Repositório RCAAP

Cities are challenging environments for human life, because of multiple environmental issues driven by urbanization. These can sometimes be mitigated through ecosystem services provided by different functions supported by biodiversity. However, biodiversity in cities is affected by numerous factors, namely habitat loss, degradation, and fragmentation, as well as pollution, altered climate, and new biotic challenges. To better understand the link between biodiversity and ecosystem functions and services, we need to improve our mechanistic knowledge of these relationships. Trait-based ecology is a promising approach for unravelling the causes and consequences of biodiversity filtering on ecosystem processes and underlying services, but large gaps remain unexplored. Here, we present a series of research directions that are aimed at extending the current knowledge of the relationship between trait-based biodiversity and ecosystem functions and services in cities. These directions are based on: (1) improving urban habitat mapping; (2) considering often neglected urban habitats and ecological niches; (3) integrating multiple urban gradients; (4) using trait-based approaches to improve our mechanistic understanding of the relationships between biodiversity and ecosystem functions and services; and (5) extending the involvement of citizens. Pursuing these research directions may support the sustainable management of urban ecosystems and the long-term provision of ecosystem services, ultimately enhancing the well-being of urban populations.

Both sex allocation and sexual conflict can be modulated by spatial structure. However, how the interplay between the type of dispersal and the scale of competition simultaneously affects these traits in sub-divided populations is rarely considered. We investigated sex allocation and sexual conflict evolution in meta-populations of the spider mite Tetranychus urticae evolving under budding (pairing females from the same patch) or random (pairing females from different patches) dispersal and either local (fixed sampling from each subpopulation) or global (sampling as a function of subpopulation productivity) competition. Females evolving under budding dispersal produced less female-biased offspring sex ratios than those from the random dispersal selection regimes, contradicting theoretical predictions. In contrast, the scale of competition did not strongly affect sex allocation. Offspring sex ratio and female fecundity were unaffected by the number of mates, but female fecundity was highest when their mates evolved under budding dispersal, suggesting these males inflict less harm than those evolving under random dispersal. This work highlights that population structure can impact the evolution of sex allocation and sexual conflict. Moreover, selection on either trait may reciprocally affect the evolution of the other, for example via effects on fecundity.

A geração de terrenos em tempo real é um problema complexo. Efectivamente, as necessidades de armazenamento e de processamento resultantes da quantidade de dados envolvida levantam um conjunto de problemas que tornaram esta área um tópico de investigação muito activo no domínio da computação gráfica. A maioria do trabalho efectuado concentra-se num conjunto de técnicas que procuram colmatar as dificuldades que surgem na representação de terrenos. Estas técnicas consistem sobretudo na aplicação de estratégias de culling e de nível de detalhe, com o intuito de reduzir o impacto que a representação de um terreno, especialmente os de grandes dimensões, tem ao nível do desempenho. Isto não obstante a grande evolução ao nível das placas gráficas que se tem verificado ao longo dos anos, mas que não tem sido, no entanto, suficiente para lidar com a tensão constante entre realismo e velocidade, entre fidelidade e número de frames por segundo que encontramos nesta área em particular e de uma forma geral na computação gráfica. Nesta dissertação apresentam-se conceitos fundamentais relacionados com a geração de terrenos em tempo real, tais como a representação do terreno, o particionamento espacial, o culling, o vertex caching, a coerência espacial e temporal e a utilização de vertex textures no envio dos valores elevação para o GPU. Inclui-se também a descrição dos algoritmos de geração de terrenos considerados mais relevantes, seleccionando-se dois da classe Tiled Blocks, segundo a classificação proposta por Losasso e Hoppe, para comparar o seu desempenho. Estes algoritmos aplicam duas técnicas diferentes de nível de detalhe, bastante comuns na maioria dos algoritmos desta classe e são, respectivamente, o Geomipmapping, descrito por De Boer e o GPU Terrain Rendering, descrito por Vistnes. Avaliou-se ainda a integração da técnica de occlusion culling empregue no algoritmo de Terrain Occlusion Culling With Horizons, descrito por Fiedler, e a utilização das vertex textures como alternativa no envio dos valores de elevação para o GPU. Como ponto de referência e com o intuito de avaliar a diferença a nível de desempenho, bem como verificar a necessidade de utilizar técnicas de nível de detalhe, concretizou-se também uma aproximação de “força bruta” que não utiliza nenhuma técnica de nível de detalhe.

