Repositório RCAAP

This study concerns the use of concepts by children and their thinking strategies playing educational games involving the number concepts of factor, prime, negative number, order relation and approximation. The games were found to constitute a stimulating learning environment and to provide observers a window on students' thinking.

Objective: To evaluate the response to CPAP in patients with chronic insomnia disorder (CID) with OSAS in an unselected patient population including all OSAS severity groups. As a secondary objective, we also wanted to evaluate the differences between patients that improve insomnia symptoms with CPAP and patients that do not improve, specifically evaluating possible gender differences. Methods: Retrospective study of patients with a diagnosis of OSAS treated with CPAP and CID at the first clinical visit, selected from a database of an outpatient sleep clinic of University Hospital. Results: From a database of total of 827 patient, 90 patients were identified with OSAS and CID (53.3% women). Middle / moderate OSAS was diagnosed in 68.9% and severe OSA in 31.1%. Most patients (61.1%) improved insomnia symptoms after CPAP therapy. In the responders group, 58.2% had initial insomnia, 63.6% middle insomnia and 12.7% late insomnia. Responders to CPAP were more frequently women (women 61.8%, men 38.2%, p = 0.035) and there was no other difference between responders and non-responders. On subgroup analysis, this difference was significant only in severe OSAS (women 88.9%, men 31.6%, p = 0.013). Conclusion: In most patients with CID and OSA, there is a consistent reduction of insomnia symptoms with the CPAP use. This factor emphasizes the importance of performing PSG in CID. Insomnia in men with severe OSAS responds less frequently to CPAP suggesting that in these cases the insomnia phenotype is less dependent on the respiratory symptoms.

The Mediterranean aquaculture has been developed mostly in brackish environment in inactive coastal salt production areas. This study aims to utilise Technosols made with aquaculture sediments for Limonium algarvense Erben cultivation. This species that has nutraceutical potential thrives in halophilic environments in the southwest of the Iberian Peninsula and in Morocco. A microcosm assay was set up with plants grown in bottom sediments (C+), commercial substrate (C-), and Technosols with amendments mixture application at 180 g/kg (Tec180) or at 360 g/kg (Tec360). These plants were irrigated with saline (assay 1) and/or with deionised water (assay 2). The bottom pond sediments, coffee wastes and the estuarine water were evaluated for diverse physicochemical parameters. Plant growth was characterised through a combined methodology using morphometric, SEM and physiological analysis. The Technosols were constructed with bottom sediments and a mixture of organic wastes used as amendments. Results revealed that the bottom sediments had low pH 3.2, Corg and extractable P and K contents, and high electroconductivity (EC) and N-NH4 concentration. The estuarine water had a neutral pH, high EC and high Cl-, HCO3-, Na+, Mg2+ and Ca2+ but low N-NO3- content. The Technosols showed a significant increase of pH, Corg, K and P and a decrease in N-NH4 and EC in comparison with sediments. Principal component analysis separated the different experiments in three groups: C-, A1 and A2 assays. The C- was highly correlated with Corg, P, K, N-NO3 parameters and total ascorbate. The A1 assay showed a strong association with Na, Ca and EC parameters, whereas the A2 assay presented a strongly correlation with plant growth. Plants from Technosols had greater development when irrigated with deionised water than under salty irrigation as opposed to plants cultivated in unamend sediments. In conclusion, these results support that highly saline sediments could be valorised through Technosols construction to cultivate plants with saline water, with potential application in the agro-food and pharmaceutical industry.

Glutamic acid decarboxylase (GAD) antibodies (ab) have been associated with rare disorders, such as Stiff-person syndrome, limbic encephalitis, cerebellar ataxia, and temporal lobe epilepsy. Other systemic autoimmune disorders have been linked to antiGAD ab, among them, diabetes mellitus (DM).

Objective: EEG value in possible transient ischemic attacks (TIA) is unknown. We aim to quantify focal slow wave activity (FSWA) and epileptiform activity (EA) frequency in possible TIA, and to analyse its contribution to the final diagnosis of seizures and/or definitive TIA. Methods: Prospective longitudinal study of possible TIA patients evaluated at a tertiary centre during 36 months and with 1-3 months follow-up. EEG was performed as soon as possible (early EEG) and one month later (late EEG). A stroke neurologist established final diagnosis after reassessing all clinical and diagnostic tests. Results: 80 patients underwent an early EEG (45.8 h after possible TIA): 52 had FSWA and 6 of them also EA. Early FSWA was associated with epileptic seizure or definitive TIA final diagnosis (p = .041). Patients with these diagnoses had more frequently early FSWA (19/23; 82.6%) than EA (6/23; 26.1%). 6/13 (46.2%) patients with epileptic seizure final diagnosis had EA.In the late EEG, 43 (58.1%) patients demonstrated persistent FSWA and 3 of them also EA. Persistent FSWA in the late EEG was more frequent in seizures than in TIA patients (91.7% vs. 45.5%). FSWA disappearance was associated with acute vascular lesion on neuroimage. Conclusions: FSWA was the commonest EEG abnormality found in the early EEG of patients with possible TIA, but did not distinguish between TIA and seizure patients. In patients with seizures, FSWA was more common than EA and its presence in the late EEG was more likely in patients with epileptic seizures than with TIA. Significance: The majority of possible TIA patients with the final diagnosis of epileptic seizures do not have EA in the early or late EEG.

