Upcycling of industrial footwear waste into nonwoven fibrous structures with thermal and acoustic insulation properties.

The footwear industry significantly impacts the environment, from raw material extraction to waste disposal. Transforming waste into new products is a viable option to mitigate the environmental consequences, reducing the reliance on virgin raw materials. This work aims to develop thermal and acoustic insulation materials using polyester waste from footwear industry. Two nonwoven and two compressed nonwoven structures, comprising 80% polyester waste and 20% commercial recycled polyester (matrix), were produced. The materials were created through needle-punching and compression molding techniques. The study included the production of sandwich and monolayer nonwoven structures, which were evaluated considering area weight, thickness, air permeability, mechanical properties, morphology using field emission scanning electron microscopy, and thermal and acoustic properties. The nonwoven samples presented high tensile strength (893 kPa and 629 kPa) and the highest strain (79.7% and 73.3%) and compressed nonwoven structures showed higher tensile strength (2700 kPa and 1291 kPa) but reduced strain (25.8% and 40.8%). Nonwoven samples showed thermal conductivity of 0.041 W/K.m and 0.037 W/K.m. Compressed nonwoven samples had higher values at 0.060 W/K.m and 0.070 W/K.m. While the sample with the highest conductivity exceeds typical insulation levels, other samples are suitable for thermal insulation. Nonwoven structures exhibited good absorption coefficients (0.640-0.644), suitable for acoustic insulation. Compressed nonwoven structures had lower values (0.291-0.536), unsuitable for this purpose. In summary, this study underscores the potential of 100% recycled polyester structures derived from footwear and textile industry waste, showcasing remarkable acoustic and thermal insulation properties ideal for the construction sector.

The Perspective of Rehabilitation Nurses on Physical Exercise in the Rehabilitation of Older People in the Community: A Qualitative Study.

In the face of an increasingly aging population, nurses have to design and implement programs aimed at the elderly in order to keep them healthy and maintain their quality of life. Structured physical exercise and overall physical activity play a major role in maintaining an active lifestyle, improving health, preventing disease, and helping to maintain older people's quality of life. To investigate the importance of implementing physical exercise programs for the older person in the community, taking into account the perspective of the rehabilitation nurse specialist, this is a qualitative, exploratory, and descriptive study with nine rehabilitation nurses from various regions of Portugal who have experience of implementing physical exercise programs with the elderly. This study used semi-structured interviews, one of the most common data collection procedures in social and health research. Content analysis was used to analyze the data. The study received a positive opinion from the Ethics Committee. The participants' perspectives focused on the following subjects: "Physical exercise program for the elderly in the community", "Importance of physical exercise in the rehabilitation of the elderly in the community", "People's adherence to the programs", "Gains in health resulting from the implementation of these strategies" and "Gains from group activities". A set of indicators emerged from the analysis. Nurses recognize the importance of using structured physical exercise programs adjusted to the rehabilitation of the older person, with gains in promoting active and healthy aging.

Incidence of postoperative residual neuromuscular blockade - A multicenter, observational study in Portugal (INSPIRE 2).

Background: Although the use of neuromuscular blocking agents (NMBAs) optimizes surgical conditions and facilitates tracheal intubation, it can lead to residual neuromuscular blockade (RNMB), with postoperative complications. This study aimed to assess RNMB incidence and management in Portugal. Methods: Prospective observational study of patients admitted for elective surgery requiring general anesthesia with nondepolarizing NMBAs between July 2018 and July 2019 at 10 Portuguese hospitals. The primary endpoint was the proportion of patients arriving at postanesthesia care unit (PACU) with a TOF ratio <0.9. Results: A total of 366 patients were included, with a median age of 59 years, and 89.1% classified as ASA II or III. Rocuronium was the most used NMBA (99.5%). A total of 96.2% of patients received a reversal agent, 96.6% of which sugammadex and 3.4% neostigmine. Twenty patients displayed a TOF ratio <0.9 at PACU arrival, representing an RNMB incidence of 5.5% (95% CI, 3.1%-7.8%). Only two patients displayed a TOF ratio <0.7. RNMB incidence was 16.7% with neostigmine and 5.3% with sugammadex (P = .114). In patients with intraoperative neuromuscular blockade (NMB) monitoring, RNMB incidence was 5% (95% CI, 2%-8%), which varied significantly according to the type of monitoring (P = .018). Incidence of adverse events was 3.3% (2 severe and 10 moderate). Conclusions: The reported overall incidence of 5.5% is numerically lower than results from similar observational studies. An appropriate pharmacological neuromuscular reversal strategy, guided by quantitative neuromuscular monitoring, has the potential to achieve even better results, converting RNMB from an unusual to a very rare or even inexistent event.

