Repositório RCAAP

Patients with heart failure (HF), particularly those with impaired renal function receiving renin-angiotensin-aldosterone system inhibitors (RAASis), are at risk of hyperkalaemia; when hyperkalaemia is severe, this can have serious clinical consequences. The incidence, prevalence, and risk factors for hyperkalaemia reported in randomized trials of RAASis may not reflect clinical practice due to exclusion of patients with elevated serum potassium (sK+ ) or severe renal impairment: information on patients managed in routine clinical care is important to understanding the actual burden of hyperkalaemia. This paper reviews the available clinical epidemiology data on hyperkalaemia in HF and considers areas requiring further research. Observational studies published since 2017 that focused on hyperkalaemia, included patients with HF, and had ≥1000 participants were considered. Hyperkalaemia occurrence in HF varied widely from 7% to 39% depending on the setting, HF severity, follow-up length, and concomitant medications. Rates were lowest in patients with newly diagnosed HF and highest in patients with greater disease severity; comorbidities, such as chronic kidney disease and diabetes, and RAASi use, reflected commonly identified risk factors for hyperkalaemia in patients with HF. Hyperkalaemia was most often mild; however, from the limited data available, persistence of mild hyperkalaemia was associated with an increased risk of mortality and major adverse cardiovascular events. There were also limited data available on the progression of hyperkalaemia. Recurrence was common, occurring in one-quarter to two-fifths of hyperkalaemia cases. Despite HF guidelines recommending close monitoring of sK+ , 55-93% of patients did not receive appropriate testing before or after initiation of RAASi or in follow-up to moderate/severe hyperkalaemia detection. Many of the observational studies were retrospective and from a single country. There is a need for international, prospective, longitudinal, observational studies, such as the CARE-HK in HF study (NCT04864795), to understand hyperkalaemia's prevalence, incidence, and severity; to identify and characterize cases that persist, progress, and recur; to highlight the importance of sK+ monitoring when using RAASi; and to assess the impact of newer HF therapies and potassium binders in clinical practice. Data from both clinical trials and observational studies with adjustments for confounding variables will be needed to assess the contribution of hyperkalaemia to clinical outcomes.

Introduction: Two of the main reasons recent guidelines do not recommend routine population-wide screening programs for asymptomatic carotid artery stenosis (AsxCS) is that screening could lead to an increase of carotid revascularization procedures and that such mass screening programs may not be cost-effective. Nevertheless, selective screening for AsxCS could have several benefits. This article presents the rationale for such a program. Areas covered: The benefits of selective screening for AsxCS include early recognition of AsxCS allowing timely initiation of preventive measures to reduce future myocardial infarction (MI), stroke, cardiac death and cardiovascular (CV) event rates. Expert opinion: Mass screening programs for AsxCS are neither clinically effective nor cost-effective. Nevertheless, targeted screening of populations at high risk for AsxCS provides an opportunity to identify these individuals earlier rather than later and to initiate a number of lifestyle measures, risk factor modifications, and intensive medical therapy in order to prevent future strokes and CV events. For patients at 'higher risk of stroke' on best medical treatment, a prophylactic carotid intervention may be considered.

Introduction: Extensively drug-resistant Pseudomonas aeruginosa (XDR-PA) is a growing concern due to its increasing incidence, limited therapeutic options, limited data on the optimal treatment, and high mortality rates. The study aimed to characterize the population, the outcome and the microbiological characteristics of XDR-PA identified in a Portuguese university hospital center. Methods: All XDR-PA isolates between January 2019 and December 2021 were identified. XDR-PA was defined as resistance to piperacillin-tazobactam, third and fourth generation cephalosporins, carbapenems, aminoglycosides and fluoroquinolones. A retrospective analysis of the medical records was performed. Results: One hundred seventy-eight individual episodes among 130 patients with XDR-PA detection were identified. The most common sources of infection were respiratory (32%) and urinary tracts (30%), although skin and soft tissue infections (18%) and primary bacteremia (14%) were also prevalent. Colonization was admitted in 64 cases. Several patients had risk factors for complicated infections, most notably immunosuppression, structural lung abnormalities, major surgery, hemodialysis or foreign intravascular or urinary devices. XDR-PA identification was more frequent in male patients with an average age of 64.3 ± 17.5 years. One non-susceptibility to colistin was reported. Only 12.4% were susceptible to aztreonam. Ceftazidime-avibactam (CZA) was susceptible in 71.5% of the tested isolates. Ceftolozane-tazobactam (C/T) was susceptible in 77.5% of the tested isolates. Antibiotic regimens with XDR-PA coverage were reserved for patients with declared infection, except to cystic fibrosis. The most frequently administered antibiotics were colistin (41 cases), CZA (39 cases), and C/T (16 cases). When combination therapy was used, CZA plus colistin was preferred. The global mortality rate among infected patients was 35.1%, significantly higher in those with hematologic malignancy (50.0%, p < 0.05), followed by the ones with bacteremia (44.4%, p < 0.05) and those medicated with colistin (39.0%, p < 0.05), especially the ones with respiratory infections (60.0%). Among patients treated with CZA or C/T, the mortality rate seemed to be lower. Discussion: XDR-PA infections can be severe and difficult to treat, with a high mortality rate. Even though colistin seems to be a viable option, it is likely less safe and efficient than CZA and C/T. To the best of the authors' knowledge, this is the first description of the clinical infection characteristics and treatment of XDR-PA in Portugal.