The Ecosystem Service Framework discloses the ecosystem’s benefits to society and provides support to preserve threatened systems while considering the economic and social dimensions of the communities more dependent on its resources. Mangroves provide important and valuable goods and services to communities, at different spatial and temporal scales. Nevertheless, over-exploitation of these resources can generate poverty traps, where rural households can no longer use the ecosystem as a source of food security or income. This study uses three communities that live in surrounding areas of mangroves from São Tomé Island (Diogo Nunes, Angolares, and Malanza) as a case study. The main aim was to evaluate locals’ perspectives about ecosystem use, threats, and conservation. Questionnaires were conducted among local populations and provided valuable information to identify the major beneficiaries of mangrove resources. These results also indicated that the services and threats identified locally are different from those identified in the literature. The importance of considering the impact of local values and traditions in the use of ecosystem resources was also highlighted by the obtained results since São Tomé residents do not acknowledge the existence of services that do not bring a direct benefit. The absence of awareness about mangroves and their threats can cause severe damages to the ecosystem’s health, requiring the implementation of specific awareness-raising policies among populations that interact with mangrove ecosystems.

Climate change and biodiversity loss are deeply intertwined anthropogenic global crises, for which forests provide powerful nature-based solutions. Biodiverse forests are more resilient to climate change than monocultures, thereby enhancing long-term carbon storage and ecosystem-based adaptation. Awareness of these interdependencies is slowly growing, but we know little about how countries are considering biodiversity within climate policies. Island and low-lying coastal states are particularly vulnerable to climate change and biodiversity loss. Here we assessed if and how the members of the Alliance of Small Island States (AOSIS) are integrating biodiversity into their national climate action plans through forest-based climate solutions. Our analysis shows that these solutions are a missed opportunity for tackling the twin crises together. Only five of the 39 countries explore co-benefits and synergies between forest-based climate solutions and biodiversity conservation measures. An additional nine mention them separately. Among these 14 countries, only a narrow range of interventions were proposed. While 28 AOSIS members prioritised forests for combating climate change, mostly for mitigation, only three prioritised their unique and globally important biodiversity. This omission is potentially risky, since mitigation measures, such as planting rapidly growing non-native trees, can have negative outcomes for biodiversity. Climate action plans must place a greater emphasis on concrete and measurable targets that create synergies with biodiversity conservation, including through the protection of old-growth forests and forest restoration. Our results highlight that forums such as the United Nations Climate Change Conferences need to continue pushing for a stronger integration of biodiversity into climate policies.

Species that the public knows and is willing to protect often do not align with international conservation priorities. Assessing perceptions on wildlife is thus essential to guide conservation initiatives, especially in island developing states where native and introduced species often have contrasting values for biodiversity. We used a game to assess the ability of third class students in São Tomé Island (São Tomé and Príncipe, central Africa) to identify wildlife and their conservation preferences. Students correctly identified 28% of the animals shown. Children who were poorer, male or from rural schools were more likely to correctly identify species. Urban children were less successful identifying species endemic to São Tomé and Príncipe than rural children. Conservation preferences were not associated with species identification and instead were justified by subjective species-specific traits, such as attractiveness or profitability. Despite the low identification rates for endemic (10% correct identifications) and threatened birds (2%), children were keen on preserving endemic species, indicating that these might become effective flagships for the unique biodiversity of the island. These results illustrate the need to consider separately the attributes that affect knowledge and willingness to protect, and how both can be used to guide conservation strategies.

In the beginning of 2020, it looked like serious climate action was finally going to take place after decades of procrastination, but we are now inevitably leaving the transformation path. Abruptly (and remarkably), the coronavirus outbreak silenced ongoing efforts to protect climate, while also partly bringing carbon emissions to a halt. A global tragedy is still unfolding with vast social impacts and we are reaching a roundabout with several distinct exits. While embracing the uncertainty of current times, we try to envision likely transition pathways using the multi-level perspective. Climate activists, social innovators, dreamers, and networkers are expected to gain momentum and play critical roles in a sequence of co-evolutionary waves leading to a just, conscious, and regenerative recovery.

