A multiple criteria approach for building a pandemic impact assessment composite indicator: The case of COVID-19 in Portugal.

The COVID-19 pandemic has caused major damage and disruption to social, economic, and health systems (among others). In addition, it has posed unprecedented challenges to public health and policy/decision-makers who have been responsible for designing and implementing measures to mitigate its strong negative impact. The Portuguese health authorities have used decision analysis techniques to assess the impact of the pandemic and implemented measures for counties, regions, or across the entire country. These decision tools have been subject to some criticism and many stakeholders requested novel approaches. In particular, those which considered the dynamic changes in the pandemic's behaviour due to new virus variants and vaccines. A multidisciplinary team formed by researchers from the COVID-19 Committee of Instituto Superior Técnico at the University of Lisbon (CCIST analyst team) and physicians from the Crisis Office of the Portuguese Medical Association (GCOM expert team) collaborated to create a new tool to help politicians and decision-makers to fight the pandemic. This paper presents the main steps that led to the building of a pandemic impact assessment composite indicator applied to the specific case of COVID-19 in Portugal. A multiple criteria approach based on an additive multi-attribute value theory aggregation model was used to build the pandemic assessment composite indicator. The parameters of the additive model were devised based on an interactive socio-technical and co-constructive process between the CCIST and GCOM team members. The deck of cards method was the adopted technical tool to assist in the assessment the value functions as well as in the assessment of the criteria weights. The final tool was presented at a press conference and had a powerful impact on the Portuguese media and on the main health decision-making stakeholders in the country. In this paper, a completed mathematical and graphical description of this tool is presented.

A network Data Envelopment Analysis to estimate nations' efficiency in the fight against SARS-CoV-2.

The ongoing outbreak of SARS-CoV-2 has been deeply impacting health systems worldwide. In this context, it is pivotal to measure the efficiency of different nations' response to the pandemic, whose insights can be used by governments and health authorities worldwide to improve their national COVID-19 strategies. Hence, we propose a network Data Envelopment Analysis (DEA) to estimate the efficiencies of fifty-five countries in the current crisis, including the thirty-seven Organisation for Economic Co-operation and Development (OECD) member countries, six OECD prospective members, four OECD key partners, and eight other countries. The network DEA model is designed as a general series structure with five single-division stages - population, contagion, triage, hospitalisation, and intensive care unit admission -, and considers an output maximisation orientation, denoting a social perspective, and an input minimisation orientation, denoting a financial perspective. It includes inputs related to health costs, desirable and undesirable intermediate products related to the use of personal protective equipment and infected population, respectively, and desirable and undesirable outputs regarding COVID-19 recoveries and deaths, respectively. To the best of the authors' knowledge, this is the first study proposing a cross-country efficiency measurement using a network DEA within the context of the COVID-19 crisis. The study concludes that Estonia, Iceland, Latvia, Luxembourg, the Netherlands, and New Zealand are the countries exhibiting higher mean system efficiencies. Their national COVID-19 strategies should be studied, adapted, and used by countries exhibiting worse performances. In addition, the observation of countries with large populations presenting worse mean efficiency scores is statistically significant.

Necessidades dos pais face ao diagnóstico de cancro na criança: Vivenciar uma transição / Parents' needs upon child cancer diagnosis: Going trough a transition

O diagnóstico de cancro numa criança e a adaptação familiar à doença oncológica constitui- -se como um processo complexo, inesperado e devastador para a criança e família, exigindo destes últimos a aquisição de novas competências e reestruturação do seu estilo de vida. Este estudo faz uma abordagem sobre as necessidades dos pais face ao diagnóstico de cancro na criança com o objetivo de conhecer e analisar as necessidades sentidas por estes pais, assim como conhecer as respostas adaptativas que os pais desenvolvem aquando do diagnóstico. Com este estudo pretende-se contribuir para a melhoria contínua da qualidade dos cuidados de enfermagem pediátricos e para a obtenção de ganhos em saúde para a criança/adolescente/família com cancro. Neste sentido, desenvolveu-se um estudo de cariz qualitativo, de natureza exploratória e descritiva, através da realização de onze entrevistas semiestruturadas, presenciais, a pais de crianças com cancro, do Centro de Referência em Oncologia Pediátrica, do Centro Hospitalar Universitário de São João. Através do modelo de análise de conteúdo de Laurence Bardin, tratou-se todo o material resultante das entrevistas e, com base na Teoria de Afaf Meleis, emergiram seis domínios da nossa análise: Propriedades da Transição; Condições Pessoais da Transição; Condições Comunitárias da Transição; Condições Sociais da Transição; Indicadores de Processo; e Indicadores de Resultado. Como conclusão do nosso estudo, podemos inferir que é crucial que os pais estejam atentos a eventuais alterações no comportamento da criança e a possíveis sinais e sintomas de doença possibilitando assim o diagnóstico precoce, início rápido dos tratamentos e otimização dos mesmos. Para além disso, o confronto com o diagnóstico marca assim o início do processo de transição dos pais da criança com cancro. Ao longo deste processo de transição, a família tem a oportunidade de adquirir e desenvolver competências e habilidades que desconhecia, até à aquisição de mestria. Os enfermeiros detêm assim de um papel preponderante na identificação das necessidades, dificuldades e potencialidades de cada elemento da família.