Ao longo destas páginas procuraremos perceber por que razão e de que modo a fotografia se revelou latente na prática pictórica ocidental desde há muito, assim como se manteve presente nesta, mesmo após a sua patência isto é, após o seu nascimento oficial enquanto técnica mecânica de reprodução de imagens

In eukaryotes, the production of mature messenger RNA that exits the nucleus to be translated into protein in the cytoplasm requires precise and extensive modification of the nascent transcript. Any failure that compromises the integrity of an mRNA may cause its retention in the nucleus and trigger its degradation. Multiple studies indicate that mRNAs with processing defects accumulate in nuclear foci or ‘dots’ located near the site of transcription, but how exactly are defective RNAs recognized and tethered is still unknown. Here, we present evidence suggesting that unprocessed β-globin transcripts render RNA polymerase II (Pol II) incompetent for termination and that this quality control process requires the integrity of the nuclear exosome. Our results show that unprocessed pre-mRNAs remain tethered to the DNA template in association with Pol II, in an Rrp6-dependent manner. This reveals an unprecedented link between nuclear RNA surveillance, the exosome and Pol II transcriptional termination.

Reading is a cultural activity too recent in the history of the humankind to be encrypted in the human genome but, paradoxically, some people fail to achieve fluent reading, despite adequate instruction and no sensorial or general cognitive deficits that could explain such specific difficulty. Intensive research has been devoted to the neurocognitive mechanisms of reading and the putative differences related to this specific developmental reading disorder or dyslexia. Much research has focused on the relation between literacy and oral language but reading is also an intensive visual activity that requires specific adaptations of the visual ventral system, including the suppression of mirror invariance (the perceptual bias by which one stimulus and its lateral reflection or mirror image, e.g., d and b, are processed as equivalent percept). Interestingly, reversal errors (e.g., confusing d with b) have long been documented in dyslexia. In the present paper, we review the available evidence regarding mirror-image processing in dyslexic children, taking into account the methodological aspects and shortcomings of prior studies. We also revisit our findings with typically-developing children (preliterate children and first grade beginning readers) and adults (illiterate, ex-illiterate, and schooled literate), and dyslexic children and their two control groups (of chronological age, and of reading level). Our research suggests that dyslexic readers fail to acquire the automatic changes promoted by literacy acquisition outside the written domain. More specifically, we argue that mirrorimage discrimination, which is triggered by learning to read and occurs automatically in the course of visual object recognition in typically-developing readers, may never become automatized in dyslexic readers.

No summary/description provided

A considerable amount of the population in more economically developed countries are functionally illiterate (i.e., low literate). Despite some years of schooling and basic reading skills, these individuals cannot properly read and write and, as a consequence have problems to understand even short texts. An often-discussed approach (Greenberg et al. 1997) assumes weak phonological processing skills coupled with untreated developmental dyslexia as possible causes of functional illiteracy. Although there is some data suggesting commonalities between low literacy and developmental dyslexia, it is still not clear, whether these reflect shared consequences (i.e., cognitive and behavioral profile) or shared causes. The present systematic review aims at exploring the similarities and differences identified in empirical studies investigating both functional illiterate and developmental dyslexic samples. Nine electronic databases were searched in order to identify all quantitative studies published in English or German. Although a broad search strategy and few limitations were applied, only 5 studies have been identified adequate from the resulting 9269 references. The results point to the lack of studies directly comparing functional illiterate with developmental dyslexic samples. Moreover, a huge variance has been identified between the studies in how they approached the concept of functional illiteracy, particularly when it came to critical categories such the applied definition, terminology, criteria for inclusion in the sample, research focus, and outcome measures. The available data highlight the need for more direct comparisons in order to understand what extent functional illiteracy and dyslexia share common characteristics.

