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Despite the wide use of Drucker-Prager plasticity-based models on polymers, the experimental measurement of the dilation angle, a critical parameter to fully describe the plastic potential, has been rarely reported in existing literature. This paper shows, for the first time, the experimental characterisation of the dilation angle of polymers over a wide range of plastic strain. These measurements were obtained from uniaxial compression experiments conducted on poly(methyl methacrylate) (PMMA) and an untoughened epoxy resin. The calculation of the dilation angle relied on the measurements of the compressive force and the strain components obtained via Digital Image Correlation (DIC). Lower values of dilation angle were obtained for the epoxy resin, suggesting that resistance to volumetric change during plastic deformation could be associated to molecular structure and internal forces. The methodology and results presented in this study can be applied to different types of materials and employed for developing and validating constitutive models that incorporate plastic dilation.

Currently, the useable compressive properties of a composite are restricted by set design limits well below the expected intrinsic performance of the materials contained within. The next generation of high-performance fibre-reinforced polymer composites will need to address the challenge of improving the absolute performance of composites in compression. This task requires a rethink of the whole system; not only to address practical limitations of current materials, but their combination, interface, and their architecture. The mechanisms involved do not simply act over the nano-, macro-, or meso-level independently, but are mutually related at the system level, complicating the approach.

This study aims to develop and implement actual carbon fibre-reinforced polymer (CFRP) solutions for realising structural fuses in real components. To this end, we have developed various concepts for structural fuses, applied to generic idealised components and aimed at engaging different in-plane and through-the-thickness damage propagation mechanisms. Micro-cut patterns (MCPs) / crack path combinations have been engraved on thin-ply CFRP prepregs (by using a laser cut machine) for manufacturing CFRP specimens. Afterwards, we have carried out a series of experimental studies to evaluate the fracture properties of various MCPs under three-point bending (3PB). Then, 3PB results were used to refine and down-select our concepts, for use in our generic idealised component design to test them under indentation test using a cantilever beam rig. The test results demonstrated that MCPs can provide significant control over the fracture locus and path, additionally allowing the failure initiation load and energy dissipation to be tailored.

Introduction: Persistent respiratory symptoms at rest and during exertion (e.g., dyspnea, fatigue) play a role on the low physical activity (PA) levels found in people with chronic obstructive pulmonary disease (COPD), but other factors may also be involved. Environmental factors have been shown to impact PA levels in other patient populations, but evidence regarding people with COPD is still scarce. Investigations have been focused mostly on outdoor factors, such as air pollution or population density, disregarding the patients’ perception of their surroundings, both indoor and outdoor milieus. Objectives: This study explored the relationship between self-reported indoor and outdoor physical environmental opportunities for PA and actual PA levels in patients with COPD. Methods: Patients with COPD completed the Physical Activity Neighbourhood Environment Survey (PANES; total score 0-6, higher scores indicating a more supportive PA environment; 11 subscales: Residential Density, Land Use Mix, Access to Transportation, Infrastructure for Pedestrians, Infrastructure for Bicycles, Recreation Facilities, Street Connectivity, Security – Crimes, Security – Traffic, Security – Pedestrians, Aesthetics) and questions regarding their indoor and outdoor home environment (car ownership; having a dog, corridor, elevator, stairs and/or exercise equipment). An accelerometer was used for 7 days to assess daily PA: steps (steps/day); time in moderate and vigorous PA (MVPA; min/day); total PA (TPA; light PA+MVPA; min/day). Mann-Whitney-U and Spearman’s correlations (r) tests were conducted. Results: Ninety-four patients [78 males (83%), 67 ± 8 years, 48 ± 19 FEV1% predicted] participated in this study. PANES total score (n = 75) was 3 [1;4] (median [Q1;Q3]). Forty-three patients had a dog (13 walked it regularly); 63 had stairs, 12 had an elevator, 71 had a corridor, 45 had exercise equipment (stationary bicycle, n = 21) and 84 owned a car. Participants performed 4,428 [2,761;6,886] steps/ day, 19 [9;41] min/day of MVPA and 144 [103;208] min/day of TPA. Patients walking the dog presented a significantly higher daily step count (4,895 [2,644;7,780] vs. 4,422 [2,850;6,775] steps/day, p = 0.01) and time in TPA (154 [100;256] vs. 144 [103;177] min/day, p =.03) than those not walking the dog. No other significant differences were observed in the indoor and outdoor home environment (p > 0.05). No significant correlations were found between any of the PANES subscales and the different PA outcomes (-0.210 ≤ r ≤ 0.181, p > 0.05). Conclusions: A minimal influence of neighbourhood environmental factors on PA levels of patients with COPD was found in this observational study. Findings support previous research, as walking the dog impacted patients’ daily step counts. Longitudinal research is needed to more definitely evaluate potential environmental opportunities to promote PA in people with COPD. published

