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A predictive model to estimate post-donation glomerular filtration rate (eGFR) and risk of CKD at 1-year was developed from a Toulouse-Rangueil cohort in 2017 and showed an excellent correlation to the observed 1-year post-donation eGFR. We retrospectively analyzed all living donor kidney transplants performed at a single center from 1998 to 2020. Observed eGFR using CKD-EPI formula at 1-year post-donation was compared to the predicted eGFR using the formula eGFR (CKD-EPI, mL/min/1.73 m2) = 31.71+ (0.521 × preoperative eGFR) − (0.314 × age). 333 donors were evaluated. A good correlation (Pearson r = 0.67; p < 0.001) and concordance (Bland-Altman plot with 95% limits of agreement −21.41–26.47 mL/min/1.73 m2; p < 0.001) between predicted and observed 1-year post-donation eGFR were observed. The area under the ROC curve showed a good discriminative ability of the formula in predicting observed CKD at 1-year post-donation (AUC = 0.83; 95% CI: 0.78–0.88; p < 0.001) with optimal cutoff corresponding to a predicted eGFR of 65.25 mL/min/1.73 m2 in which the sensibility and specificity to predict CKD were respectively 77% and 75%. The model was successfully validated in our cohort, a different European population. It represents a simple and accurate tool to assist in evaluating potential donors.

Older to older living kidney transplantation is an acceptable alternative to avoid dialysis, improve quality of life and maintain favorable long-term outcomes of patients with end-stage kidney disease. However, the management of these patients is complex and the acceptance of older donors and recipients to kidney transplantation remains controversial. The older recipients usually have several comorbidities that may complicate the postoperative course and increase the risk of end-stage kidney disease. We present a clinical case of living kidney transplantation between an older donor and recipient, both over 70 years old, who evolved to a stage 3 chronic kidney disease, without proteinuria, hypertension, or other complications, three years after transplantation. Our case reinforces favorable outcomes in older living transplantation, both for recipient and donor, as has been demonstrated in several published studies.

This article was funded by the project NORTE-08-5369-FSE-000018, supported by Norte Portugal Regional Programme (Norte2020), under the PORTUGAL 2020 Partnership Agreement, through the European Regional Development Fund (ERDF) and by FCT—Fundação para a Ciência e a Tecnologia [UID/ BIM/04293/2013]. Background: In phenylketonuria (PKU), modified casein glycomacropeptide supplements (CGMP-AA) are used as an alternative to the traditional phenylalanine (Phe)-free L-amino acid supplements (L-AA). However, studies focusing on the long-term nutritional status of CGMP-AA are lacking. This retrospective study evaluated the long-term impact of CGMP-AA over a mean of 29 months in 11 patients with a mean age at CGMP-AA onset of 28 years (range 15–43) [8 females; 2 hyperphenylalaninaemia (HPA), 3 mild PKU, 3 classical PKU and 3 late-diagnosed]. Outcome measures included metabolic control, anthropometry, body composition and biochemical parameters. Results: CGMP-AA, providing 66% of protein equivalent intake from protein substitute, was associated with no significant change in blood Phe with CGMP-AA compared with baseline (562 ± 289 µmol/L vs 628 ± 317 µmol/L; p = 0.065). In contrast, blood tyrosine significantly increased on CGMP-AA (52.0 ± 19.2 μmol/L vs 61.4 ± 23.8 μmol/L; p = 0.027). Conclusions: Biochemical nutritional markers remained unchanged which is an encouraging finding in adults with PKU, many of whom are unable to maintain full adherence with nutritionally fortified protein substitutes. Longitudinal, prospective studies with larger sample sizes are necessary to fully understand the metabolic impact of using CGMP-AA in PKU. publishersversion published

Funding: This article was supported by National Funds through FCT-Fundação para a Ciência e a Tecnologia, I.P., within CINTESIS, R&D Unit (reference UIDB/4255/2020). We aimed to report the implementation of a phenylketonuria (PKU) transition program and study the effects of follow-up with an adult team on metabolic control, adherence, and loss of follow-up. Fifty-five PKU patients were analysed in the study periods (SP): 2 years before (SP1) and after the beginning of adult care (SP2). Retrospective data on metabolic control and number of clinic appointments were collected for each SP, and protein intakes were analysed. In SP2, three patients (6%) were lost to follow-up. There was a small but statistically significant increase in median number of annual blood spots from SP1 to SP2: 11 (7–15) vs. 14 (7–20); p = 0.002. Mean ± SD of median blood Phe remained stable (525 ± 248 µmol/L vs. 552 ± 225 µmol/L; p = 0.100); median % of blood Phe < 480 µmol/L decreased (51 (4–96)% vs. 37 (5–85)%; p = 0.041) and median number of clinic appointments increased from SP1 to SP2: (5 (4–6) vs. 11 (8–13); p < 0.001). No significant differences were found regarding any parameter of protein intake. Our results suggest that the implementation of an adult service was successful as impact on metabolic control was limited and attendance remained high. Continuous dietetic care likely contributed to these results by keeping patients in fol-low-up and committed to treatment. publishersversion published

Para alívio da pobreza energética, é fundamental identificar as medidas mais adequadas e mais rentáveis a aplicar em edifícios de habitação social e garantir que os investimentos necessários resultem em necessidades energéticas compatíveis com os rendimentos da população residente neste tipo de edifícios.

Additional file 1. Supplementary data.

A reabilitação energética do parque edificado existente é crucial para que se consigam cumprir os objetivos delineados pela União Europeia para 2050. De facto, a responsabilidade dos edifícios já construídos na percentagem das emissões de carbono relacionadas com o uso de energia está bem estabelecida e é muito significativa. No caso dos edifícios residenciais, estes são responsáveis por cerca de 36% das emissões de carbono [1].