Diagnosis of cancer in a child is always an unexpected and devastating event in the child's life and family; going through this situation represents a long and unpredictable path, that may require adjustments in their lifestyle. This study approaches the perception of the disease with the objective of knowing and analyzing the necessities felt by the parents after child cancer diagnosis and also find out their adaptive responses upon the diagnosis. Thus, we intend to contribute to the continuous improvement of the nursing care quality and to obtain health gains for the child/teenager/parents who face this situation. For this, we have developed a qualitative, exploratory and descriptive research, using eleven face-to-face semi-structured interviews to parents of children diagnosed with cancer and followed by "Centro de Referência em Oncologia Pediátrica, do Centro Hospitalar Universitário de São João". Through Laurence Bardin's content analysis model, we have treated all the material resulted from the interviews and - based on Afaf Meleis's Theory - we have obtained six domains of analysis: Transition Properties; Personal Transition Conditions; Community Transition Conditions; Social Conditions of Transition; Process Indicators; and Result Indicators. As a conclusion of our study, we can infer that it is crucial that parents are attentive to possible changes in the child's behavior and to possible signs and symptoms of illness, which enables early diagnosis, rapid initiation of treatments and their optimization. In addition, the confrontation with the diagnosis marks the beginning of the transition process for the child's parents with cancer. Throughout this transition process, the family has the opportunity to acquire and develop unknow skills and abilities to them, until the acquisition of mastery. Nurses have a crucial role in identifying the needs, difficulties and potential of each member of the family.

Palladium-benzodiazepine derivatives as promising metallodrugs for the development of antiepileptic therapies.

We synthesized two organometallic diazepam-palladium(II) derivatives by C-H activation of diazepam (DZP) with palladium salts, i.e., PdCl2 and Pd(OAc)2 (OAc=acetate). Both compounds obtained are air stable and were isolated in good yields. The anticonvulsant potential of the complexes, labeled [(DZP)PdCl]2 and [(DZP)PdOAc]2, was evaluated through two animal models: pentylenetetrazole (PTZ)- and picrotoxin (PTX)-induced convulsions. The organometallic DZP-palladium(II) acetate complex, [(DZP)PdOAc]2, significantly increased (p<0.01 or p<0.001) latencies and protected the animals against convulsions induced by PTZ and PTX, while the analogous chloro derivative, [(DZP)PdCl]2, was effective (p<0.01) only in the PTZ model. These effects appear to be mediated through the GABAergic system. The possible mechanism of action of the DZP-palladium(II) complexes was also confirmed with the use of flumazenil (FLU), a GABAA-benzodiazepine receptor complex site antagonist. Herein, we present the first report of the anticonvulsant properties of organometallic DZP-palladium(II) complexes as well as evidence that these compounds may play an important role in the study of new drugs to treat patients with epilepsy.

Hypervolume Subset Selection in Two Dimensions: Formulations and Algorithms.

The hypervolume subset selection problem consists of finding a subset, with a given cardinality k, of a set of nondominated points that maximizes the hypervolume indicator. This problem arises in selection procedures of evolutionary algorithms for multiobjective optimization, for which practically efficient algorithms are required. In this article, two new formulations are provided for the two-dimensional variant of this problem. The first is a (linear) integer programming formulation that can be solved by solving its linear programming relaxation. The second formulation is a k-link shortest path formulation on a special digraph with the Monge property that can be solved by dynamic programming in [Formula: see text] time. This improves upon the result of [Formula: see text] in Bader ( 2009 ), and slightly improves upon the result of [Formula: see text] in Bringmann et al. ( 2014b ), which was developed independently from this work using different techniques. Numerical results are shown for several values of n and k.

User Expectations for Media Sharing Practices in Open Display Networks.