A 41-year-old woman with congenital Holt-Oram syndrome, permanent pacemaker, neurogenic bladder with recurrent urinary infections, type 2 diabetes mellitus, and dyslipidemia developed recurrent episodes of somnolence, transient anterograde amnesia, irritability, anorexia, occasional changes in the eating habits (craving for French fries) and subtle derealization feelings (she felt her house and bedroom were different and strange). Her family history was positive for bipolar disorder in a first-degree relative.

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The Mediterranean diet is promoted as one of the healthiest and closely linked to socioecological practices, knowledge and traditions, promoting sustainable food production, and linking geographical origin with food quality and ecosystem services. Consumer adherence to this dietary pattern drives increased consumption of authentic “premium” foods, such as Iberian pig meat and dry-cured ham from Portugal and Spain, argan oil from Morocco, “Djebel” lamb from Tunisia and truffles from Italy and Slovenia, i.e., food products that respond to current ethical, environmental and socially sustainable demands. Geographical indication and appellation of origin can increase traditional food products competitiveness, but the high-value recognition of these products can also lead to economically motivated product adulteration. It is therefore imperative to protect the high added value of these unique food products by ensuring their quality, authenticity, provenance and sustainable production systems. In this review, we provide a critical evaluation of the analytical methods that are currently used for the determination of provenance and authenticity of these Mediterranean products as well as possible strategies for improving the throughput and affordability of the methods discussed.

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This paper describes a qualitative case study dealing with the views about mathematics teaching and learning held by students of a school involved in a experience of new curricula, stressing active methodologies and groupwork. At grade 7, the students noticed important differences in the mathematics classes and welcomed them. At grade 10, students had a general positive attitude towards mathematics but did not perceive major chnages. However, they were very concerned with the implications of this experience for their academic progression.

In heterogeneous environments, dispersal may be hampered not only by direct costs, but also because immigrants may be locally maladapted. While maladaptation affects both sexes, this cost may be modulated in females if they express mate preferences that are either adaptive or maladaptive in the new local population. Dispersal costs under local adaptation may be mitigated if it is possible to switch to expressing traits of locally adapted residents. In a sexual selection context, immigrant females may learn to mate with locally favoured males. Mate‐choice copying is a type of social learning, where individuals, usually females, update their mating preferences after observing others mate. If it allows immigrant females to switch from maladapted to locally adapted preferences, their dispersal costs are mitigated as mate choice helps them create locally adapted offspring. To study if copying can promote the evolution of dispersal, we created an individual‐based model to simulate the coevolution of four traits: copying, dispersal, a trait relevant for local adaptation, and female preference. We contrast two scenarios with copying—either unconditional or conditional such that only dispersers copy—with a control scenario that lacks any copying. We show copying to lead to higher dispersal, especially if copying is conditionally expressed. This leads to an increase in gene flow between patches and, consequently, a decrease in local adaptation and trait‐preference correlations. While our study is phrased with female preference as the learned trait, one may generally expect social learning to mitigate dispersal costs, with consequent feedback effects on the spatial dynamics of adaptation.

Home respiratory care (HRC) is the provision of healthcare services at the place of residence of patients or their families, with the aim of meeting needs mainly resulting from chronic respiratory conditions, permanent disability, or terminal illness. In 2016, an innovative electronic prescription system, PEM-CRD, was fully implemented for HRC services in Portugal. To date, no study has addressed the impact of the execution of this digital innovation. For this purpose, we carried out an analysis of the prevalence and number of prescriptions for people with chronic respiratory diseases receiving HRC in the Lisbon metropolitan area, during 2014–2018, using the information obtained from the PEM-CRD database. The data analysis shows that while the number of patients receiving HRC treatment with a prescription has remained stable over the last four years, the number of prescriptions has significantly dropped since 2016 (2016–2018), with consequent paper and processes efficiency. The implementation of the digital Medical Electronic Prescription for Home Respiratory Care tool (PEM-CRD) and consequent dematerialization of these processes has increased the efficiency of prescribing in HRC. Additionally, the possibility of obtaining data through the PEM-CRD allows the monitoring of the evolving prevalence of therapies, improving the health services optimization and allowing reporting on data other than medicines.