Ambiente de prática de cuidados e perfil dos enfermeiros de ambulâncias de SIV / Care practice environment and profile of SIV ambulance nurses

Introdução: As ambulâncias de Suporte Imediato de Vida (SIV) são um meio relativamente recente. Destinam-se a garantir cuidados de saúde altamente diferenciados, através da prestação de cuidados em SIV, contendo um enfermeiro na sua tripulação. Torna-se importante traçar o perfil de caraterização do enfermeiro nas ambulâncias de SIV, nomeadamente, o perfil demográfico, perfil académico e perfil profissional. Por outro lado, o ambiente das práticas dos cuidados influência os resultados dos cuidados de enfermagem, tornando-se importante conhecer a perceção dos enfermeiros neste contexto de trabalho. Objetivos: Caraterizar o perfil dos enfermeiros que exercem funções nas ambulâncias de SIV em Portugal continental e conhecer a perceção dos enfermeiros relativamente ao ambiente de prática de enfermagem nestes meios. Metodologia: Estudo descritivo, correlacional e transversal, com uma abordagem quantitativa, envolvendo 92 enfermeiros que exercem a sua prática de enfermagem nas ambulâncias de SIV. A recolha de dados foi efetuada através de um questionário sociodemográfico e da versão portuguesa da Practice Environment Scale of Nursing Work Index (PES-NWI). Foram cumpridos os pressupostos éticos. Os dados obtidos, foram tratados e analisados através de estatística descritiva e inferencial com recurso a um aplicativo informático. Resultados: A maior parte dos enfermeiros que trabalham nas ambulâncias de SIV é do género masculino (63%), com uma média de idade de 39,73 anos. Relativamente a habilitações literárias, a maioria dispõe da licenciatura em enfermagem. A especialidade de enfermagem médico-cirúrgica é a mais predominante, no entanto, apenas uma parte destes, dispõe da categoria profissional de enfermeiro especialista. Os resultados sugerem que os enfermeiros que exercem nas ambulâncias de SIV consideram que o ambiente de prática de enfermagem é desfavorável (média global de 2,38). A única dimensão que os enfermeiros consideram favorável é a relação entre os enfermeiros e os médicos. As restantes dimensões são percecionadas como desfavorável, sendo que, a respeitante à participação dos enfermeiros nas políticas institucionais é a mais desfavorável. Conclusões: A qualidade dos ambientes de prática de enfermagem evidenciada neste estudo requer uma imediata e profunda intervenção, especialmente nas dimensões participação dos enfermeiros nas políticas institucionais, adequação de recursos humanos e materiais, fundamentos de Enfermagem para a qualidade dos cuidados e gestão, liderança e apoio dos enfermeiros.

Effect of lower limb orthoses on cartilage in patients with knee osteoarthritis: A narrative review.

