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Climate warming and the resulting acceleration of freshwater discharge from the Greenland Ice Sheet are impacting Arctic marine coastal ecosystems, with implications for their biological productivity. To accurately project the future of coastal ecosystems and place recent trends into perspective, palaeo-records are essential. Here, we show runoff estimates from the late 19th century to the present day for a large sub-Arctic fjord system (Nuup Kangerlua, southwest Greenland) influenced by both marine- and land-terminating glaciers. We followed a multiproxy approach to reconstruct spatial and temporal trends in primary production from four sediment core records, including diatom fluxes and assemblage composition changes and biogeochemical and sedimentological proxies (total organic carbon, nitrogen, C/N ratio, biogenic silica, δ13C, δ15N, and grain-size distribution). We show that an abrupt increase in freshwater runoff in the mid-1990s was reflected by a 3-fold increase in biogenic silica fluxes in the glacier-proximal area of the fjord. In addition to increased productivity, freshwater runoff modulates the diatom assemblages and drives the dynamics and magnitude of the diatom spring bloom. Our records indicate that marine productivity is higher today than it has been at any point since the late 19th century and suggest that increased mass loss of the Greenland Ice Sheet may continue promoting high productivity levels at sites proximal to marine-terminating glaciers. We highlight the importance of palaeo-records in offering a unique temporal perspective on ice–ocean–ecosystem responses to climate forcing beyond existing remote sensing or monitoring time series.

The emergence of antimicrobial resistance (AMR) is one of the biggest health threats globally. In addition, the use of antimicrobial drugs in humans and livestock is considered an important driver of antimicrobial resistance. The commensal microbiota, and especially the intestinal microbiota, has been shown to have an important role in the emergence of AMR. Mobile genetic elements (MGEs) also play a central role in facilitating the acquisition and spread of AMR genes. We isolated Escherichia coli (n = 627) from fecal samples in respectively 25 poultry, 28 swine, and 15 veal calf herds from 6 European countries to investigate the phylogeny of E. coli at country, animal host and farm levels. Furthermore, we examine the evolution of AMR in E. coli genomes including an association with virulence genes, plasmids and MGEs. We compared the abundance metrics retrieved from metagenomic sequencing and whole genome sequenced of E. coli isolates from the same fecal samples and farms. The E. coli isolates in this study indicated no clonality or clustering based on country of origin and genetic markers; AMR, and MGEs. Nonetheless, mobile genetic elements play a role in the acquisition of AMR and virulence genes. Additionally, an abundance of AMR was agreeable between metagenomic and whole genome sequencing analysis for several AMR classes in poultry fecal samples suggesting that metagenomics could be used as an indicator for surveillance of AMR in E. coli isolates and vice versa.

Matrix stiffness is a crucial regulator of cell fate in both in vitro and in vivo setting. Although studies with non-degradable polymers have contributed to our understanding of the influence of rigidity on cell response, very little work has been conducted with biodegradable polymers that constitute the building blocks of implantable devices. Herein, we investigated human bone marrow stem cell response as a function of rigidity (7 kPa, 10 kPa, 12 kPa, 22 kPa, 15 MPa elastic modulus values) that induced by five different aliphatic polyesters (tissue culture plastic with ~ 3 GPa rigidity was used as control). Cell morphology analysis revealed that stiff substrates stimulated a large cell area with defined stress fibres, whilst soft substrates prompted a small cell area without evident stress fibres. Immunocytochemistry analysis made apparent that YAP was accumulated at the nuclei when the cells were seeded on stiff substrates and at the cytoskeleton on soft substrates. Substrate stiffness did not affect (p > 0.05) the expression of positive (> 97% CD73, CD90, CD105, CD44), but increased (p < 0.05) the expression of negative (< 44% CD45, < 14% CD31, < 28% CD146) mesenchymal stem cell markers after 21 days of culture. With respect to trilineage differentiation, the 15 MPa substrate induced the highest (p < 0.05) calcium deposition and SPP1 mRNA expression in osteogenic media, the 22 kPa substrate induced the highest (p < 0.05) COMP and ACAN mRNA expression in chondrogenic media and the 10 kPa substrate induced the highest (p < 0.05) FABP4 and CEBPA mRNA expression in adipogenic media, all after 21 days in culture. Although some issues associated with degradation were encountered, our data clearly illustrate that biodegradable polymers also contribute to cell phenotype and function in a rigidity dependant manner., This work has also received funding from the European Union’s Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie, grant agreement No. 676338, the European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation programme, grant agreement No. 866126 and the European Union’s Horizon 2020 research and innovation Widespread: Twinning programme, grant agreement No. 810850. This publication has emanated from research supported in part by Grants from Science Foundation Ireland (SFI) under grant numbers 15/CDA/3629 and 19/FFP/6982 and Science Foundation Ireland (SFI) and European Regional Development Fund (ERDF) under grant number 13/RC/2073_2. This work was also supported by TERM RES Hub, Infraestrutura Científica para a Engenharia de Tecidos e Medicina Regenerativa, under grant number Norte-01-0145-FEDER-02219015.

Antes de março de 2020, o teletrabalho não tinha expressão relevante em Portugal. De forma a diminuir a propagação da pandemia Covid-19 e a garantir a continuidade das atividades económicas, este regime foi adotado de forma súbita e massiva por milhares de portugueses, apresentando-se como uma experiência laboral que a maioria desconhecia e à qual teve de se adaptar. O presente estudo analisa a perceção dos trabalhadores relativamente às vantagens e desvantagens associadas ao teletrabalho, identifica fatores que a influenciam e verifica a intenção dos trabalhadores de manter ou adotar este regime pós-pandemia. A pesquisa é de natureza exploratória, a metodologia é de cariz quantitativo e conta com uma amostra de 341 inquiridos que experienciaram o regime de teletrabalho em contexto de pandemia. Os resultados obtidos, com recurso à análise descritiva e inferencial, mostram que, para a generalidade dos trabalhadores, esta experiência foi essencialmente positiva. Os fatores que se mostraram com mais impacto na influência da perceção dos trabalhadores quanto ao teletrabalho foram as condições oferecidas pela sua casa e o apoio prestado pela organização e pela chefia. A esmagadora maioria dos trabalhadores revelou que gostaria de manter-se em regime de teletrabalho, caso tal fosse possível. Este estudo contribui para o conhecimento da experiência de teletrabalho durante a pandemia Covid-19, centrando-se na perceção dos trabalhadores relativamente às vantagens e desvantagens associadas ao teletrabalho e nos fatores influenciadores da mesma. Tendo sido demonstrado que as organizações têm um papel fundamental neste processo, oferecemos recomendações para a implementação do teletrabalho. Before march 2020, telework had no relevant expression in Portugal. In order to reduce the spread of the Covid-19 pandemic and ensure the continuity of economic activities, this scheme was suddenly and massively adopted by thousands of Portuguese, presenting itself as a work experience that most were unaware of and had to adapt. This study analyzes the perception of workers regarding the advantages and disadvantages associated with telework, identifies factors that influence it, and verifies the intention of workers to maintain or adopt this scheme after the pandemic. The research is exploratory, the methodology is quantitative in nature and has a sample of 341 survey respondents who experienced the telework scheme in the context of a pandemic. The results obtained using descriptive and inferential analysis, show that for most workers, this experience was essentially positive. The factors that have been shown to have the most impact on influencing workers' perception as to telework were the conditions offered by their home and the support provided by the organization and their management. The vast majority of workers revealed that they would like to remain in teleworking scheme, if possible. This study contributes to the knowledge of the telework experience during the Covid-19 pandemic, focusing on the workers' perception of the advantages and disadvantages associated with telework and its influencing factors. Having demonstrated that organizations play a key role in this process, we offer recommendations for implementing telework.