RESUMO Introdução A Larva Migrans Cutânea é uma dermatose infeciosa provocada por parasitas nematoides que infestam o Homem de forma acidental. É uma doença endémica em países tropicais, sendo o diagnóstico pouco comum nos países industrializados. Os autores apresentam o caso clínico de um trabalhador infetado durante uma viagem laboral ao Brasil, tendo como objetivo alertar os trabalhadores que viajam para destinos laborais com praias e climas tropicais sobre o risco de infestação por esta larva e as respetivas medidas preventivas. Descrição do Caso Clínico Os autores descrevem o caso de um homem de 32 anos, regressado de uma viagem em trabalho a zona endémica, com lesões pruriginosas, serpiginosas típicas na região plantar do pé direito. Teve evolução favorável com terapêutica oral com Albendazol. Faz-se uma revisão da epidemiologia, manifestações clínicas e opções terapêuticas. Discussão/Conclusão As crescentes viagens de lazer, mas sobretudo de trabalho, no contexto português, para as zonas endémicas, obrigam o profissional de saúde, sobretudo o Médico do Trabalho, a estar apto a diagnosticar patologias que cada vez mais deixarão de ser raridades.

RESUMO Introdução A COVID-19 é uma infeção respiratória causada pelo coronavírus SARS-CoV-2, de elevada transmissibilidade e de distribuição global. Apesar de precoces, os dados atuais apontam para a capacidade do SARS-CoV-2 atingir o sistema nervoso central, periférico e até mesmo o músculo. Descrição do Caso Clínico Este caso diz respeito a uma profissional de saúde, 31 anos de idade, em contacto diário com doentes COVID-19. Recorreu ao Serviço de Urgência, por alteração da sensibilidade da hemiface direita e assimetria facial, tendo tido alta medicada e sendo assumido o diagnóstico de Paralisia de Bell. Cerca de uma semana após este episódio, recorre novamente por mal-estar geral, febre, náuseas e vómitos, procedendo-se ao despiste de COVID-19, que se revelou positivo. Discussão/Conclusão O relato deste caso apoia a hipótese da paralisia do nervo facial como uma possível manifestação neurológica devido à infeção por COVID-19. Reforça também a importância de exame físico cuidado e historial médico detalhado, evitando atrasos no diagnóstico e consequentemente a transmissibilidade do vírus.

RESUMO Introdução: O ruído é um dos mais importantes poluentes ambientais e o seu impacto na saúde tem vindo a ser cada vez mais reconhecido. Além dos seus efeitos no sistema auditivo, o ruído afeta vários outros órgãos e sistemas. Objectivo: Nesta revisão pretendemos conhecer o impacto do ruído a nível extra-auditivo, bem como identificar medidas preventivas, de forma a minimizar os seus efeitos nocivos. Material e métodos: Trata-se de uma Scoping Review realizada através de uma pesquisa nas bases de dados PUBMED e MEDLINE, entre os meses de janeiro e março de 2021. As palavras-chave utilizadas foram ‘noise’, ‘sleep disturbance’, ‘cardiovascular diseases’, ‘metabolic diseases’, ‘cancer’ e ‘hospital noise’. Resultados: Foi demonstrado que o ruído está relacionado com perturbações do sono, doenças cardiovasculares, doenças metabólicas e neoplasias; afetando também a nível hospitalar o desempenho dos profissionais de saúde. Conclusão: Os efeitos extra-auditivos do ruído são variados, assumindo-se como um problema de saúde pública que exige medidas de controlo e de prevenção, de forma a limitar a tendência crescente das suas consequências negativas, quer a nível de saúde, quer a nível económico.