Open Display Networks have the potential to allow many content creators to publish their media to an open-ended set of screen displays. However, this raises the issue of how to match that content to the right displays. In this study, we aim to understand how the perceived utility of particular media sharing scenarios is affected by three independent variables, more specifically: (a) the locativeness of the content being shared; (b) how personal that content is and (c) the scope in which it is being shared. To assess these effects, we composed a set of 24 media sharing scenarios embedded with different treatments of our three independent variables. We then asked 100 participants to express their perception of the relevance of those scenarios. The results suggest a clear preference for scenarios where content is both local and directly related to the person that is publishing it. This is in stark contrast to the types of content that are commonly found in public displays, and confirms the opportunity that open displays networks may represent a new media for self-expression. This novel understanding may inform the design of new publication paradigms that will enable people to share media across the display networks.

Evaluation of naphthoquinones identified the acetylated isolapachol as a potent and selective antiplasmodium agent.

This study reports on the design, synthesis and antiparasitic activity of three new semi-synthetic naphthoquinones structurally related to the naturally-occurring lapachol and lapachone. Of the compounds tested, 3-(3-methylbut-1-en-1-yl)-1,4-dioxo-1,4-dihydronaphthalen-2-yl acetate (1) was the most active against Plasmodium falciparum among both natural and semi-synthetic naphthoquinones, showing potent and selective activity. Compound 1 was able to reduce the in vitro parasite burden, in vitro parasite cell cycle, as well as the blood parasitemia in Plasmodium berghei-infected mice. More importantly, infection reduction under compound 1-treatment was achieved without exhibiting mouse genotoxicity. Regarding the molecular mechanism of action, this compound inhibited the hemozoin crystal formation in P. falciparum treated cells, and this was further confirmed by observing that it inhibits the ß-hematin polymerization process similarly to chloroquine. Interestingly, this compound did not affect either mitochondria structure or cause DNA fragmentation in parasite treated cells. In conclusion, we identified a semi-synthetic antimalarial naphthoquinone closely related to isolapachol, which had stronger antimalarial activity than lapachol.

MobiPag: integrated mobile payment, ticketing and couponing solution based on NFC.

Mobile payments still remain essentially an emerging technology, seeking to fill the gap between the envisioned potential and widespread usage. In this paper, we present an integrated mobile service solution based on the near field communication (NFC) protocol that was developed under a research project called MobiPag. The most distinctive characteristic of Mobipag is its open architectural model that allows multiple partners to become part of the payment value-chain and create solutions that complement payments in many unexpected ways. We describe the Mobipag architecture and how it has been used to support a mobile payment trial. We identify a set of design lessons resulting from usage experiences associated with real-world payment situations with NFC-enabled mobile phones. Based on results from this trial, we identify a number of challenges and guidelines that may help to shape future versions of NFC-based payment systems. In particular, we highlight key challenges for the initial phases of payment deployments, where it is essential to focus on scenarios that can be identified as more feasible for early adoption. We also have identified a fundamental trade-off between the flexibility supported by the Mobipag solution and the respective implications for the payment process, particularly on the users' mental model.

On local search for bi-objective knapsack problems.

In this article, a local search approach is proposed for three variants of the bi-objective binary knapsack problem, with the aim of maximizing the total profit and minimizing the total weight. First, an experimental study on a given structural property of connectedness of the efficient set is conducted. Based on this property, a local search algorithm is proposed and its performance is compared to exact algorithms in terms of runtime and quality metrics. The experimental results indicate that this simple local search algorithm is able to find a representative set of optimal solutions in most of the cases, and in much less time than exact algorithms.

Pins and posters: Paradigms for content publication on situated displays.

Public-display systems are still far from being a medium for meeting people's diverse communication goals. Moving toward open displays will require publication paradigms that can overcome the challenges of meaningful engagement and enable users to fully understand and control the publication process. The metaphors of pins and posters have inspired two complementary paradigms for public displays. Researchers implemented these paradigms in the Instant Places system, which they deployed on 10 displays in diverse urban locations for six months. They collected user and system data regarding the users' practices. The findings improve the understanding of what might drive user-generated content in networks of urban displays. Such knowledge can inform the design of tools and procedures for situated publication in public displays.

Photodynamic therapy with verteporfin in polypoidal choroidal vasculopathy: results after 3 years of follow-up.