Fire strongly impacts the composition and structure of ecosystems, with consequences yet to be understood. We used Moderate Resolution Imaging Spectroradiometer (MODIS) data to map fire frequency and fire intensity and investigate their effects on miombo woodlands (MW) of central Mozambique. Tree species diversity was evaluated and compared using rarefaction curves. Non-metric multidimensional scaling (NMDS) ordination was used to identify patterns of species composition occurrence. The indicator value index method was applied to verify the occurrence of fire indicator species. In general, tree communities responded differently to varied fire regimes. We found low tree density in Intermediate fire frequency and intensity (IfIi) (180 trees ha−1) and High-frequency and Low intensity (HfLi) (316 trees ha−1) areas. The IfIi fire regime had the lowest carbon stocks (9.1 Mg ha−1), when compared to the rest of fire regimes. The species diversity decreased as fire intensity increased. IfIi areas had the maximum species diversity. The NMDS showed a varied species composition according to fire regime. We found a strong relationship between the species diversity and composition, and the pattern of fire occurrence in each fire regime. Our results are critical in supporting fire management policies and understanding fire regimes and their effects on miombo trees’ structure and composition.

OHEJP project DISCOVER

Research indicates that engaging younger audiences in the creation of their own digital games for learning may increase the interest towards the addressed theme and a better understanding of the value of what is learned. Giving young creators the tools needed to develop good games emerges as a key point for the success of this kind of activity. Toolkits, due to its problem-solving features and support materials, are often seen as powerful learning and teaching tools, assisting in the production of interactive artefacts. Taking this into consideration, the Gamers4Nature project developed a Toolkit to support youngsters in the creation of mobile games. The Gamers4Nature Toolkit to Game Design includes resources developed to support younger audiences in the creation of digital games: a game construction cards set, a rapid game design document, a set of thematic cards addressing environmental awareness theme and a set of cards presenting guidelines to be followed when developing mobile games interfaces. This paper describes the Mobile Game Design Guidelines cards development and validation process. The cards were developed following a User-Centered Design approach and validated through Expert Evaluation, with industry and academic experts in game design and development (N = 9) invited to analyze and validate the Guidelines Cards. Although additional tests are still needed, namely with the target audience, preliminary results indicate that the guidelines presented in the cards can be a useful guide along the process of constructing a game while promoting the acquisition of knowledge related to the mobile interface design field.

Dissertação de Mestrado Integrado em Arquitetura apresentada à Faculdade de Ciências e Tecnologia A partir do final do século XIX, a paisagem agrícola, sob domínio da aristocracia lisboeta, com os seus belos palácios barrocos, é substituída por instalações fabris, que se fixaram na zona ribeirinha, pela facilidade de escoamento de produtos, o que fez com que a população crescesse significativamente, em busca de emprego e de uma vida melhor. Inúmeras indústrias foram sendo implantadas por toda a margem oriental, até que o ciclo de crescimento económico acabou por ruir, reflexo de um país marcado pela guerra colonial, primeiro, e pelo processo de desindustrialização que se seguiu à Revolução de Abril de 1974. Algumas fábricas, continuaram a sua atividade num novo lugar, outras acabaram por entrar em declínio e fechar, permanecendo muitos dos edifícios, que outrora laboraram abandonados até aos dias de hoje. O principal objetivo desta dissertação, centra-se na revisita e no reaproveitamento da memória industrial da zona oriental de Lisboa, em tempos esquecida, mas que é fundamental para o conhecimento global desta outrora capital industrial. Ao interpretar a sua história é possível conhecer, e dar a conhecer esse património da cidade, que não há muito tempo começou a patentear novas utilidades e a albergar outro tipo de atividades, maioritariamente, de cariz cultural. Assim, pretende-se dar uma nova utilidade aos armazéns vinícolas da firma Abel Pereira da Fonseca, que tal como o seu passado, necessitam de ser rememorados. From the end of the XIX century, the agricultural landscape, under domain of Lisbon aristocracy with their beautiful baroque palaces is replaced by factory facilities, fixed at the riverside for the facility of product flow. This fact leads to a significant increase of the population, searching for job and a better life. Countless industries were being established all over the oriental bank of the river, until the economical growth cycle end up collapsing, as reflex of a country marked by colonial war and de-industrialization, following to the April 25th Revolution. Some factories continued their activity in a new place, others ended up declining and closed doors. Many of these buildings remained abandoned until today. The main propose of this dissertation is focused in the review and reuse of the industrial memory of the oriental zone of Lisbon, which, despite having been forgotten in the past, is in fact crucial for the global knowledge of this former industrial capital. When interpreting its history it became possible to acknowledge and to show the cultural heritage of the city of Lisbon, which, not long ago started to patent new utilities and hosting a new kind of activities, mainly cultural. In this context, the intention is to give a new opportunity to the winery warehouses of the firm Abel Pereira da Fonseca, which, together with their past, require to be remembered.

Contains fulltext : 225261.pdf (Publisher’s version ) (Closed access) Hereditary diffuse gastric cancer (HDGC) is an autosomal dominant cancer syndrome that is characterised by a high prevalence of diffuse gastric cancer and lobular breast cancer. It is largely caused by inactivating germline mutations in the tumour suppressor gene CDH1, although pathogenic variants in CTNNA1 occur in a minority of families with HDGC. In this Policy Review, we present updated clinical practice guidelines for HDGC from the International Gastric Cancer Linkage Consortium (IGCLC), which recognise the emerging evidence of variability in gastric cancer risk between families with HDGC, the growing capability of endoscopic and histological surveillance in HDGC, and increased experience of managing long-term sequelae of total gastrectomy in young patients. To redress the balance between the accessibility, cost, and acceptance of genetic testing and the increased identification of pathogenic variant carriers, the HDGC genetic testing criteria have been relaxed, mainly through less restrictive age limits. Prophylactic total gastrectomy remains the recommended option for gastric cancer risk management in pathogenic CDH1 variant carriers. However, there is increasing confidence from the IGCLC that endoscopic surveillance in expert centres can be safely offered to patients who wish to postpone surgery, or to those whose risk of developing gastric cancer is not well defined.