Insect pollinator biodiversity is changing rapidly, with potential consequences for the provision of crop pollination. However, the role of land use–climate interactions in pollinator biodiversity changes, as well as consequent economic effects via changes in crop pollination, remains poorly understood. We present a global assessment of the interactive effects of climate change and land use on pollinator abundance and richness and predictions of the risk to crop pollination from the inferred changes. Using a dataset containing 2673 sites and 3080 insect pollinator species, we show that the interactive combination of agriculture and climate change is associated with large reductions in insect pollinators. As a result, it is expected that the tropics will experience the greatest risk to crop production from pollinator losses. Localized risk is highest and predicted to increase most rapidly, in regions of sub-Saharan Africa, northern South America, and Southeast Asia. Via pollinator loss alone, climate change and agricultural land use could be a risk to human well-being.

Com o continuado aumento das necessidades energéticas da sociedade torna-se imprescindível pensar em soluções para obter a energia necessária através de sistemas de produção que não comprometam as gerações futuras, sistemas renováveis. Os sistemas de produção de energia fotovoltaicos têm ganho uma grande importância pela sua simplicidade e relativo baixo custo. De modo a aproveitar áreas inutilizadas para a produção de energia surge a ideia fulcral para este trabalho, a utilização das laterais das autoestradas portuguesas para este mesmo efeito através de sistemas fotovoltaicos. Ao longo deste trabalho foram analisados dois tipos de sistema, um vertical, com módulos bifaciais (podendo substituir barreiras acústicas), e um inclinado, mais convencional. Tendo em conta algumas aproximações serão apresentados valores expectáveis de produção para diferentes casos de estudo (alguns com sistemas verticais bifaciais, outros com sistemas inclinados monofaciais). O impacto do aumento da circulação de veículos elétricos é também abordado de forma a compreender se tal produção pode compensar o aumento do consumo. A incorporação de sistemas de produção de energia fotovoltaica ao longo das autoestradas portuguesas pode ser benéfica em termos energéticos. Os cálculos realizados apontam para uma produção de cerca 4069 GWh/ano para sistemas bifaciais na totalidade da extensão das autoestradas e cerca de 4501 GWh/ano para sistemas inclinados na mesma extensão. A substituição de barreiras acústicas já existentes aponta para a geração de cerca de 200 GWh/ano.

Groundwater is a vital ecosystem of the global water cycle, hosting unique biodiversity and providing essential services to societies. Despite being the largest unfrozen freshwater resource, in a period of depletion by extraction and pollution, groundwater environments have been repeatedly overlooked in global biodiversity conservation agendas. Disregarding the importance of groundwater as an ecosystem ignores its critical role in preserving surface biomes. To foster timely global conservation of groundwater, we propose elevating the concept of keystone species into the realm of ecosystems, claiming groundwater as a keystone ecosystem that influences the integrity of many dependent ecosystems. Our global analysis shows that over half of land surface areas (52.6%) has a medium-to-high interaction with groundwater, reaching up to 74.9% when deserts and high mountains are excluded. We postulate that the intrinsic transboundary features of groundwater are critical for shifting perspectives towards more holistic approaches in aquatic ecology and beyond. Furthermore, we propose eight key themes to develop a science-policy integrated groundwater conservation agenda. Given ecosystems above and below the ground intersect at many levels, considering groundwater as an essential component of planetary health is pivotal to reduce biodiversity loss and buffer against climate change.

The present work investigates the feasibility of producing boards, with unconventional materials, namely hazelnut shells as a high-mass bio-aggregate and a sodium silicate solution as a no-toxic adhesive, and discusses possible applications based on an extensive characterization. The aim is to define a feasible reuse of a largely produced agro-industrial by-product to reduce the high environmental impact caused by both the construction and the agriculture sectors, by proposing a building composite that improves indoor comfort. The presented combination of aggregate-adhesive generated a product with characteristics interesting to explore. The thermal conductivity is moderated, and the composite achieved values of σmax = 0.39 N/mm2 for flexural strength and σmax = 2.1 N/mm2 for compressive strength, but it showed high sorption capacity with a moisture buffering value of about 3.45 g/(m2 %RH), and a peak of sound absorption between 700 and 900 Hz. Therefore, the boards’ most promising performance parameters seem to be their high hygroscopicity and acoustic absorption behaviour, namely in the frequency range of the human voice. Hence, the proposed composite could improve indoor comfort if applied as an internal coating board.

