Mortality and Excess Mortality: Improving FluMOMO.

FluMOMO is a universal formula to forecast mortality in 27 European countries and was developed on EuroMOMO context, http://www.euromomo.eu. The model has a trigonometric baseline and considers any upwards deviation from that to come from flu or extreme temperatures. To measure it, the model considers two variables: influenza activity and extreme temperatures. With the former, the model gives the number of deaths because of flu and with the latter the number of deaths because of extreme temperatures. In this article, we show that FluMOMO lacks important variables to be an accurate measure of all-cause mortality and flu mortality. Indeed, we found, as expected, that population ageing and exposure to the risk of death cannot be excluded from the linear predictor. We model weekly deaths as an autoregressive process (lag of one together with a lead of one week). This step allowed us to avoid FluMOMO trigonometric baseline and have a fit to weekly deaths through demographic variables. Our model uses data from Portugal between 2009 and 2020, on ISO-week basis. We use negative binomial-generalized linear models to estimate the weekly number of deaths as an alternative to traditional overdispersion Poisson. As explanatory variables were found to be statistically significant, we registered the number of deaths from the previous week, the influenza activity index, the population average age, the heat waves, the flu season, the number of deaths with COVID-19, and the population exposed to the risk of dying. Considering as excess mortality the number of deaths above the best estimate of deaths from our model, we conclude that excess mortality in 2020 (net of COVID-19 deaths, heat wave of July, and ageing) is low or inexistent. The model also allows us to have the number of deaths arising from flu and we conclude that FluMOMO is overestimating deaths from flu by 78%. Averages from the probability of dying are obtained as well as the probability of dying from flu. The latter is shown to be decreasing over time, probably due to the increase of flu vaccination. Higher mortality detected with the start of COVID-19, in March-April 2020, was probably due to COVID-19 deaths not recognized as COVID-19 deaths.

Sediment Sampling in Estuarine Mudflats with an Aerial-Ground Robotic Team.

This paper presents a robotic team suited for bottom sediment sampling and retrieval in mudflats, targeting environmental monitoring tasks. The robotic team encompasses a four-wheel-steering ground vehicle, equipped with a drilling tool designed to be able to retain wet soil, and a multi-rotor aerial vehicle for dynamic aerial imagery acquisition. On-demand aerial imagery, properly fused on an aerial mosaic, is used by remote human operators for specifying the robotic mission and supervising its execution. This is crucial for the success of an environmental monitoring study, as often it depends on human expertise to ensure the statistical significance and accuracy of the sampling procedures. Although the literature is rich on environmental monitoring sampling procedures, in mudflats, there is a gap as regards including robotic elements. This paper closes this gap by also proposing a preliminary experimental protocol tailored to exploit the capabilities offered by the robotic system. Field trials in the south bank of the river Tagus' estuary show the ability of the robotic system to successfully extract and transport bottom sediment samples for offline analysis. The results also show the efficiency of the extraction and the benefits when compared to (conventional) human-based sampling.

Monte Carlo validation of the irradiator parameters of the Portuguese gamma irradiation facility after its replenishment.

In December 2003 the irradiator of the Portuguese (60)Co irradiation facility, UTR, was replenished. Monte Carlo simulation studies were used to characterize the facility. Comparison of simulation results with experimental measurements were useful in estimating where the source elements were positioned and what the total activity was. For this purpose the MCNPX code was used. From the experimental point of view ionization chambers and PMMA dosemeters were used. The results indicate that the geometry of the irradiator used for simulation studies shows a shift on the vertical dimension relative to the actual geometry of approximately 8cm, but with reduced influence on the irradiation process. Considering the uncertainties of the experimental and simulated approaches the activity of the irradiator stated by supplier has been confirmed.

Technical modification for composite grafts in myocardial revascularization surgery

OBJETIVO: A operaçäo de revascularizaçäo do miocárdio com enxertos arteriais tem tido grande destaque nesta última década, e principalmente, os enxertos combinados em forma de Y ou T a partir da artéria torácica interna esquerda (ATIE). Trabalhando com este tipo de enxerto, identificamos alguma preocupaçäo quanto à anastomose da artéria radial na ATIE, principalmente quando é realizada em T, podendo qualquer pequena traçäo, angulaçäo ou mesmo espasmo da artéria radial, prejudicar o fluxo na porçäo distal da ATIE para a artéria interventricular anterior. MÉTODO: Modificamos a técnica do enxerto combinado, fazendo a anastomose da artéria radial na artéria interventricular anterior e, a seguir, a ATIE foi suturada sobre a anastomose da artéria radial na artéria interventricular anterior, privilegiando, portanto, a revascularizaçäo da artéria interventricular anterior com a ATIE, transformando a artéria radial em quase um prolongamento da ATIE para os demais ramos da artéria coronária esquerda. CONCLUSÕES: Esta modificaçäo técnica para estes enxertos combinados é simples, mais segura e efetiva, e possibilitará que um maior número de cirurgiöes passe a utilizar rotineiramente os enxertos combinados em suas operações de revascularizaçäo do miocárdio.