Introduction: Cardiovascular diseases contribute to the increase in morbidity and mortality rates, loss of quality of life and increase in public spending. Objectives: To promote educational action through a lecture on prevention and correction of cardiovascular risk factors aimed at CRAS participants Nezinho Guida, Setor Vila Iris, Gurupi-TO. Methodology: Experience report on primary performance directed to individuals over 18 years of age, of both sexes. After CRAS authorization, the participants underwent an initial lecture to explain the action and its importance. Secondly, anthropometric measurements (weight, height, blood pressure, heart rate) and an evaluation form were checked to check for the presence of cardiovascular risk factors. They were submitted weekly to lectures and preventive guidelines for cardiovascular diseases, followed by the measurement of vital data before and after group physical exercises. Results: It can be inferred that the action contributed to greater clarification of the participants, where the presence of risk factors for atherosclerotic diseases was detected. Final considerations: It can be inferred that the existence of cardiovascular risk factors constitutes an important public health problem, which demonstrates the importance of educational actions in primary prevention. Keywords: Risk factors. Cardiovascular diseases. Prevention of diseases. Physiotherapy.

Men who have sex with men (MSM) are at greater risk for sexually transmitted infections (STIs). Data on MSM chlamydia and gonorrhea prevalence estimates and associated risk factors are scarce. To our knowledge, this is the first study to describe the prevalence and the determinants of both chlamydia and gonorrhea infections in MSM in Portugal. We conducted a cross-sectional study using data from 1832 visits to CheckpointLX, a community-based center for screening blood-borne viruses and other STIs in MSM. Overall prevalence of chlamydia or gonorrhea in our sample was 16.05%, with 14.23% coinfection and 40.73% asymptomatic presentation among those testing positive. Anorectal infection was most common for chlamydia (67.26%), followed by urethral (24.78%) and oral (19.47%) infection. Oral infection was most common for gonorrhea (55.63%), followed by anal (51.25%) and urethral (17.50%) infection. In multivariate analyses, young age ( U = 94684, p = 0.014), being foreign-born (χ2 = 11.724, p = 0.003), reporting STI symptoms (χ2 = 5.316, p = 0.021), inhaled drug use (χ2 = 4.278, p = 0.039) and having a higher number of concurrent (χ2 = 18.769, p 2 = 5.988, p = 0.050) sexual partners were each associated with higher rates of chlamydia or gonorrhea infection. Young and migrant MSM are a vulnerable population to STIs, as are those who use inhaled drugs and those with a higher number of concurrent or total sexual partners. Although Portugal has no guidelines on chlamydia and gonorrhea screening, our results point toward a need for greater awareness about the importance of high-frequency screening for those at increased risk (i.e., every three to six months).

Holistic processing, a hallmark of expert processing, has been shown for written words, signaled by the word composite effect, similar to the face composite effect: fluent readers find it difficult to focus on just one half of a written word while ignoring the other half, especially when the two word halves are aligned rather than misaligned. This effect is signaled by a significant interaction between alignment and congruency of the two word parts. Face and visual word recognition, however, involve different neural mechanisms with an opposite hemispheric lateralization. It is then possible that faces and words can both involve holistic processing in their own separate face and word processing systems, but by using different mechanisms. In the present study, we replicated with words a previous study done with faces (Richler, Bukach, & Gauthier, 2009, Experiment 3). In a first experiment we showed that in a composite task with aligned artificial objects, no congruency effects are found. In a second experiment, using an interleaved task, a congruency effect for Ziggerins was induced in trials in which a word was first encoded, but more strongly when it was aligned. However, in a stricter test, we found no differences between the congruency effect for Ziggerins induced by aligned words versus pseudowords. Our results demonstrate that different mechanisms can underlie holistic processing in different expertise domains.

Nos dias de hoje, derivada das mudanças cada vez mais rápidas nos mercados globais, a gestão do conhecimento assume cada vez mais uma importância estratégica nas organizações. É necessário compreender de que forma as empresas conseguem gerir o conhecimento internamente. Para tal é necessário conhecer as principais fases da gestão de conhecimento e apontar metodologias, ferramentas e boas práticas neste âmbito. É neste seguimento que surge a modelação de processos como uma metodologia de suporte à gestão do conhecimento organizacional. O presente trabalho tem como objetivo contribuir para a melhoria da gestão de conhecimento da empresa Mesa Ceramics, através da implementação da modelação dos processos no seu Departamento Comercial, dado o seu emergente crescimento no mercado e constante aposta na inovação. Para tal, foi seguida uma metodologia de investigação-ação com o desenvolvimento de um caso de estudo. As etapas iniciais foram o enquadramento teórico, a aculturação e participação ativa nas atividades do Departamento Comercial. Esta participação foi proporcionada por um programa de estágio curricular no âmbito do Mestrado em Gestão. Posteriormente foi realizado um diagnóstico ao estado atual da empresa, em particular ao departamento comercial. De seguida, através do Ciclo de Vida Business Process Management (BPM), utilizando a notação Business Process Model Notation (BPMN), foi apresentada uma proposta de modelação dos principais processos na área comercial. Com o presente projeto, espera-se que a organização consiga melhorar a interpretação e compreensão dos processos do seu departamento comercial, permitindo a redução de ambiguidades e erros aquando da sua execução, bem como a rápida e eficaz integração dos colaboradores nas tarefas correspondentes. Foi possível ainda fornecer um conjunto de sugestão de melhorias ao nível da análise dos processos, permitindo, de uma forma global, contribuir para a gestão e manutenção do conhecimento na Mesa Ceramics. Nowadays, due to fast paced changes in global markets, knowledge management assumes more and more a strategic importance in organizations. It is essential to understand how companies manage to preserve knowledge internally. To do so, it is necessary to know the main stages of knowledge management and point out methodologies, tools and best practices in this area. It is in this context that process modeling emerges as a support methodology for organizational knowledge management. This work aims to contribute to the improvement of knowledge management at Mesa Ceramics, through the implementation of process modeling in its Commercial Department, given its emerging market growth and constant focus on innovation. To this end, an action-research methodology was followed with the development of a case study. The main steps were the theoretical framework, acculturation and active participation in the activities of the Commercial Department. This participation was provided by a curricular internship program under the Master’s Degree in Management. Subsequently, a diagnosis of the current state of the company was carried out, particularly of the commercial department. Then, through the Business Process Management Life Cycle, using the Business Process Model Notation, a proposal for modeling the main processes in the commercial unit was presented. With this project, it is expected that the organization will be able to improve the interpretation and understanding of its commercial department's processes, allowing for the reduction of ambiguities and errors during its execution, as well as the quick and effective integration of employees in the corresponding tasks. It was also possible to provide a set of suggestions for improvements in the analysis of processes, allowing, in a global way, to contribute to the management and maintenance of knowledge at Mesa Ceramics. Mestrado em Gestão

