Search results for: Nice Vasconcelos Coimbra

Authors: Nice Vasconcelos Coimbra, Fábio dos Santos Gonçalves, Marisa Nascimento, Ellen Cristine Giese

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The development of chemical routes for the recovery and separation of rare earth elements (REE) is seen as a priority and strategic action by several countries demanding these elements. Among the possibilities of alternative routes, the biosorption process has been evaluated in our laboratory. In this theme, the present work attempts to assess and fit the solution equilibrium data in Langmuir, Freundlich and DKR isothermal models, based on the biosorption results of the lanthanum and samarium elements by Bacillus subtilis immobilized on calcium alginate gel. It was observed that the preference of adsorption of REE by the immobilized biomass followed the order Sm (III)> La (III). It can be concluded that among the studied isotherms models, the Langmuir model presented better mathematical results than the Freundlich and DKR models.

Keywords: rare earth elements, biosorption, Bacillus subtilis, adsorption isotherm models

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Authors: Shai Sarussi

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Let S be an integral domain which is not a field, let F be its field of fractions, and let A be an F-algebra. An S-subalgebra R of A is called S-nice if R ∩ F = S and F R = A. A topological space whose set of open sets is closed under arbitrary intersections is called an Alexandroff space. Inspired by the well-known Zariski-Riemann space and the Zariski topology on the set of prime ideals of a commutative ring, we define a topology on the set of all S-nice subalgebras of A. Consequently, we get an interplay between Algebra and topology, that gives us a better understanding of the S-nice subalgebras of A. It is shown that every irreducible subset of S-nice subalgebras of A has a supremum; and a characterization of the irreducible components is given, in terms of maximal S-nice subalgebras of A.

Keywords: Alexandroff topology, integral domains, Zariski-Riemann space, S-nice subalgebras

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Authors: Georgia Mills, Rachel Parsonage

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Thrombocytosis is a platelet count above the upper limit of the normal range. An urgent referral is advised for counts over 1000 x109 and if the count is between 600-1000 x109 with certain conditions/age. A non-urgent referral is warranted when the level is above 450 × 109/L (for more than 3 months) or over 600 × 109/L on at least two occasions (4–6 weeks apart) or within the range 450–600 × 109/L with other haematological abnormalities. The aim of this audit is the assess how well Roseneath's general practice has adhered to the National Institute for Health and Care Excellence (NICE) guidelines for investigations and management of high platelet counts. Through the filtering tool on Vision, all blood results in the surgery were filtered to only show those with a platelet count above 450 x 109 /L. These patients were then analyzed individually to see where they fall on the current NICE guidance pathway for management. The investigations and management of thrombocytosis were generally poor. 60% of those who needed an urgent referral did not have it done. 30% of those who needed a follow-up blood test did not have it done. 60% of those needing a routine referral from complete investigations did not have it done. To improve the knowledge of NICE guidelines within the practice, a teaching session was delivered. Percentages then reached 100% in the 2nd audit. There is a lack of awareness of guidelines and education on thrombocytosis in primary care. Teaching sessions will benefit outcomes greatly

Keywords: platelets, thrombocytosis, management, referral

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Authors: Shai Sarussi

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Let S be an integral domain with field of fractions F and let A be an F-algebra. An S-subalgebra R of A is called S-nice if R∩F = S and the localization of R with respect to S \{0} is A. Denoting by W the set of all S-nice subalgebras of A, and defining a notion of open sets on W, one can view W as a T0-Alexandroff space. A characterization of the property of immediate neighbors in an Alexandroff topological space is given, in terms of closed and open subsets of appropriate subspaces. Moreover, two special subspaces of W are introduced, and a way in which their closed and open subsets induce W is presented.

Keywords: integral domains, Alexandroff topology, immediate neighbors, valuation domains

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Authors: Emily Jin, Harry Sharples, Anne Weist

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Introduction: NICE Evidence Search Student Champion Scheme is a peer-assisted learning scheme that aims to improve the routine use of evidence-based information by future health and social care staff. The focus is on the NICE evidence search portal that provides selected information from more than 800 reliable health, social care, and medicines sources, including up-to-date guidelines and information for the public. This paper aims to evaluate the effectiveness of the scheme when implemented in Liverpool School of Medicine and to understand the experiences of those attending. Methods: Twelve student champions were recruited and trained in February 2020 as peer tutors during a workshop facilitated by NICE. Cascade sessions were then organised and delivered on an optional basis for students, in small groups of < 10 to approximately 70 attendees. Surveys were acquired immediately before and 8-12 weeks after cascade sessions (n=47 and 45 respectively). Data from these surveys facilitated the analysis of the scheme. Results: Surveys demonstrated 74% of all attendees frequently searched for health and social care information online as a part of their studies. However, only 15% of attendees reported having prior formal training on searching for health information, despite receiving such training earlier on in the curriculum. After attending cascade sessions, students reported a 58% increase in confidence when searching for information using evidence search, from a pre-session a baseline of 36%. Conclusion: NICE Evidence Search Student Champion Scheme provided clear benefits for attending students, increasing confidence in searching for peer-reviewed, mainly secondary sources of health information. The lack of reported training represents the unmet need that the champion scheme satisfies, and this likely benefits student champions as well as attendees. Increasing confidence in searching for healthcare information online may support future evidence-based decision-making.

