM levels seems to be an effective tool for managing indoor air in schools. © 2022 17th International Conference on Indoor Air Quality and Climate, INDOOR AIR 2022. All rights reserved.

COVID-19 and Viral Pneumonia Classification Using Radiomic Features and Deep Learning

The new coronavirus has become the greatest challenge of the 21st century. But since the first cases, much is being discovered about the disease and its effects on the body. Medical imaging, such as X-Rays and CT is widely used to visualize and follow up the patient's clinical picture, especially the effects on the lungs. Although useful, the analysis of this type of image requires some expertise from the radiologist. In less developed countries, the amount of radiologists specialized in chest X-Rays is inadequate, which motivates the development of new technologies to assist clinicians to provide reliable diagnoses. Therefore, this paper addresses the development of a computer-based method to assist in COVID-19 detection among viral pneumonia and health patients through X-Rays images. The proposed method is based on extracting radiomic features and analyzing them using Deep Neural Networks. Experiments following K-Fold Cross-Validation achieved an overall accuracy of 94.98%, a sensibility of 94.89% and an AUC of 99.20%. A benchmark with traditional machine learning algorithms and a binary assessment are also provided. From a multiclass perspective, the analysis and differentiation of COVID-19 and other viral pneumonia reached great results and may assist radiologists in better diagnosing the disease worldwide. © 2022 IEEE.

Wearable Temperature Sensor and Artificial Intelligence to Reduce Hospital Workload

Patient sensing and data analytics provide information that plays an important role in the patient care process. Patterns identified from data and Machine Learning (ML) algorithms can identify risk/abnormal patients' data. Due to automatization this process can reduce workload of medical staff, as the algorithms alert for possible problems. We developed an integrated approach to monitor patients' temperature applied to COVID-19 elderly patients and an ML process to identify abnormal behavior with alerts to physicians. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Teaching Practical Robotics During the COVID-19 Pandemic: A Case Study on Regular and Hardware-in-the-Loop Simulations

Laboratory experiments are important pedagogical tools in engineering courses. Restrictions related to the COVID-19 pandemic made it very difficult or impossible for laboratory classes to take place, resulting on a fast transition to simulation as an approach to guarantee the effectiveness of teaching. Simulation environments are powerful tools that can be adopted for remote classes and self-study. With these tools, students can perform experiments and, in some cases, make use of the laboratory facilities from outside of the University. This paper proposes and describes two free tools developed during the COVID-19 pandemic lock-down that allowed students to work from home, namely a set of simulation experiments and a Hardware-in-the-loop simulator, accessible 24/7. Two approaches in Python and C languages are presented, both in the context of Robotics courses for Engineering students. Successful results and student feedback indicate the effectiveness of the proposed approaches in institutions in Portugal and in the Netherlands. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Impact de l'infection par le SARS-CoV-2 sur l'activité de la maladie des patients atteints de rhumatisme psoriasique sous bDMARD : données réelles