Os consumidores não possuem, em geral, consciência da ineficiência do seu sistema de aquecimento e dos custos associados ao seu funcionamento. Uma ferramenta de apoio à decisão pode ser determinante para uma escolha acertada do sistema de aquecimento mais adequado e eficiente.

A hepatite C é uma doença altamente prevalente no Brasil e que possui 6 genótipos diferentes. Objetiva-se apresentar um caso clínico no qual o paciente apresenta um genótipo atípico no Brasil, sendo possivelmente o primeiro caso desse genótipo no Norte do Brasil. Objetiva-se ainda analisar possíveis fatores de contaminação do referente caso. O estudo foi realizado mediante análise de prontuário do paciente e após discussão concluiu-se que o paciente teve como provável fator de contaminação a prática de relações sexuais com nativos de outros países. Assim, torna-se necessário avaliar a difusão de diferentes genótipos do vírus da Hepatite C (VHC) em diversas regiões e incentivar a implementação de medidas de saúde pública para conter a transmissão do vírus.

Introdução: As hepatites virais são consideradas a principal causa de comorbidades hepáticas no mundo, o que as tornam um grave problema de saúde pública devido à grande morbimortalidade associada à infecção. O HCV (Vírus da Hepatite C) é um vírus de RNA da família Flaviviridae e se encontra principalmente no sangue de indivíduos infectados. Desse modo, as principais formas de transmissão estão relacionadas ao uso de drogas, à transfusão de sangue e/ou hemoderivados e à transmissão sexual. Contudo, entre os casos rotulados como ocasionais, há uma porcentagem significativa de contágio em atos cirúrgicos, de forma a permitir que pacientes primariamente não infectados contraiam o HCV ao realizar tais procedimentos. Objetivo: Identificar a incidência do contágio de HCV via ato cirúrgico nas diferentes regiões brasileiras. Métodos: Trata-se de um estudo transversal, cujos dados foram obtidos por meio de consulta a base de dados SINAN (Sistema de Informações de Agravos de Notificação), disponibilizado pelo Departamento de Informática do Sistema Único de Saúde (DATASUS). Foram analisados os dados de 2010 a 2018 que relatam a incidência e as formas de contágio da Hepatite Crônica C nas diferentes regiões brasileiras, com ênfase no contágio por ato cirúrgico. Resultados: Foram notificados 4.729 casos de Hepatite Crônica C adquiridos por tratamentos cirúrgicos no Brasil, de 2010 a 2018. A região Sul se destacou com 2.279 (48,19%) casos confirmados no período analisado, seguido pela região Sudeste, com 2.054 (43,43%). Em oposição, a região Centro-Oeste apresentou 46 (0,97%) casos e a região Norte, 59 (1,24%). Em 2012 houveram 652 (13,21%) casos de infecção por tratamentos cirúrgicos; enquanto que 2018 obteve os menores valores absolutos, com 279 (5,8%) casos confirmados. Conclusão: O estudo demonstrou a maior prevalência de contágio da Hepatite Crônica C por meio de cirurgias na região Sul. Em contrapartida, a região Centro-Oeste apresentou os menores valores absolutos. Em relação aos anos, 2012 obteve uma quantidade alarmante de casos confirmados, contrapondo 2018, com os menores números dentro do período analisado. Nesse contexto, apesar da infecção por tratamentos cirúrgicos ser rotulada como esporádica, demonstrou-se uma porcentagem alarmante, posto que é responsável por 3,46% dos casos de Hepatite Crônica C de 2010 a 2018. Dessa maneira, são necessárias medidas de prevenção voltadas, principalmente, à redução da contaminação e à segurança do ato cirúrgico.

Para reduzir as necessidades energéticas dos edifícios é necessário dar primazia aos sistemas passivos. As estratégias de aquecimento passivo da arquitetura vernácula podem ser uma solução.

Introduction: ABO incompatibility was considered a barrier to kidney transplant. However, the shortage of available organs for transplantation and the excellent long-term results further establish ABO-incompatible (ABOi) as a safe and effective therapeutic strategy. The aim of the present study was to evaluate the outcomes of ABOi transplantation in terms of graft survival and function, rejection episodes and infections complications. Methods: The authors present a single-center retrospective observational study in a unit with approximately 370 living donor kidney transplants registered. This study includes the analysis of 12 patients who underwent ABOi living donor kidney transplantation between November 2014 and July 2019. Desensitization protocol consisted of intravenous Rituximab 375mg/m2 single dose administration 2 weeks pretransplant. Tacrolimus and Mycophenolate Mofetil were started before transplantation one week and 48 hours respectively. Plasmapheresis was performed to remove anti-A or B antibodies until their titers were

O Pacto Ecológico Europeu lançou um desafio sem precedentes relativamente à necessidade de duplicar as taxas de reabilitação energética do edificado. Apesar de o potencial do investimento prometido para apoiar a transição necessária ser grande, é necessário que os instrumentos de políticas utilizados sejam adequadamente desenhados, pois a sua implementação é fortemente influenciada pelo contexto local.

Spontaneous rupture of the uterine artery is a rare cause of hemoperitoneum during pregnancy. This is a life-threatening condition associated with maternal and fetal mortality. We describe a case of spontaneous rupture of the left uterine artery in a 32-year-old healthy pregnant woman with an uneventful pregnancy.