Keywords: evidence-based medicine, NICE, medical education, medical school, peer-assisted learning

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Authors: Gusa Hall, Barrie Keeler, Achal Khanna

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Introduction: NICE guidelines have highlighted the consequences of IV fluid mismanagement. The main aim of this study was to audit fluid prescribing post laparotomies to identify if fluids were prescribed in accordance to NICE guidelines. Methodology: Retrospective database search of eight specific laparotomy procedures (colectomy right and left, Hartmann’s procedure, small bowel resection, perforated ulcer, abdominal perineal resection, anterior resection, pan proctocolectomy, subtotal colectomy) highlighted 29 laparotomies between April 2019 and May 2019. Two of 29 patients had secondary procedures during the same admission, n=27 (patients). Database case notes were reviewed for date of procedure, length of admission, fluid prescribed and amount, nasal gastric tube output, daily bloods results for electrolytes sodium and potassium and operational losses. Results: n=27 based on 27 identified patients between April 2019 – May 2019, 93% (25/27) received IV fluids, only 19% (5/27) received the correct IV fluids in accordance to NICE guidelines, 93% (25/27) who received IV fluids had the correct electrolytes levels (sodium & potassium), 100% (27/27) patients received blood tests (U&E’s) for correct electrolytes levels. 0% (0/27) no documentation on operational losses. IV fluids matched nasogastric tube output in 100% (3/3) of the number of patients that had a nasogastric tube in situ. Conclusion: A PubMed database literature review on barriers to safer IV prescribing highlighted educational interventions focused on prescriber knowledge rather than how to execute the prescribing task. This audit suggests IV fluids post laparotomies are not being prescribed consistently in accordance to NICE guidelines. Surgical management plans should be clearer on IV fluids and electrolytes requirements for the following 24 hours after the plan has been initiated. In addition, further teaching and training around IV prescribing is needed together with frequent surgical audits on IV fluid prescribing post-surgery to evaluate improvements.

Keywords: audit, IV Fluid prescribing, laparotomy, NICE guidelines

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Authors: Shai Sarussi

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Let S be an integral domain with field of fractions F and let A be an F-algebra. An S-subalgebra R of A is called S-nice if R∩F = S and the localization of R with respect to S \{0} is A. Denoting by W the set of all S-nice subalgebras of A, and defining a notion of open sets on W, one can view W as a T0-Alexandroff space. Thus, the algebraic structure of W can be viewed from the point of view of topology. It is shown that every nonempty open subset of W has a maximal element in it, which is also a maximal element of W. Moreover, a supremum of an irreducible subset of W always exists. As a notable connection with valuation theory, one considers the case in which S is a valuation domain and A is an algebraic field extension of F; if S is indecomposed in A, then W is an irreducible topological space, and W contains a greatest element.

Keywords: integral domains, Alexandroff topology, prime spectrum of a ring, valuation domains

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Authors: Inês Amorim Leitão, Loes van Shaick, António Dinis Ferreira, Violette Geissen

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Plastic pollution is a growing concern worldwide: plastics are commercialized in large quantities and it takes a long time for them to degrade. When in the environment, plastic is fragmented into microplastics (<5mm), which have been found in all environmental compartments at different locations. Microplastics contribute to the environmental pollution in water, air and soil and are linked to human health problems. The progressive increase of population living in cities led to the aggravation of the pollution problem worldwide, especially in urban environments. Urban areas represent a strong source of pollution, through the roads, industrial production, wastewater, landfills, etc. It is expected that pollutants such as microplastics are transported diffusely from the sources through different pathways such as wind and rain. Therefore, it is very complex to quantify, control and treat these pollutants, designated current problematic issues by the European Commission. Green areas are pointed out by experts as natural filters for contaminants in cities, through their capacity of retention by vegetation. These spaces have thus the capacity to control the load of pollutants transported. This study investigates the spatial distribution of microplastics in urban soils of different land uses, their transport through atmospheric deposition, wind erosion, runoff and streams, as well as their deposition in vegetation like grass and tree leaves in urban environment. Coimbra, a medium large city located in the central Portugal, is the case-study. All the soil, sediments, water and vegetation samples were collected in Coimbra and were later analyzed in the Wageningen University & Research laboratory. Microplastics were extracted through the density separation using Sodium Phosphate as solution (~1.4 g cm−3) and filtration methods, visualized under a stereo microscope and identified using the u-FTIR method. Microplastic particles were found in all the different samples. In terms of soils, higher concentrations of microplastics were found in green parks, followed by landfills and industrial places, and the lowest concentrations in forests and pasture land-uses. Atmospheric deposition and streams after rainfall events seems to represent the strongest pathways of microplastics. Tree leaves can retain microplastics on their surfaces. Small leaves such as needle leaves seem to present higher amounts of microplastics per leaf area than bigger leaves. Rainfall episodes seem to reduce the concentration of microplastics on leaves surface, which suggests the wash of microplastics down to lower levels of the tree or to the soil. When in soil, different types of microplastics could be transported to the atmosphere through wind erosion. Grass seems to present high concentrations of microplastics, and the enlargement of the grass cover leads to a reduction of the amount of microplastics in soil, but also of the microplastics moved from the ground to the atmosphere by wind erosion. This study proof that vegetation can help to control the transport and dispersion of microplastics. In order to control the entry and the concentration of microplastics in the environment, especially in cities, it is essential to defining and evaluating nature-based land-use scenarios, considering the role of green urban areas in filtering small particles.

Keywords: microplastics, cities, sources, pathways, vegetation

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Authors: B. J. Mahen, N. E. Lloyd-Gale, S. Johnson, W. P. Rakowicz, M. J. Harris, A. D. Miller