Introduction L'infection par le SARS-CoV-2 peut entraîner une inflammation sévère et il a été suggéré d'induire des poussées de rhumatisme psoriasique (RP). Cependant, l'impact sur l'activité de la maladie et la réponse aux DMARD biologiques modificateurs de la maladie (bDMARD) reste inconnu. Patients et méthodes Nous avons réalisé une analyse rétrospective incluant tous les patients atteints de RP, répondant aux critères CASPAR et sous biothérapie, suivis dans le service de rhumatologie d'un CHU universitaire tertiaire. Les données démographiques et cliniques, y compris la survenue d'une infection par le SARS-CoV-2, ont été collectées à partir de notre base de données nationale (reuma.pt). L'activité de la maladie (CDAI, SDAI, DAS28 4v, BASDAI, ASDAS) et les réponses aux bDMARD (réponses EULAR, ASDAS, ASAS, ACR et PsARC) ont été évaluées avant et après l'infection par le SARS-Cov-2. Résultats Au total, 102 patients atteints de RP ont été inclus. Cinquante-deux étaient des femmes (51 %). L'âge moyen était de 53 ± 11,09 ans et la durée médiane de la maladie était de 15 ans [min 2, max 47]. Au total, 54 (53 %) patients avaient une atteinte axiale prédominante, 26 (26 %) périphérique et 36 (37 %) enthésopathique. Le bDMARD le plus utilisé était l'étanercept (n = 28, 27,5 %) suivi de l'adalimumab (n = 22, 21,6 %) et du sécukinumab (n = 18, 17,6 %). La prévalence de l'infection par le SARS-CoV-2 était de 15,7 % (n = 16). Soixante-trois pour cent ont reçu le vaccin BNT162b2 (Pfizer/BioNtech), 31 % ont reçu l'ARNm-1273 (Moderna), 13 % ont reçu l'AZD1222 (AstraZeneca) et 13 % ont reçu l'AD26.COV2.S (Janssen/Johnson & Johnson). Soixante-trois pour cent étaient infectés avant toute vaccination, 13 % après la première dose et 25 % après la seconde. Les symptômes les plus fréquents étaient l'anosmie (65 %), la dysgueusie (56 %) et la toux (56 %). Tous les patients se sont complètement remis de l'infection, sans nécessiter d'hospitalisation. Quel que soit le score utilisé, la différence entre l'activité moyenne de la maladie après l'infection par le SARS-CoV-2 et celle au départ n'a pas atteint la signification statistique. Au départ et après l'infection, les paramètres moyens de l'activité de la maladie étaient respectivement : CDAI 8,6 ± 5,7 vs 8,6 ± 5,7, p = 0,997 ;SDAI 9,3 ± 6,6 contre 9,2 ± 6,1, p = 0,928 ;DAS 28 4v 2,9 ± 1,2 contre 2,9 ± 1,2, p = 0,818 ;BASDAI 3,6 ± 2,6 contre 3,2 ± 2,7, p = 0,506 ;ASDAS 2,2 ± 1,2 contre 2,2 ± 1, p = 0,721. Le nombre de patients ne répondant pas aux bDMARD (selon EULAR, ASDAS, ASAS, ACR et PsARC) avant l'infection n'était pas différent de celui post-infection. Conclusion Notre étude suggère que l'infection par le SARS-CoV-2 n'a aucun impact négatif sur l'activité de la maladie PSA et les réponses bDMARD. Cependant, d'autres études sont encore nécessaires pour mieux comprendre les effets à long terme de l'infection par le SARS-CoV-2.

New proposed measures to evaluate contact tracing effectiveness : João Vasco Santos

Issue/problem Contact tracing is an important and widely used method to control transmission of communicable diseases. The COVID-19 pandemic presented a new and big challenge with a high number of confirmed cases and contacts and subsequent high burden on contact tracing activities. Naturally, the effectiveness of such interventions needs to be assessed, and appropriate measures are still rather underdeveloped. Description of the problem We propose two new measures for assessing contact tracing effectiveness: “number needed to quarantine” (NNQ), which is the number of quarantined person-days needed to prevent one infectious person-day, and the proportion of infectious days prevented by the quarantined (PPID). We have applied these measures to assess COVID-19 contact tracing effectiveness in COVID-19 confirmed cases diagnosed between July and mid-September 2020 in a local Public Health Unity in the Northern region of Portugal (Espinho/Gaia). For robustness checks and accounting for the uncertainty of the infectiousness period, we used three different scenarios. Results Depending on the infectiousness period considered, we have found a NNQ between 19.8 and 41.8 and a PPID between 19.7% and 38.2%. Contact tracing effectiveness was higher for some specific groups such as cohabitants and symptomatic contacts. Effectiveness also decreased with the increasing time from diagnosis or symptom onset to contact isolation Lessons NNQ and PPID are straightforward and easy to use measures to evaluate contact tracing effectiveness in communicable diseases. Although this example focuses in the COVID-19 pandemic at a local setting, these measures can also be used for different communicable diseases and at different levels. This assessment step can be important for priority setting of transmission control activities but also on a health management perspective. Key messages • New measures to evaluate contact tracing effectiveness are proposed: “number needed to quarantine” and “proportion of prevented infectious days”. • These measures allow the identification of priority groups that must be quarantined, as well as time periods of intervention, for better transmission control.