Photovoice is a research method that uses photographs taken by participants to share, through narratives, their lives, and experiences. Over the years this method has been frequently used with marginalized populations. As is the case with the LGBTIQ community, a community made up of individuals of different sexual orientations and gender identities. In this review, articles reporting the use of photovoice with participants from the LGBTIQ community were analyzed, with the aim of understanding the potential of the methodology with this population, analyzing the advantages and disadvantages, and the topics that have been addressed. The results demonstrate that photovoice provides self-expression and gives voice and empowerment to people from sexual and gender minorities and has potential as an intervention strategy. However, using photovoice with this population can be a challenge both for ethical reasons and because some subjects are difficult to portray with photographs, or are not suitable for group discussion. Photovoice has been used to explore a wide range of topics in the LGBTIQ population, such as their experiences, identity, social relationships, resilience, social support, and health. It is therefore a method with the potential to work with vulnerable populations, being quite flexible and subject to adaptations. O photovoice é um método de pesquisa que utiliza fotografias captadas pelos participantes para que partilhem, através de narrativas, as suas vidas e experiências. Ao longo dos anos este método tem sido frequentemente utilizado com populações marginalizadas. Como é o caso da comunidade LGBTIQ, uma comunidade constituída por indivíduos de diferentes orientações sexuais e identidades de gênero. Nesta revisão foram analisados os artigos que reportam a utilização do photovoice com participantes da comunidade LGBTIQ, com o objetivo de se compreender as potencialidades da metodologia com esta população, analisando as vantagens e desvantagens, e os tópicos que têm sido abordados. Os resultados demonstram que o photovoice proporciona a autoexpressão e dá voz e empoderamento a pessoas de minorias sexuais e de género e tem potencial como estratégia de intervenção. No entanto, utilizar o photovoice com esta população pode ser um desafio tanto por motivos éticos como por alguns assuntos serem difíceis de retratar com fotografias, ou não serem adequados para discussão em grupo. O photovoice tem sido utilizado para explorar uma ampla variedade de tópicos na população LGBTIQ, como as suas experiências, identidade, relações sociais, resiliência, suporte social, e saúde. Trata-se então de um método com potencial para trabalhar com populações vulneráveis, sendo bastante flexível e passível de adaptações. Mestrado em Psicologia da Saúde e Reabilitação Neuropsicológica

We investigate the collective scattering of coherent light from a thermal alkali-metal vapor with temperatures ranging from 350 to 450 K, corresponding to average atomic spacings between $0.7 \lambda$ and $0.1 \lambda$. We develop a theoretical model treating the atomic ensemble as coherent, interacting, radiating dipoles. We show that the two-time second-order correlation function of a thermal ensemble can be described by an average of randomly positioned atomic pairs. Our model illustrates good agreement with the experimental results. Furthermore, we show how fine-tuning of the experimental parameters may make it possible to explore several photon statistics regimes., Comment: 12 pages, 5 figures. Comments are welcomed

High Arctic ecosystems and Indigenous livelihoods are tightly linked and exposed to climate change, yet assessing their sensitivity requires a long-term perspective. Here, we assess the vulnerability of the North Water polynya, a unique seaice ecosystem that sustains the world’s northernmost Inuit communities and several keystone Arctic species. We reconstruct mid-to-late Holocene changes in sea ice, marine primary production, and little auk colony dynamics through multi-proxy analysis of marine and lake sediment cores. Our results suggest a productive ecosystem by 4400–4200 cal yrs b2k coincident with the arrival of the first humans in Greenland. Climate forcing during the late Holocene, leading to periods of polynya instability and marine productivity decline, is strikingly coeval with the human abandonment of Greenland from c. 2200–1200 cal yrs b2k. Our long-term perspective highlights the future decline of the North Water ecosystem, due to climate warming and changing sea-ice conditions, as an important climate change risk., The North Water polynya is a unique but vulnerable ecosystem, home to Indigenous people and Arctic keystone species. New palaeoecological records from Greenland suggest human abandonment c. 2200–1200 cal yrs BP occurred during climate-forced polynya instability, foreshadowing future ecosystem declines.

Objetivo As benzodiazepinas (BZDs) e os fármacos relacionados (BZRDs) são comumente utilizados para tratar diversas patologias psiquiátricas, devido às suas propriedades ansiolíticas, hipnóticas e sedativas, apesar dos seus efeitos adversos conhecidos, incluindo efeitos cognitivos agudos. Recentemente, alguns estudos também sugeriram a coexistência de efeitos cognitivos a longo prazo, nomeadamente um aumento do risco de declínio cognitivo e demência. Esta revisão tem como objetivo avaliar e resumir os estudos de síntese publicados sobre o risco de desenvolvimento de demência devido ao uso de BZDs/BZRDs. Métodos Foi realizada uma pesquisa nas bases de dados PubMed, Web of Science, Cochrane Library e Epistemonikos. Foi igualmente realizada uma pesquisa na literatura cinzenta, bem como uma pesquisa manual das listas de referências dos estudos incluídos. Foram incluídas meta-análises, revisões sistemáticas e revisões não sistemáticas. Não foi aplicada qualquer restrição de idioma ou data. Estudos não correspondentes a revisões foram excluídos. A qualidade metodológica das revisões incluídas foi avaliada através das ferramentas AMSTAR-2 e SANRA. Resultados Foram obtidos inicialmente 877 artigos, tendo 15 cumprido os critérios de inclusão. Cinco corresponderam a revisões sistemáticas com meta-análise de estudos observacionais, 2 a revisões sistemáticas e 8 a revisões não sistemáticas. A maioria dos estudos primários incluídos nas revisões analisadas encontraram uma associação entre o uso de BZDs/BZRDs e o desenvolvimento de demência, com os estudos de meta-análise a reportar um risco aumentado nos utilizadores (ORs entre 1,38 e 1,78). No entanto, a considerável heterogeneidade clínica e metodológica dos estudos primários torna difícil estabelecer uma relação causal. Conclusão Embora prejudicados pela heterogeneidade entre os estudos, estes achados sugerem uma associação entre o uso de BZDs/BZRDs e o aumento do risco de demência em idosos. Purpose Benzodiazepines (BZDs) and related drugs (BZRDs) are commonly used to treat diverse psychiatric disorders due to their anxiolytic, hypnotic and sedative proprieties, despite their known associated side effects, including acute consequences on cognition. Recently, some studies have also suggested that long-term cognitive effects may coexist, as the increased risk of cognitive decline and dementia. This review aims to appraise and summarise published synthesis studies on the risk of dementia development due to BZDs/BZRDs use. Methods A comprehensive systematic search was carried out in PubMed, Web of Science, Cochrane Library and Epistemonikos databases. Grey literature and hand-search of the studies' reference lists were undertaken. Meta-analysis, systematic and non-systematic reviews were included. No language nor date restrictions were applied. Search results other than synthesis studies were excluded. The methodological quality of the included reviews was analyzed with AMSTAR-2 and SANRA tools. Results 877 records were initially retrieved and 15 complied with the inclusion criteria. Five were systematic reviews with meta-analysis of observational studies, 2 were systematic reviews and 8 were non-systematic reviews. Most of the primary studies included in the analysed reviews found an association between BZDs/BZRDs use and subsequent dementia, with meta-analysis studies reporting an increased risk for users (ORs ranging from 1.38 to 1.78). However, the considerable clinical and methodological heterogeneity of the primary studies makes it difficult to stablish a causal relationship. Conclusion Although hampered by the heterogeneity between the studies, the present findings suggest an association between BZDs/BZRDs use and increased risk of dementia in older adults.