During bryological work conducted in the Sharon plane region (Israel), a colony of Acaulon Müll. Hal. was discovered. The plants showed morphological affinities both to A. longifolium Herrnst. & Heyn and A. fontiquerianum Casas & Sérgio depending on the floras used for their identification which challenged their recognition as separate species. In order to solve this taxonomic dilemma, we conducted a detailed morphological characterization of the two species based on representative samples. The micromorphological study of vegetative, sporophytic and spore traits revealed the large overlap of range values between both species. Both species showed the characteristic combination of morphological characters, including the broadly incurved leaves with smooth cells and the 4-6 rows of inflated cells on the adaxial surface of nerve. Spore micromorphology revealed the same ornamentation pattern and the presence of 1-2 lamellar glomeruli on spore surface. Multivariate and ordination analyses based on quantitative traits did not reveal a significant separation among samples of the two species, thus opposing their recognition as separate species. As A. fontiquerianum has priority over A. longifolium, the latter is thus subsumed in the synonymy of A. fontiquerianum. The addition of new chorological data and amended taxonomy reveals that A. fontiquerianum has a distribution area extending from the Canary Islands to the eastern Mediterranean basin. However, the scattered pattern suggests its known distribution is largely incomplete because of the tiny size of the plants and their ephemeral nature.

Deposits of coal combustion wastes, especially fly ash, are sources of environmental and health risks in industrial regions. Recently, fly ash deposits have been reported as habitat surrogates for some threatened arthropods in Central Europe. However, the potential environmental risks of fly ash have not yet been assessed in the region. We analysed concentrations of 19 minor and trace elements in 19 lignite combustion waste deposits in the Czech Republic. We assessed their environmental risks by comparison with the national and EU legislation limits, and with several commonly used indices. Over 50% of the samples exceeded the Czech national limits for As, Cu, V, or Zn, whilst only V exceeded the EU limits. For some studied elements, the high-risk indices were detected in several localities. Nevertheless, the measured water characteristics, the long-term presence of fly ash, previous leaching by acid rains, and the low amount of organic matter altogether can infer low biological availability of these elements. We presume the revealed high concentrations of some heavy metals at some studied sites can be harmful for some colonising species. Nevertheless, more ecotoxicological research on particular species is needed for final decision on their conservation potential for terrestrial and freshwater biota.

Raccoons are American carnivores, considered invasive across several countries worldwide, especially in Europe. In the Iberian Peninsula, previous studies on raccoons documented several breeding populations in Spain a decade ago and only two confirmed records from isolated individuals in Portugal. Given the need for updating its Iberian distribution and identifying suitable areas with higher invasion risk, we compiled presence records from established breeding populations and isolated individuals. By using a Maxent approach based on breeding records, we forecasted the suitable habitats in Iberia with higher invasion risk for raccoons and identified the related environmental drivers. Overall, we collected 1039 records of raccoon presence throughout the Iberian Peninsula, including 980 records from established breeding populations. Their origin is probably linked to escapes from captivity. Climatic conditions, linked to both drier and wetter environments, and proximity to water bodies were the main predictors of suitable areas for raccoon’s expansion from the currently established breeding nuclei in Iberia. The forecasted high probability areas showed a wide, but fragmented distribution concentrated on four main areas: central, central-north, central-east, and north-west Iberia. NW Portugal seems to be the area with higher invasion risk in the country, although field surveys showed no evidence of raccoon presence yet. However, there are several records in Spain near the Portuguese border, comprising isolated individuals and breeding populations. Therefore, it is crucial to ensure regular monitoring of areas with high invasion risk, particularly those near facilities with captive raccoons that often act as a source of feral individuals, to assure early detection and effective control for the expansion of this invasive carnivore.

Adaptation Pathways is a decision support tool designed to create adaptation policies under different climate change scenarios. This tool has been used successfully in several sectors and contexts such as coastal and river adaptation, urban heat waves, floods and rural livelihoods but its use in natural resource management, has faced several challenges and limitations. In the sector of agroforestry its use has seldom been done or documented and one of the reasons for this may due to some of its specific challenges. In this study, these challenges were addressed when using the Adaptation Pathways for the adaptation planning of three case studies in the semi-arid Alentejo region, a Mediterranean dryland of southern Portugal. This tool was integrated in a participatory approach combined with the Scenario Workshop method, to plan the adaptation of the agriculture and forestry sector of one municipality (Mértola) and two agroforestry farms (221 ha and 1000 ha). The methodology included, for each case study, 20 interviews, two workshops, literature review, expert analysis and the use of indicators of efficacy of adaptation measures, to define tipping points. The adaptation process and the resulting adaptation plans were evaluated by questionnaire and expert review. This combination of methods has supported the choice of effective adaptation measures for the case studies and when combined with several adaptation pathways and a landscape approach it supported the creation of integrated climate change adaptation plans that are now in implementation. We discuss how this combination of methods deals with limitation to Adaptation Pathways identified in the literature, conclude that the method was able to create adaptation plans that are now under implementation and present avenues for future research.

