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Guilherme Castela,1– 3 Joana Providência,1,2 Madalena Monteiro,1 Bárbara Oliveiros,2 Sónia Silva,4 Manuel Brito,4 Egídio Machado,5 Joaquim Neto Murta,1,2 Miguel Castelo-Branco,2,3,* Zélia Correa6,* 1Department of Ophthalmology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; 2Faculty of Medicine, University of Coimbra (FMUC), Coimbra, Portugal; 3Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), Coimbra, Portugal; 4Department of Pediatric Oncology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; 5Department of Medical Imaging, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; 6University of Miami, Bascom Palmer Eye Institute, Miami, FL, USA*These authors contributed equally to this workCorrespondence: Guilherme Castela, Department of Ophthalmology, Centro Hospitalar e Universitário de Coimbra, Praceta Prof Mota Pinto, Coimbra, 3004-561, Portugal, Tel +351919702206, Email gcastela@hotmail.comPurpose: We aim to report about effectiveness and safety in the context of our centers’ setting in the management of retinoblastoma with intra-arterial chemotherapy (IAC) in a 5-year retrospective analysis of the Portuguese population.Patients and Methods: Retrospective analysis of consecutive cases of retinoblastoma selected to initiate IAC between 2015 and 2020, at the Portuguese National Reference Center. All included patients underwent complete ophthalmological evaluation under anesthesia with fundus photography. Diagnosis and classification of retinoblastoma was made according to the International Classification of Intraocular Retinoblastoma (ICRB). The patients were further divided into two groups: Group I for primary IAC and Group II for secondary IAC. Tumor recurrence or relapses, systemic metastasis and deaths were documented. Main efficacy outcome included ocular salvage and recurrence-free survival rates estimated using the Kaplan–Meier method.Results: Twenty-eight eyes (19 eyes included in Group I and 9 eyes included in Group II) were eligible and a total of 130 IAC procedures were performed, with a median number of sessions of 4 (range 1– 8) for each treated eye, during a median follow-up of 21 months (range 4– 64). Of the included eyes, 22 (78.6%) were preserved. An overall survival of 100% was achieved. Considering the preserved eyes, the overall median decimal visual acuity achieved at the last visit was 0.15 (range 0.02– 0.8). Three patients had permanent adverse events related to IAC (cataract, vitreous hemorrhage and choroidal ischemia). Considering the survival analysis of recurrence, the mean survival without recurrence was 84.2% for Group I and 66.7% for Group II, and the mean survival without enucleation was 78.6% (no events in Group II).Conclusion: IAC has been shown to be an effective and safe treatment for children with intraocular retinoblastoma. This study demonstrates that IAC is effective even in moderate sample sizes, when a multidisciplinary approach is available.Keywords: retinoblastoma, intra-arterial chemotherapy, ocular oncology, pediatric oncology

Since the nation joined the European Union, the process that regulates housing policy in Portugal has been subject to specificities that are proper of the Portuguese situation. In a State which has a considerable housing deficit, it was the quantifier elements that judged the various governments regarding this matter. Almost all of the housing production depended on mortgage loans in which soft loans played an important part, together with tax benefits. The negative effects produced by lease blocking were increasingly felt throughout the analyzed period of time. The changes in context due to the decrease of tax rates and the legislative alterations on soft loans, conditioned the agents behavior and, necessarily, the rhythm of Portugal’s housing market. Using the STATIS (Structuration of Tableaux A Trois Indices de la Statistique) methodology and through the analysis of the housing policy instruments, it was possible to identify the trajectories and changes in performance of the State, Owners and Families during the period between 1992 and 2008, as well as the most significant variables for understanding the problematic of housing in Portugal.

Since the nation joined the European Union, the process that regulates housing policy in Portugal has been subject to specificities that are proper of the Portuguese situation. In a State which has a considerable housing deficit, it was the quantifier elements that judged the various governments regarding this matter. Almost all of the housing production depended on mortgage loans in which soft loans played an important part, together with tax benefits. The negative effects produced by lease blocking were increasingly felt throughout the analyzed period of time. The changes in context due to the decrease of tax rates and the legislative alterations on soft loans, conditioned the agents behavior and, necessarily, the rhythm of Portugal’s housing market. Using the STATIS (Structuration of Tableaux A Trois Indices de la Statistique) methodology and through the analysis of the housing policy instruments, it was possible to identify the trajectories and changes in performance of the State, Owners and Families during the period between 1992 and 2008, as well as the most significant variables for understanding the problematic of housing in Portugal.

Objective The aim of our study was to characterize the evacuated African patients diagnosed with retinoblastoma and referred to the Portuguese national referral center (Centro Hospital e Universitário de Coimbra, University of Coimbra), identifying inequalities in the stage of diagnosis and prognostic results. Design Retrospective observational study of evacuated African patients diagnosed with retinoblastoma and referred to the Portuguese National Referral Center (Centro Hospital e Universitário de Coimbra, University of Coimbra). Results The study included 15 patients between October 2015 and October 2020 from Angola, Cape Verde, Guinea-Bissau and São Tomé and Príncipe. Seven (46.7%) children presented bilateral retinoblastoma. The median age at the time of diagnosis was 20.9 (interquartile range, 16–41) months. The presenting symptoms were leukocoria (86.7%), strabism (53.3%) and buphthalmus (40%). In terms of tumor staging, five (33.3%) children presented with extraocular retinoblastoma and 10 (66.7%) children presented with intraocular retinoblastoma. At presentation, no pineal involvement was diagnosed but two (13.3%) children presented with central nervous system involvement at the time of the first observation. Children were treated with enucleation, exenteration, systemic chemotherapy, intra-arterial chemotherapy and/or supportive palliative care. During the follow-up period (mean 27.2 ± 18.2 months), the overall survival was 73.3%. Conclusion A small proportion of African children are being referred to our center, when considering the expected incidence of retinoblastoma in these countries, and referred children arrive at advanced stages of the disease, compromising treatment outcomes. Considering retinoblastoma is now a curable disease, national and international interventions are required to attempt a better management of children born in low-income countries., Video abstract Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/qQxfSPun_bk