Objective: Tyrosinemia type III (HT III) is the rarest form of tyrosinemia, and the full clinical spectrum of this disorder is still unknown. The neurological involvement varies, including intellectual impairment and attention deficit disorder with hyperactivity (ADHD). We report the case of two siblings diagnosed with HT III at different ages. Case description: The index case was diagnosed by newborn screening for endocrine and metabolic disorders, starting a low-protein diet immediately, with a consistent decrease in tyrosine levels. By the age of three, the child displayed a hyperactive behavior, starting treatment for ADHD two years later. At seven years of age, he shows a slight improvement in terms of behavior and attention span and has a cognitive performance slightly lower than his peers, despite maintaining acceptable tyrosine levels. His sister, who had a history of ADHD since age five, was diagnosed with HT III after family screening at the age of eight. Despite initiating a dietetic treatment, her behavior did not improve, and she has a mild intellectual impairment. Comments: This is the first case report describing siblings with HT III who underwent nutritional treatment with a low-protein diet in different phases of life, with a better neurological and behavioral evaluation in the patient who started treatment earlier. RESUMO Objetivo: A tirosinemia tipo III (TT III) é a forma mais rara das tirosinemias e o espectro clínico desta entidade não está totalmente esclarecido. O envolvimento neurológico é variável, incluindo o atraso cognitivo ou transtorno do déficit de atenção com hiperatividade (TDAH). Descrevemos o caso de dois irmãos que foram diagnosticados com TT III em idades diferentes. Descrição dos casos: O caso índice foi diagnosticado no contexto do rastreio endócrino-metabólico neonatal, tendo iniciado imediatamente dieta hipoproteica, com redução consistente dos níveis de tirosina. Por volta dos três anos, foi detectado um comportamento hiperativo, tendo iniciado dois anos depois tratamento para o TDAH. Aos sete anos, apresenta leve melhora de comportamento e da atenção e avaliação cognitiva levemente inferior ou pouco abaixo quando comparado a crianças da mesma faixa etária, apesar de manter níveis aceitáveis de tirosina. A sua irmã, com história de TDAH desde os cinco anos, foi diagnosticada de TT III aos oito anos no contexto do rastreio de familiares. Apesar de iniciar tratamento dietético, nenhum efeito foi notado em termos de comportamento e a doente apresenta leve atraso cognitivo. Comentários: Este é o primeiro caso clínico descrito de irmãos com TT III que iniciaram terapêutica dietética com dieta hipoproteica em diferentes fases da vida, com melhor avaliação em termos neurológicos e comportamentais no doente que iniciou tratamento mais precocemente.

A reabilitação energética de edifícios é cada vez mais apontada como uma necessidade urgente no caminho do desenvolvimento sustentável dos meios urbanos. No entanto, devido à existência de barreiras a vários níveis (técnicos, económicos, e outros), não foi ainda possível fazer uma abordagem sistemática ao edificado existente. É por isso urgente o desenvolvimento de soluções com carácter rentável e com um elevado potencial de adoção por parte dos principais atores envolvidos nas decisões relativas à reabilitação dos edifícios. Neste contexto, as soluções prefabricadas modulares podem trazer grandes oportunidades como a redução de custos e de tempos de intervenção, ao mesmo tempo que aumentam a qualidade e a eficiência energética dos edifícios. Este capítulo apresenta o desenvolvimento de um protótipo de um painel modular prefabricado para aplicação na fachada de edifícios com o objetivo de reduzir significativamente as suas necessidades energéticas e que foi realizado no âmbito do projeto More-Connect financiado por verbas Europeias. O capítulo discute ainda a rentabilidade da aplicação deste painel no âmbito de uma reabilitação integrada num edifício piloto em Vila Nova de Gaia na zona metropolitana do Porto em Portugal. A rentabilidade desta solução é avaliada com recurso a uma metodologia de determinação do custo-ótimo que possibilita a análise e avaliação do impacto em termos energéticos e económicos de diferentes combinações de medidas de reabilitação a nível da envolvente juntamente com a utilização de sistemas de climatização e AQS (Águas Quentes Sanitárias) e soluções que permitam o aproveitamento de energia renovável.

Não descurando o peso significativo que as poupanças de energia e custos possam ter na decisão de levar a cabo uma intervenção de reabilitação, há outros benefícios adicionais decorrentes destas intervenções que, se não considerados, levam à subestimação do valor real das melhorias implementadas, facto agora enfatizado na revisão de 2018 da diretiva do desempenho energético de edifícios.

A adaptação da metodologia internacional SBTool para a Avaliação da Sustentabilidade de Edifícios de Ensino Secundário em Portugal, a metodologia SAHSBPT, irá auxiliar os profissionais da área da construção civil a melhorar a sustentabilidade dos edifícios escolares, quer na fase de projeto quer na reabilitação dos edifícios existentes.

The passenger lymphocyte syndrome may cause hemolytic anemia after bone marrow and solid organ transplantation when there is minor erythrocyte antigen incompatibility in the donor/recipient pair. Anemia is usually self-limiting, frequently related to ABO antibodies and rarely to Rh mismatches. We report a rare case of passenger B lymphocyte syndrome mediated by Rh antibodies occurring after a donor living renal transplantation and discuss its clinical severity at presentation, the therapeutic decisions and their outcome.

An adequate supply of fresh outdoor air is important to create healthy and comfortable indoor building environments. Currently, most of the residential buildings in mild climate European countries, such as Portugal or Spain, remain naturally ventilated. Distinct concerns have emerged in the building community regarding the indoor air quality (IAQ) in these buildings since several studies have shown that they are often poorly ventilated. The main cause has been identified as occupants' different window opening behaviour, which can vary notably from one apartment to the next. This work presents a comparative method for evaluating occupants' exposure to CO2 concentration levels in existing buildings based on the comparison of cumulative frequency distribution curves. Indoor CO2 concentration levels recorded over 17 months in the bedrooms and living rooms of eight apartments of a naturally ventilated residential building located in Porto (Portugal) were used as experimental input data for developing the method and to calibrate the IAQ performance of an EnergyPlus building model. The calibrated building model exhibited a good agreement with the recorded data on the apartments, reporting maximum Root Mean Square Errors (RMSE) for the majority of the apartments below 5 and 10% for the living rooms and bedrooms, respectively., MORE-CONNECT project is funded by the European Commission within the framework of the Horizon 2020 program. The European More-Connect project deals with the distinct energy, economic and environmental aspects present in the complex field of building refurbishment, through the development of cost-optimal renovation packages to renovate buildings towards achieving NZEB features. This support is gratefully acknowledged. The authors are grateful for the availability and use of data that is an integral part of the More-Connect research project (http://www.more-connect.eu/). We also greatly acknowledge the funding received from the University of Castilla-La Mancha through its call for visits and stays for Professors and researchers in other research centers and universities in 2017