The open science movement has developed out of growing concerns over the scientific standard of published academic research and a perception that science is in crisis (the "replication crisis"). Bullying research sits within this scientific family and without taking a full part in discussions risks falling behind. Open science practices can inform and support a range of research goals while increasing the transparency and trustworthiness of the research process. In this paper, we aim to explain the relevance of open science for bullying research and discuss some of the questionable research practices which challenge the replicability and integrity of research. We also consider how open science practices can be of benefit to research on school bullying. In doing so, we discuss how open science practices, such as pre-registration, can be of benefit to a range of methodologies including quantitative and qualitative research and studies employing a participatory research methods approach. To support researchers in adopting more open practices, we also highlight a range of relevant resources and set out a series of recommendations to the bullying research community.

Studies from high, low and middle-income countries suggest significant associations between poverty and children’s school readiness outcomes (Bornstein et al., 2012). While consistent evidence, mostly from high income countries, indicate that parental income influences school readiness through ability to afford educational resources as well as parenting behaviours (Sosu & Schmidt, 2017), our understanding of these mechanisms in low and middle income countries is poor (Wolf, & McCoy, 2019). Additionally, we know little about the extent to which current educational policies such as the introduction of universal early years education moderate the poverty and school readiness gap. In this ongoing study, we draw on family investment models to shed light on the relationship between poverty and school readiness outcomes. Further, we investigate the extent to which access to early childhood education moderate the relationship between poverty and school readiness.

Polarizing beam splitters are key elements widely used in different optical instruments. This paper introduces the design and simulation of a novel thin-film multilayer polarizing micro beam splitter based on airgap layers (n = 1.002828 at 400 nm). The negligible absorption coefficient of the air over a wide spectral region (κ ≈ 0 from about 200 nm and higher) satisfies the conditions of a perfect low refractive index material (L). Moreover, using titanium dioxide (TiO2) as high refractive index material (H), a very high refractive index contrast is obtained. The micro beam splitter optical structure consists in a 7 optimized multilayer of TiO2 and air, providing a refractive contrast higher than 1.2. The polarizing beam splitter cube is projected in a borosilicate glass substrate (BK7) and the optical multilayer obtained, expressed in multiples of the quarter wavelength optical thickness – QWOT, is 1.6H L 1.1H 1.5L 1.1H L 1.6H. This optical structure ensures the transmission of p- polarization and the reflection of s- polarization, from visible to NIR spectral range, over a bandwidth higher than 170 nm. Additionally, the designed polarizing beam splitter can be fabricated using standard microtechnology fabrication processes., This work is supported by ANI through the Brain-Lighting project by FEDER funds through Portugal 2020, COMPETE 2020 with the reference POCI-01-0247-FEDER-003416.

The GO-DACT is an investigator-initiated, multicentric randomized placebo-controlled double-blinded trial, that assesses dactylitis as primary endpoint. Psoriatic arthritis patients naïve to methotrexate and biologic disease modifying anti-rheumatic drugs, with at least one active dactylitis, were assigned to golimumab in combination with methotrexate or placebo in combination with methotrexate, for 24 weeks. Both clinical (dactylitis severity score and the Leeds dactylitis index) and imaging (high resolution magnetic resonance imaging), among others, were assessed as outcomes. The main objective of GO-DACT is to provide evidence to improve the treatment algorithm and care of psoria - tic arthritis patients with active dactylitis. In this manuscript we describe the GO-DACT protocol and general concepts of the methodology of this trial. publishersversion published