The objective of this review was to infer how the use of an orthosis affects cartilage in patients with knee osteoarthritis. A search was performed in four different databases (Web of Science, Scopus, EMBASE, and PubMed) up to the 21st of November of 2020 to evaluate how the patient's condition was monitored. The parameters chosen for this review were medial tibial cartilage volume, x-ray evaluation, Lequesne Index, pain visual analog scale score, Western Ontario and McMaster Universities Arthritis Index pain score, and Knee Injury and Osteoarthritis Outcome Score pain subscale score. The initial search yielded a total of 12,622 documents. After thoroughly screening them, 38 were selected for analysis. Of the resulting data, only two objectively evaluated the cartilage (medial tibial cartilage volume, n = 1; x-ray evaluation, n = 1), with the remainder evaluating subjective symptoms (Lequesne Index, n = 8; pain visual analog scale score, n = 18; Western Ontario and McMaster Universities Arthritis Index pain score, n = 10; Knee Injury and Osteoarthritis Outcome Score pain subscale score, n = 10). The data did not converge toward any general outcome. The articles read demonstrated a great tendency to evaluate qualitative parameters pertinent to the symptoms of this condition or quantitative parameters related to the biomechanics of the knee. However, these parameters are not ideal because they are ambiguous. As such, a shift toward more objective quantitative parameters that directly assess the cartilage volume of the knee should be considered in future clinical trials.

A dual-process approach to prosocial behavior under COVID-19 uncertainty.

Uncertainty has been shown to reduce the willingness to cooperate in various social dilemmas and negatively affect prosocial behavior. However, some studies showed that uncertainty does not always decrease prosocial behavior, depending on the type of uncertainty. More specifically, recent research has shown that prosocial behavior tends to increase under impact uncertainty-uncertainty about the consequences for others if they become infected. In addition, researchers have argued that intuition favors prosocial behavior while deliberation leads to selfish behavior. Our study explored how intuitive (time pressure) or deliberate mental processing, under outcome, or impact uncertainty affect prosocial behavior in the context of the COVID-19 pandemic. Our sample consists of 496 participants, and we used a 4 (COVID-19 scenario: Control vs. Impact Uncertainty vs. Worst-Case vs. Indirect Transmission) by 2 (decision time: time delay vs. time pressure) between-subjects design. Results suggest that participants are more inclined to stay at home (prosocial intention) when forced to make their decisions intuitively rather than deliberately. Additionally, we found that uncertainty does not always decrease prosocial behavior. It seems that uncertainty does not affect the prosocial intention in a scenario with a real infectious disease. These findings suggest that the distinction between outcome and impact uncertainty may be due to the realism of experimental stimuli interventions.

Development of the HIV360 international core set of outcome measures for adults living with HIV: A consensus process.

OBJECTIVES: HIV outcomes centre primarily around clinical markers with limited focus on patient-reported outcomes. With a global trend towards capturing the outcomes that matter most to patients, there is agreement that standardizing the definition of value in HIV care is key to their incorporation. This study aims to address the lack of routine, standardized data in HIV care. METHODS: An international working group (WG) of 37 experts and patients, and a steering group (SG) of 18 experts were convened from 14 countries. The project team (PT) identified outcomes by conducting a literature review, screening 1979 articles and reviewing the full texts of 547 of these articles. Semi-structured interviews and advisory groups were performed with the WG, SG and people living with HIV to add to the list of potentially relevant outcomes. The WG voted via a modified Delphi process - informed by six Zoom calls - to establish a core set of outcomes for use in clinical practice. RESULTS: From 156 identified outcomes, consensus was reached to include three patient-reported outcomes, four clinician-reported measures and one administratively reported outcome; standardized measures were included. The WG also reached agreement to measure 22 risk-adjustment variables. This outcome set can be applied to any person living with HIV aged > 18 years. CONCLUSIONS: Adoption of the HIV360 outcome set will enable healthcare providers to record, compare and integrate standardized metrics across treatment sites to drive quality improvement in HIV care.

Predicting COVID-19 Vaccination Intention: The Determinants of Vaccine Hesitancy.