Apesar de todas as vantagens associadas às práticas de construção sustentáveis, a sua ampla implementação encontra-se condicionada pela vontade e disponibilidade de investimento dos stakeholders. Apresenta-se, neste artigo, o método MAViS (Método de Avaliação da Viabilidade económica de soluções sustentáveis), que permite selecionar soluções que, maximizando o nível de sustentabilidade do edifício, vão ao encontro desta disponibilidade e vontade de investimento.

The Millennium Development Goals and the 17 Global Goals for Sustainability Development have been acting as a global and inclusive framework for the implementation of a new and sustainable development model (United Nations, 2015). Higher Education Institutions (HEI) are a privileged space for the analysis of the necessary conditions for a sustainable future, and can represent a crucial role in providing the theory and practice of sustainability, by reducing their own impacts (UNEP, 2013) and extending their engagement to the activities that support and extend teaching and research: i) the management of campi and operations; ii) campus planning, design, construction and rehabilitation of buildings and infrastructures; iii) purchasing practices; iv) mobility and v) involvement with the community (Leal Filho et al., 2015). But, HEI face important sustainability challenges over resource use, being Energy one of the most significant. This paper focus on the energy consumption, and associated indicators, over a 10-year period, in a HEI in Portugal. Although literature on sustainable consumption of energy in HEI is not abundant, two studies stand out, Altan (2010) and Lo (2013). Altan (2010) analyse the energy efficiency of several types of interventions (technical, non-technical and management) in UK HEI, while Lo (2013) does a similar study for eight Chinese HEI, stressing the role played by stakeholders, such as administrators, governmental agencies, networks, students and non-governmental organizations. This paper adds to this literature by enriching benchmark data on: energy consumption in HEI, the efficiency of technical, non-technical and management energy interventions, and by providing evidence of the need for the development of new indicators in a context of continuous and rapid change of future demands for higher education.

The occurrence of ascites after Renal Transplant (RT) is infrequent, and may be a consequence of surgical or medical complications. Case report: 61 year-old, male, history of arterial hypertension, tongue carcinoma and alcoholic habits 12-20g/day. He had chronic kidney disease secondary to autosomal dominant polycystic kidney disease, without hepatic polycystic disease. He underwent cadaver donor RT in September 2017. He had delayed graft function by surgically corrected renal artery stenosis. He was admitted in January 2018 for ascites de novo, with no response to diuretics. HE had visible abdominal collateral circulation. Graft dysfunction, adequate tacrolinemia, Innocent urinary sediment, mild anemia, without thrombocytopenia. Serum albumin 4.0g / dL. Normal hepatic biochemistry. Peritoneal fluid with transudate characteristics and serum albumin gradient > 1.1. Ultrasound showed hepatomegaly, permeable vascular axes, without splenomegaly. Mycophenolate mofetil was suspended, with reduced remaining immunosuppression. He maintained refractory ascites: excluded infectious, metabolic, autoimmune and neoplastic etiologies. No nephrotic proteinuria and no heart failure. MRI: micronodules compatible with bile cysts. Upper Digestive Tract Endoscopy did not show gastroesophageal varicose veins. Normal abdominal lymphoscintigraphy. He underwent exploratory laparoscopy with liver biopsy: incomplete septal cirrhosis of probable vascular etiology some dilated bile ducts. He maintained progressive RT dysfunction and restarted hemodialysis. The proposed direct measurement of portal pressure was delayed by ascites resolution. There was further recovery of the graft function. Discussion: Incomplete septal cirrhosis is an uncommon cause of non-cirrhotic portal hypertension. Its definition is not well known, morphological and pathophysiological. We have not found published cases of post-RT ascites secondary to this pathology, described as possibly associated with drugs, immune alterations, infections, hypercoagulability and genetic predisposition. Resumo A ocorrência de ascite no pós-Transplante Renal (TR) é infrequente, podendo ser consequência de complicações cirúrgicas ou médicas. Caso clínico: 61 anos, masculino, antecedentes de hipertensão arterial, carcinoma da língua e hábitos alcoólicos 12-20g/dia. Doença renal crônica secundária à doença renal poliquística autossômica dominante, sem poliquistose hepática. Submetido a TR de doador cadáver em setembro de 2017. Atraso na função de enxerto por estenose da artéria renal, corrigida cirurgicamente. Internado em janeiro de 2018 por ascite de novo, sem resposta a diuréticos. Circulação colateral abdominal visível. Disfunção do enxerto, tacrolinemia adequada. Sedimento urinário inocente. Anemia ligeira, sem trombocitopenia. Albumina sérica 4,0g/dL. Bioquímica hepática normal. Líquido peritoneal com características de transudado e gradiente sero-ascítico de albumina > 1,1. Ecografia com hepatomegalia, eixos vasculares permeáveis, sem esplenomegalia. Suspendeu micofenolato mofetil, reduziu restante imunossupressão. Manteve ascite refratária: excluídas etiologias infecciosas, metabólicas, autoimunes e neoplásicas. Sem proteinúria nefrótica e sem insuficiência cardíaca. RM: micronódulos compatíveis com quistos biliares. EDA sem varizes gastroesofágicas. Linfocintigrafia abdominal normal. Submetido a laparoscopia exploradora com biópsia hepática: cirrose septal incompleta de provável etiologia vascular, alguns ductos biliares dilatados. Manteve disfunção progressiva do TR, reiniciou hemodiálise. Proposta medição direta da pressão portal, protelada por resolução da ascite. Recuperação posterior da função de enxerto. Discussão: A cirrose septal incompleta é uma causa incomum de hipertensão portal não cirrótica. A sua definição é morfológica e a fisiopatologia, pouco conhecida. Não encontramos publicados casos de ascite pós-TR secundária a esta patologia, descrita como possivelmente associada a fármacos, alterações imunitárias, infecções, hipercoagulabilidade e predisposição genética.