Challenges of Education In Energy and Environment: Comparison before and after Pandemic Constraints

Energy systems present a complex and dynamic interrelation between energy, environment, and society. Therefore, properly educating new professionals for the renewable energy sector is a challenging endeavor by itself. The COVID-19 pandemic has imposed an additional challenge on how to engage students in energy and environment education through distance learning. In this paper, we present the methodology applied at the Federal University of São Paulo (UNIFESP) for students of the discipline "Energy and Environment". The graduate student interns developed an integrated methodology of disseminating knowledge about renewable energy and environment for those students and society as a whole. A positive feedback over 95% was obtained from the enrolled students in the period of 2019-2020. It was also noticed a failure rate of 24% in 2020 in contrast to zero occurrences in 2019, when face-to-face activities were in place. Finally, we present a brief discussion on the primary challenges and lessons learned during the studied period. © 2021. The Authors. Published by International Solar Energy Society Selection and/or peer review under responsibility of Scientific Committee.

IMPACT of SARS-COV-2 INFECTION on the DISEASE ACTIVITY of PATIENTS with PSORIATIC ARTHRITIS under BDMARDS: REAL LIFE DATA

Background: SARS-CoV-2 infection can lead to severe infammation and has been suggested to induce Psoriatic Arthritis (PsA) fares.1 However, the impact on disease activity and response to biological disease modifying anti-rheumatic drugs DMARDs (bDMARDs) remains unknown. Objectives: To evaluate the effect of SARS-CoV-2 infection on disease activity and bDMARDs responses in patients with PsA. Methods: We performed a retrospective analysis including all the patients with PsA, meeting the CASPAR criteria and under biologic therapy, followed in the Rheumatology department of a tertiary university hospital. Demographic and clinical data, including occurrence of SARS-CoV-2 infection, were collected from our national database (reuma.pt). Disease activity (CDAI, SDAI, DAS28 4v, BASDAI, ASDAS) and bDMARDs responses (EULAR, ASDAS, ASAS, ACR and PsARC responses) were evaluated before and after SARS-Cov-2 infection. Statistical analysis was performed with SPSS. Continuous variables were compared through paired samples t-test. Results: A total of 102 patients with PsA were included. Fifty-two were females (51%).The mean age was 53 ± 11.09 years and the median disease duration was 15 years [min 2, max 47]. Overall, 54 (53%) patients had predominant axial involvement, 26 (26%) peripheric and 36 (37%) enthesopathic. The most used bDMARD was etanercept (n=28, 27.5%) followed by adalimumab (n=22, 21.6%) and secukinumab (n=18, 17.6%). The prevalence of SARS-CoV-2 infection was 15.7% (n=16). Sixty-three per cent received the BNT162b2 (Pfzer/BioNtech) vaccine, 31% received mRNA-1273 (Moderna), 13% received AZD1222 (AstraZeneca) and 13% received AD26. COV2.S (Janssen/Johnson & Johnson). Sixty-three percent were infected before any vaccination, 13% after the frst dose and 25% after the second. The most common symptoms were anosmia (65%), dysgeusia (56%) and cough (56%). All patients fully recovered from the infection, with no need for hospitalization. Regardless of the score used, the difference between the mean disease activity after SARS-CoV-2 infection and that at baseline did not reach statistical significance. At baseline and after infection, mean (SD) disease activity parameters were, respectively: CDAI 8.6±5.7 vs 8.6±5.7, p=0.997;SDAI 9.3±6.6 vs 9.2±6.1, p=0,928;DAS 28 4v 2.9±1.2 vs 2.9 ±1.2, p= 0.818;BASDAI 3.6 ±2.6 vs 3.2±2.7, p=0.506;ASDAS 2.2±1.2 vs 2.2±1, p=0.721. The number of patients unresponsive to bDMARDs (according EULAR, ASDAS, ASAS, ACR and PsARC) before the infection wasn't different from post-infection. Conclusion: Our study suggests that SARS-CoV2 infection has no negative impact on PsA disease activity and bDMARD responses. However, more studies are still needed to better understand the long-term effects of SARS-CoV2 infection.