Background: Advances in osteoporosis (OP)case definition, treatment options, optimal therapy duration and pharmacoeconomic evidence in the national context motivated the Portuguese Society of Rheumatology (SPR) to update the Portuguese recommendations for the diagnosis and management of osteoporosis published in 2007. Methods: SPR bone diseases’ working group organized meetings involving 55 participants (rheumatologists, rheumatology fellows and one OP specialist nurse) to debate and develop the document. First, the working group selected 11 pertinent clinical questions for the diagnosis and management of osteoporosis in standard clinical practice. Then, each question was investigated through literature review and draft recommendations were built through consensus. When insufficient evidence was available, recommendations were based on experts’ opinion and on good clinical practice. At two national meetings, the recommendations were discussed and updated. A draft of the recommendations full text was submitted to critical review among the working group and suggestions were incorporated. A final version was circulated among all Portuguese rheumatologists before publication and the level of agreement was anonymously assessed using an online survey. Results: The 2018 SPR recommendations provide comprehensive guidance on osteoporosis prevention, diagnosis, fracture risk assessment, pharmacological treatment initiation, therapy options and duration of treatment, based on the best available evidence. They attained desirable agreement among Portuguese rheumatologists. As more evidence becomes available, periodic revisions will be performed. Target audience and patient population: The target audience for these guidelines includes all clinicians. The target patient population includes adult Portuguese people. Intended use: These recommendations provide general guidance for typical cases. They may not be appropriate in all situations - clinicians are encouraged to consider this information together with updated evidence and their best clinical judgment in individual cases.

Objective: To update the recommendations for the treatment of rheumatoid arthritis (RA) with biological therapies, endorsed by the Portuguese Society of Rheu -matology (SPR). Methods: These treatment recommendations were formulated by Portuguese rheumatologists based on litera -ture evidence and consensus opinion. At a national meeting the 11 recommendations were discussed and updated. The document resulting from this meeting circulated to all Portuguese rheumatologists, who anonymously voted online on the level of agreement with the recommendations. Results: These recommendations cover general aspects as shared decision, prospective registry in Reuma.pt, asses sment of activity and RA impact and treatment objec tive. Consensus was also achieved regarding specific aspects as initiation of biologic therapy, assessment of res pon se, switching and definition of persistent remission. Conclusion: These recommendations may be used for guidance of treatment with biological therapies in patients with RA. As more evidence becomes available and more therapies are licensed, these recommendations will be updated. publishersversion published

Objective: To update the recommendations for the treatment of axial spondyloarthritis (axSpA) with biological therapies, endorsed by the Portuguese Society of Rheumatology. Methods: These treatment recommendations were formulated by Portuguese rheumatologists based on lite - rature evidence and consensus opinion. At a national meeting, the recommendations included in this document were discussed and updated. A draft of the full text of the recommendations was then circulated and suggestions were incorporated. A final version was again circulated before publication and the level of agreement among Portuguese Rheumatologists was anonymously assessed using an online survey. Results: A consensus was achieved regarding the initiation, assessment of response and switching of biological therapies in patients with axSpA. In total, se ven recommendations were produced. The first recommendation is a general statement indicating that biological therapy is not a first-line drug treatment option and should only be used after conventional treatment has failed. The second recommendation is also a ge - neral statement about the broad concept of axSpA adopted by these recommendations that includes both non-radiographic and radiographic axSpA. Recommendations 3 to 7 deal with the definition of active di - sease (including the recommended threshold of 2.1 for the Ankylosing Spondylitis Disease Activity Score [ASDAS] or the threshold of 4 [0-10 scale] for the Bath Ankylosing Spondylitis Disease Activity Index [BASDAI]), conventional treatment failure (nonsteroidal anti-inflammatory drugs being the first-line drug treatment), assessment of response to treatment (based on an ASDAS improvement of at least 1.1 units or a BASDAI improvement of at least 2 units [0-10 scale] or at least 50%), and strategy in the presence of an ina -dequate response (where switching is recommended) or in the presence of long-term remission (where a process of biological therapy optimization can be consi - dered, either a gradual increase in the interval between doses or a decrease of each dose of the biological the - rapy). Conclusion: These recommendations may be used for guidance in deciding which patients with axSpA should be treated with biological therapies. They co - ver a rapidly evolving area of therapeutic intervention. As more evidence becomes available and more biological therapies are licensed, these recommendations will have to be updated. publishersversion published

The GO-DACT is an investigator-initiated, national, multicentric randomized placebo-controlled double-blinded trial, that assesses dactylitis as primary endpoint. Psoriatic arthritis patients naïve to methotrexate and biologic disease modifying anti-rheumatic drugs, with at least one active dactylitis, were assigned to golimumab in combination with methotrexate or placebo in combination with methotrexate, for 24 weeks. Both clinical (dactylitis severity score and the Leeds dactylitis index) and imaging (high resolution magnetic resonance imaging), among others, were assessed as outcomes. The main objective of GO-DACT is to provide evidence to improve the treatment algorithm and care of psoriatic arthritis patients with active dactylitis. In this manuscript we describe the GO-DACT protocol and general concepts of the methodology of this trial. info:eu-repo/semantics/publishedVersion

