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Background Primary health care services are the cornerstone of all health systems. Having clear data on allocated human resources is essential for planning. This work intended to map and compare the primary health care human resources of the five administrative regions (ARS) of the Portuguese public health system, so that better human resources management can be implemented. Methods The chosen design was a descriptive cross sectional study. Each of the five ARS were divided into primary health care clusters, which included several primary health care units. All of these units periodically sign a “commitment letter”, where they stand their service commitments to the covered population. This includes allocated health professionals (doctors, nurses), and the information is publicly accessible at www.bicsp.min-saude.pt. Data was collected for 2017, the year for which more commitment letters were available. Several ratios were calculated: patients/health professional; patients/doctor (family medicine specialists and residents); patients/nurse and patients/family medicine specialist. Mean, standard deviation, minimum and maximum values were calculated. Results National patients/health professional ratio was 702 with the mean of the 5 ARS calculated at 674+-7.15% (min 619, max 734) whilst the national patients/doctor ratio was 1247 with the mean of the 5 ARS calculated at 1217+-7.17% (min 1074, max 1290). National patients/nurse ratio was 1607 with the mean of the 5 ARS calculated at 1529+-13.08% (min 1199, max 1701). Finally, national patients/family medicine specialist ratio was 1711 with the mean of the 5 ARS calculated at 1650+-6,36% (min 1551, max 1795). Conclusions Human resources were differently spread across Portugal, with variations between the five ARS in all ratios. The largest differences occur between nursing staff, and may translate into inequities of access, with impact on health results. A more homogeneous human resources allocation should be implemented. Key messages Human resources in the Portuguese primary health care services are not homogeneously allocated. A better and more homogeneous allocation of human resources should be implemented to reduce access health inequities.

Background: Hereditary Hemorrhagic Telangiectasia type 2 (HHT2) is an inherited genetic disorder characterized by vascular malformations and hemorrhage. HHT2 results from ACVRL1 haploinsufficiency, the remaining wild-type allele being unable to contribute sufficient protein to sustain endothelial cell function. Blood vessels function normally but are prone to respond to angiogenic stimuli, leading to the development of telangiectasic lesions that can bleed. How ACVRL1 haploinsufficiency leads to pathological angiogenesis is unknown. Methods: We took advantage of Acvrl1 +/− mutant mice that exhibit HHT2 vascular lesions and focused on the neonatal retina and the airway system after Mycoplasma pulmonis infection, as physiological and pathological models of angiogenesis, respectively. We elucidated underlying disease mechanisms in vitro by generating Acvrl1 +/− mouse embryonic stem cell lines that underwent sprouting angiogenesis and performed genetic complementation experiments. Finally, HHT2 plasma samples and skin biopsies were analyzed to determine whether the mechanisms evident in mice are conserved in humans. Results: Acvrl1 +/− retinas at postnatal day 7 showed excessive angiogenesis and numerous endothelial “tip cells” at the vascular front that displayed migratory defects. Vascular endothelial growth factor receptor 1 (VEGFR1; Flt-1) levels were reduced in Acvrl1 +/− mice and HHT2 patients, suggesting similar mechanisms in humans. In sprouting angiogenesis, VEGFR1 is expressed in stalk cells to inhibit VEGFR2 (Flk-1, KDR) signaling and thus limit tip cell formation. Soluble VEGFR1 (sVEGFR1) is also secreted, creating a VEGF gradient that promotes orientated sprout migration. Acvrl1 +/− embryonic stem cell lines recapitulated the vascular anomalies in Acvrl1 +/− (HHT2) mice. Genetic insertion of either the membrane or soluble form of VEGFR1 into the ROSA26 locus of Acvrl1 +/− embryonic stem cell lines prevented the vascular anomalies, suggesting that high VEGFR2 activity in Acvrl1 +/− endothelial cells induces HHT2 vascular anomalies. To confirm our hypothesis, Acvrl1 +/− mice were infected by Mycoplasma pulmonis to induce sustained airway inflammation. Infected Acvrl1 +/− tracheas showed excessive angiogenesis with the formation of multiple telangiectases, vascular defects that were prevented by VEGFR2 blocking antibodies. Conclusions: Our findings demonstrate a key role of VEGFR1 in HHT2 pathogenesis and provide mechanisms explaining why HHT2 blood vessels respond abnormally to angiogenic signals. This supports the case for using anti-VEGF therapy in HHT2.