A reabilitação nZEB pode ter um papel preponderante no combate à pobreza energética, proporcionando, para além de uma poupança significativa de energia, condições interiores saudáveis e resiliência relativamente a eventuais subidas dos custos de energia.

Zero or nearly zero energy houses ((n)ZEB) are in fact houses that meet their energy demand by on site production of (renewable) energy, that is, by limiting consumption of fossil fuels and replacing them with local, building-connected generation. There is an ongoing discussion whether energy neutral buildings could sometimes be a better option, namely, the houses that use only renewable energy, which can be produced elsewhere, either in the direct vicinity, or by the classic grid. National power supply systems are also in transition in most countries, and they will eventually shift towards renewable energy production. For the housing sector, however, it has been decided to start as locally as possible, and not to wait until the whole system has been transformed. In some countries, local district heating will still be the major option to explore. This is the starting point in analysing retrofitting concepts for housing. With this in mind, to create zero energy houses, or nearly zero energy houses 4 main areas can be targeted: 1. (Local) production of renewable energy; 2. Reduction of energy loss in buildings; 3. Adaptation of building use; 4. Changing inhabitant behaviour. This book approach focuses mainly on Steps 1 and 2, assuming the usual mode of operations for Steps 3 and 4. Although it might turn out that to reach real zero energy targets and possibly beyond energy plus houses, which, for instance, include energy generation for electric driving, Steps 3 ad 4 might have to be addressed as well. Within Step 3, for instance, there is an option that the heated (or cooled) area should be reduced square wise. Within Step 4, there is an option that average temperature levels are reduced or differentiated among different rooms. In some retrofit concepts, Steps 3 and 4 are already addressed. We will also consider them within ?Concepts? section. The approach focuses mainly on heating and ventilation (cooling), since this energy demand is related to the building itself. Household-related energy use will not be influenced by retrofitting directly. Optimization in energy and materials input will mainly be ensured by optimization of heating/ventilation. If Steps 3 and 4 are left out, household energy is a set demand that can be supplied by the related given amount of extra energy generation. This will be shortly addressed in Chapters 2 and 3C., EU Framework Programme for Research and Innovation H2020 under grant agreement No 633477

Adequate supply of fresh air is essential to provide a healthy, safe and comfortable indoor environment in buildings. Currently, the majority of the residential buildings in mild climate European countries, such as Portugal or Spain, remain naturally ventilated. This fact has raised concerns in the building sector regarding the indoor air quality present in these buildings as fresh air supply mostly relies on occupants? window opening behavior and personal habits, which can vary significantly from one apartment to the next. In this context, this work presents the indoor CO2 concentration levels registered during more than one year in the bedrooms and living rooms of eight apartments of a naturally ventilated residential building located in Porto, Portugal. Monitored CO2 concentrations confirmed relevant periods of time with inadequate indoor air quality, exhibiting great variations between apartments. Differential occupants? window opening behavior, personal habits as well as presence of internal CO2 sources (e.g. smokers) were stated as the major reasons behind these wide discrepancies. Results suggest that, in some situations, implementation of mechanical ventilation systems in residential contexts should be promoted in order to guarantee adequate IAQ at all times and regardless of outdoor weather conditions or occupants? window opening behavior., info:eu-repo/semantics/publishedVersion

O processo de reabilitação energética do parque edificado coloca inúmeros desafios, para os quais é necessária uma estratégia que combine inovação de produto e de processos, optimização de custos e uma abordagem inovadora ao mercado. Neste contexto, as soluções prefabricadas modulares na renovação de edifícios são um caminho a ser explorado. A este tipo de soluções é reconhecido o potencial para uma optimização de processos de fabrico e consequente redução de custos, assim como para a redução de tempos de intervenção e de distúrbios causados aos utilizadores dos edifícios, ao mesmo tempo que aumenta a qualidade e eficiência energética das edificações. Neste artigo é apresentado de forma geral o projeto de investigação europeu More-Connect, no qual o Centro de Território, Ambiente e Construção (CTAC) da Universidade do Minho participa, e que tem como objectivo principal o desenvolvimento de soluções modulares que permitam, em conjugação com a aplicação de sistemas eficientes, alcançar edifícios com necessidades energéticas quase nulas (nZEB) ou nulas (ZEB), numa perspectiva de rentabilidade económica., info:eu-repo/semantics/publishedVersion