© 2017 International Committee on Composite Materials. All rights reserved. The longitudinal strength of unidirectional fibre-reinforced composites is one of the most basic strength properties of fibre-reinforced composites. Many different models have been developed, but a systematic and unbiased comparison between those models is not available in the literature. This paper therefore presents a benchmarking exercise that compares three state-of-the-art models: a hierarchical scaling law, a direct numerical simulation method and a multiscale finite element simulation method. The results reveal significant discrepancies between the predictions of the models, which can be explained by the inherent assumptions of each of the models. Experimental results were compared against blind predictions by all three models. This comparison revealed that the basic mechanisms are understood and captured, but that more experimental and modelling work is required to advance our understanding to a higher level. ispartof: Proceedings ICCM21 vol:2017-August ispartof: International Conference on Composite Materials (ICCM) location:Xi'an, China date:20 Aug - 25 Aug 2017 status: published

Pre-cut unidirectional carbon fibre prepreg (M21/194/34%/T800S) composites were tested in tension with a 20 mm overlapped finger joint architectures. In between the overlapping finger jointed region the effect of introducing polyethersulfone (PES) interleaves is investigated. Samples with the addition of a thick PES interleave arrested the initial crack which formed at the pre-cut site. The strain-to-failure of the thick PES interleaved samples was over 3.2%, an increase of 85% compared to the baseline samples, and catastrophic failure was delayed in the majority of instances.

Background: Methotrexate (MTX) is the first-line drug in the treatment of rheumatoid arthritis (RA) and the most commonly prescribed disease modifying antirheumatic drug. Moreover, it is also used as an adjuvant drug in patients under biologic therapies, enhancing the efficacy of biologic agents. Objectives: To review the literature and update the Portuguese recommendations for the use of MTX in rheumatic diseases first published in 2009. Methods: The first Portuguese guidelines for the use of MTX in rheumatic diseases were published in 2009 and were integrated in the multinational 3E Initiative (Evi - dence Expertise Exchange) project. The Portuguese rheumatologists based on literature evidence and consensus opinion formulated 13 recommendations. At a national meeting, the recommendations included in this document were further discussed and updated. The document resulting from this meeting circulated to all Portuguese rheumatologists, who anonymously voted online on the level of agreement with the updated recommendations. Results: Results presented in this article are mainly in accordance with previous guidelines, with some new information regarding hepatitis B infection during MTX treatment, pulmonary toxicity monitoring, hepatotoxi - city management, association with hematologic neoplasms, combination therapy and tuberculosis scree - ning during treatment. Conclusion: The present recommendations combine scientific evidence with expert opinion and attained desirable agreement among Portuguese rheumatologists. The regular update of these recommendations is essen - tial in order to keep them a valid and useful tool in daily practice. publishersversion published

This work investigates the potential and the applicability of combining hierarchical and discontinuous microstructures to overcome the brittleness of man-made composites. Finite Element simulations were developed to model hierarchical “brick-and-mortar” composites, in which each brick of the structure is itself made of an arrangement of bricks at a smaller scale. Then, optimal brick geometrieswere identified, manufactured and tested. The experimental results confirmedthe potential of such microstructures to dissipate energy stably through damage dispersion in the whole material, hence delaying damage localisation, and providing warning before failure. Finally, non-self-similar microstructureswere identified and optimised to improve furtherthe tensile response of co mposites. It was found that relaxing the constraints of self-similarity could delay damage localisation even more, and increase both the strength and the damage tolerance of hierarchical discontinuous composites.