AIMS: To assess tolerability and optimal time point for initiation of sacubitril/valsartan in patients stabilised after acute heart failure (AHF). METHODS AND RESULTS: TRANSITION was a randomised, multicentre, open-label study comparing two treatment initiation modalities of sacubitril/valsartan. Patients aged ≥ 18 years, hospitalised for AHF were stratified according to pre-admission use of renin-angiotensin-aldosterone system inhibitors and randomised (n = 1002) after stabilisation to initiate sacubitril/valsartan either ≥ 12-h pre-discharge or between Days 1-14 post-discharge. Starting dose (as per label) was 24/26 mg or 49/51 mg bid with up- or down-titration based on tolerability. The primary endpoint was the proportion of patients attaining 97/103 mg bid target dose after 10 weeks. Median time of first dose of sacubitril/valsartan from the day of discharge was Day -1 and Day +1 in the pre-discharge group and the post-discharge group, respectively. Comparable proportions of patients in the pre- and post-discharge initiation groups met the primary endpoint [45.4% vs. 50.7%; risk ratio (RR) 0.90; 95% confidence interval (CI) 0.79-1.02]. The proportion of patients who achieved and maintained for ≥ 2 weeks leading to Week 10, either 49/51 or 97/103 mg bid was 62.1% vs. 68.5% (RR 0.91; 95% CI 0.83-0.99); or any dose was 86.0% vs. 89.6% (RR 0.96; 95% CI 0.92-1.01). Discontinuation due to adverse events occurred in 7.3% vs. 4.9% of patients (RR 1.49; 95% CI 0.90-2.46). CONCLUSIONS: Initiation of sacubitril/valsartan in a wide range of heart failure with reduced ejection fraction patients stabilised after an AHF event, either in hospital or shortly after discharge, is feasible with about half of the patients achieving target dose within 10 weeks. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT02661217. © 2019 The Authors. European Journal of Heart Failure published by John Wiley & Sons peerReviewed

Block 32, deep offshore Angola, is located in an area of the Lower Congo Basin heavily affected by the salt tectonism: salt domes or canopies are extensive. As a consequence having a good seismic image is critical in terms of exploration but also development of discoveries. Over the past decade the focus has moved towards the sub-salt play and the use of conventional seismic has reached its limits. As a consequence, Total E&P Angola embarked in 2012 in a project to address complex subsalt challenges in the Central North East part of the Block 32, using innovative technologies: from survey design, to acquisition, processing and imaging. The objective was to deliver interpreters a state-of-the-art and fit for purpose solution in a timely and cost-effective manner. This project is known as the Block 32 CNE Bi WATS. This abstract aims to give a full overview of the project, from its genesis to its execution, and finally present some of the results

Since the pioneering work of Ramsey, atom interferometers are employed for precision metrology, in particular to measure time and to realize the second. In a classical interferometer, an ensemble of atoms is prepared in one of the two input states, whereas the second one is left empty. In this case, the vacuum noise restricts the precision of the interferometer to the standard quantum limit (SQL). Here, we propose and experimentally demonstrate a novel clock configuration that surpasses the SQL by squeezing the vacuum in the empty input state. We create a squeezed vacuum state containing an average of 0.75 atoms to improve the clock sensitivity of 10,000 atoms by 2.05 dB. The SQL poses a significant limitation for today's microwave fountain clocks, which serve as the main time reference. We evaluate the major technical limitations and challenges for devising a next generation of fountain clocks based on atomic squeezed vacuum., 9 pages, 6 figures

Defective paracrine Transforming Growth Factor-β (TGF-β) signaling between endothelial cells and the neighboring mural cells have been thought to lead to the development of vascular lesions that are characteristic of Hereditary Hemorrhagic Telangiectasia (HHT). This review highlights recent progress in our understanding of TGF-β signaling in mural cell recruitment and vessel stabilization and how perturbed TGF-β signaling might contribute to defective endothelial-mural cell interaction affecting vessel functionalities. Our recent findings have provided exciting insights into the role of thalidomide, a drug that reduces both the frequency and the duration of epistaxis in individuals with HHT by targeting mural cells. These advances provide opportunities for the development of new therapies for vascular malformations.

En el presente trabajo se presentan los detalles necesarios para el diseño del control de posición de un motor DC, teniendo en cuenta los parámetros del motor dados por el fabricante. Explicaremos los métodos para hallar los parámetros reales del motor, con los cuales se hallan los parámetros del controlador, además de las constantes de Kalman y de control utilizados en los programas tanto en lenguaje C++ como ensamblador del DSP que queramos utilizar, los datos de la señal de referencia, del encoder de posición, de la señal de control y de la señal de error que se pueden obtener como resultado del programa en tiempo real con lenguaje C++, dichos datos de salida se dibujan con software de Matlab. Con los datos obtenidos en tiempo real, se pueden crear los dos archivos de entrada de señal de referencia y del encoder de posición al programa en lenguaje ensamblador del DSP seleccionado, y para producir la señal de control que también es obtenida como resultado del programa en lenguaje C++, finalmente dibujamos los resultados del programa en lenguaje ensamblador de DSP seleccionado con software de Matlab. Palabras clave.-.- Identificación, SISO, Matlab, Señal de referencia, Señal de control, Señal de error, Lenguaje ensamblador, DSP, Encoder. ABSTRACTIn this work is presented the required details for the design a DC motor positioning control, having into account the parameters of the motor given by the manufacturer. It is explain in detail the method used to find their operation parameters, with the controller parameter, the Kalman and control constants are calculated. All of those used in the C++ language as well as in DSP assembler. With the data collected in real time is produced the control signal that also is obtained from C++, finally we drew the results in DSP assembly language. Keywords.- Identification, SISO, Matlab, Reference signal, Control signal, Error signal, Assembly language, DSP, Encoder.