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Background: Migraine is a leading cause of disability in the world. Calcitonin gene-related peptide (CGRP) receptor antagonists offer an approach to migraine prophylaxis by inhibiting the inflammatory and vasodilatory effects of CGRP. In recent years, NICE licensed the use of three CGRP-receptor antagonists: Fremanezumab, Galcanezumab, and Erenumab. Here, we present the outcomes of CGRP-antagonist treatment in a cohort of patients who suffer from episodic or chronic migraine and have failed at least three oral prophylactic therapies. Methods: We offered CGRP antagonists to 86 patients who met the NICE criteria to start therapy. We recorded the number of headache days per month (HDPM) at 0 weeks, 3 months, and 12 months. Of those, 26 patients were switched to an alternative treatment due to poor response or side effects. Of the 112 total cases, 9 cases did not sufficiently maintain their headache diary, and 5 cases were not followed up at 3 months. We have therefore included 98 sets of data in our analysis. Results: Fremanezumab achieved a reduction in HDPM by 51.7% at 3 months (p<0.0001), with 63.7% of patients meeting NICE criteria to continue therapy. Patients trialed on Galcanezumab attained a reduction in HDPM by 47.0% (p=0.0019), with 51.6% of patients meeting NICE criteria to continue therapy. Erenumab, however, only achieved a reduction in HDPM by 17.0% (p=0.29), and this was not statistically significant. Furthermore, 34.4%, 9.7%, and 4.9% of patients taking Fremanezumab, Galcanezumab, and Erenumab, respectively, continued therapy beyond 12 months. Of those who attempted drug holidays following 12 months of treatment, migraine symptoms relapsed in 100% of cases. Conclusion: We observed a significant improvement in HDPM amongst episodic and chronic migraine patients following treatment with Fremanezumab or Galcanezumab.

Keywords: migraine, CGRP, fremanezumab, galcanezumab, erenumab

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Authors: Maria Campos, Alain Massart, Hugo Sarmento

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The Meter Matters Erasmus Sport European Project (ID: 101050372) explores the field of social inclusion in and through sports with the aim of a) proposing appropriate criteria for co-funding sports programs involving people with intellectual and developmental disabilities and other more vulnerable people, primarily in mainstream sports organizations and b) proposing a model for co-funding social inclusion in and through sports at the national level. This European project (2022-2024) involves 6 partners from 3 countries: Univerza V Ljubljani – coordinator and Drustvo Specialna Olimpiada Slovenije (Slovenia); Magyar Specialis Olimpia Szovetseg and Magyar Testnevelesi Es Sporttudomanyi Egyetem (Hungary) and APPDA Coimbra - Associação Portuguesa para as Perturbações do Desenvolvimento e Autismo and Universidade De Coimbra, Faculty of Sport Sciences and Physical Education (Portugal). Equal involvement of all people in sports activities is, in terms of national and international guidelines, enshrined in some conventions and strategies in the field of sports, as well as human rights, social security, physical and mental health, architecture, environment and public administration. However, there is a gap between the practice and EU guidelines in terms of sustainable support for socially inclusive sports programs in the form of co-funding by state and local (municipal) resources. We observe considerable opacity in the regulation of the field. Given that there are both relevant programs and inclusive legislation and policies, we believe that the reason for the missing article is reflected in the undeveloped criteria for measuring social inclusion in sports. Major sports programs are usually co-funded based on crowds (number of involved athletes) and performance (sports score). In the field of social inclusion in sports, the criteria cannot be the same, as it is a smaller population. Therefore, the goals of inclusion in sports should not be the focused on competitive results but on opening equal opportunities for all, regardless of their psychophysical abilities. In the Meter Matters program, we are searching for criteria for co-funding social inclusion in sports through focus groups with coaches, social workers, psychologists and others professionals involved in inclusive sports programs in regular sports clubs and with athletes and their parents or guardians. Moreover, experts in the field of social inclusion in sports were also interviewed. Based on the proposals for measuring social inclusion in sports, we developed a model for co-funding socially inclusive sports programs.

Keywords: European project, meter matters, inclusion, sport

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Authors: Rania Mustafa, Anfal Gadour

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Specialty area: Manchester University NHS Foundation Trust, Wythenshawe Hospital Accident and Emergency Department. About, Documentation of verbal and written head injury advice given to all adults presenting following a head injury. Our aim was to assess verbal & written head injury advice for an adult patient attending ED in Wythenshawe hospital during the period from January 2022 to May 2022, with a view to evaluating the NICE head injury guidelines concerning discharge advice and also to review the clinical notes to ensure that all adult patients presenting with a head injury are documented to have received both verbal & written head injury advice as per the NICE guidelines. Here we collected data from a random sample over a 1 month period. This data was furtherly filtered to include the adult patient >16 years and resulted in 54 patients with head injuries attending ED during this time period; then patient’s age, sex and hospital number were used to identify the discharge advice for the purpose of chart review and to assess the documentation of head injuries compliance with recommendation for NICE assessment. Data were checked between January 2022 up to May 2022 to allow more intervals for better assessment. Our finding indicates that documentation of verbal advice, 26% of patients were not recorded to have received this in January compared to only 3% in May & Written advice was not recorded in 44% of patients studied in January compared to 1% in May.

Keywords: head, injuries, advice, leaflets

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Authors: R. E. Vasconcelos, K. R. M. da Silva, J. M. B. Pinto

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This study aims to determine and to present the results of an experimental study of Synthetic (polypropylene) Fibers Reinforced Concrete (SFRC), in levels of 0.33% - 3kg/m3, 0.50% - 4.5kg/m3, and 0.66% - 6kg/m3, using cement CP V – ARI, at ages 28 and 88 days after specimens molding. The specimens were exposed for 60 days in aggressive environment (in solution of water and 3% of sodium chloride), after 28 days. The bending toughness tests were performed in prismatic specimens of 150 x 150 x 500 mm. The toughness factor values of the specimens in aggressive environment were the same to those obtained in normal environment (in air).