Background: There is increasing evidence for the role of inflammation in clinical outcome after subarachnoid hemorrhage (SAH). Specifically, the TNF-alfa(α) pathway seems to be relevant after SAH. Although the TNF-α main receptor, TNF-R1 is associated with aneurysm growth and rupture, its relation to prognosis is unknown. We sought to compare TNF-R1 levels in peripheral venous blood and arterial blood closer to the ruptured aneurysm to study the association of TNF-R1 blood levels with poor prognosis (modified Rankin Scale > 2 at discharge, 3 and 6 months) and complications (hydrocephalus or delayed cerebral ischemia/DCI) following SAH. Methods: We included consecutive SAH patients admitted in the first 72 h of symptoms. Blood samples were simultaneously collected from a peripheral vein and from the main parent artery of the aneurysm. Levels of TNF-R1 were measured using enzyme-linked immunosorbent assays. Results: We analyzed 58 patients. Arterial and venous levels of TNF-R1 were correlated (R = 0.706, p < 0.001). In multivariate regression analysis, venous TNF-R1 was an independent predictor of poor outcome at 6 months after adjusting by age and sex [odds ratio (OR) 11.63; 95% CI 2.09-64.7, p = 0.005] and after adjusting by Glasgow Coma Scale and Fisher scales (OR 8.74; 95% CI 1.45-52.7, p = 0.018). There was no association of TNF-R1 with DCI. A cut-off for arterial TNF-R1 of 1523.7 pg/mL had 75% sensitivity/66% specificity for the prediction of hydrocephalus. Conclusion: Levels of venous TNF-R1 are associated with poor outcome in SAH. A specific association was found between levels of arterial TNF-R1 and hydrocephalus. These results are consistent with the role of TNF-α pathway in SAH and need to be validated in larger cohorts.

Este estudo enquadra-se numa experiência de formação que articula conhecimentos de conteúdo e de didática da Estatística, no âmbito de um curso de especialização para professores de Matemática do ensino básico. O nosso objetivo é identificar os conhecimentos desenvolvidos pelos participantes sobre o ensino da Estatística, de modo a saber como percepcionam este processo formativo. Os dados foram coletados através de questionários, relatórios, gravações de áudio e vídeo, além de um diário de bordo, no qual analisamos o trabalho e o balanço realizado pelos participantes. Concluímos que este processo formativo teve impacto no desenvolvimento profissional dos professores no que diz respeito à valorização da abordagem exploratória da Estatística, nomeadamente na realização de investigações no contexto escolar.

Objective: Perimesencephalic hemorrhage (PMH) is a subtype of nonaneurysmal subarachnoid hemorrhage (SAH). In patients with aneurysmal SAH, the occurrence of acute ischemic lesions is associated with severity and poor outcome. We investigated the frequency of ischemic lesions on DWI in patients with PMH and compared it with the frequency of ischemic lesions in patients with aneurysmal SAH. Subjects and methods: From a prospective cohort of 80 patients with acute spontaneous SAH, we included 15 patients with PMH and 39 patients with aneurysmal SAH who were matched on the basis of their clinical condition (World Federation of Neurological Societies grade 1 or 2). MRI was performed less than 72 hours after SAH, 8-10 days after SAH, or at both points in time. The number and distribution of lesions previously seen on DWI that were also seen on a second MRI examination were assessed. Nonparametric tests were used to compare groups. Results: Early acute ischemic lesions (those identified < 72 hours after SAH) were found in 46.2% of patients with PMH and in 62.9% of patients with aneurysmal SAH. No significant differences in the number of acute ischemic lesions between groups were noted less than 72 hours after SAH (median, 0.5 lesion [interquartile range {IQR}, two lesions] in patients with PMH vs one lesion [IQR, three lesions] in patients with aneurysmal SAH [p = 0.48] or 8-10 days after SAH (median, 0.5 lesion [IQR, four lesions] in patients with PMH vs 1.5 lesions [IQR, three lesions] in patients with aneurysmal SAH [p = 0.26]). However, 58.3% of patients with aneurysmal SAH had new infarcts at 8-10 days, compared with 7.1% of patients with PMH. Patients with PMH had diffuse ischemic lesions, whereas patients with aneurysmal SAH in the anterior circulation had mainly supratentorial lesions. Conclusion: Early ischemic lesions appeared on DWI both in patients with PMH and in patients with aneurysmal SAH. The number of lesions increased during the time window for vasospasm, mainly in patients with aneurysmal SAH. Further studies are required to better understand the pathophysiologic mechanisms behind early ischemia in patients with PMH and their impact on prognosis.