Tratamento das afecçöes da aorta com a primeira geraçäo de stents auto-expansíveis / Aortic diseases treatment with a first generation of self expanding stent-grafts

INTRODUÇÄO: O emprego de stents auto-expansíveis no tratamento das afecçöes da aorta descendente apresenta-se como uma nova alternativa, e o objetivo deste trabalho é avaliar o seu desempenho. CASUíSTICA E MÉTODOS: No período de abril de 1998 a novembro de 2000 (32 meses), foram operados 144 pacientes com doenças da aorta, sendo 66 (45,83 por cento) dissecçöes, 50 (34,72 por cento) aneurismas e 28 (19,44 por cento) outros procedimentos com operaçäo da aorta associada. Implantamos 37 stents auto-expansíveis na aorta descendente com acesso transesternal, circulaçäo extracorpórea, hipotermia profunda (18°C-20°C) e parada circulatória com perfusäo cerebral retrógrada. Foram 21 (56,76 por cento) dissecçöes agudas tipo B, 9 (24,32 por cento) aneurismas e dissecçöes crônicas tipo B e 7 (18,92 por cento) dissecçöes agudas tipo A. A idade média dos pacientes era de 57,95 ± 11,66 anos, sendo 64,86 por cento do sexo masculino. O acompanhamento foi de 32 meses (16,36 ± 10,29 meses) em 87,5 por cento dos pacientes com entrevistas aos médicos assistentes de regiöes distantes, ecocardiograma e tomografia computadorizada a cada 12 meses no ambulatório da Santa Casa. RESULTADOS: A mortalidade cirúrgica (30 dias) foi de 13,51 por cento, sendo 9,52 por cento nas dissecçöes agudas tipo B, 28,57 por cento nas dissecçöes agudas do tipo A e 11,22 por cento nos aneurismas e dissecçöes crônicas tipo B. As curvas de sobrevivência em 12, 24 e 33 meses säo, respectivamente, 87,92 por cento, 82,75 por cento e 74,48 por cento. Estäo livres de eventos 70,15 por cento dos pacientes, ao final de 33 meses. Dois óbitos hospitalares näo foram relacionados ao procedimento, se fossem excluídos teríamos uma mortalidade hospitalar de 8,10 por cento, o mesmo acontecendo a 1 óbito tardio. O implante de stent isolado ocorreu em 40,5 por cento dos pacientes, 3 apresentaram vazamentos distais pára-protéticos e vêm sendo acompanhados. CONCLUSÄO: Os implantes de stents intraluminais auto-expansíveis apresentaram uma mortalidade hospitalar de 13,51 por cento, mortalidade em 12, 24 e 33 meses de 9,37 por cento, 3,44 por cento e 3,57 por cento, com 70,15 por cento dos pacientes livre de eventos em 33 meses de seguimento, tornando o método factível e diminuindo a mortalidade no tratamento cirúrgico das dissecçöes agudas e crônicas do tipo B

Fasceíte necrotizante do tórax em pós-operatório de cirurgia cardíaca / Postoperative necrotizing fasciitis of the thorax in cardiac surgery

Necrotizing fasciitis is a rare soft tissue infection and a life-threatening emergency, often fatal. Its incidence and management are described plentifully in the medical literature regarding the most common anatomical sites involved like the abdomen, lower and upper limbs, and perineum. However, available data and case reports of chest wall necrotizing fasciitis after thoracic procedures are scarce, mainly after major cardiac operations. We report and discuss a case of necrotizing fasciitis of the chest wall occurring in the immediate postoperative period of a cardiac procedure, and include a brief review of the concepts, pathophysiology, and treatment reported in the medical literature. We emphasize the need for early diagnosis and urgent and effective surgical debridement. Of importance is the fact that we have not found any references in the literature to cases similar or equal to the one we describe here, which occurred in the postoperative period of a cardiac procedure