Keywords: concrete reinforced with polypropylene fibers, toughness in bending, synthetic fibers, concrete reinforced

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Authors: Margarida Franca

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The influence of the ‘cultural turn’ movement and the consequent deconstruction of scientific thought allowed geography and other social sciences to open or deepen their studies based on the analysis of multiple identities, on singularities, on what is particular or what marks the difference between individuals. In the context of postmodernity, the geography of religion has gained a favorable scientific, thematic and methodological focus for the qualitative and subjective interpretation of various religious identities, sacred places, territories of belonging, religious communities, among others. In the context of ‘late modernity’ or ‘net modernity’, sacred places and the definition of a network of sacred territories allow believers to attain the ‘ontological security’. The integration on a religious group or a local community, particularly a religious community, allows human beings to achieve a sense of belonging, familiarity or solidarity and to overcome, in part, some of the risks or fears that society has discovered. The importance of sacred places comes not only from their inherent characteristics (eg transcendent, mystical and mythical, respect, intimacy and abnegation), but also from the possibility of adding and integrating members of the same community, creating bonds of belonging, reference and individual and collective memory. In addition, the formation of different networks of sacred places, with multiple scales and dimensions, allows the human being to identify and structure his times and spaces of daily life. Thus, each individual, due to his unique identity and life and religious paths, creates his own network of sacred places. The territorial expression of religious identity allows to draw a variable and unique geography of sacred places. Through the case study of the practicing Catholic population in the diocese of Coimbra (Portugal), the aim is to study the territorial expression of the religious identity of the different local communities of this city. Through a survey of six parishes in the city, we sought to identify which factors, qualitative or not, define the different territorial expressions on a local, national and international scale, with emphasis on the socioeconomic profile of the population, the religious path of the believers, the religious group they belong to and the external interferences, religious or not. The analysis of these factors allows us to categorize the communities of the city of Coimbra and, for each typology or category, to identify the specific elements that unite the believers to the sacred places, the networks and religious territories that structure the religious practice and experience and also the non-representational landscape that unifies and creates memory. We conclude that an apparently homogeneous group, the Catholic community, incorporates multitemporalities and multiterritorialities that are necessary to understand the history and geography of a whole country and of the Catholic communities in particular.

Keywords: geography of religion, sacred places, territoriality, Catholic Church

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Authors: Abhishek Oswal

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Background: Inconsistencies between the guidelines for childhood asthma can pose a diagnostic challenge to clinicians. NICE guidelines are the most commonly followed guidelines in primary care in the UK; they state that to be diagnosed with asthma, a child must be more than 5 years old and must have objective evidence of the disease. When diagnoses are coded in general practice (GP), these guidelines may be superseded by communications from secondary care. Hence it is imperative that diagnoses are correct, as per up to date guidelines and evidence, as this affects follow up and management both in primary and secondary care. Methods: A snapshot audit at a general practice surgery was undertaken of children (less than 16 years old) with a coded diagnosis of 'asthma', to review the age at diagnosis and whether any objective evidence of asthma was documented at diagnosis. 50 cases of asthma in children presenting to the emergency department (ED) were then audited to review the age at presentation, whether there was evidence of previous asthma diagnosis and whether the patient was discharged from ED. A repeat audit is planned in ED this winter. Results: In a GP surgery, there were 83 coded cases of asthma in children. 51 children (61%) were diagnosed under 5, with 9 children (11%) who had objective evidence of asthma documented at diagnosis. In ED, 50 cases were collected, of which 4 were excluded as they were referred to the other services, or for incorrect coding. Of the 46 remaining, 27 diagnoses confirmed to NICE guidelines (59%). 33 children (72%) were discharged from ED. Discussion: The most likely reason for the apparent low rate of a correct diagnosis is the significant challenge of obtaining objective evidence of asthma in children. There were a number of patients who were diagnosed from secondary care services and then coded as 'asthma' in GP, without having objective documented evidence. The electronic patient record (EPR) system used in our emergency department (ED) did not allow coding of 'suspected diagnosis' or of 'viral induced wheeze'. This may have led to incorrect diagnoses coded in primary care, of children who had no confirmed diagnosis of asthma. We look forward to the re-audit, as the EPR system has been updated to allow suspected diagnoses. In contrast to the NICE guidelines used here, British Thoracic Society (BTS) guidelines allow for a trial of treatment and subsequent confirmation of diagnosis without objective evidence. It is possible that some of the cases which have been classified as incorrect in this audit may still meet other guidelines. Conclusion: The diagnosis of asthma in children is challenging. Incorrect diagnoses may be related to clinical pressures and the provision of services to allow compliance with NICE guidelines. Consensus statements between the various groups would also aid the decision-making process and diagnostic dilemmas that clinicians face, to allow more consistent care of the patient.

Keywords: asthma, diagnosis, primary care, emergency department, guidelines, audit

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Authors: A. Escoffier, A. Albrecht, F. Consigny

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In order to host the Football Euro in 2016, many French cities have launched architectural competitions in recent years to improve the quality of their stadiums. The winning project in Nice was designed by Wilmotte architects together with Elioth structural engineers. It has a capacity of 35,000 seats. Its roof structure consists of a complex 3D shape timber and steel lattice and is covered by 25,000m² of ETFE, 10,500m² of PES-PVC fabric and 8,500m² of photovoltaic panels. This paper focuses on the ETFE part of the cover. The stadium is one of the first constructions to use flat single layer ETFE on such a big area. Due to its relatively recent appearance in France, ETFE structures are not yet covered by any regulations and the existing codes for fabric structures cannot be strictly applied. Rather, they are considered as cladding systems and therefore have to be approved by an “Appréciation Technique d’Expérimentation” (ATEx), during which experimental tests have to be performed. We explain the method that we developed to justify the ETFE, which eventually led to bi-axial tests to clarify the allowable stress in the film.