Introduction: Few studies assessed diffusion tensor imaging (DTI) changes in the acute phase of subarachnoid haemorrhage (SAH). We prospectively evaluated DTI parameters in the acute phase of SAH and 8-10 days after and analysed whether changes could be related to SAH severity or to the development of delayed cerebral ischemia (DCI). Methods: Apparent diffusion coefficient (ADC) and fractional anisotropy (FA) changes over time were assessed in a prospective cohort of patients with acute SAH. Two MRI studies were performed at <72 h (MRI-1) and 8-10 days (MRI-2). DTI parameters were recorded in 15 ROIs. Linear mixed regression models were used. Results: Forty-two patients were included. Subtle changes in DTI parameters were found between MRI-1 and MRI-2. At the posterior limb of internal capsule (PLIC), a weak evidence of a 0.02 mean increase in FA (p = 0.064) and a 17.55 × 10-6 mm2/s decrease in ADC (p = 0.052) were found in MRI-2. Both FA and ADC changed over time at the cerebellum (increase of 0.03; p = 0.017; decrease of 34.73 × 10-6 mm2/s; p = 0.002, respectively). Patients with DCI had lower FA values on MRI-1 and lower ADC on MRI-2, although not reaching statistical significance, compared to non-DCI patients. DTI parameters on MRI-1 were not correlated to clinical admission scales. Conclusion: ADC and FA values show subtle changes over time in acute SAH at the PLIC and cerebellum although not statistically associated with the severity of SAH or the occurrence of DCI. However, DTI changes occurred mainly in DCI patients, suggesting a possible role of DTI as a marker of DCI.

Background: Changes in cerebral perfusion occur in subarachnoid hemorrhage that possibly relate to clinical presentation and complications. Purpose: To evaluate changes in computed tomography perfusion (CTP) parameters between the acute and subacute stage of subarachnoid hemorrhage. To analyze correlation of these parameters to SAH severity and delayed cerebral ischemia. Material and Methods: Cerebral CT perfusion was assessed in a prospective cohort of 44 patients with acute subarachnoid hemorrhage at < 72 h (CTP1) and 8–10 days (CTP2), using the mean of all regions of interest. Regions of interest were located at arterial territories of the anterior, middle, and posterior cerebral artery and basal ganglia and midpons cerebellar hemispheres. Linear regression models (univariable and multivariable) were used to explore the association between changes in perfusion parameters (absolute and relative differences) and relevant clinical data. Results: Worse perfusion parameters on the first 72 h were correlated with poor admission clinical scores: cerebral blood flow positively correlated with Glasgow Coma Scale (rS ¼ 0.398, P ¼ 0.008), and negatively correlated with Hunt & Hess scale (rS ¼ 0.348, P ¼ 0.020) and World Federation of Neurosurgeons scale (rS ¼ 0.384, P ¼ 0.010). Cerebral blood volume positively correlated with Glasgow Coma Scale (rS ¼ 0.332, P ¼ 0.028) and negatively correlated with World Federation of Neurosurgeons scale (rS ¼ 0.353, P ¼ 0.019). Mean transit time negatively correlated with Glasgow Coma Scale (rS ¼ 0.415, P ¼ 0.005) and positively correlated with Hunt & Hess scale (rS ¼ 0.471, P ¼ 0.001) and World Federation of Neurosurgeons scale (rS ¼ 0.386, P ¼ 0.010) scores. There were no differences between absolute CTP1/CTP2 parameters. Patients with delayed cerebral ischemia had DTmax mean decrease of 2.08 s (95% CI ¼ 4.04–0.12; P ¼ 0.038). Conclusion: Early cerebral hypoperfusion correlates with poor clinical grade at admission in subarachnoid hemorrhage and with higher amounts of blood. Tmax was decreased at 8–10 days, in patients with delayed cerebral ischemia, which may favor the application value of Tmax in signaling delayed cerebral ischemia.

Objective: Clinical outcome in nontraumatic subarachnoid hemorrhage (SAH) is multifactorial and difficult to predict. Diffusion tensor imaging (DTI) findings are a prognostic marker in some diseases such as traumatic brain injury. The authors hypothesized that DTI parameters measured in the subacute phase of SAH can be associated with a poor clinical outcome. Methods: Diffusion tensor imaging was prospectively performed in 54 patients at 8–10 days after nontraumatic SAH. Logistic regression analysis was performed to evaluate the association of fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values with a poor clinical outcome (modified Rankin Scale score ≥ 3) at 3 months. Results: At 8–10 days post-SAH, after adjusting for other variables associated with a poor outcome, an increased ADC at the frontal centrum semiovale was associated with a poor prognosis (OR estimate 1.29, 95% CI 1.04–1.60, p = 0.020). Moreover, an increase of 0.1 in the FA value at the corpus callosum at 8–10 days after SAH corresponded to 66% lower odds of having a poor outcome (p = 0.002). Conclusions: Decreased FA and increased ADC values in specific brain regions were independently associated with a poor clinical outcome after SAH. This preliminary exploratory study supports a potential role for DTI in predicting the outcome of SAH.