THE IMPACT of SARS-COV-2 INFECTION on DISEASE ACTIVITY and CLINICAL RESPONSE to BIOLOGICAL DMARDS in PATIENTS with RHEUMATOID ARTHRITIS

Background: Infections are a known trigger for Rheumatoid Arthritis (RA) fares.1 It is still unclear whether SARS-Cov-2 infection affects RA disease activity and the clinical response to biological disease-modifying antirheumatic drugs (bDMARDs). Objectives: To evaluate the effect of SARS-Cov-2 infection on disease activity and bDMARD responses in patients with RA. Methods: A retrospective study was carried out in a cohort of RA patients treated with bDMARDs from a tertiary hospital centre. Demographic and clinical data, including occurrence of SARS-Cov-2 infection, were obtained through medical records. Disease activity (DAS28, DAS28-CRP, CDAI and SDAI) and ACR and EULAR bDMARD responses were evaluated at four time points: baseline (t1-last evaluation before Covid-19 pandemic), before (t2) and after (t3) SARS-Cov-2 infection and at the end of follow-up (t4-last appointment of 2021). In patients with no record of SARS-Cov-2 infection the middle evaluations were obtained from two random consecutive appointments during Covid-19 pandemic. Statistical analysis (signifcance at p<0.05) was performed using paired t-test, Wilcoxon and McNemar tests for paired samples and unpaired t-test, Mann-Whitney, Fisher and χ2 tests for independent samples according to the type of variable and the presence of normal distribution. Results: Of the 237 patients included, most of them was women [n = 195 (82.3%)], with a mean age of 59.6 ± 10.1 years old and a median [min, max] disease duration of 18 [2, 50] years. The majority presented rheumatoid factor (RF) and/or anti-citrullinated protein antibodies (ACPA) positivity [n = 204 (87.9%)] and radiographic erosions [n = 119 (72.6%)]. The prevalence of SARS-Cov-2 infection was 11.4% (n=27). Mean disease activity was lower after SARS-Cov-2 infection compared to the previous evaluation on all scores used;however, this difference was not statistically signifcant. Nevertheless, when compared to the mean disease activity at the end of follow-up, there were statistically signifcant differences in DAS28-CRP (t2 3.2±1.0 vs. t4 2.8±1.1, p=0.017) and CDAI (t2 11.1±8.1 vs. t4 8.7±6.2, p=0.05) scores. The relative number of patients with no ACR or EULAR bDMARD responses before SARS-Cov-2 infection wasn't different from post infection and at the end of follow-up. At baseline, the infected and uninfected groups were similar regarding gender, age, RF and/or ACPA positiv-ity, erosive disease, disease and biologic treatment durations, baseline disease activity and ACR and EULAR response. The variation in disease activity and the relative number of patients with worsening or improving EULAR and ACR bDMARD responses between t2 and t3 were not signifcantly different in the two groups, as well as between t2 and t4. The prevalence of patients who switched to another bDMARD was signifcantly higher in the group of patients who had Covid-19 [n=4 (14.8%) vs. 9 (4.3%), p=0.047]. The main reason for switching was the ineffectiveness of the therapy (n=11). Conclusion: No worsening of disease activity or ACR and EULAR bDMARD responses was found after SARS-Cov-2 infection in RA patients under bDMARD. However, the later can be explained by the small sample size. Indeed, these patients exhibited a higher rate of switch due to ineffectiveness of therapy, suggesting a negative impact of SARS-Cov2 infection on the disease course.

CHARACTERISTICS ASSOCIATED with POOR COVID-19 OUTCOMES in PEOPLE with PSORIASIS and SPONDYLOARTHRITIS: DATA from the COVID-19 PSOPROTECT and GLOBAL RHEUMATOLOGY ALLIANCE PHYSICIAN-REPORTED REGISTRIES