O aumento do nível de vida da sociedade verificado nas últimas décadas levou a um avanço tecnológico e ao desenvolvimento de novas práticas construtivas. Em muitos casos, estas práticas não foram desenvolvidas com consideração dos aspetos da qualidade do ambiente interior, o que levou ao surgimento de problemas construtivos. A qualidade do ambiente interior dos edifícios está relacionada com a saúde e produtividade dos ocupantes dos edifícios. Possui também repercussões nos custos de manutenção do edifício e no lucro das organizações. A norma EN 15251 indica que o custo de um ambiente interior de baixa qualidade para os utilizadores é mais elevado do que os custos energéticos do edifício. Estima-se que atualmente, devido ao atual estilo de vida, 90% da população passe 90% do seu tempo no interior de edifícios. Grande parte do parque edificado português apresenta necessidades de reabilitação. Muitas destas necessidades estão relacionadas com a fraca qualidade do ambiente interior. Após alguns anos de grave crise económica, o país encontra-se neste momento a relançar a atividade económica do sector da construção. Tendo em conta o panorama do sector, é expectável e desejável que grande parte desta atividade se foque na reabilitação. Com este estudo pretendeu-se analisar a disponibilidade de investimento dos proprietários de edifícios residenciais portugueses em soluções de melhoria da qualidade do ambiente interior. O estudo foi efetuado com recurso a entrevistas e questionários. Os resultados demonstraram que a ordem de preferência de investimento dos proprietários é a seguinte: conforto térmico, conforto acústico, qualidade do ar interior e iluminação. Verificou-se ainda que os proprietários estão disponíveis para investir cerca de duas vezes mais em conforto térmico do que em conforto acústico, cerca de duas vezes mais em conforto acústico do que em qualidade do ar e cerca de duas vezes mais em qualidade do ar do que em iluminação., info:eu-repo/semantics/publishedVersion

Energy is crucial to the wellbeing and development of nowadays society and will remain important for the foreseeable future. With respect to the type and quantity of energy consumed, significant changes are ongoing and further major changes can be expected in the near future. There are also various policy objectives that shape energy policy, depending on the country context. Among these objectives, the following can be highlighted: minimizing any adverse effects on the climate and on the environment; providing energy access to all; securing energy supply; reducing dependence on energy imports; looking for new energy sources, routes and suppliers that offer local economic benefits; reducing local environmental pollution; driving job creation; achieving low energy costs for society. Key strategic elements to reach such objectives are in particular the gradual transformation of the energy systems from fossil fuels to renewable energy, the increase of the efficiency of the energy systems, the reduction of energy use by consumers, the creation of fully integrated energy markets and the removal of unnecessary regulatory or technical barriers. The information provided in this guidebook aims to contribute to the reaching of the above-mentioned policy objectives. The guidebook is based on the results of a research project carried out within the IEA Energy in Buildings and Communities Programme (EBC) called "Cost-Effective Energy and Carbon Emissions Optimization in Building Renovation (Annex 56)". The guidebook was compiled to raise awareness among the players that can influence policies and standard definition and to engage them in the subjects of energy efficiency and renewable energy sources in the context of building renovation. Existing buildings present a tremendous potential, not only to reduce energy use and emissions, but also on other areas of the political agenda. It is the objective of this guidebook to highlight how energy related building renovation is a policy tool to achieve broad benefits to society., info:eu-repo/semantics/publishedVersion

This guidebook was compiled to raise awareness among the players that can influence policies and standard definition and to engage them in the subjects of energy efficiency and renewable energy sources in the context of building renovation. Existing buildings present a tremendous potential, not only to reduce energy use and emissions, but also on other areas of the political agenda. It is the objective of this guidebook to highlight how energy related building renovation is a policy tool to achieve broad benefits to society, info:eu-repo/semantics/publishedVersion

This guidebook is particularly intended for professional home-owners, i.e. individuals or companies that own and manage residential buildings. It is assumed that these owners are responsible for ensuring maintenance, repair and general servicing tasks and lead the decisions on the improvements to be made regarding comfort, safety, saving energy or just uplifting the buildings to contemporary needs or style. The main goal is to help in the decision-making process towards the optimized renovation of the residential building stock. More specifically, the guidebook provides a framework for the understanding of the relationships between cost-effective building renovation, energy savings and the use of renewable energy sources, highlighting the total added value achieved with the interventions., info:eu-repo/semantics/publishedVersion

Patients who are candidates for a second kidney transplant (SKT) frequently have a higher level of panel reactive antibodies (PRA). We assessed the allosensitisation change after a first graft failure (GF), its predictors and impact on retransplantat outcomes. We retrospectively selected 140 adult patients who received a SKT. Recipient and donor characteristics were analyzed. We defined the delta PRA (dPRA) as the difference between peak PRA before the SKT and first one (cohort median value = +10%). Logistic regression analysis was used to determine risk factors for dPRA ≥ 10% and acute rejection (AR) in the SKT. Univariable and multivariable Cox analysis was applied to assess independent predictors of second GF. Risk factors for dPRA ≥ 10% at SKT were AR (OR = 2.57; P = 0.022), first graft survival

O setor dos edifícios é um dos principais responsáveis para os desafios ambientais do planeta Terra. A diminuição dos impactes ambientais neste sector tem sido um tema amplamente discutido e abrangido por muitas das metas governamentais dos últimos anos. Contudo, a decisão pela aplicação de soluções que efetivamente permitam diminuir os impactes ambientais dos edifícios está muitas vezes do lado do utilizador. Por este motivo, apesar de muitas vezes, algumas soluções terem elevado desempenho e reduzido impacto ambiental, a baixa aceitação por parte dos utilizadores acaba por ditar o seu insucesso. Tendo em conta que esta aceitação está maioritariamente associada a questões económicas, é importante compreender qual a vontade e a disponibilidade de investimento dos utilizadores em medidas de baixo impacto ambiental. Com o presente estudo pretendeu-se analisar concretamente qual o valor que os utilizadores estão dispostos a investir de forma a produzir menores impactes ambientais através dos seus edifícios. Para tal foi levada a cabo uma série de entrevistas a proprietários de edifícios residenciais localizados em Portugal. Os resultados permitiram concluir que embora uma parte da população não esteja disposta a investir neste tipo de questões, a maioria das pessoas está disposta a investir mais para obter menores impactes ambientais., The building sector is one of the main contributors to the environmental challenges of the planet. The decrease of the environmental impacts of the sector has been a widely discussed theme. This issue has also been embraced by many governmental targets of the last years. However, the decision about whether or not implement sustainable measures is many times on the user’s side. For this reason, despite the high performance and low environmental impact of some solutions, the low acceptance by the consumers dictates its failure. This acceptance is most of the time related to economic issues. Thus, it is important to understand the users’ real investment availability and willingness in low environmental impact solutions. This study intends to analyze the value that the users are willing to pay in order to produce less building-related environmental impacts. An interview and survey campaign to Portuguese building owners was conducted. The results showed that although some of the population (around 25%) did not want to invest more to decrease the building's environmental impact, the majority is willing to pay more in order to obtain environmental benefits., Fundação para a Ciência e a Tecnologia e ao POPH/FSE-MCTES pelo apoio a este estudo através da bolsa com a referência SFRH/BD/112703/2015., info:eu-repo/semantics/publishedVersion