Gabriel Alejandro Galaviz Mosqueda1, Raul Aquino Santos2, Luis A. Villasenor Gonzalez1, Victor Rangel Licea3 and Arthur Edwards Block2 1Centro de Investigacion Cientifica y Educacion Superiore de Ensenada. Carretera Ensenada-Tijuana, num. 3918, Zona playitas, C. P. 22860, Ensenada, Baja California, 2Facultad de Telematica, Avenida Universidad 333, C. P. 28040, Colima, Col., 3Facultad de Ingenieria, Edificio Valdez Vallejo, 3er piso, Circuito Interior, Ciudad Universitaria, Delegacion Coyoacan, C. P. 04510, Mexico

Este artigo teve como objetivo identificar e analisar a dinâmica de crescimentoda cafeicultura em Minas Gerais e em duas regiões do estado tipicamenteprodutoras – Sudoeste e Cerrado. O referencial teórico utilizado baseia-se na teoriade inovação induzida. O modelo analítico é o denominado Shift-Share, que permitedecompor as fontes de crescimento nos efeitos área, rendimento, localização geográ-fica e composição, a fim de encontrar os fatores responsáveis pelo crescimento (ouqueda) da produção. Os resultados apresentados indicam que existem diferenças nosfatores que determinam o crescimento da produção de café na região mais tradicional(Sudoeste) comparada à região relativamente mais moderna (Cerrado). Assim,pode-se salientar que programas e políticas que visam o desenvolvimento agrícolade determinadas regiões devem levar em consideração as especificidades destas,de forma a estimular atividades e práticas agrícolas segundo suas necessidades eparticularidades, gerando o melhor impacto possível para as mesmas.

La usabilidad caracteriza buenas interacciones entre las personas y sus procesos y prácticas. Promueve la satisfacción y crea entornos seguros para la innovación. Los principios de usabilidad como el feedback y la tolerancia a errores están presentes en muchos conceptos de ingeniería de software, como los procesos iterativos y las revisiones de pares. El propósito de la investigación realizada para esta Tesis es traer el concepto de usabilidad de prácticas y procesos a la ingeniería de software. Para lograr este objetivo, y dada la falta de modelos de calidad de procesos enfocados en la usabilidad, un Modelo de Usabilidad de Prácticas y Procesos (UMP) ha sido creado, refinado y evaluado, siguiendo el marco Desing Science Research. UMP ha sido efectivamente aplicado a Scrum, Test Driven Development (TDD), Integración Continua, Behaviour Driven Development (BDD) y el método Visual Milestone Planning (VMP). UMP fue diseñado para ayudar a practicantes, coaches, consultores, docentes e investigadores. Para evaluar UMP se realizaron varios estudios empíricos: una evaluación de expertos inicial para determinar su factibilidad; un focus group para obtener feedback sobre las características y métricas de UMP; dos estudios de confiabilidad, un estudio de acuerdo entre evaluadores sobre Scrum y un estudio de confiabilidad entre evaluadores sobre TDD-BDD; y dos estudios para evaluar la utilidad de UMP, un estudio de caso sobre la aplicación de UMP al método VMP, y un cuasi-experimento de campo en el cual un equipo de desarrollo en la industria aplicó UMP para mejorar su práctica de BDD. Los resultados de los estudios de utilidad muestran que los usuarios consideran a UMP útil, y 37 evaluaciones independientes por expertos fueron realizadas sobre procesos y prácticas del mundo real. Las contribuciones de esta tesis incluyen: UMP con sus características y métricas, el proceso de evaluación de UMP, el conocimiento creado sobre la confiabilidad y utilidad de UMP a través de los estudios empíricos, y los perfiles que caracterizan la usabilidad de prácticas y procesos de amplio uso actual en la industria como Scrum, Integración Continua, TDD y BDD, obtenidos a través de la aplicación de UMP., Asesor científico: Alejandro Oliveros., Facultad de Informática