Keywords: biaxial test, creep, ETFE, single layer, stadium roof

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Authors: Amel Osman, Stewart McKenna

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Aim: Fever may present as the sole sign of a serious underlying infection in young infants. Febrile Infants aged less than 90 days are at an elevated susceptibility to invasive bacterial infections, thus presenting a challenge in ensuring the appropriate management of these cases. This study aims to ensure strict adherence to NICE guidelines for the management of fever in infants between 0 and 90 days presenting to Tallaght Hospital ED. A comprehensive audit, followed by a re-audit, was conducted to enhance the quality of care delivered to these patients. In accordance with NICE guidelines, all febrile infants should undergo blood tests. Additionally, LP should be performed in all neonates under 28 days, infants displaying signs of illness, and those with WCC below 5 or above 15. Method: A retrospective case review was performed, encompassing all patients aged between 0 to 90 days who presented with fever at Tallaght ED. Data retrieval was conducted from electronic records on two separate occasions, six months apart. The evaluation encompassed the assessment of body temperature as well as both partial and full septic workups. Results: Over the study period, 150 infants presented to the ED with fever in the initial audit, and 120 in the re-audit. In the first study, 81 patients warranted a full septic workup as per NICE, but only 48 received it. Conversely, 40 patients met criteria for a partial septic workup, with 12 undergoing blood tests. In the second study, 73 patients qualified for a full septic workup, of which 52 were completed. Additionally, 27 patients were indicated for a partial workup, with 20 undergoing blood tests. Conclusion: Managing febrile infants under three months of age presenting to Tallaght ED remains a persistent challenge, underscoring the need for continuous educational initiatives to guarantee that these patients receive the requisite assessments and treatments.

Keywords: infants, fever, septic workup, tallaght

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Authors: Diab Z., Hamad A., Dixit A., Al-Rikabi M., Keshaverzi F.

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Introduction: According to the NICE guidelines, 2020Prasugrel is the recommended first line treatment in adults with acute coronary syndromes (ACS) in patients with ST-segment-elevation myocardial infarction (STEMI), defined as ST elevation or new left bundle branch block on ECG , that cardiologists intend to treat with primary percutaneous coronary intervention (PCI). The current literature suggests that this is largely due to safety and efficacy, and cost effectiveness. We wanted to do an audit to examine the adherence of the MRI hospital with guidelines in using prasugrel as first-line therapy in patients with STEMI and undergoing PPCI. AIM: To examine the adherence of the MRI hospital with guidelines in using prasugrel as first-line therapy in patients with STEMI and undergoing PPCI Methods: We looked at the patients presented to MRI during1^st of January 2022 to 28th February 2022. We included all the people who were above 18 and were brought to the hospital through the PPCI pathway and diagnosed as ACS and underwent PPCI. We excluded Patients who were brought to the hospital through the PPCI pathway and underwent coronary angiography and their diagnosis was found other than STEMI or if the outcome was death before discharge or they were above age >75 (as per guideline increase bleeding risk of prasugrel in a person aged 75 or older). Results: The total number of patients was 100. There were a total of seventy patients who had STEMI and fit the criteria for inclusion. Out of these, only 72.9% (51) were given Prasugrel as a first line. Seventeen (17) 24.3% STEMI patients were candidates for prasugrel as first-line therapy but were instead offered (clopidogrel/ticagrelor). Two 2 (2.9%) STEMI patients were not given prasugrel as first-line therapy because of C/I (CVA) or the use of anticoagulant Nine 9 (9%) of them died before discharge. Eleven 11 (11%) were above the age of 75. Ten 10 (10%) of patients had a diagnosis other than STEMI. Conclusions and recommendations: Our audit has shown the need to increase awareness amongst staff re: the first line use of Prasugrel as per NICE guidelines. We aim to arrange awareness sessions for staff and increase visibility of the guidelines for the staff to encourage them to adhere to the guideline. Further research is needed to find the optimum treatment in patients above 75.

Keywords: pasurgrel, PCI, NICE, STEMI

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Authors: Vanessa Vasconcelos, Mariza A. S. Bigonha

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In order to facilitate both processes, this paper presents HaskellFL, a tool that uses fault localization techniques to locate a logical error in Haskell code. The Haskell subset used in this work is sufficiently expressive for those studying functional programming to get immediate help debugging their code and to answer questions about key concepts associated with the functional paradigm. HaskellFL was tested against functional programming assignments submitted by students enrolled at the functional programming class at the Federal University of Minas Gerais and against exercises from the Exercism Haskell track that are publicly available on GitHub. Furthermore, the EXAM score was chosen to evaluate the tool’s effectiveness, and results showed that HaskellFL reduced the effort needed to locate an error for all tested scenarios. Results also showed that the Ochiai method was more effective than Tarantula.

Keywords: debug, fault localization, functional programming, Haskell

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Authors: Renata L. C. Leão, João E. Nascimento, Natalia C. E. S. Nascimento, Elaine S. Vasconcelos, Mércia L. Oliveira

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The quality control procedures of a radiopharmaceutical include the assessment of its chemical purity. The method suggested by international pharmacopeias consists of a thin layer chromatographic run. In this paper, the method proposed by the United States Pharmacopeia (USP) is compared to a direct method to determine the final concentration of aminopolyether in Fludeoxyglucose (¹⁸F-FDG) preparations. The approach (no chromatographic run) was achieved by placing the thin-layer chromatography (TLC) plate directly on an iodine vapor chamber. Both methods were validated and they showed adequate results to determine the concentration of aminopolyether in ¹⁸F-FDG preparations. However, the direct method is more sensitive, faster and simpler when compared to the reference method (with chromatographic run), and it may be chosen for use in routine quality control of ¹⁸F-FDG.