In this study, three differently-configured sandwich structures were manufactured with three different core materials: Balsa wood, Tycor and Polyethylene terephthalate (PET). Glass-Fibre Reinforced Polymer (GFRP) skins were used to understand the effects of different types of core materials on the flexural behavior of sandwich composites under four point bending (4PB) condition, using digital image correlation (DIC). DIC is one of the most outstanding techniques to understand the mechanical behavior of the structure during the test, thus defining any problematic regions in the structures. The failure mechanisms of the structures were observed by using strain maps of the structures. The results show that the sandwich structure with Balsa wood as a core material has the highest stiffness; however, catastrophic failure appeared in the early stages of the test. The sandwich structure with PET and Tycor exhibited very similar behaviour under load.

The detection of cancer at the dysplasia stage is one of the most important goals in biomedical research. Optical techniques, specifically diffuse reflectance and intrinsic fluorescence, may improve the ability to detect gastrointestinal (GI) cancers, since they have exquisite sensitivity to some intrinsic biomarkers present on the tissues. This work follows the research that has been done towards the implementation of a spectroscopy microsystem for the early detection of GI cancers. For that purpose, the behavior of the fluorescence signal, at different temperatures and considering the most important biomarkers in GI malignancy detection, was studied and presented., This work is funded by FEDER funds through the "Eixo I do Programa Operacional Fatores de Competitividade (POFC) QREN, project references COMPETE: FCOMP-01-0124-FEDER-020241 and FCOMP-01-0124-FEDER-022711 (PEst-C/FIS/UI0607/2013) and by FCT – Fundação para a Ciência e a Tecnologia, project reference PTDC/EBB-EBI/120334/2010. S. Pimenta thanks the FCT for the SFRH/BD/87605/2012 PhD grant.

The ability to detect cancer at its earliest stages, called “dysplasia”, is the key of its successful treatment. Optical techniques, such as diffuse reflectance and intrinsic fluorescence, may improve the ability to detect gastrointestinal (GI) dysplasia since they have the potential to provide morphological and biochemical information of normal and malignant tissues. However, those optical tissue properties can only be provided if it is possible to extract information from the measured diffuse reflectance and intrinsic fluorescence signals. This paper presents the implementation and the validation of a preliminary Monte Carlo based inverse model to extract optical tissue properties, such as the absorption and the scattering coefficients, from diffuse reflectance experimental measurements in phantoms., This work is funded by FEDER funds through the "Eixo I do Programa Operacional Fatores de Competitividade (POFC) QREN, project reference COMPETE: FCOMP-01-0124-FEDER-020241, and by FCT- Fundação para a Ciência e a Tecnologia, project reference PTDC/EBB-EBI/120334/2010. S. Pimenta thanks the FCT for the SFRH/BD/87605/2012 PhD grant.

The paper discusses the entry strategies adopted by research-based firms introducing advanced renewable energy technologies in the electricity production sector, which combines strong incumbent power with fast technological change. Drawing on contributions from the literatures on sustainability transitions and on strategic management of technology we build an analytical framework to address the conditions faced by the new entrants and the attitude of established incumbents towards their technologies. This framework is applied through in-depth case studies of new firms in two energy fields that display different levels of technological maturity: wind and wave energy. The paper presents preliminary results from a first set of case studies, which provide some insights into the “commercialisation environment” prevailing in those fields. They suggest that research-based firms tend to depend on the complementary assets possessed by incumbents, but have conditions to protect their technologies; and that the technology is relevant for (at least some) incumbents, which show interest on them, or are directly involved in their development/use. This is, in most cases, conducive to “cooperation” strategies, which assume different forms according to the stage of development of the technology and its proximity to incumbent competences and business models FCT QREN – Operational Programme for Competitiveness Factors, the European Union – European Regional Development Fund and National Funds Portuguese Foundation for Science and Technology under Project FCOMP-01-0124-FEDER-011377, Project PEst-C/EGE/UI4105/2011 and Project Project Pest-OE/EME/UI0252/2011 INESC Coimbra

The authors review the practical aspects of biological therapy use for rheumatoid arthritis patients, commenting safety issues before and after treatment initiation and the best treatment strategies to optimize efficacy.