Caffeine causes most of its biological effects via antagonizing all types of adenosine receptors (ARs): A1, A2A, A3, and A2B and, as does adenosine, exerts effects on neurons and glial cells of all brain areas. In consequence, caffeine, when acting as an AR antagonist, is doing the opposite of activation of adenosine receptors due to removal of endogenous adenosinergic tonus. Besides AR antagonism, xanthines, including caffeine, have other biological actions: they inhibit phosphodiesterases (PDEs) (e.g., PDE1, PDE4, PDE5), promote calcium release from intracellular stores, and interfere with GABA-A receptors. Caffeine, through antagonism of ARs, affects brain functions such as sleep, cognition, learning, and memory, and modifies brain dysfunctions and diseases: Alzheimer’s disease, Parkinson’s disease, Huntington’s disease, Epilepsy, Pain/Migraine, Depression, Schizophrenia. In conclusion, targeting approaches that involve ARs will enhance the possibilities to correct brain dysfunctions, via the universally consumed substance that is caffeine.

Masting, the synchronized production of variable quantities of seeds, is a global phenomenon in diverse ecosystems, including treed grazing systems where trees and grazing animals coexist. This phenomenon can be interspersed with years of extreme crop failure, whose frequency and unpredictability are increasing. Yet, the combined impact of crop failure and grazing on seed dispersal and seed-to-seedling transition remains poorly understood. To address this concern, we investigated rodent-mediated cork-oak (Quercus suber) acorn predation, dispersal, and seedling emergence in cattle grazed and non-grazed areas in central Portugal during years with contrasting masting seasons. We found that the acorns supplied in the crop failure year were dispersed more rapidly and over longer distances than those supplied in the crop success year when other acorns were naturally available. The crop failure year also had 83 % more dispersal events and 84 % more predated acorns than the reproductive success year. However, the higher acorn predation was offset by a 2.4-fold higher percentage of unpredated dispersed acorns recruiting into seedlings. Both years ended up recruiting a similar number of seedlings. Acorns emerged seedlings 3.4 times farther in the crop failure year than in the crop success year. Cattle grazing was the main constraint on seed dispersal distance by rodents, reducing it by 53 %. Our study provides empirical evidence that cattle grazing modulates how an extreme crop failure year can surprisingly be an opportunity for the few existing acorns to have seedlings established farther apart than in a crop success year. If we are to better manage and preserve the high conservation and socio-economic value of Mediterranean cork oak woodlands in the face of climate change, we must prioritize fecund trees and carefully manage seed dispersal factors such as cattle grazing, particularly during years of crop failure.

Laboratory tests were carried out to evaluate the feasibility of producing boards or coating panels with good hygrothermal performance by using different agro-industrial wastes (grape and olive press wastes, hazelnut shells, spent coffee and pine) and adhesives (gypsum-based binder, sodium silicate solution and starch-based glue). Hygrothermal properties and resistance to mould growth, including the effect of citric acid, were evaluated. The results highlighted the benefits and drawbacks of each adhesive: the binder seems more adequate to produce bio-based plastering mortars than boards; the other adhesives seem efficient solutions to produce boards with good hygrothermal properties; for the natural glue the bio-susceptibility needs improvement.

Gradients in community diversity and composition rarely track rates of warming, prompting efforts to understand the factors causing non-equilibrium responses to climatic change and their implications for conservation. Here, we test the roles of fine-resolution habitat heterogeneity and microclimate in delaying butterfly community responses to warming over a mountain elevation gradient. We assess species diversity and Community Temperature Index (CTI) in 2004–2005 and 2017 across 120 transect sites in the Sierra de Guadarrama (Spain), modelling temperatures based on topography, and vegetation structure based on LiDAR. A humped elevation gradient in species diversity was maintained over time. However, diversity in the later period was more positively related to vegetation heterogeneity, and sites with reduced rates of warming and greater forest cover maintained or increased their diversity. Site CTI declines with increasing elevation, showing little evidence of systematic change over the gradient between periods, although CTI increased most in locations with the greatest rates of spring microclimatic warming. Our results show that delays in community tracking of climatic conditions could result partly from positive effects of habitat and topographic heterogeneity providing microclimatic buffering against warming to existing communities; although barriers to colonization could also delay diversity increases and community thermophilization at high elevations. We suggest that protecting and managing complex habitats with high community diversity, and identifying localized microclimates that buffer populations against negative effects of warming, are more immediate conservation priorities over elevation gradients than efforts to ensure that communities track prevailing rates of warming.