Keywords: chemical purity, Kryptofix 222, thin layer chromatography, validation

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Authors: T. Arkle, D. Pournaras, S. Lam, B. Kumar

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Introduction: Fundoplication is widely recognised as the best surgical option for gastro-oesophageal reflux disease (GORD) in the general population. However, there is controversy surrounding the use of conventional fundoplication in obese patients. Whilst the intra-operative failure of fundoplication, including wrap disruption, is reportedly higher in obese individuals, the more significant issue surrounds symptom recurrence post-surgery. Could a bariatric procedure be considered in obese patients for weight management, to treat the GORD, and to also reduce the risk of recurrence? Roux-en-Y gastric bypass, a widely performed bariatric procedure, has been shown to be highly successful both in controlling GORD symptoms and in weight management in obese patients. Furthermore, NICE has published clear guidelines on eligibility for bariatric surgery, with the main criteria being type 3 obesity or type 2 obesity with the presence of significant co-morbidities that would improve with weight loss. This study aims to identify the proportion of patients who undergo conventional fundoplication for GORD and/or hiatus hernia, which would have been eligible for bariatric surgery referral according to NICE guidelines. Methods: All patients who underwent fundoplication procedures for GORD and/or hiatus hernia repair at a single NHS foundation trust over a 10-year period will be identified using the Trust’s health records database. Pre-operative patient records will be used to find BMI and the presence of significant co-morbidities at the time of consideration for surgery. This information will be compared to NICE guidelines to determine potential eligibility for the bariatric surgical referral at the time of initial surgical intervention. Results: A total of 321 patients underwent fundoplication procedures between January 2011 and December 2020; 133 (41.4%) had available data for BMI or to allow BMI to be estimated. Of those 133, 40 patients (30%) had a BMI greater than 30kg/m², and 7 (5.3%) had BMI >35kg/m². One patient (0.75%) had a BMI >40 and would therefore be automatically eligible according to NICE guidelines. 4 further patients had significant co-morbidities, such as hypertension and osteoarthritis, which likely be improved by weight management surgery and therefore also indicated eligibility for referral. Overall, 3.75% (5/133) of patients undergoing conventional fundoplication procedures would have been eligible for bariatric surgical referral, these patients were all female, and the average age was 60.4 years. Conclusions: Based on this Trust’s experience, around 4% of obese patients undergoing fundoplication would have been eligible for bariatric surgical intervention. Based on current evidence, in class 2/3 obese patients, there is likely to have been a notable proportion with recurrent disease, potentially requiring further intervention. These patient’s may have benefitted more through undergoing bariatric surgery, for example a Roux-en-Y gastric bypass, addressing both their obesity and GORD. Use of patient written notes to obtain BMI data for the 188 patients with missing BMI data and further analysis to determine outcomes following fundoplication in all patients, assessing for incidence of recurrent disease, will be undertaken to strengthen conclusions.

Keywords: bariatric surgery, GORD, Nissen fundoplication, nice guidelines

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Authors: Hossein Afzali

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Increasingly, decision analytic models are used to inform decisions about whether or not to publicly fund new health technologies. It is well noted that the accuracy of model predictions is strongly influenced by the appropriateness of model structuring. However, there is relatively inadequate methodological guidance surrounding this issue in guidelines developed by national funding bodies such as the Australian Pharmaceutical Benefits Advisory Committee (PBAC) and The National Institute for Health and Care Excellence (NICE) in the UK. This presentation aims to discuss issues around model structuring within decision making with a focus on (1) the need for a transparent and evidence-based model structuring process to inform the most appropriate set of structural aspects as the base case analysis; (2) the need to characterise structural uncertainty (If there exist alternative plausible structural assumptions (or judgements), there is a need to appropriately characterise the related structural uncertainty). The presentation will provide an opportunity to share ideas and experiences on how the guidelines developed by national funding bodies address the above issues and identify areas for further improvements. First, a review and analysis of the literature and guidelines developed by PBAC and NICE will be provided. Then, it will be discussed how the issues around model structuring (including structural uncertainty) are not handled and justified in a systematic way within the decision-making process, its potential impact on the quality of public funding decisions, and how it should be presented in submissions to national funding bodies. This presentation represents a contribution to the good modelling practice within the decision-making process. Although the presentation focuses on the PBAC and NICE guidelines, the discussion can be applied more widely to many other national funding bodies that use economic evaluation to inform funding decisions but do not transparently address model structuring issues e.g. the Medical Services Advisory Committee (MSAC) in Australia or the Canadian Agency for Drugs and Technologies in Health.

Keywords: decision-making process, economic evaluation, good modelling practice, structural uncertainty

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Authors: Stavroula Stavropoulou-Tatla, Danyal Awal, Mohammad Ayaz Hossain

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The first wave of the COVID-19 pandemic saw several countries issue guidance postponing all non-urgent diagnostic evaluations and operations, leading to an estimated backlog of 28 million cases worldwide and over 4 million in the UK alone. In an attempt to regulate the resumption of elective surgical activity, the National Institute for Health and Care Excellence (NICE) introduced the ‘COVID-19 rapid guideline [NG179]’. This project aimed to increase healthcare staff knowledge of the aforementioned guideline to a targeted score of 100% in the disseminated questionnaire within 3 months at the Royal Free Hospital. A standardized online questionnaire was used to assess the knowledge of surgical and medical staff at baseline and following each 4-week-long Plan-Study-Do-Act (PDSA) cycle. During PDSA1, the A4 visual summary accompanying the guideline was visibly placed in all relevant clinical areas and the full guideline was distributed to the staff in charge together with a short briefing on the salient points. PDSA2 involved brief small-group teaching sessions. A total of 218 responses was collected. Mean percentage scores increased significantly from 51±19% at baseline to 81±16% after PDSA1 (t=10.32, p<0.0001) and further to 93±8% after PDSA2 (t=4.9, p<0.0001), with 54% of participants achieving a perfect score. In conclusion, the targeted distribution of guideline printouts and visual aids, combined with small-group teaching sessions, were simple and effective ways of educating healthcare staff about the new standards of elective surgical care at the time of COVID-19. This could facilitate the safe restoration of surgical activity, which is critical in order to mitigate the far-reaching consequences of surgical delays on an unprecedented scale during a time of great crisis and uncertainty.