Nowadays, in the European Union the construction rate of new buildings is very low and therefore achieving the EU targets at the energy consumption level of the building sector is only possible through nearly zero energy renovation of the existing building stock. Reducing energy consumption through passive measures is a priority but this is not enough to achieve the nearly Zero Energy Building (nZEB) level. Therefore, the active systems, namely those that allow harvesting the solar energy to partially replace the use of non-renewable energy, are one of the best solutions to consider. At this level, solar thermal and photovoltaic panels play an important role, mainly in countries with high levels of solar radiation, as in the Southern European countries. Nevertheless, there are still some barriers to overcome for the broader dissemination of the implementation of these systems. One of the most important is that building owners are not fully aware of the life-cycle benefits that systems have at the economic level. As in every new different design approach, the best way to arise awareness is through the analysis of case studies, highlighting the reduced life-cycle costs and potential environmental impacts and other long-term benefits resulting from the integration of these active solutions. Thus, this paper is aimed at assessing the contribution of the solar systems to achieve three levels of energy performance (Basic Renovation, nearly Zero Energy Buildings - nZEB and Zero Energy Buildings - ZEB) in the energy renovation of a multifamily building located in Portugal. From the results, it is possible to conclude that, on an annual basis, and for the Portuguese climate, it is possible to overcome, a large amount of the energy needs for acclimatization and domestic hot water preparation with the integration of these systems. The study also shows attractive cost and carbon payback times resulting from their use., info:eu-repo/semantics/publishedVersion

The aim of the report is to illustrate the application of the methodology developed within the IEA EBC Annex 56 project and present several tools available for the successive implementation of the several steps of the process. The tools include those that have been used by the participating countries in the selected case-studies and also tools that, although not being used in the IEA EBC Annex 56 project, are compatible with the developed methodology.

To promote energy efficient buildings, with low energy consumption and energy generation onsite, innovative renovation projects are needed that can act as forerunners and inspiration but also serve as best practice examples for the expert audience and the general public. Within this IEA EBC Annex 56 project, six different Case Studies from six European countries were compiled and analysed . The Case Studies are both residential and non-residential buildings, which serve as model projects for renovations in each individual country. The specific aim of the case study activity of this IEA EBC Annex 56 project is to provide significant and useful feedback from practice on a scientific basis.

"Energy in Buildings and Communities Programme, March 2017", The renovation of the existing building stock represents a huge potential in actions to mitigate climate change, not only by the improvement of the overall energy performance of the built environment, but also by the reduction of resource depletion and minimization of waste production related with new construction. Nevertheless, this potential hasn?t been fully explored. Contributing to this, the evaluation of building renovation measures normally considers only the energy savings and the costs, disregarding other relevant benefits and thus, significantly underestimating the full value of improvement and re-use of buildings at several levels of the economy. In IEA EBC Annex 56 project, the reduction of energy use, emissions and global costs are the direct benefits resulting from energy related renovation measures and the notion of co benefits refers to all the other positive or negative effects resulting from those renovation measures., info:eu-repo/semantics/publishedVersion

"Energy in Buildings and Communities Programme, March 2017", Buildings are responsible for a major share of energy use and have been a special target in the global actions for climate change mitigation, with measures that aim at improving their energy efficiency, reduce carbon emissions and increase renewable energy use. The IEA-EBC Annex 56 project «Cost-Effective Energy and Carbon Emissions Optimization in Building Renovation» intends to develop the basics for future standards, which aim at maximizing effects on reducing carbon emissions and primary energy use while taking into account the cost-effectiveness of related measures. The IEA EBC Annex 56 project pays special attention to cost effective energy related renovation of existing residential buildings and low-tech office buildings (without air conditioning systems)., info:eu-repo/semantics/publishedVersion

The relevance of the building sector in the global energy use as well as in the global carbon emissions makes the improvement of the overall energy performance of existing buildings an important part of the actions to mitigate climate changes. Regardless of this potential, large-scale building renovation has been found hard to trigger, with present standards mainly focused on new buildings, not responding effectively to the technical, functional and economic constraints of the existing ones. One of the common problems in the assessment of building renovation scenarios is that only energy savings and costs are normally considered, despite the fact that the investment on energy efficiency yield several benefits beyond the value of saved energy (the so-called co-benefits). To demonstrate and highlight the relevance of co-benefits achieved in the renovation process, a Portuguese neighbourhood with nearly 17.000 inhabitants that has been recently renovated is analysed in search for evidences of the existence of these co-benefits and their relevance. Indoor temperature, humidity and noise insulation were monitored and a survey to the residents was carried out. Results clear indicate the achievement of co-benefits at the building level such as increased user comfort and reduced problems with building physics (mould and water infiltrations), but also the elimination of the feeling of gentrification by outside people to the neighbourhood. The analysis demonstrates that the decision-making process canâ t only be based on investment costs and energy savings, being necessary that owners, investors, promoters, but also policy makers adapt their reasoning to include these additional benefits.