PURPOSE: The purpose of this study was to evaluate the efficacy of verteporfin photodynamic therapy on the treatment of polypoidal choroidal vasculopathy. METHODS: A prospective, nonrandomized institutional study was conducted involving 42 eyes of 38 patients with newly diagnosed symptomatic polypoidal choroidal vasculopathy treated exclusively with photodynamic therapy. Twenty-seven eyes completed 3 years of follow-up. Subjects were observed every 3 months with evaluation of best-corrected visual acuity (BCVA), retinography, and fluorescein and indocyanine green angiography. Treatment was given whenever the patient exhibited subfoveal exudation on fluorescein angiography. RESULTS: Mean BCVA was 0.91 +/- 0.33 logarithm of the minimum angle of resolution on the initial visit and 0.93 +/- 0.39 on the 36-month visit. Patients were submitted to an average of 3.19 treatment sessions. On the final evaluation at 36 months, 14.8% of the treated eyes improved their BCVA by at least 0.3 logarithm of the minimum angle of resolution, 74.1% had no significant loss of BCVA, and 25.9% lost >or=0.3 logarithm of the minimum angle of resolution. Recurrences were frequent (59.3% of the eyes at 3 years of follow-up), responded well to retreatment, and were not associated with additional BCVA loss. CONCLUSION: Photodynamic therapy remains a good option for management of polypoidal choroidal vasculopathy. After 3 years, approximately three fourths of the treated eyes had no significant loss of vision, and 14.8% showed significant improvement in visual acuity.

Conformational characterization of disulfide bonds: a tool for protein classification.

BACKGROUND: Throughout evolution, mutations in particular regions of some protein structures have resulted in extra covalent bonds that increase the overall robustness of the fold: disulfide bonds. The two strategically placed cysteines can also have a more direct role in protein function, either by assisting thiol or disulfide exchange, or through allosteric effects. In this work, we verified how the structural similarities between disulfides can reflect functional and evolutionary relationships between different proteins. We analyzed the conformational patterns of the disulfide bonds in a set of disulfide-rich proteins that included twelve SCOP superfamilies: thioredoxin-like and eleven superfamilies containing small disulfide-rich proteins (SDP). RESULTS: The twenty conformations considered in the present study were characterized by both structural and energetic parameters. The corresponding frequencies present diverse patterns for the different superfamilies. The least-strained conformations are more abundant for the SDP superfamilies, while the "catalytic" +/-RHook is dominant for the thioredoxin-like superfamily. The "allosteric" -RHSaple is moderately abundant for BBI, Crisp and Thioredoxin-like superfamilies and less frequent for the remaining superfamilies. Using a hierarchical clustering analysis we found that the twelve superfamilies were grouped in biologically significant clusters. CONCLUSIONS: In this work, we carried out an extensive statistical analysis of the conformational motifs for the disulfide bonds present in a set of disulfide-rich proteins. We show that the conformational patterns observed in disulfide bonds are sufficient to group proteins that share both functional and structural patterns and can therefore be used as a criterion for protein classification.

Activities of naphthoquinones against Aedes aegypti (Linnaeus, 1762) (Diptera: Culicidae), vector of dengue and Biomphalaria glabrata (Say, 1818), intermediate host of Schistosoma mansoni.

Larvicidal (against Aedes aegypti Linnaeus, 1762) and molluscicidal (against Biomphalaria glabrata Say, 1818) activities of several natural and synthetic naphthoquinones were measured, with significant results. The best larvicidal compound is 3-bromojuglone, while the better molluscicides are 2-bromo- and 3-bromo-5-acetoxy-1,4-naphthoquinones together with the 3-bromo-5-methoxy derivative. The present results reinforce the potential use of substituted hydroxyquinones, their salts and halogenated quinones as very promising compounds against 4th instar larves of Aedes aegypti, the vector of dengue and against adult snail of Biomphalaria glabrata.

NMR characterization of new 10-membered-ring macrolactones and dihydrobenzophenazine-5-one, oxidized derivatives of benzo[a]phenazines.

Peroxidation of the phenazine of beta-lapachone using m-ClC6H4CO3H-CH2Cl2 furnished a macrolactone with a rigid 10-membered ring, and the corresponding N-oxide, along with a dihydrobenzophenazine-5-one. All of the new compounds were fully characterized by spectroscopic methods, with the unambiguous assignment of the hydrogens and carbon NMR signals for the N-oxide, with the aid of 2-D NMR, mainly COSY, HMQC, HSQC and HMBC. For the other two compounds some signals could not be assigned owing to their own intrinsic features.

Marketing médico / The physicians marketing

Este artigo objetiva desenvolver a ideia de marketing do medico, adaptando-se os conceitos gerais do marketing de servicos a realidade medica, no sentido de buscar, com eficacia, melhor qualidade do servico prestado aos clientes. Tentaremos, pois, repassar as ideias de marketing medico de modo claro, entretanto, sob a visao exclusiva do medico