Keywords: COVID-19, elective surgery, NICE guidelines, quality improvement

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Authors: N. Sena, C. Vasconcelos

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Portugal has a lower rate of people who exercise. Fitness centers are a widely recognized context for the performance of an exercise. Thus, the objective of this study is to analyze the motivational factors for the practice of exercise in a sample of Portuguese fitness center users. The sample consists of 34 users (23 men and 11 women), aged between 16 and 60 years old (24.7 ± 11,5 years old). The instrument used for data collection was the Motivation Questionnaire for Exercise (version translated and validated into Portuguese), consisting of forty-nine items grouped into ten motivational factors. Responses to the Exercise Motivation Questionnaire are given on a 6-point Likert scale (0="not at all true for me" to 5="completely true for me"). With regard to the results, it is possible to verify that the motivational factors considered most relevant by the sample of our study were “Well-being” (4.44 ± 0.28), followed by “Health” (4.29 ± 0.57) and “Stress Management” (4.06 ± 0.54). The factors “Affiliation” (3.11 ± 0.49) “Personal Appreciation” (2.26 ± 0.59) and “Medical History” (1.71 ± 0.74) were considered by the respondents to be the least important factors for performing the exercise. The conclusion of this study is that in the sample of this study, the factors that most motivated the practice of exercise were “Well-being”, “Health” and “Stress Management”. In the opposite direction, the factors that least motivated the individuals in this sample to practice exercise were “Affiliation”, “Personal Appreciation” and “Medical History”.

Keywords: exercise, fitness center users, motivational factors, Portugal

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Authors: Aref Aasi, Sahar Ebrahimi Bajgani, Erfan Aasi

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Breast cancer (BC) continues to be the most frequent cancer in females and causes the highest number of cancer-related deaths in women worldwide. Inspired by recent advances in studying the relationship between different patient attributes and features and the disease, in this paper, we have tried to investigate the different classification methods for better diagnosis of BC in the early stages. In this regard, datasets from the University Hospital Centre of Coimbra were chosen, and different machine learning (ML)-based and neural network (NN) classifiers have been studied. For this purpose, we have selected favorable features among the nine provided attributes from the clinical dataset by using a random forest algorithm. This dataset consists of both healthy controls and BC patients, and it was noted that glucose, BMI, resistin, and age have the most importance, respectively. Moreover, we have analyzed these features with various ML-based classifier methods, including Decision Tree (DT), K-Nearest Neighbors (KNN), eXtreme Gradient Boosting (XGBoost), Logistic Regression (LR), Naive Bayes (NB), and Support Vector Machine (SVM) along with NN-based Multi-Layer Perceptron (MLP) classifier. The results revealed that among different techniques, the SVM and MLP classifiers have the most accuracy, with amounts of 96% and 92%, respectively. These results divulged that the adopted procedure could be used effectively for the classification of cancer cells, and also it encourages further experimental investigations with more collected data for other types of cancers.

Keywords: breast cancer, diagnosis, machine learning, biomarker classification, neural network

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Authors: Pedro Dias, Lurdes Verissimo, Maria Joao Baptista, Ana Pinheiro, Patricia Oliveira-Silva, Sofia Serra, Daniela Coimbra

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To achieve a high standard in performance, a musician must be well in all aspects of health (physical, mental and social). Anxiety in performance is related to the high level of coordination and skill needed in performance, as well as to the public evaluation of the performer. It affects some key elements of performance, such as concentration, memory, motor coordination, and relaxation. This work presents two studies focused on the adaptation and evaluation of the psychometric properties of the Music Performance Anxiety Inventory (MPAI-A) in young Portuguese music students. The first study was conducted with a sample of 161 adolescent music students, who responded to the Portuguese version of this instrument, and to the State-Trait Anxiety Inventory for Children (STAIC-c2). Validity and reliability were examined, and this measure revealed robust psychometric properties in this sample. The second study aimed to adapt the MPAI to a younger population (one hundred 8-10 years-old music students). Again, the MPAI and the STAIC c-2 were used in this study. Exploratory factor analysis, correlations, and internal consistency were used to evaluate the final children version of the instrument (MPAI-C), presenting a different factor structure compared to the adolescent version (10 items organized in 2 factors) and high levels of reliability and convergent validity.

Keywords: anxiety, assessment, children and adolescents, music performance

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Authors: Rômulo Eustáquio Martins de Souza, Paulo Alexandre Rodrigues de Vasconcelos Figueiredo

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In recent years, there has been a surge in interest in applying artificial intelligence techniques, particularly machine learning algorithms. Machine learning is a data-analysis technique that automates the creation of analytical models, making it especially useful for designing complex situations. As a result, this technology aids in reducing human intervention while producing accurate results. This methodology is also extensively used in aerospace engineering since this is a field that encompasses several high-complexity operations, such as rocket propulsion. Rocket propulsion is a high-risk operation in which engine failure could result in the loss of life. As a result, it is critical to use computational methods capable of precisely representing the spacecraft's analytical model to guarantee its security and operation. Thus, this paper describes the use of machine learning algorithms for rocket propulsion to aid the realization that this technique is an efficient way to deal with challenging and restrictive aerospace engineering activities. The paper focuses on three machine-learning-aided rocket propulsion applications: set-point control of an expander-bleed rocket engine, supersonic retro-propulsion of a small-scale rocket, and leak detection and isolation on rocket engine data. This paper describes the data-driven methods used for each implementation in depth and presents the obtained results.

Keywords: data analysis, modeling, machine learning, aerospace, rocket propulsion

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Authors: Jairson Barbosa Rodrigues, Paulo Romero Martins Maciel, Germano Crispim Vasconcelos

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This paper presents an investigation of the performance impacts regarding the variation of five factors (input data size, node number, cores, memory, and disks) when applying a distributed implementation of Naïve Bayes for text classification of a large Corpus on the Spark big data processing framework. Problem: The algorithm's performance depends on multiple factors, and knowing before-hand the effects of each factor becomes especially critical as hardware is priced by time slice in cloud environments. Objectives: To explain the functional relationship between factors and performance and to develop linear predictor models for time and cost. Methods: the solid statistical principles of Design of Experiments (DoE), particularly the randomized two-level fractional factorial design with replications. This research involved 48 real clusters with different hardware arrangements. The metrics were analyzed using linear models for screening, ranking, and measurement of each factor's impact. Results: Our findings include prediction models and show some non-intuitive results about the small influence of cores and the neutrality of memory and disks on total execution time, and the non-significant impact of data input scale on costs, although notably impacts the execution time.