Atualmente, o modelo de Medicina Centrada no Paciente (MCP) é defendido por diversas organizações vocacionadas para a saúde (incluindo a Organização Mundial de Saúde, ou OMS), em detrimento do modelo de Medicina Centrada na Doença. Na MCP, as decisões clínicas devem resultar de uma Decisão Médica Partilhada (DMP) entre este o doente e o médico. A DMP em Obstetrícia é um processo dinâmico que tem em consideração os valores, interesses e necessidades individuais da mulher/casal, e as circunstâncias particulares da sua gravidez, parto e/ou puerpério. Este processo deve ser caracterizado por uma comunicação otimizada, pela disponibilidade para explorar opções e pelo respeito mútuo entre a utente e o profissional de saúde. Esta revisão atualizada da literatura acerca da tomada de DMP inclui cerca de duas centenas de artigos científicos, encontrados através do recurso à PubMed® e recorrendo a palavras-chave, tais como “tomada de decisão partilhada”, “obstetrícia”, “autonomia” e “plano de parto”. Foram redigidos nas línguas portuguesa e inglesa e as suas datas de publicação vão desde 1995 até 2021.

A esquizofrenia é uma doença psiquiátrica crónica caracterizada por sintomas positivos, negativos e cognitivos cujo diagnóstico assenta exclusivamente numa base clínica. Com o advento da ressonância magnética, tem sido possível uma maior compreensão da fisiopatologia subjacente à perturbação. Paralelamente, observou-se que doentes com primeiro episódio psicótico já apresentavam alterações neuro-imagiológicas. Neste trabalho pretendeu-se comparar as alterações apresentadas por doentes crónico e por doentes com primeiro episódio psicótico, e, ainda, compará-las com as apresentadas por doentes com perturbação afetiva bipolar. Para a realização desta revisão narrativa procedeu-se a uma pesquisa bibliográfica através da Pubmed. A evidência revelou uma extensa heterogeneidade de dados. Contudo, verificaram-se, no doente crónico, com maior frequência as seguintes alterações: aumento volumétrico dos ventrículos laterais e III ventrículo acompanhado por uma diminuição do volume cerebral total; diminuição volumétrica do lobo temporal, quer das suas estruturas neocorticais, quer dos elementos do sistema límbico, incluindo o complexo amígdala-hipocampo, circunvoluções para-hipocâmpica, temporal superior e circunvolução do corpo caloso; do córtex pré-frontal e circunvoluções frontais média e inferior; do lobo parietal, incluindo a circunvolução parietal ascendente e o lóbulo parietal inferior com as circunvoluções supramarginal e angular. Foi constatado um envolvimento das estruturas subcorticais tendo sido identificado um aumento volumétrico dos gânglios da base e uma redução do volume talâmico. De maneira global, estes mesmos achados são identificados nos doentes com primeiro episódio psicótico, à exceção do volume intracraniano e do volume da amígdala que frequentemente se encontram preservados. A comparação com as alterações presentes na perturbação afetiva bipolar exibiu uma extensa sobreposição. Porém, nesta o que mais contrasta com a esquizofrenia é a aparente manutenção do volume da amígdala e hipocampo e ausência de diminuição do volume talâmico. Conclui-se que as alterações neuro-imagiológicas são visíveis desde fases precoces da esquizofrenia e há uma extensa sobreposição com a doença bipolar.