OHEJP project DISCOVER

Introduction: Kawasaki disease, an acute self-limited vasculitis of small and medium arteries of unknown etiology, is the leading cause of heart disease in children in most developed countries. If untreated, it can lead to coronary artery dilatation and aneurysm, placing patients at risk for coronary thrombosis, myocardial infarction, or sudden death. Case Report: A previously healthy five-month-old boy presented with a history of respiratory symptoms and fever, being admitted for respiratory syncytial virus bronchiolitis. He maintained fever for five days associated with progressive clinical worsening and sequential development of conjunctival injection, cracked lips, swelling of hands and feet, and polymorphous rash of the limbs. Diagnostic procedures showed increased levels of inflammatory markers, hyponatremia, hypoalbuminemia, sterile pyuria, and aseptic meningitis. Despite an initial normal echocardiogram, Kawasaki disease was suspected and the boy started intravenous immunoglobulin on the fifth day. On the seventh day, echocardiogram showed signs of pancarditis and mild coronary artery ectasia and acetylsalicylic acid was started. The boy was discharged, but eight days later echocardiogram revealed major and diffuse coronary artery ectasia in a follow-up consultation and he was readmitted to start corticosteroid therapy. After five months, the boy displayed normalization of cardiac changes, without further complications. Comments: Kawasaki disease below six months of age is rare and associated with a high risk of coronary artery aneurysm. It is important to recognize the clinical and laboratory criteria associated with this entity and start early treatment, avoiding cardiac complications., Introdução: A doença de Kawasaki, uma vasculite aguda e autolimitada das artérias de pequeno e médio calibre de etiologia desconhecida, é a principal causa de doença cardíaca em idade pediátrica nos países desenvolvidos. Em ausência de tratamento, pode levar a ectasia e aneurisma das artérias coronárias, colocando os doentes em risco de trombose coronária, enfarte agudo do miocárdio e morte súbita. Caso Clínico: Um lactente de cinco meses do sexo masculino, previamente saudável, foi internado com diagnóstico de bronquiolite aguda a vírus sincicial respiratório. Manteve febre e agravamento do estado geral durante cinco dias, associado ao aparecimento sequencial de hiperemia conjuntival, queilite, edema das mãos e dos pés e exantema polimorfo das extremidades. Os exames complementares de diagnóstico demonstraram elevação da proteína C reativa, hiponatremia, hipoalbuminemia, piúria estéril e meningite assética. Perante suspeita de doença de Kawasaki, e apesar de um ecocardiograma inicial normal, foi iniciada imunoglobulina endovenosa ao quinto dia. O ecocardiograma foi repetido ao sétimo dia, revelando sinais de pancardite e ectasia das artérias coronárias, tendo sido iniciado ácido acetilsalicílico. O rapaz teve alta, mas foi reinternado oito dias depois por agravamento da ectasia das coronárias para tratamento com corticoide, que manteve durante quatro semanas. Apresentou normalização das alterações cardíacas aos cinco meses de seguimento, sem novas intercorrências. Comentários: A doença de Kawasaki em idade inferior a seis meses é rara e caracteriza-se por evolução mais grave e maior risco de desenvolvimento de aneurisma das artérias coronárias. É importante reconhecer os critérios clínicos e laboratoriais associados a esta entidade, de forma a implementar um tratamento precoce e evitar complicações cardíacas.

Introduction: Kawasaki disease, an acute self-limited vasculitis of small and medium arteries of unknown etiology, is the leading cause of heart disease in children in most developed countries. If untreated, it can lead to coronary artery dilatation and aneurysm, placing patients at risk for coronary thrombosis, myocardial infarction, or sudden death. Case Report: A previously healthy five-month-old boy presented with a history of respiratory symptoms and fever, being admitted for respiratory syncytial virus bronchiolitis. He maintained fever for five days associated with progressive clinical worsening and sequential development of conjunctival injection, cracked lips, swelling of hands and feet, and polymorphous rash of the limbs. Diagnostic procedures showed increased levels of inflammatory markers, hyponatremia, hypoalbuminemia, sterile pyuria, and aseptic meningitis. Despite an initial normal echocardiogram, Kawasaki disease was suspected and the boy started intravenous immunoglobulin on the fifth day. On the seventh day, echocardiogram showed signs of pancarditis and mild coronary artery ectasia and acetylsalicylic acid was started. The boy was discharged, but eight days later echocardiogram revealed major and diffuse coronary artery ectasia in a follow-up consultation and he was readmitted to start corticosteroid therapy. After five months, the boy displayed normalization of cardiac changes, without further complications. Comments: Kawasaki disease below six months of age is rare and associated with a high risk of coronary artery aneurysm. It is important to recognize the clinical and laboratory criteria associated with this entity and start early treatment, avoiding cardiac complications.