Do people want to be vaccinated against COVID-19? Herd immunity is dependent on individuals' willingness to be vaccinated since vaccination is not mandatory. Our main goal was to investigate people's intention to be vaccinated and their intentions to vaccinate their children. Moreover, we were interested in understanding the role of the personal characteristics, psychological factors, and the lockdown context on that decision. Therefore, we conducted an online survey during the lockdown in Portugal (15 January 2021 until 14 March 2021). Participants completed a socio-demographic questionnaire, questions about their intentions of being vaccinated, concerns about the vaccine, a COVID-19 attitudes and beliefs scale, a COVID-19 vaccine attitudes and beliefs scale, and the Domain-Specific Risk-Taking (DOSPERT) Scale. Our results showed that from the 649 participants, 63% of the participants reported being very likely to have the vaccine, while 60% reported being very likely to vaccinate their children. We conducted two linear regression models, explaining 65% of the variance for personal vaccination and 56% of the variance for children vaccination. We found that the COVID-19 vaccine general beliefs and attitudes were the main determinants of vaccination intention. Additionally, our proposed artificial neural network model was able to predict with 85% accuracy vaccination intention. Thus, our results suggest that psychological factors are an essential determinant of vaccination intention. Thus, public policy decision makers may use these insights for predicting vaccine hesitancy and designing effective vaccination communication strategies.

Extraction With Sweat-Sebum Emulsion as a New Test Method for Leachables in Patch-Based Medical Devices, Illustrated by Assessment of Isobornylacrylate (IBOA) in Diabetes Products.

BACKGROUND: The increasing offering of patch-based medical devices is accompanied by growing numbers of reported adverse skin reactions. Procedures for testing leachables according to ISO 10993 may not be optimal for lipophilic substances that can be mobilized on skin by sweat and sebum. We propose an improved extraction method for targeted analysis of leachables using low volumes of a sweat-sebum emulsion. The approach is illustrated by the analysis of isobornylacrylate (IBOA), a compound found in some devices and suspected for allergenic potential. METHOD: Three patch-based products were tested: an implantable device for continuous glucose monitoring (CGM), an intermittently scanned CGM (isCGM) device, and a micro-insulin pump. Quantification of IBOA was performed by gas chromatography and allergenic potential of IBOA levels was assessed by the KeratinoSens cell assay. Different combinations were used for extraction solvent (isopropanol, 5% ethanol-water solution, and sweat-sebum emulsion), extraction volumes (complete immersion vs partial immersion in 2 mm of solvent), and extraction time (3, 5, and 14 days). RESULTS: Isobornylacrylate was only found in the isCGM device. About 20 mg/L IBOA were eluted after 3 days in isopropanol but only about 1 mg/L in ethanol-water. Sweat-sebum emulsion dissolves IBOA better and gives a more stable solution than ethanol-water. Decomposition of IBOA solutions requires adjusted extraction timing or correction of results. In the sweat-sebum extract, IBOA levels were about 20 mg/L after 3 days and about 30 mg/L after 5 days, clearly above the threshold found in the KerationSens assay for keratinocyte activation (10 mg/L). CONCLUSION: Extraction by low volumes of sweat-sebum emulsion can be a superior alternative for the targeted simulating-use assessment of leachables in patch-based medical devices.

The impact of SSRIs on mortality and cardiovascular events in patients with coronary artery disease and depression: systematic review and meta-analysis.