A presente dissertação visa o estudo semiótico dos mapeamentos conducentes a imagens metafóricas vigentes na imprensa alemã (Bild, Sportbild, Kicker, Spiegel, Focus), com especial incidência nas suas versões on-line, durante os Campeonatos Europeus e Munidas de Futebol de 2006 a 2010 a luz do modelo dos espaços mentais de Brandt (2004a) Brandt/Brandt (2005a). Na senda de outros trabalhos de estudo das construções metafóricas e mescladas na imprensa desportiva portuguesa (Almeida (2003, 2004, 2005, 2006a, 2006b, 2010a, 2010b, 2011); Almeida, Órfão, Teixeira (2010); Almeida, Sousa (2010)), a presente dissertação debruça-se sobre as ocorrências metafóricas elaboradas a partir dos mapeamentos dos diversos domínios-fonte da experiência para o domínio-alvo dos eventos futebolísticos, tendo por objetivo elencar o conjunto de imagens presentes nos textos jornalísticos alemães. Tomando como ponto de partida a metáfora conceptual e convencional de DESPORTO E GUERRA” (Lakoff/Johnson, 1980a), analisaremos a panóplia de entrecruzamentos dos diversos mundos no mundo do futebol, numa dupla abordagem qualitativa e quantitativa, por forma a aquilatar a relevância das diversas imagens mescladas na representação dos eventos futebolísticos e dos seus protagonistas, os jogadores de futebol, na imprensa alemã.

Introdução: A escala de acidente vascular cerebral (AVC) do National Institute of Health (NIHSS) é uma ferramenta de quantificação da gravidade de um AVC. Apesar de amplamente utilizada, estudos sugerem que não avalia igualmente os 2 hemisférios cerebrais. Pensa-­‐se que o NIHSS subestima o volume das lesões do hemisfério direito possivelmente devido ao facto de 2 pontos serem atribuídos ao neglect e 7 às alterações de linguagem. Embora o NIHSS de doentes com neglect possa sugerir melhor outcome funcional comparativamente com doentes com afasia, estudos demonstram que o neglect está associado a piores outcomes. Objetivos: Comparar as correlações entre o volume da lesão e o NIHSS de doentes com neglect e sem neglect e estudar se uma modificação das regras de pontuação de neglect no NIHSS aumentaria a sua capacidade de predição do volume de lesão. Métodos: A amostra de doentes com AVC na artéria cerebral média direita foi dividida 2 grupos: doentes com neglect e sem neglect. Comparámos as correlações entre o volume de lesão e o NIHSS dos grupos e calculámos a correlação parcial entre o volume da lesão, NIHSS e a variável ter ou não neglect. Estudamos ainda diferentes modificações das regras de pontuação de neglect e repetimos a análise. Resultados: A correlação entre volume de lesão e NIHSS foi menor em doentes com neglect e a correlação parcial entre volume de lesão e a variável grupo, controlando o NIHSS, foi estatisticamente significativa. Com a pontuação de neglect triplicada e com a soma de todas as modalidades de neglect duplicada e triplicada, a correlação entre o volume da lesão e o NIHSS foi significativamente maior do que com o NIHSS original e a correlação parcial deixou de ser estatisticamente significativa.

Esta Newsletter (NL) resulta de uma parceria entre o Instituto de Saúde Baseada na Evidência e a Cochrane Portugal, e tem como objectivo disponibilizar informação sobre áreas interessantes para a prática clínica, com base na melhor evidência científica. São incluídos estudos relevantes, criticamente avaliados pela sua validade, importância dos resultados e aplicabilidade prática, resumidos numa óptica de suporte à decisão. É dada prioridade a estudos de causalidade incluindo-se ainda, quando justificado, estudos qualitativos e metodológicos, assim como revisões científicas. O conteúdo da NL é da exclusiva responsabilidade do(s) seu(s) autor(es).

Current definitions of populism are insufficiently determinate. They fail to distinguish between populism and nationalism. We propose to remedy this problem by advancing a new definition of populism as the logic of democratic resentment. We apply this new definition to a comparison between Spain's Podemos and Portugal's Left Bloc (BE), which we classify as social carriers of populism. We make two contributions to the literature. First, our findings dispute existing characterisations of the Portuguese case, which fail to distinguish between populist and nationalist claim-making. Second, our analysis undermines depictions of Podemos as the consummate populist party in Iberia: In 2015, the little studied BE was a stronger populist carrier than Podemos. The analytical framework underpinning this conclusion offers a more refined approach to populism than the alternatives and sets a higher standard for empirical replication.