Background: Some factors associated with severe COVID-19 outcomes have been identifed in patients with psoriasis (PsO) and infammatory/autoimmune rheumatic diseases, namely older age, male sex, comorbidity burden, higher disease activity, and certain medications such as rituximab. However, information about specifcities of patients with PsO, psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA), including disease modifying anti-rheumatic drugs (DMARDs) specifcally licensed for these conditions, such as IL-17 inhibitors (IL-17i), IL-23/IL-12 + 23 inhibitors (IL-23/IL-12 + 23i), and apremilast, is lacking. Objectives: To determine characteristics associated with severe COVID-19 outcomes in people with PsO, PsA and axSpA. Methods: This study was a pooled analysis of data from two physician-reported registries: the Psoriasis Patient Registry for Outcomes, Therapy and Epidemiology of COVID-19 Infection (PsoProtect), comprising patients with PsO/PsA, and the COVID-19 Global Rheumatology Alliance (GRA) registry, comprising patients with PsA/axSpA. Data from the beginning of the pandemic up to 25 October, 2021 were included. An ordinal severity outcome was defned as: 1) not hospitalised, 2) hospitalised without death, and 3) death. A multivariable ordinal logistic regression model was constructed to assess the relationship between COVID-19 severity and demographic characteristics (age, sex, time period of infection), comorbidities (hypertension, other cardiovascular disease [CVD], chronic obstructive lung disease [COPD], asthma, other chronic lung disease, chronic kidney disease, cancer, smoking, obesity, diabetes mellitus [DM]), rheumatic/skin disease (PsO, PsA, axSpA), physician-reported disease activity, and medication exposure (methotrexate, lefunomide, sulfasalazine, TNFi, IL17i, IL-23/IL-12 + 23i, Janus kinase inhibitors (JAKi), apremilast, glucocorticoids [GC] and NSAIDs). Age-adjustment was performed employing four-knot restricted cubic splines. Country-adjustment was performed using random effects. Results: A total of 5008 individuals with PsO (n=921), PsA (n=2263) and axSpA (n=1824) were included. Mean age was 50 years (SD 13.5) and 51.8% were male. Hospitalisation (without death) was observed in 14.6% of cases and 1.8% died. In the multivariable model, the following variables were associated with severe COVID-19 outcomes: older age (Figure 1), male sex (OR 1.53, 95%CI 1.29-1.82), CVD (hypertension alone: 1.26, 1.02-1.56;other CVD alone: 1.89, 1.22-2.94;vs no hypertension and no other CVD), COPD or asthma (1.75, 1.32-2.32), other lung disease (2.56, 1.66-3.97), chronic kidney disease (2.32, 1.50-3.59), obesity and DM (obesity alone: 1.36, 1.07-1.71;DM alone: 1.85, 1.39-2.47;obesity and DM: 1.89, 1.34-2.67;vs no obesity and no DM), higher disease activity and GC intake (remission/low disease activity and GC intake: 1.96, 1.36-2.82;moderate/severe disease activity and no GC intake: 1.35, 1.05-1.72;moderate/severe disease activity and GC intake 2.30, 1.41-3.74;vs remission/low disease activity and no GC intake). Conversely, the following variables were associated with less severe COVID-19 outcomes: time period after 15 June 2020 (16 June 2020-31 December 2020: 0.42, 0.34-0.51;1 January 2021 onwards: 0.52, 0.41-0.67;vs time period until 15 June 2020), a diagnosis of PsO (without arthritis) (0.49, 0.37-0.65;vs PsA), and exposure to TNFi (0.58, 0.45-0.75;vs no DMARDs), IL17i (0.63, 0.45-0.88;vs no DMARDs), IL-23/IL-12 + 23i (0.68, 0.46-0.997;vs no DMARDs) and NSAIDs (0.77, 0.60-0.98;vs no NSAIDs). Conclusion: More severe COVID-19 outcomes in PsO, PsA and axSpA are largely driven by demographic factors (age, sex), comorbidities, and active disease. None of the DMARDs typically used in PsO, PsA and axSpA, were associated with severe COVID-19 outcomes, including IL-17i, IL-23/IL-12 + 23i, JAKi and apremilast.