INTRODUÇÃO: O stenting carotídeo (SC) tem emergido como uma alternativa minimamente invasiva à endarterectomia carotídea (EAC) no tratamento da doença aterosclerótica da bifurcação carotídea, apesar do risco de acidente vascular cerebral (AVC) após SC permanecer significativamente superior. Recentemente, com o intuito de reduzir os eventos embólicos cerebrais após SC, foi desenvolvida uma nova geração de stents de dupla camada (SDC). Esta revisão visa analisar de forma detalhada a evidência disponível sobre a segurança e eficácia dos SDC na estenose carotídea sintomática e assintomática. AQUISIÇÃO DE EVIDÊNCIA: Foi elaborada uma revisão sistemática de acordo com as recomendações PRISMA. O endpoint primário consistiu na taxa de enfarte agudo do miocárdio (EAM), AVC e mortalidade aos 30 dias. Os outcomes secundários incluíram a taxa e o timing de oclusão/re-estenose do stent. SÍNTESE DE EVIDÊNCIA: Foram incluídos 20 artigos com um total de 1193 doentes. A taxa de EAM aos 30 dias variou entre 0 e 5%, a taxa de AVC aos 30 dias variou entre 0 e 10.5% e a mortalidade aos 30 dias variou entre 0 e 10%. A taxa de oclusão do stent variou entre 0 e 52.4%, tendo a maioria ocorrido durante o procedimento (n=50; 61.7%), em doentes tratados em contexto emergente. A incidência de novas lesões isquémicas cerebrais ipsilaterais após SC com SDC foi avaliada em cinco estudos, variando entre 5.5 e 37%. CONCLUSÕES: Apesar da redução teórica do risco de eventos embólicos em comparação com os stents convencionais, ainda existe pouca evidência de qualidade na literatura. Têm também surgido questões relativas à segurança da utilização de SDC em contexto emergente, incidindo particularmente em complicações trombóticas. Serão necessários Ensaios Clínicos Randomizados para determinar o verdadeiro valor dos SDC. INTRODUCTION: Carotid artery stenting (CAS) has emerged as a minimally invasive alternative to carotid endarterectomy (CEA) in atherosclerotic carotid artery disease, even though the risk for procedural stroke after CAS remains significantly higher. Recently, in order to reduce embolic cerebral events after CAS, a new generation of dual-layer stents (DLS) has been developed. This review aimed to perform a detailed analysis of the available evidence on safety and efficacy of DLS in both symptomatic and asymptomatic atherosclerotic carotid artery stenosis. EVIDENCE ACQUISITION: A systematic review was conducted according to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The primary endpoint was the 30-day rate of myocardial infarction (MI), stroke and death. Secondary outcomes included rate and timing of stent occlusion/restenosis. EVIDENCE SYNTHESIS: A total of 20 articles with 1193 patients were included. Thirty-day MI ranged from 0-5%, 30-day stroke ranged from 0-10.5% and 30-day mortality ranged from 0-10%. Stent occlusion rate ranged from 0-52.4%, the majority of which occurred intraprocedurally (n=50; 61.7%), in emergency treated patients. The incidence of new ipsilateral cerebral ischemic lesions after CAS with DLS was reported in five studies, ranging from 5.5-37%. CONCLUSIONS: Despite the theoretic advantage of reducing the risk for procedural embolic events when compared to conventional stents, high quality evidence is scarce. Also, safety issues regarding DLS in the emergency setting have been raised, particularly for thrombotic complications. Additional data from well-designed Randomized Controlled Trials are needed to assert the true value of DLS.

Baffin Bay hosts the largest and most productive of the Arctic polynyas: the North Water (NOW). Despite its significance and active role in water mass formation, the history of the NOW beyond the observational era remains poorly known. We reconcile the previously unassessed relationship between long-term NOW dynamics and ocean conditions by applying a multiproxy approach to two marine sediment cores from the region that, together, span the Holocene. Declining influence of Atlantic Water in the NOW is coeval with regional records that indicate the inception of a strong and recurrent polynya from ~ 4400 yrs BP, in line with Neoglacial cooling. During warmer Holocene intervals such as the Roman Warm Period, a weaker NOW is evident, and its reduced capacity to influence bottom ocean conditions facilitated northward penetration of Atlantic Water. Future warming in the Arctic may have negative consequences for this vital biological oasis, with the potential knock-on effect of warm water penetration further north and intensified melt of the marine-terminating glaciers that flank the coast of northwest Greenland.

Patient A was a 71-year-old man with a medical history of hypertension, ischaemic cardiomyopathy and diabetes. Patient B was a 71-year-old man with smoking history, diabetes and dyslipidaemia. They were both admitted to the intensive care unit 1 week apart for critical COVID-19 requiring high-flow nasal cannula oxygen therapy. On days 2 and 4 of admission, respectively, both developed severe pain of their right upper extremities and pale, pulseless right hands. Right upper extremity CT angiography revealed an …

Arctic sea ice is declining at an unprecedented pace as the Arctic Ocean heads towards ice-free summers within the next few decades. Because of the role of sea ice in the Earth System such as ocean circulation and ecosystem functioning, reconstructing its past variability is of great importance providing insight into past climate patterns and future climate scenarios. Today, much of our knowledge of past sea-ice variability derives from a relatively few microfossil and biogeochemical tracers, which have limitations, such as preservation biases and low taxonomic resolution. Marine sedimentary ancient DNA (marine sedaDNA) has the potential to capture more of the arctic marine biodiversity compared to other approaches. However, little is known about how well past communities are represented in marine sedaDNA. The transport and fate of DNA derived from sea-ice associated organisms, from surface waters to the seafloor and its eventual incorporation into marine sediment records is poorly understood. Here, we present results from a study applying a combination of methods to examine modern and ancient DNA to material collected along the Northeast Greenland Shelf. We characterized the vertical export of genetic material by amplicon sequencing the hyper-variable V4 region of the 18S rDNA at three water depths, in surface sediments, and in a dated sediment core. The amplicon sequencing approach, as currently applied, includes some limitations for quantitative reconstructions of past changes such as primer competition, PCR errors, and variation of gene copy numbers across different taxa. For these reasons we quantified amplicons from a single species, the circum-polar sea ice dinoflagellate Polarella glacialis in the marine sedaDNA, using digital droplet PCR. The results will increase our understanding on the taphonomy of DNA in sea ice environments, how sedimentation differs among taxonomic groups, and provide indications to potentially useful marine sedaDNA-based proxies for climate and environmental reconstructions.