Estágio realizado no Imperial College London e orientado pelo Prof. Dr. Paul Robinson Tese de mestrado integrado. Engenharia Mecânica. Faculdade de Engenharia. Universidade do Porto. 2008

The inherent brittleness of continuous unidirectional fibre reinforced composites is a major drawback to their otherwise outstanding mechanical performance. This paper exploits composites with overlapped discontinuities at the ply level to create a significantly non-linear response, due to progressive interlaminar damage under tensile loading. Two distinct configurations were manufactured with the same carbon/epoxy system and tested under quasi-static tension, showing that varying the thickness and length of the overlapping ply blocks resulted in significantly different mechanical responses and failure modes. A previously developed generalised shear-lag model was successfully used to optimise the overlap configuration, and accurately predicted the response in both strength- and toughness-dominated cases. This work demonstrates that unidirectional composites with well-designed discontinuities at the ply level can provide a significantly non-linear response with clear warning before failure, while retaining similar stiffness and up to 50% of the strength of their continuous counterparts.

Biotechnological drugs have become a fundamental resource for the treatment of rheumatic patients. Patent expiry of some of these drugs created the opportunity for biopharmaceutical manufacturers to develop biosimilar drugs intended to be as efficacious as the originator product but with a lower cost to healthcare systems. Due to the complex manufacturing process and highly intricate structure of biologicals, a biosimilar can never be an exact copy of its reference product. Consequently, regulatory authorities issued strict preclinical and clinical guidelines to ensure safety and efficacy equivalence and, in September 2013, the biosimilar of infliximab was the first biosimilar monoclonal antibody to be authorized for use in the European Union. The current document is a position statement of the "Sociedade Portuguesa de Reumatologia" (Portuguese Society of Rheumatology) on the use of biosimilar drugs in rheumatic diseases. Two systematic literature reviews were performed, one concerning clinical trials and the other one concerning international position papers on biosimilars. The results were presented and discussed in a national meeting and a final position document was discussed, written and approved by Portuguese rheumatologists. Briefly, this position statement is contrary to automatic substitution of the originator by the biosimilar, defends either a different INN or the prescription by brand name, supports that switching between biosimilars and the originator molecule should be done after at least 6 months of treatment and based on the attending physician decision and after adequate patient information, recommends the registration of all biosimilar treated patients in Reuma.pt for efficacy, safety and immunogenicity surveillance, following the strategy already ongoing for originators, and opposes to extrapolation of indications approved to the originator to completely different diseases and/or age groups without adequate pre-clinical, safety or efficacy data. info:eu-repo/semantics/publishedVersion

Introduction: Features suggestive of neuropathic pain (NP) have been described in RA in addition to nociceptive pain. We aimed to determine the clinical predictors of NP in RA patients and study its association with radiographic structural damage. Methods: Cross-sectional study was performed with RA patients followed at our Rheumatology department. Patients with diagnosed neuropathy of other origin, non-RA related risk factors for NP (e.g. diabetes mellitus) or fibromyalgia according to expert opinion were excluded. Demographic and clinical data were collected and disease activity/functional measures were evaluated. Two questionnaires were applied to assess NP: the Leeds Assessment of Neuropathic Symptoms (LANSS) and the painDETECT questionnaire (PDQ). Radiographs performed in up to 12 months before/after the evaluation were classified according to the modified van der Heijde Sharp´s method. Univariate and multivariate logistic regression were performed to identify the predictors of NP. Results: 112 patients were included. 86 (77%) were women, with a mean (SD) age of 55.1 (10.8) years and median disease duration of 13 [2-41] years. 45 (40%) patients had NP by the LANSS (≥12) and 28% had a possible/likely NP in the PDQ (≥13). Female sex was predictive of NP by both tests and disease duration was inversely associated with LANSS NP. After adjusting for those two variables, pain VAS and TJC were positive predictors of NP by both tests. The same was not true for SJC, ESR or CRP levels. DAS28-CRP was significantly associated with PDQ NP, losing its statistical significance after adjustment for TJC and pain VAS. The HAQ score increased the odds of NP for both tests, independently of DAS 28-CRP. Positivity for ACPA and previous/current hydroxychloroquine treatment had lower odds of NP. 90 patients performed radiographic evaluation. Joint narrowing score was a significant negative predictor of LANSS NP. After adjusting for global radiographic score, current methotrexate treatment had lower odds of LANSS NP and previous/current leflunomide was a positive predictor of NP by both tests. Conclusion: NP was associated with disease activity/functional scores but not with objective inflammatory measures. Greater structural damage, increased disease duration and ACPA positivity did not seem to increase the odds of NP. Possible association of NP and underlying csDMARD treatment was uncovered.