COVID19 in SPONDYLOARTHRITIS PATIENTS under BDMARD-A COMPREHENSIVE ASSESSMENT

Background: SARS-Cov-2 infection had a major impact on patients with infam-matory rheumatic diseases. Spondyloarthritis (SpA) patients were one of the most affected groups of these patients. Objectives: To assess the impact of Covid19 in spondyloarthritis patients under biological disease modifying anti-rheumatic drugs (bDMARDs). Methods: A retrospective observational study was conducted using registry data of patients with SpA under bDMARD therapy, followed at a tertiary level hospital, that have been diagnosed with COVID19 from March 2019 to December 2021. At least one evaluation previous (t0) and two evaluations after SARS-CoV-2 infection (t1, t2) were included in our analysis. Sociodemographic, clinical, disease activity, therapeutic response, function and general health status data were collected. Statistical analysis (signifcance at p < 0.05) was performed using paired T-test, Wilcoxon test and McNemar tests for paired samples. Linear and logistic regression models were performed to assess direction and strength of association Results: Thirty-two patients with SpA under bDMARD had COVID19, mostly women (20, 62.5%), with a disease course time averaged 18.65 (± 9.69) years, mainly with axial involvement (19, 59.4%) and positive for HLA-B27 antigen (11, 64.7%). The majority were under TNF inhibitors (30, 93.75%), with golimumab being the most common (9, 28.1%), and with a median bDMARD persistence of 2.63 (5.09) years. Seven (21.9%) were under a cDMARD, 3 (9.4%) under NSAID and 18 (56.3%) under corticosteroids. Three (9.4%) were already vaccinated against SARS-CoV-2, 2 (66.6%) with the mRNA-1273 vaccine, presenting a medium time since inoculation of 240 (± 234.01) days. Arterial hypertension was the most common comorbidity (5, 15.6%) and one patient (3.1%) had a previous diagnosis of type 2 diabetes. Most were never-smokers (17, 53.1%) and never-drinkers (29, 90.6%). The average age at infection was 40.97 (± 6.15) years and the most common symptom was cough (22, 68.8%), followed by headache (20, 62.5%) and myalgia (19, 59.4%). Event tree analysis didn't show association with SpA subtype, education level, work status, tobacco or alcohol consumption. Only one patient needed hospital admission but without needing of oxygen, therapy, ventilator or ECMO. Only one patient had an overlaid bacterial infection and no thromboembolic complications were observed. Two patients needed specific SARS CoV-2 infection treatment, one with hydroxychloroquine and another with azithromycin. Twelve (37.5%) patients suspended bDMARD at the time of infection, with only 2 (6.3%) maintaining suspension at the time of the first post-infection visit. When comparing clinical variables, higher disease activity was seen at t1 only for BASDAI mean values, without statistical signifcance. Higher all domains VAS scores were also observed at t1, but not at t2, also without statistical signifcance;moreover, physical function didn't change signifcantly. No differences were observed according to gender or SpA subtype, nor with the use of cDMARDs, NSAIDs or corticosteroids. The only statistically signifcant difference concerned MASES score between t0 and t1 (1 ± 4 vs. 2 ± 6, p=0.04), but not between t0 and t2. Higher baseline tender joint score (p < 0.01) and higher baseline LEI (p=0.03) negatively correlated with MASES score variation. Several baseline variables correlated positively with MASES at t1, including female gender (p < 0.01), corticosteroid use (p = 0.04), BASDAI (p < 0.01), ASDAS-ESR (p < 0.01), ASDAS-CRP (p < 0.01), DAS28 (p < 0.01), SPARCC (p = 0.04), physician VAS (p = 0.03) and total spine VAS (p = 0.01). Working status varied signifcantly after SARS-Cov-2 infection (at least part-time-29, 90.6% vs. 22, 68.8%, p= 0.016). Conclusion: SpA patients on bDMARD had a mild course of SARS-CoV-2 infection, with slight changes in enthesitis score in the short term, the latter particularly in those with higher disease activity in the pre-infection period. Long-term effects on work status could represent confounding factors related to the e onomic constraints of the pandemic.

Analysis of the COVID-19 Pandemic Impact on the Pattern of Addiction Disorders Treated in Portuguese Addiction Intervention Services