Many regulations and initiatives to promote the reduction of the energy consumption and carbon emissions have been implemented in the building sector. However, they are mostly targeted for new buildings. In order to have an effective impact and reach the goals that are being established, it is necessary to act in new but especially in the existing buildings, which correspond to the majority of the European building stock. Building renovation improves the buildings’ energy performance, reducing the carbon emissions related to the operation of the building but the renovation involves adding new materials and technical systems. The production process of these new materials uses energy (embodied energy) and releases carbon emissions. In this sense, after a certain level of energy efficiency, the materials added to the building may have more embodied energy than the energy savings they will lead to. To evaluate the relevance of the embodied energy in building renovation, IEA EBC project Annex 56, developed a methodological framework to evaluate the cost-effectiveness of building renovation solutions which include a life-cycle impact assessment. In this context and using a particular case study, different renovation solutions are compared with and without considering the embodied energy. The results have shown that the embodied energy do not have a major impact on the evaluation of the cost-effectiveness of the renovation solutions, but as the renovation approach gets closer to zero non-renewable energy level, its relevance increases.

The social and environmental urgency of large-scale integrated retrofitting of the European residential building stock is widely acknowledged and supported by all Member States. However, the European building sector is currently still not able to offer an integral solution for deep renovation toward nearly Zero Energy Building (nZEB) for reasonable costs. MORE-CONNECT project aims to tackle this issue by developing cost optimal solutions to renovate buildings towards nZEB. In this project, the optimal solutions include the development of prefabricated, multifunctional renovation elements for the total building envelope (façade and roof) and installation/building services. This paper presents the first stage of the project, namely the analysis and comparison of three scenarios following the current national requirements in Portugal i) 80% reduction of the current primary energy consumption of the building, ii) cost optimal solution (nZEB) and iii) net zero energy (NZEB). The optimization of the building envelope will be the main driver for the three scenarios as well as the inclusion of renewable energy strategies. Overall, results suggest that it is possible to achieve cost-effective solutions for the renovation of Portuguese residential buildings. Moreover, the cost-optimal solution (scenario ii) matches approximately with the 80% reduction of energy scenario (scenario i)., MORE-CONNECT is funded by the European Commission within the framework of the Horizon 2020 program

Introduction: Malignancy management in renal transplant recipients is becoming a major factor affecting long‑term patient survival. Thus, we intended to evaluate both incidence and prognosis of malignant diseases following renal transplantation at a single centre in Portugal. Methods: We studied retrospectively the 2,358 patients who underwent kidney transplantation (KT) between 1983 and 2014. Apart from descriptive analysis, both demographic and clinical characteristics of cancer and non‑cancer cancer patients were compared. Results: During a median follow‑up of 118 (IQR 57‑179) months, 139 patients (5.8%) developed 158 de novo malignancies, with a median time from KT to diagnosis of 76..5 (IQR 21.0‑132.0) months. When compared to non‑cancer patients, they were older at KT date, had longer graft survival and a lower living donor recipients’ prevalence. As for post-transplant malignancies analysis, the most common were non‑cutaneous non‑lymphomatous cancers (49.4%, n=78), skin cancers (35.4%, n=56) and post‑transplant lymphoproliferative disorders (9.5%, n=15). Considering specific diagnosis, squamous cell carcinoma and basal cell carcinoma with 17.1% and 16.5% respectively, and non‑Hodgkin lymphomas with 7.6%, were the most frequent. Global mortality among cancer patients was 36.0%, with a median time of 9.7 (IQR 1.9‑17.5) months from time of diagnosis to death. As for survival analysis, cancer patient survival was significantly lower while censored graft survival was significantly higher in this group. Conclusion: Incidence and characteristics of malignancy following renal transplantation in our unit are similar to those globally described, despite some traits probably a result of specific ethnic and environmental characteristics. info:eu-repo/semantics/publishedVersion

The Portuguese socio-economic context of the last decades of XX century led to a great investment by the construction industry in new construction. This tendency continued even after the number of buildings had largely overcome the number of families. Nowadays, there are in Portugal more 45% of dwellings than families. On the other hand, the existing buildings were several times built without a proper consideration of important issues, such as thermal comfort, acoustic comfort, ventilation needs, natural lighting, among many others. For these reasons, many Portuguese buildings have big retrofitting needs. This study intends to present a statistical analysis of the Portuguese residential buildings retrofitting needs. Additionally, it was intended to study in what extent the retrofitting works currently being carried out overcome these needs. This analysis was made based on collected data from a survey responded by construction companies operating in Portugal., Portuguese Foundation for Science and Technology and POPH/FSE-MCTES for the financial support for this study under Reference SFRH/BD/112703/2015

ISBN 978-85-92631-00-0, Glazing contributes significantly to heat transfer between outdoor and indoor spaces and these surfaces act directly on daylighting and thermal comfort. Based on these aspects, spectrophotometric characterization of double glazings was accomplished to study components for a modular facade system for the climate of Portugal. This study focused on results of spectrophotometric measurements of optical behavior in the different solar spectrum intervals ultraviolet, visible and near infrared, specifically transmittance of two types of double glazings. The first double glazing presents a single pane of green glass with a solar control foil and a single pane of a glass with an extremely low-emissivity foil; the second one presents a single pane of self-cleaning glass and a float clear annealed glass. Results show the percentage of transmission to spectrum intervals, which enabled the verification of the efficiency of the glazing in terms of daylighting and the correlation to thermal performance. These results generate subsides and indications for specification and adequate uses of transparent surfaces, and also complements the datasheets available from the manufactures., Erasmus Mundus ISAC - Improving Skills Across Continents