A tradução médica é um dos campos da tradução especializada mais prevalente no mercado de trabalho de tradução. No entanto, existe muito pouca literatura acerca do alemão e português europeu como línguas de trabalho, dificultando o processo tradutológico de profissionais que trabalhem com este par de línguas. O presente relatório visa mostrar a metodologia, análise e resolução de problemas durante o decorrer do projeto de tradução de documentos de saúde, intitulados Arztbrief, característicos do sistema de saúde alemão, para uma melhor compreensão deste género textual e contributo para o estudo da tradução médica entre o alemão e o português. Medical translation is one of the most predominant fields of specialized translation in the translation market. However, there is very little literature on European German and Portuguese as working languages, making it difficult for professionals working with this pair of languages to translate. This report aims to show the methodology, analysis and problem solving during the course of the project of translation of health documents, entitled Arztbrief, characteristic of the German healthcare system, for a better understanding of this type of text and contribution to the study of medical translation between German and Portuguese. Mestrado em Tradução Especializada

A woman in her early 50s with a history of poorly controlled hypertension was admitted to the intensive care unit for an electrical storm complicating an anterolateral myocardial infarction. After admission, she went into a cardiogenic shock refractory to medical treatment and was proposed for mechanical circulatory support. However, her clinical condition suddenly deteriorated, with severe hypotension, absent femoral pulses and a significant fall of haemoglobin without visible blood loss. …

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Metagenomics can unveil the genetic content of the total microbiota in different environments, such as food products and the guts of humans and livestock. It is therefore considered of great potential to investigate the transmission of foodborne hazards as part of source-attribution studies. Source-attribution of antimicrobial resistance (AMR) has traditionally relied on pathogen isolation, while metagenomics allows investigating the full span of AMR determinants. In this study, we hypothesized that the relative abundance of fecal resistome components can be associated with specific reservoirs, and that resistomes can be used for AMR source-attribution. We used shotgun-sequences from fecal samples of pigs, broilers, turkeys- and veal calves collected across Europe, and fecal samples from humans occupationally exposed to livestock in one country (pig slaughterhouse workers, pig and broiler farmers). We applied both hierarchical and flat forms of the supervised classification ensemble algorithm Random Forests to classify resistomes into corresponding reservoir classes. We identified country-specific and -independent AMR determinants, and assessed the impact of country-specific determinants when attributing AMR resistance in humans. Additionally, we performed a similarity percentage analysis with the full spectrum of AMR determinants to identify resistome signatures for the different reservoirs. We showed that the number of AMR determinants necessary to attribute a resistome into the correct reservoir increases with a larger reservoir heterogeneity, and that the impact of country-specific resistome signatures on prediction varies between countries. We predicted a higher occupational exposure to AMR determinants among workers exposed to pigs than among those exposed to broilers. Additionally, results suggested that AMR exposure on pig farms was higher than in pig slaughterhouses. Human resistomes were more similar to pig and veal calves’ resistomes than to those of broilers and turkeys, and the majority of these resistome dissimilarities can be explained by a small set of AMR determinants. We identified resistome signatures for each individual reservoir, which include AMR determinants significantly associated with on-farm antimicrobial use. We attributed human resistomes to different livestock reservoirs using Random Forests, which allowed identifying pigs as a potential source of AMR in humans. This study thus demonstrates that it is possible to apply metagenomics in AMR source-attribution.

In a context where the urgency to act towards the promotion of environmental awareness is imperative, the Gamers4Nature (G4N) project aims to encourage the active participation of students in the creation of mobile games addressing environmental-related themes. This chapter introduces the G4N Cards Set Canvas, a tool integrated into the G4N portal-repository. The G4N Cards Set Canvas is a digital tool that allows the design of environmental-related thematic cards and has two main goals: (i) to provide the G4N project with a tool to ease the creation of the thematic cards for the Toolkit to Game Design by environmental organizations and/or teachers; (ii) to be used by users with no experience in the design field. This tool will be developed following a User-Centered Design approach, with iterative and systematic reviews of the tool, and it will emphasize the connection between the physical (i.e. Toolkit) and digital (i.e. portal-repository) artifacts. A snowball literature review and an overview of design and presentation tools and platforms currently available did not reveal the existence of suitable platforms to create graphical design contents while complying with a brand’s standard’s manual for non-experienced users in the design field. Thus, an opportunity for novelty arises from this gap, adding a layer of concern with designing a usable and accessible tool for the end-users.

In the aftermath of catastrophes, art based participatory research has proven to be a useful tool for evoking emotions and knowledge in affected children, as well as for informing risk education and recovery psychology practices. Framed by disaster risk reduction and environmental philosophy, this article analyses a sample of drawings produced by schoolchildren aged 6–10 years old affected by the wildfires of October 2017 in the central inland region of Portugal, obtained using a ‘draw and write’ technique. The children’s narratives expressed concerns for their own safety and that of others, as well as concern for ecological damage. Emotional distress was also reported. The verbal statements accompanying the drawings helped the children to express their narratives carefully, allowing them to become active participants in their own process of thinking about the phenomena. We argue that children’s drawings constitute a valuable methodology to access children’s experiences after a disaster, as their visual richness reaches more than humans worlds. We recommend training for professionals, age-appropriate levels of informational support and a children’s disaster intervention model.

The present study was carried out in Limpopo National Park (LNP) with the objective to map floristic communities that occur inside the park. Three (3) Landsat 8 satellite images were obtained by Operational Land Imager (OLI) and Thermal Infrared Sensor (TIRS) tools and were pre-processed and classified, culminating in six (6) types of land use and cover. The floristic survey consisted of stratified sampling in three (3) main LNP landscapes types, namely landscape of limestone soils, landscape of rhyolite shallow soils and landscape of deep sandy soils. The final map presents 13 floristic communities identified by the names of greatest value of ecological importance (IVI) species. The community of Terminalia sericea / Combretum apiculatum / Guibourtia conjugata / Colophospermum mopane presented a larger occurrence area. Colophospermum mopane was the most representative species among the mapped communities, mostly occurring in association with other species. The overall accuracy was 74% and the Kappa index was 68%, thus giving a good rating. The mapping also showed that human occupied areas are larger than some floristic communities areas, so we suggest that these smaller communities, should be given priority actions for their conservation, especially those without human occupation. Resumo O presente estudo foi realizado no Parque Nacional do Limpopo (PNL), com o objetivo de mapear comunidades florísticas que ocorrem no parque. Foram obtidas três (3) imagens do satélite Landsat 8 com os sensores Operational Land Imager (OLI) and Thermal Infrared Sensor (TIRS), para as quais foi feito o pré-processamento e a classificação, culminando em seis (6) tipos de uso e cobertura de terra. O levantamento florístico consistiu numa amostragem estratificada por paisagem, nomeadamende paisagem de solos calcários, paisagem de solos rasos de riolito e paisagem de solos arenosos profundos. O mapa final apresenta 13 comunidades florísticas identificadas pelos nomes das espécies de maior valor de importância ecológica (VI). A comunidade de Terminalia sericea / Combretum apiculatum / Guibourtia conjugata / Colophospermum mopane apresentou maior área de ocorrência. Colophospermum mopane foi a espécie mais representativa entre as comunidades mapeadas, ocorrendo em maior parte associada com outras espécies. A exatidão global foi de 74% e o índice Kappa foi 68%, atribuindo assim um nível de boa classificação. O mapeamento também demonstrou que áreas de ocupação humana são maiores que as áreas de cobertura de algumas comunidades florísticas, deste modo sugerimos que estas comunidades menores sejam priorizadas na conservação, especialmente aquelas que não apresentam ocupação humana.