Keywords: big data, design of experiments, distributed machine learning, natural language processing, spark

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Authors: Tiago Sampaio, André Vasconcelos, Bruno Fragoso

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The Normalized Systems Theory, which is designed to be applied to software architectures, provides a set of theorems, elements and rules, with the purpose of enabling evolution in Information Systems, as well as ensuring that they are ready for change. In order to make that possible, this work’s solution is to apply the Normalized Systems Theory to the domain of enterprise architectures, using Archimate. This application is achieved through the adaptation of the elements of this theory, making them artifacts of the modeling language. The theorems are applied through the identification of the viewpoints to be used in the architectures, as well as the transformation of the theory’s encapsulation rules into architectural rules. This way, it is possible to create normalized enterprise architectures, thus fulfilling the needs and requirements of the business. This solution was demonstrated using the Portuguese Public Procurement System. The Portuguese government aims to make this system as fair as possible, allowing every organization to have the same business opportunities. The aim is for every economic operator to have access to all public tenders, which are published in any of the 6 existing platforms, independently of where they are registered. In order to make this possible, we applied our solution to the construction of two different architectures, which are able of fulfilling the requirements of the Portuguese government. One of those architectures, TO-BE A, has a Message Broker that performs the communication between the platforms. The other, TO-BE B, represents the scenario in which the platforms communicate with each other directly. Apart from these 2 architectures, we also represent the AS-IS architecture that demonstrates the current behavior of the Public Procurement Systems. Our evaluation is based on a comparison between the AS-IS and the TO-BE architectures, regarding the fulfillment of the rules and theorems of the Normalized Systems Theory and some quality metrics.

Keywords: archimate, architecture, broker, enterprise, evolvable systems, interoperability, normalized architectures, normalized systems, normalized systems theory, platforms

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Authors: Zahra R. Almansoor

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Background: Selective serotonin reuptake inhibitors (SSRI’s) and cognitive behavioural therapy (CBT) are the main treatment methods used for patients with obsessive compulsive disorder (OCD) under the National Institute of Health and Care Excellence (NICE) guidelines. Yet many patients are left with residual symptoms or remit, so several other therapeutic approaches have been explored. Objective: The objective was to systematically review the available literature regarding the treatment efficacy of current and potential approaches and diagnostic strategies. Method: First, studies were examined concerning diagnosis, prognosis, and influencing factors. Then, one reviewer conducted a systematic search of six databases using stringent search terms. Results of studies exploring the efficacy of treatment interventions were analysed and compared separately for adults and children. This review was limited to randomised controlled trials (RCT’s) conducted from 2016 onwards, and an improved Y-BOCS (Yale- Brown obsessive compulsive scale) score was the primary outcome measure. Results: Technology-based interventions including internet-based cognitive behavioural therapy (iCBT) were deemed as potentially effective. Discrepancy remains about the benefits of SSRI use past one year, but potential medication adjuncts include amantadine. Treatments such as association splitting and family and mindfulness strategies also have future potential. Conclusion: A range of potential therapies exist, either as treatment adjuncts to current interventions or as sole therapies. To further improve efficacy, it may be necessary to remodel the current NICE stepped-care model, especially regarding the potential use of lower intensity, cheaper treatments, including iCBT. Although many interventions show promise, further research is warranted to confirm this.

Keywords: family and group treatment, mindfulness strategies, novel treatment approaches, standard treatment, technology-based interventions

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Authors: I. Ramalho, S. Campos, M. Dias

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Introduction: Endometriosis may play a role in the pathogenesis of ovarian cancer (OC), however, the risk and prognosis have not been well established. The association between these two pathologies could have an important impact on prevention and early diagnosis of OC. Objective: To analyze the prevalence of endometriosis associated ovarian cancer and related clinical, epidemiological and histopathological issues. Design: We conducted a retrospective case series analysis of patients diagnosed with endometriosis and ovarian cancer in the Gynecology Department of Coimbra University Hospital Center since 2006 to 2015. Methods: We collected data from women diagnosed with ovarian cancer, with anatomopathology records reporting findings of endometriosis in ovarian cancer patients. Patients were retrieved from the pathological records and appropriate medical records were retrospectively reviewed. Statistical analysis was performed using SPSS 22.0. Results: Histological evidence of endometriosis was found in 17 out of 261 patients diagnosed with ovarian cancer (OC) (6.51%). The most usual symptoms were pelvic pain, abdominal distension, asthenia, ascites, weight loss and nausea. Mean age at diagnosis was 61.2 ± 15.1, 41-86 years old, 33.3% were pre-menopausal patients and cancer stage distribution was predominantly stage I (31.3%) and stage III (56.3%). OC occurred unilaterally in 14 patients and 2 patients were diagnosed with a synchronous ovarian and endometrial cancer. Regarding histological type, 10 OC were classified as clear cell carcinoma (CCC), 4 endometrioid carcinomas (EC) and 3 mixed type (clear cell and endometrioid). Four ovarian carcinomas presumably arose from endometriomas: 3 CCC and 1 EC. Conclusions: In accordance with previous studies, clear cell was the most common pathological type in endometriotic patients, followed by endometrioid carcinomas, and two rare synchronous ovarian and endometrial carcinomas were registered. Although endometriosis association to OC is uncommon, endometriosis should be managed with special care in order to early diagnosis.

Keywords: endometriosis, histology, observational study, ovarian cancer

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