BACKGROUND: Depression is common in patients after acute coronary syndromes (ACS) and with stable coronary artery disease (CAD) and has been associated with increased mortality and morbidity. However, it is unclear whether selective serotonin receptor inhibitors (SSRIs) reduce mortality or cardiac events in patients with CAD and depression. OBJECTIVE: We conducted a systematic review and meta-analysis to assess the effects of SSRIs on cardiovascular events in depressed CAD patients. METHODS: The CENTRAL, MEDLINE, and PsycINFO databases were searched (April 2020) for randomized controlled trials (RCTs) and extended follow-up analyses of RCTs that compared SSRIs with placebo or no intervention in patients with CAD and depression. The primary outcomes were all-cause mortality, cardiovascular mortality, and myocardial infarction incidence. The results were calculated through random-effect meta-analyses and reported in terms of risk ratio (RR) with 95% confidence intervals (CI). RESULTS: We retrieved 8 RCTs (2 of which with extended follow-up analyses), comprising a total of 1148 patients. 7 studies only included post-ACS patients. SSRIs were associated with a significantly lower risk of myocardial infarction in patients with CAD and depression (RR 0.54, 95% CI 0.34-0.86), and in post-ACS patients with depression (RR 0.56, 95% CI 0.35-0.90). We found no statistically significant difference in all-cause mortality, cardiovascular mortality, hospitalizations, angina, congestive heart failure, or stroke incidence. CONCLUSION: The use of SSRIs in post-ACS patients with depression was associated with a 44% relative risk reduction of myocardial infarction. No difference in mortality was found. Given that the quality of the evidence was low, further research is warranted.

The feasibility of an augment reality system to study the psychophysiological correlates of fear-related responses.

BACKGROUND: Previous studies have successfully used augmented reality (AR) as an aid to exposure-based treatments for anxiety disorders. However, to the best of our knowledge, none of these studies have measured the physiological correlates of the fear response, relying solely on self-reports and behavioral avoidance tests. METHODS: As the physiological defensive reactivity pattern impacts on the treatment effectiveness, we tested the feasibility of an AR system integrated in a mobile and wearable device for assessing the psychophysiological mechanisms (heart rate) involved in fear responses in real-life contexts. Specific phobia was used as a model given its prototypical defensive hyperreactivity toward the feared stimulus (spiders to spider phobics, in the current study). RESULTS: The results showed that the stimuli presented using AR were able to induce physiological alterations in the participants, which were specific depending on the stimulus type (fear or neutral) and on the participants' level of spider fear (phobic and control group). These physiological correlates of the fear response were reflected both in the intensity of heart rate (in relation to the baseline) and in the time needed to react and recover after the stimulus exposure. Finally, we tested a theoretical model that showed that the physiological responses of phobic individuals when facing their phobic stimulus only explained its own data. CONCLUSIONS: We argue in favor of the system's feasibility at capturing and quantifying the physiological dimension of fear-related responses, which may be of great value for diagnostic and treatment purposes in anxiety disorders, namely specific phobia.

Personalized monitoring of therapeutic salicylic acid in dried blood spots using a three-layer setup and desorption electrospray ionization mass spectrometry.

Desorption electrospray ionization (DESI) mass spectrometry is an emerging technology for direct therapeutic drug monitoring in dried blood spots (DBS). Current DBS methods require manual application of small molecules as internal standards for absolute drug quantification. With industrial standardization in mind, we superseded the manual addition of standard and built a three-layer setup for robust quantification of salicylic acid directly from DBS. We combined a dioctyl sodium sulfosuccinate weave facilitating sample spreading with a cellulose layer for addition of isotope-labeled salicylic acid as internal standard and a filter paper for analysis of the standard-containing sample by DESI-MS. Using this setup, we developed a quantification method for salicylic acid from whole blood with a validated linear curve range from 10 to 2000 mg/L, a relative standard deviation (RSD%) ≤14%, and determination coefficients of 0.997. The limit of detection (LOD) was 8 mg/L and the lower limit of quantification (LLOQ) was 10 mg/L. Recovery rates in method verification by LC-MS/MS were 97 to 101% for blinded samples. Most importantly, a study in healthy volunteers after administration of a single dose of Aspirin provides evidence to suggest that the three-layer setup may enable individual pharmacokinetic and endpoint testing following blood collection by finger pricking by patients at home. Taken together, our data suggests that DBS-based quantification of drugs by DESI-MS on pre-manufactured three-layer cartridges may be a promising approach for future near-patient therapeutic drug monitoring.