Background: The COVID-19 pandemic prompted a reformulation of all health services shifting towards care for patients infected by the SARS-COV-2 virus. Among these health services, those dedicated to patients with addiction disorders might also be affected, in a time for which the need might actually have increased. Aims of the Study: To assess the impact of the COVID-19 pandemic on the activity of Portuguese addiction treatment services, according to the pattern of addictions (alcohol, substance use or behavioural). Methods: A national retrospective observational study was carried out based on the analysis of Portuguese secondary data, between March 2019 and July 2021, related to the activity of addiction treatment services, according to the addiction's pattern (i.e. alcohol, behavioural and substance use addictions). Number of consultations and new users were used as the main outcomes. To account for seasonal variation only time periods between March to July of each year were considered. Results: In the study period, behavioural addictions were the reason for 45590 (9.21%) consultations, being the addiction pattern with the lowest number. Substance use disorders totalled 6391712 (63.92%) consultations, showing the highest value. From March to July 2020, there were 73996 (29.04%) consultations and 1867 (57.80%) new patients admitted less than in the same period of 2019. This reduction was observed in the three patterns of addiction, with alcohol addiction showing the highest relative reduction on the number of new patients admitted (65.02%) and on the number of consultations (30.38%). In 2021, there was a general increase of 73.21%, 78.52% and 85.33% in the number of new patients admitted for alcohol addiction, behavioural addiction and substance use disorders, respectively. However, the number of consultations and new patients admitted is, respectively, 93.85% and 24.27% of the values for the respective period in 2019. Discussion and Limitations: Despite potential increase of some addictions during the pandemic, namely alcohol or behavioural addictions, there was a decrease in the number of new patients admitted to addiction intervention services when comparing the periods from March to July 2019 and 2021. Moreover, behavioural addiction is still a minority when compared to alcohol addiction and substance use disorder, which may be because in Portugal addiction intervention services are still mainly focused on the management and treatment of substance use disorders. One of this study's limitations is inherent to the fact that it is based on the reuse of data collected for purposes other than research. Implications for Health Policies: Understanding the impact that the COVID-19 pandemic had on health care services, namely on addiction intervention services, as well as on the epidemiological picture and further needs, is essential for better health care planning. Health system plans should consider such needs and potential scarcity of provision for better adaptation after the pandemic. Implications for Further Research: To study if the current needs of addiction patients are being covered should be done in order to adapt health policies to that. Qualitative studies should also be considered.

Developing and validating high-value patient digital follow-up services: a pilot study in cardiac surgery.

BACKGROUND: The existing digital healthcare solutions demand a service development approach that assesses needs, experience, and outcomes, to develop high-value digital healthcare services. The objective of this study was to develop a digital transformation of the patients' follow-up service after cardiac surgery, based on a remote patient monitoring service that would respond to the real context challenges. METHODS: The study followed the Design Science Research methodology framework and incorporated concepts from the Lean startup method to start designing a minimal viable product (MVP) from the available resources. The service was implemented in a pilot study with 29 patients in 4 iterative develop-test-learn cycles, with the engagement of developers, researchers, clinical teams, and patients. RESULTS: Patients reported outcomes daily for 30 days after surgery through Internet-of-Things (IoT) devices and a mobile app. The service's evaluation considered experience, feasibility, and effectiveness. It generated high satisfaction and high adherence among users, fewer readmissions, with an average of 7 ± 4.5 clinical actions per patient, primarily due to abnormal systolic blood pressure or wound-related issues. CONCLUSIONS: We propose a 6-step methodology to design and validate a high-value digital health care service based on collaborative learning, real-time development, iterative testing, and value assessment.