Establishment of persistent infection in memory B cells by murid herpesvirus-4 (MuHV-4) depends on the proliferation of latently infected germinal center B cells, for which T cell help is essential. Whether the virus is capable of modulating B-T helper cell interaction for its own benefit is still unknown. Here, we investigate if the MuHV-4 latency associated M2 protein, which assembles multiprotein complexes with B cell signaling proteins, plays a role. We observed that M2 led to the upregulation of adhesion and co-stimulatory molecules in transduced B cell lines. In an MHC-II restricted OVA peptide-specific system, M2 polarized to the B-T helper contact zone. Furthermore, it promoted B cell polarization, as demonstrated by the increased proximity of the B cell microtubule organizing center to the interface. Consistent with these data, M2 promoted the formation of B-T helper cell conjugates. In an in vitro competition assay, this translated into a competitive advantage, as T cells preferentially conjugated with M2-expressing B cells. However, expression of M2 alone in B cells was not sufficient to lead to T cell activation, as it only occurred in the presence of specific peptide. Taken together, these findings support that M2 promotes the formation of B-T helper cell conjugates. In an in vivo context this may confer a competitive advantage to the infected B cell in acquisition of T cell help and initiation of a germinal center reaction, hence host colonization.

Glycine transporters (GlyT), GlyT1 and GlyT2, are responsible for the termination of glycine-mediated synaptic activity through removal of neurotransmitter from synaptic cleft. Brain-derived neurotrophic factor (BDNF) activates its high affinity tropomyosin-related kinase (Trk) receptors, namely TrkB, which includes full length (TrkB-FL) and truncated (TrkB-T) isoforms. In this article we evaluated the influence of BDNF upon the activity of glycine transporters in astrocytes. We report that BDNF decreases GlyT1- and GlyT2- mediated [(3) H]glycine transport in primary cultures of astrocytes from rat cerebral cortex. BDNF decreased Vmax but not Km values of transport, which suggests that BDNF induces transporter internalization. Accordingly, dynasore, an inhibitor of dynamin/clathrin-dependent endocytosis, prevented the influence of BDNF upon GlyT-mediated transport. While quantifying mRNA and protein levels, we detected a predominance of truncated isoforms over the TrkB-FL receptor. The effect of BDNF was not abolished by specific inhibitors of PLCγ, PI3K and MAPK, indicating that it did not occur through TrkB-FL canonical pathways. However, BDNF action was lost in the presence of a Rho family-specific blocker (toxin B), a signaling pathway that has been associated to TrkB-T1. Furthermore, the effect of BDNF was abolished upon TrkB-T knockdown in astrocytes by RNA interference. Immunofluorescence assays confirmed an increased GlyT expression in endosomes upon BDNF incubation, which was prevented in the presence of either dynasore or toxin B. We conclude that BDNF, acting on TrkB-T1 receptors, inhibits glycine uptake in astrocytes by promoting GlyT internalization through a Rho-GTPase activity dependent mechanism.

The percentage of time in therapeutic range (TTR) is a measure of anticoagulation quality with vitamin K antagonists (VKAs). The method most commonly used in clinical trials is the Rosendaal TTR. However, the application of this method in daily practice for clinical decision lacks appropriate instruments. We aimed to evaluate the percentage of tests within the target international normalized ratio (INR) (tests ratio) as a surrogate of Rosendaal TTR. We performed an observational and retrospective study to evaluate the TTR according to the Rosendaal method and tests ratio. We included all outpatients who attended the cardiology anticoagulation clinic of a Portuguese hospital (2011-2013), whose target INR was 2.0-3.0. Three hundred and seventy-seven VKA-treated patients followed for a mean 1.3 years were evaluated. Rosendaal methold and tests ratio significantly correlated (Rho Spearman 0.88, P < 0.001), but the Bland-Altman plot evaluation showed a clinically relevant data dispersion [95% confidence interval (95% CI) -12.9 to 23.1] around a mean difference in TTR -5.1% using the tests ratio method. The linear regression Passing-Bablok confirmed the existence of significant data dispersion and systematic differences. The tests ratio less than 60% had a sensitivity of 91.6%, specificity of 72.3%, positive predictive value (PPV) of 72.2% and negative predictive value (NPV) of 91.6%, for the diagnosis of patients inadequately anticoagulated (Rosendaal TTR <60%). Tests ratio had a c-statistics of 0.94 (95% CI 0.91-0.96). Number of tests in 6 months had a c-statistics of 0.70 (95% CI 0.65-0.75). Tests ratio underestimated TTR in 5% and was not considered equivalent to Rosendaal TTR due to the high variability between methods. Nevertheless, the use of tests ratio less than 60% may be a reasonable option to detect inadequate anticoagulation, as it is a sensitive method and excluded most of the patients with adequate control.