It has increasingly been recognized that electrical currents play a pivotal role in cell migration and tissue repair, in a process named “galvanotaxis”. In this review, we summarize the current evidence supporting the potential benefits of electric stimulation (ES) in the physiology of peripheral nerve repair (PNR). Moreover, we discuss the potential of piezoelectric materials in this context. The use of these materials has deserved great attention, as the movement of the body or of the external environment can be used to power internally the electrical properties of devices used for providing ES or acting as sensory receptors in artificial skin (e-skin). The fact that organic materials sustain spontaneous degradation inside the body means their piezoelectric effect is limited in duration. In the case of PNR, this is not necessarily problematic, as ES is only required during the regeneration period. Arguably, piezoelectric materials have the potential to revolutionize PNR with new biomedical devices that range from scaffolds and nerve-guiding conduits to sensory or efferent components of e-skin. However, much remains to be learned regarding piezoelectric materials, their use in manufacturing of biomedical devices, and their sterilization process, to fine-tune their safe, effective, and predictable in vivo application.

The Coronavirus Disease 2019 (COVID-19) pandemic that spread through the world in 2020 had a major effect on academia. Research projects relying on participatory methods and action research approaches were especially harmed by the restrictions and changes the situation imposed. This study performs a rapid literature review to identify common themes in the narratives of published studies concerning the difficulties of carrying-out participatory research during the COVID-19 pandemic. Perceptions and experiences of the authors of these studies are compiled and summarized. Additionally, insights and lessons learned from two projects in which the authors of this study participated are discussed and used to establish a comparison with the common challenges found in the literature. Over 90% of authors experienced challenges related to digitalization and methodological changes, 70% encountered difficulties with organizational and operational aspects of research, and over 30% felt that personal challenges, as well as issues with participatory aspects of research, were significant. On a positive note, almost 40% of authors from our sample recognize that the pandemic also brought unexpected benefits, such as a reduction in logistical expenses, and the creation of new opportunities for participation. This study adds to the growing body of literature regarding the effects of the COVID-19 pandemic on the research community. Additionally, it comments on the adaptation of participatory action research methods for added sustainability and social inclusion in the face of global crises.

The identification of the main degradation agents and knowledge of the degradation mechanisms and long-term performance of ETICSs are of fundamental importance for the sustainable and efficient use of these systems. This review article presents the state of the art related to the durability of ETICSs, defining the required bases for their sustainable and efficient use. The aim is to identify the most common anomalies detected on ETICS façades and their causes, to overview the performance of ETICS, their performance parameters and requirements and to identify the most significant degradation mechanisms and the related failure modes. The results show that ETICS application is a key aspect in the performance and durability of the system, since most of the anomalies can be prevented with proper design, execution and appropriate assembly of the system components. The greatest drawbacks lie in dealing with enhancing the water resistance over time, which leads to extensive cases of anomalies, and improving the mechanical and thermal performance during the life cycle. Further research is needed to evaluate the synergistic effect of several degradation agents and mechanisms toward a development in optimized durability assessment methodologies for ETICSs.

In order to find the best and most reliable practices for ecological restoration of degraded lands, longer time scales should be considered when evaluating restoration efforts. We assessed the long-term (16 years) effects of different grassland restoration treatments – seeding, mowing, and carbon amendment – in the Pannonian sand grasslands. After re-plowing in 1 m × 1 m plots, treatments were carried out in two abandoned croplands. Seeding was applied only initially (2002) while mowing and carbon amendment were carried out for six years (2003–2008). Vegetation was surveyed yearly from 2003 to 2008 and re-sampled in 2019 in each permanent treatment plot. We used principal coordinates analysis to describe the trajectories of vegetation development and linear mixed-effects models to test changes in the relative cover of native sand grassland (target) and invasive (neophyte) species with time and treatments. Relative cover of target species increased while neophyte species decreased with time in both sites. There was a higher relative cover of target species from the first or third year on and a lower relative cover of neophyte species from the third year on in one site in seeded plots compared to other treatments. Seeded species also spread into non-seeded plots by 2019, obscuring the differences between treatments 16 years after sowing. Carbon amendment proved to be beneficial in the early and mowing in the later phases of restoration. Based on the long-term results, initial seeding is the best method for restoring sand grasslands in old fields by favoring the establishment of target species and controlling non-native invasion. As a supplement to seeding, carbon amendment can be suggested in the initial phases and/or low-intensity mowing in the later phases of the restoration after land abandonment. Although the spread from seeded plots obscured the long-term differences between treatments, it optimized the restoration process, suggesting that the use of small seed introduction units can be enough to restore the whole degraded area.