[Postoperative recovery of blood in patients undergoing total knee or hip arthroplasty]. / Recuperação pós-operatória de sangue em doentes submetidos a artroplastias totais do joelho ou da anca.

BACKGROUND: In total knee arthroplasty and total hip arthroplasty occurs a considerable loss of blood, which often requires homologous transfusions of red blood cells. However, homologous transfusions have risks, besides being expensive and a limited resource. Thus, in order to reduce the need for homologous transfusions alternatives strategies have been developed, like post-operative recovery of blood. OBJECTIVES: Evaluation of post-operative recovery of blood in postoperatively red blood cells consumption and in hospital stay, by a retrospective analysis of patients undergoing total knee arthroplasty or total hip arthroplasty. MATERIAL AND METHODS: Patients (n = 976) were divided in 2 groups: CELL TRANS - after implementation of postoperative recovery of blood and CONT - before implementation of the strategy. The red blood cells requests to Serviço de Imunohemoterapia gave the number of RBC units administered and the length of hospital stay was obtained through the Sistema de Apoio ao Médico. Statistical analysis was performed using the R language, considering significant differences between groups when p values < 0,05. RESULTS: After the introduction of this strategy, 29% of patients undergoing total knee arthroplasty and 38% of patients undergoing total hip arthroplasty received red blood cells in the postoperative period, a number considerably lower to that observed before the implementation of post-operative recovery of blood, 68% and 59% respectively. Concomitantly, there was a statistically significant reduction in the length of stay of 9.0 to 8.3 days in the case of total knee arthroplasty patients and from 9.1 to 8.8 days in the case of patients undergoing total hip arthroplasty. CONCLUSION: Post-operative recovery of blood in patients undergoing total knee arthroplasty or total hip arthroplasty significantly reduces the need for red blood cells transfusion and the length of hospital stay.

Introdução: Na artroplastia total do joelho e na artroplastia total da anca ocorrem perdas de sangue consideráveis, sendo necessário recorrer frequentemente a transfusões de concentrado de eritrócitos. No entanto, para além dos potenciais riscos inerentes, o sangue homólogo é um recurso limitado e caro. No sentido de reduzir o recurso a transfusões homólogas, tem-se desenvolvido estratégias alternativas, como a recuperação pós-operatória de sangue.Objetivos: Avaliação da implementação da recuperação pós-operatória de sangue no consumo de concentrado de eritrócitos no período pós-operatório e no tempo de internamento, pela avaliação retrospetiva de doentes submetidos a artroplastia total do joelho ou a artroplastia total da anca.Material e Métodos: Os 976 doentes foram divididos em 2 grupos: CELL TRANS ­ doentes submetidos à intervenção após a implementação da recuperação pós-operatória de sangue e CONT ­ submetidos à intervenção antes da implementação da estratégia referida. O número de unidades de concentrado de eritrócitos administradas foi obtido pela análise das requisições ao Serviço de Imunohemoterapia e o tempo de internamento foi obtido através do Sistema de Apoio ao Médico. A análise estatística foi realizada com recurso à linguagem R, considerando-se diferenças significativas entre os grupos quando p < 0,05.Resultados: Após a introdução da recuperação pós-operatória de sangue, 29% dos doentes submetidos a artroplastia total do joelho e 38% dos doentes submetidos a artroplastia total da anca receberam concentrado de eritrócitos no período pós-operatório, um número consideravelmente menor ao observado antes da implementação da estratégia, 68% e 59% respetivamente. Concomitantemente, verificou-se uma redução estatisticamente significativa no tempo de internamento de 9,0 para 8,3 dias para o caso dos doentes submetidos a artroplastia total do joelho e de 9,1 para 8,8 dias para o caso dos doentes submetidos a artroplastia total da anca.Conclusões: A recuperação pós-operatória de sangue em doentes submetidos a artroplastia total do joelho ou a artroplastia total da anca reduz significativamente a necessidade de transfusão de concentrado de eritrócitos bem como o tempo de internamento.