MANIFESTAÇÕES GASTROINTESTINAIS EM PACIENTE COM DENGUE: UM RELATO DE CASO

Introdução: A dengue é considerada a doença viral transmitida por mosquitos mais prevalente e de disseminação rápida entre os seres humanos. Geralmente se manifesta de forma abrupta com febre, cefaleia, mialgias e artralgias, podendo também apresentar sintomas respiratórios e gastrointestinais como vômitos, náuseas, diarreia e dor abdominal, mimetizando - em alguns casos - colicistite aguda alitiásica. Este trabalho objetiva destacar a importância de um diagnóstico preciso de pacientes com manifestações gastrointestinais em áreas endêmicas da dengue. Descrição do caso: Paciente feminina, 32 anos, compareceu ao serviço de emergência relatando febre, náuseas, vômitos e dor no abdome superior há um dia. Referiu ter realizado Colangiopancreatografia Retrógrada Endoscópica por coledocolitíase e colecistectomia videolaparoscópica em 2020. Ao exame físico, observou-se pele corada, levemente desidratada, anictérica e febril (37.9 °C);e dor a palpação do abdome superior, sobretudo no hipocôndrio direito. Nos exames laboratoriais, hemograma e bilirrubinas estavam normais e aspartato aminotransferase, alanina aminotransferase, gama glutamil transferase e fosfatase alcalina com valores elevados. Diante disso, solicitou-se tomografia computadorizada abdominal, que evidenciou colédoco de 1,5 mm, não sendo visualizados cálculos em via biliar. Assim, com a hipótese diagnóstica de colangite, iniciou-se antibioticoterapia e solicitou-se colangiorresonância para melhor avaliação das vias biliares e da presença ou não de cálculo de colédoco. O resultado da colangiorressonância foi normal. Tendo em vista que ela veio de uma cidade com vários casos de dengue, solicitou-se o exame de dengue NS1, cujo resultado foi positivo. Para o diagnóstico diferencial, solicitou-se exames para Covid-19 e leptospirose, os quais resultaram negativos. A paciente melhorou seu quadro clínico gradativamente, aliviando sua sintomatologia, tendo alta hospitalar com boas condições clínicas. Comentários: As manifestações gastrointestinais em pacientes com dengue e alterações laboratoriais podem nos levar subestimar patologias com gravidade considerável como por exemplo a colangite, como também pode nos levar a um “over diagnóstico” de patologias correlacionadas com histórico e exame físico do paciente. O correto direcionamento, assim como uma avaliação clínica epidemiológica cuidadosa e acompanhamento integral do paciente, constituem fatores de grande relevância em situações como a do caso relatado.

Trends and challenges of starch-based foams for use as food packaging and food container

Background: Expanded polystyrene (EPS), an inexpensive and widely available polymer, has been extensively employed in foam packaging. However, EPS-based foams cause environmental problems because they are non-biodegradable and little recycled. Therefore, developing foams from renewable sources for application in biodegradable packaging for food and express food delivery is essential to tackle pollution issues of synthetic plastics. Scope and approach: Starch is a renewable, abundant, and low-cost source with thermoplastic properties. For this reason, starch has been used as raw material to develop foams for packaging. This review emphasizes different strategies for improving the mechanical properties, processibility, and antimicrobial activity of starch-based foams and for decreasing their sensitivity to humidity, aiming at employing them as competitive replacement for EPS in packaging. Key findings and conclusions: Starch source, foaming process conditions, plasticizer concentration, fiber type and concentration, and addition of other polymers to form blends can affect the properties and morphology of biodegradable foams, so these factors should be better studied and optimized. Agroindustrial residues have become an interesting alternative to reduce the cost of foams, aiming at a competitive replacement for EPS. Few works have been developed on bioactive starch-based foams. Searching for starch-based foams with antiviral properties against SARS-Cov-2 is also necessary. © 2021 Elsevier Ltd

What if your plant were truly digital?

With the increasing volatility of the oil and gas markets, involving price fluctuations and oil demand uncertainties, and stricter environmental constraints, higher levels of digital maturity will be required to face these challenges. As a result of the COVID-19 pandemic, the drivers to invest in digital capabilities have pivoted from optimization and growth toward ensuring safe remote operations and also toward gathering and analyzing the right data across the organization to make optimal business decisions. While the market and drivers have changed, new technologies and digital trends continue to emerge, leveraging massive remote communications, and continuity of operations and maintenance. Top digital approaches that oil companies should consider when facing these market uncertainties include planning and network optimization, value chain optimization, artificial intelligence-driven predictive maintenance, and enterprise visibility.

Psychosocial Care Center: daily work and articulation with the network in the pandemic

Objective: to analyze the daily work of a Psychosocial Care Center and its articulation with the Psychosocial Care Network in the context of the COVID-19 pandemic. Methods: this is a qualitative study, produced by means of the researcher's diary and semi-structured interviews with nine health professionals, submitted to thematic-categorical content analysis. Results: the pandemic revealed failures in the management of services, lack of public investment, and the unpreparedness of professionals, intensifying work fragmentation, network disarticulation, non-assistance, and pre-existing asylum practices. Conclusion: the reality of the daily work of psychosocial care services shows that multifaceted actions that consider the complex social process of the psychiatric reform are necessary, especially in the pandemic, seeking the effective institutionalization of the psychosocial care model and the formation of centers of resistance to the established asylum model.