Physical anatomic models obtained from medical images can be a powerful aid in the treatment of several medical situations. In this work, a complete methodology, from the acquisition of medical images to materialisation of three-dimensional models, with a particular emphasis on image segmentation techniques, was studied, developed and applied to organs of the female pelvic cavity. This methodology is presented in this paper, including several experimental results of each involved step.

Pre-cut unidirectional carbon fibre prepreg composites, with an overlapped finger-joint architecture, were modified through the addition of polyethersulfone (PES) interleaves. The properties arising from these finger-jointed configurations were strongly dependent on the interply overlap region. When the tough thermoplastic interleaves spanned only the central portion of the overlap, a crack arresting failure mechanism was observed in tension. A pronounced plateau region or pseudo-ductile response was shown in conjunction with a strain hardening response after crack arrest. The local strain-to-failure of PES interleaved samples was ~3.2%, an increase of 85% compared to the pre-cut baseline (strain-to-failure 1.6%, pre-cut specimens without interleaves).

Objective: To update the recommendations for the treatment of axial spondyloarthritis (axSpA) with biological therapies, endorsed by the Portuguese Society of Rheumatology. Methods: These treatment recommendations were formulated by Portuguese rheumatologists based on lite - rature evidence and consensus opinion. At a national meeting, the recommendations included in this document were discussed and updated. A draft of the full text of the recommendations was then circulated and suggestions were incorporated. A final version was again circulated before publication and the level of agreement among Portuguese Rheumatologists was anonymously assessed using an online survey. Results: A consensus was achieved regarding the initiation, assessment of response and switching of biological therapies in patients with axSpA. In total, seven recommendations were produced. The first recommendation is a general statement indicating that biological therapy is not a first-line drug treatment option and should only be used after conventional treatment has failed. The second recommendation is also a ge - neral statement about the broad concept of axSpA adopted by these recommendations that includes both non-radiographic and radiographic axSpA. Recommendations 3 to 7 deal with the definition of active di - sease (including the recommended threshold of 2.1 for the Ankylosing Spondylitis Disease Activity Score [ASDAS] or the threshold of 4 [0-10 scale] for the Bath Ankylosing Spondylitis Disease Activity Index [BASDAI]), conventional treatment failure (nonsteroidal anti-inflammatory drugs being the first-line drug treatment), assessment of response to treatment (based on an ASDAS improvement of at least 1.1 units or a BASDAI improvement of at least 2 units [0-10 scale] or at least 50%), and strategy in the presence of an ina - dequate response (where switching is recommended) or in the presence of long-term remission (where a process of biological therapy optimization can be consi - dered, either a gradual increase in the interval between doses or a decrease of each dose of the biological the - rapy). Conclusion: These recommendations may be used for guidance in deciding which patients with axSpA should be treated with biological therapies. They co - ver a rapidly evolving area of therapeutic intervention. As more evidence becomes available and more biological therapies are licensed, these recommendations will have to be updated. publishersversion published

Eosinophilic granulomatosis with polyangiitis is a rare multisystemic disorder, characterized by necrotizing vasculitis affecting small to medium-sized vessels, associated with asthma and eosinophilia. Cardiac involvement is the most important predictor of mortality and it seems to be more frequent in anti–neutrophil cytoplasmic antibodies-negative patients. Cardiomyopathy and congestive heart failure can occur but a significant proportion of patients are asymptomatic. We present a case of this condition in a 65-year-old woman with a past medical history of rhinosinusitis and recent episodes of asthma, that developed palpable purpura, sensory deficiency and excruciating pain mainly in the lower limbs. A significant hypereosinophilia and elevated troponin level were found, although she had not cardiac symptomatology. Cardiovascular magnetic resonance revealed late gadolinium enhancement and a severe reduction of the left ventricular ejection fraction. Mononeuritis multiplex was documented and diagnosis was confirmed by biopsy. Complementary cardiac investigation is mandatory in any patient with suspicion of Eosinophilic granulomatosis with polyangiitis. Early detection and the appropriate treatment are crucial due to the possible life-threatening manifestations.