The source of a foodborne disease outbreak (FBO) is often difficult to identify, especially in the early phase where interventions would be most efficient. In addition, data on FBOs are mostly scattered in different formats either in national databases and reports or within pathogen-specific or regional reporting networks, both of which are often only accessible to a selected number of individuals.Here, we developed an international, open, shared and searchable data catalogue of past FBOs – the Global Food-source Identifier (GFI). GFI was developed with two objectives: a) to create a collaborative online community of FBO investigators, encouraging the international sharing of data in a harmonized, detailed and comparable manner and b) to support foodborne outbreak investigation worldwide by providing access to detailed records of past outbreaks, which can convey valuable insight into potential ‘risk foods’ of a detected pathogen. GFI is hosted within a Virtual Research Environment (VRE), which offers additional features to facilitate the collaboration between the outbreak investigators. These features allow document exchange, communication and data visualization and analysis between the VRE members.Based on scientific literature on foodborne outbreaks and discussions within a working group, we selected a total of 46 attributes characterising the outbreak records to be included in the catalogue, aggregated under the four overarching categories causative agent, epidata, food source and report details. Detailed descriptions of the attributes in the catalogue and instructions for harmonized data reporting are available on a wiki page in the VRE. At the time of writing and public launch of GFI, the data catalogue was populated with records of 102 FBOs occurred in Denmark over a period of 12 years (2005–2016) and covering the most frequent pathogens and a broad range of typing methods.The VRE features that enable data analysis, document sharing and communication between members were applied for the graphical representation of the records available in GFI, and for the sharing of results and script files within the VRE. The descriptive analysis included the relationship between the most frequent causative agents and outbreak food sources. Such results can support a risk-based food sampling strategy in the very beginning of a foodborne outbreak investigation.The Global Food-source Identifier is a data catalogue specifically designed to host an international collection of FBO records reported in a detailed and harmonized manner. It is implemented in a virtual research environment that offers key features to facilitate and enhance the global collaboration and data sharing among FBO investigators. Once in active use by the international food safety community, we envisage that GFI will contribute to the success of FBO investigations worldwide.

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O paradigma biomédico, que estabelece e regula os protocolos e os cuidados de saúde, tem como objetivo a cura. Os profissionais de saúde empreendem todos os esforços para curar a pessoa: em última análise, o fim do processo terapêutico é a eliminação da doença. Terminado o tratamento, o cancro – cada vez mais entendido como uma doença crónica – é vigiado periodicamente através da realização de exames complementares de diagnóstico e de consultas médicas. Ora, pode dizer-se que a doença oncológica é mais vigiada e monitorizada do que a pessoa, que continua, quase sempre, a sentir efeitos secundários do tratamento. Estes podem ser de natureza física, psicológica, emocional e/ou espiritual (Ness, Kokal, & Fee schroeder, 2013; Pongthavornkamol et al., 2019). Tendo em conta os desafios e os sintomas que a população sobrevivente continua a enfrentar depois do tratamento, é fundamental acompanhá-la adequadamente (Ness, Kokal, & Fee-schroeder, 2013). As necessidades do sobrevivente de cancro são tão complexas que exigem dos profissionais o desenvolvimento de competências apropriadas. Os enfermeiros especialistas em oncologia são os profissionais indicados para prestar cuidados específicos à população sobrevivente (Corcoran, Dunne, & McCabe, 2015). Perante esta problemática, defini como objetivo desenvolver competências de enfermeiro especialista em Enfermagem Médico-Cirúrgica, na opção de Enfermagem Oncológica. Estas competências permitir-me-ão estruturar e, futuramente, implementar uma Consulta de Enfermagem para o Sobrevivente Oncológico (CESO). Foi realizada uma Revisão Scoping (Apêndice I), tendo por base a seguinte questão de investigação: quais são as intervenções de Enfermagem que promovem a adaptação da pessoa à sobrevivência oncológica? Para a elaboração deste relatório, foram realizados estágios em três locais. Estas experiências foram fundamentais para o desenvolvimento de competências e para a aquisição dos conhecimentos necessários à estruturação da CESO, que contribuirá para a melhoria da qualidade dos cuidados de Enfermagem prestados ao sobrevivente. O Modelo de Adaptação de Callista Roy foi o referencial teórico utilizado na elaboração deste trabalho.

Introduction: Intestinal volvulus is a surgical emergency in which a segment of the intestine twists over its mesenteric attachment, causing bowel obstruction. It usually presents with bilious vomiting and can progress to bowel necrosis and shock. Case Report: A 40-days-old male infant presented with acute onset irritability, bilious vomiting, abdominal distention, and hematochezia. He rapidly evolved to shock with metabolic acidosis and coagulopathy, requiring fluid resuscitation, vasoactive agents, and invasive mechanical ventilation. The patient was submitted to urgent laparotomy, confirming midgut volvulus without malrotation. Partial reperfusion of the affected midgut was achieved, with no resection initially performed, but 48 hours later he was re-evaluated and partial enterectomy for midgut necrosis was performed. Despite the condition´s severity, the patient had a good evolution with full recovery.Discussion: Bilious vomiting in the infant is highly suggestive of intestinal obstruction. The authors emphasize the presence of midgut volvulus without malrotation, complicated with bowel necrosis and shock., Introdução: O vólvulo intestinal é uma emergência cirúrgica que consiste na torção de uma ansa intestinal sobre o seu ponto de inserção, causando obstrução intestinal. Habitualmente apresenta-se com um quadro de vómitos biliares, podendo evoluir para necrose intestinal e choque.Caso Clínico: Um lactente de 40 dias de idade foi observado por inicio súbito de irritabilidade, vómitos biliares, distensão abdominal e hematoquézia. Evoluiu para choque com acidose metabólica e coagulopatia, necessidade de volemização, aminas vasopressoras e ventilação mecânica. Foi submetido a laparotomia, com identificação de vólvulo intestinal sem malrotação e, recuperação da perfusão após desrotação, sem necessidade de resseção intestinal inicial. Após 48 horas, foi submetido a laparotomia de revisão, que demonstrou necrose intestinal com necessidade de enterectomia parcial do intestino delgado. Apesar da gravidade do quadro, o doente apresentou boa evolução clínica.Discussão: A presença de vómitos biliares no lactente é sugestiva de obstrução intestinal. Os autores salientam a presença de vólvulo intestinal sem malrotação, complicado com choque e necrose intestinal.