Chemotherapy; Childhood cancer; Radiotherapy Quimioterapia; Cáncer infantil; Radioterapia Quimioteràpia; Càncer infantil; Radioteràpia Introduction Advanced intraocular retinoblastoma can be cured by enucleation, but spread of retinoblastoma cells beyond the natural limits of the eye is related to a high mortality. Adjuvant therapy after enucleation has been shown to prevent metastasis in children with risk factors for extraocular retinoblastoma. However, histological criteria and adjuvant treatment regimens vary and there is no unifying consensus on the optimal choice of treatment. Method Data on guidelines for adjuvant treatment in European retinoblastoma referral centres were collected in an online survey among all members of the European Retinoblastoma Group (EURbG) network. Extended information was gathered via personal email communication. Results Data were collected from 26 centres in 17 countries. Guidelines for adjuvant treatment were in place at 92.3% of retinoblastoma centres. There was a consensus on indication for and intensity of adjuvant treatment among more than 80% of all centres. The majority of centres use no adjuvant treatment for isolated focal choroidal invasion or prelaminar optic nerve invasion. Patients with massive choroidal invasion or postlaminar optic nerve invasion receive adjuvant chemotherapy, while microscopic invasion of the resection margin of the optic nerve or extension through the sclera are treated with combined chemo- and radiotherapy. Conclusion Indications and adjuvant treatment regimens in European retinoblastoma referral centres are similar but not uniform. Further biomarkers in addition to histopathological risk factors could improve treatment stratification. The high consensus in European centres is an excellent foundation for a common European study with prospective validation of new biomarkers. Open access funding enabled and organized by Projekt DEAL.

In a world that is getting more and more complex regarding the threats to everyone’s safety, we aim to understand in which way hotel units are prepared to respond to the terrorism threat, in order to guarantee the safety of the touristic destination itself. This investigation with the title “Of business protection in hospitality - terrorism and resilience” aims to understand how security is conceptualized within the Portuguese hospitality industry, comparing it to other three European destinations, through a series of short interviews to hospitality security leaders, an interview to the president of the Portuguese Association of Security Directors and other literary works. This work is divided in three chapters, following the rational framework, where we first define the theoretical standpoint, then the second chapter where we define the methodology and, finally, the investigation analysis through the interviews. We have taken the examples of cities like London, Paris and Barcelona, where we found distinctive results that help us understand the reach of safety and security cultures within big European cities. With the development of the investigation, we conclude how different hotel units put in practice different security concepts and how they communicate among each other and with public authorities to create safe environments that promote the touristic destination itself. Num mundo que se mostra cada vez mais complexo a nível de ameaças à segurança de todos, importa compreender de que formas as unidades hoteleiras estão preparadas para responder à ameaça do terrorismo, de forma a contribuir para a segurança do próprio destino e dos turistas que o visitam. O presente trabalho intitulado “Da proteção do negócio em hotelaria - terrorismo e resiliência” procura perceber de que forma se pensa a segurança na hotelaria portuguesa, comparando com três destinos europeus através da condução de entrevistas curtas a responsáveis de segurança de unidades hoteleiras, uma entrevista mais extensa ao presidente da Associação de Diretores de Segurança de Portugal e demais investigação literária. O trabalho divide-se em três capítulos, seguindo o enquadramento lógico de exposição dos temas, onde se define o enquadramento teórico no primeiro, o enquadramento metodológico no segundo e, por fim, a análise da investigação segundo as entrevistas conduzidas. Para isso, recorremos à análise de cidades como Londres, Paris e Barcelona, onde obtivemos resultados distintos e que nos ajudam a completar o panorama da criação e desenvolvimento de uma cultura de segurança nas grandes cidades europeias. Com o desenvolvimento da investigação, acabamos por concluir de que forma as unidades hoteleiras põem em prática os conceitos de segurança aplicáveis ao setor do turismo e como comunicam entre si e com as entidades públicas para criar ambientes seguros que promovem também o próprio destino.

BackgroundThe travel distance from home to a treatment centre, which may impact the stage at diagnosis, has not been investigated for retinoblastoma, the most common childhood eye cancer. We aimed to investigate the travel burden and its impact on clinical presentation in a large sample of patients with retinoblastoma from Africa and Europe.MethodsA cross-sectional analysis including 518 treatment-naïve patients with retinoblastoma residing in 40 European countries and 1024 treatment-naïve patients with retinoblastoma residing in 43 African countries.ResultsCapture rate was 42.2% of expected patients from Africa and 108.8% from Europe. African patients were older (95% CI −12.4 to −5.4, pConclusionsFewer than half the expected number of patients with retinoblastoma presented to African referral centres in 2017, suggesting poor awareness or other barriers to access. Despite the relatively shorter distance travelled by African patients, they presented with later-stage disease. Health education about retinoblastoma is needed for carers and health workers in Africa in order to increase capture rate and promote early referral.

Trauma is the main cause of physical loss of an eye by evisceration or enucleation of the globe. Immediate or early removal of an eye may be required, or removal of the globe may be undertaken as a secondary procedure. From a cosmetic viewpoint, the aim of reconstructive surgery is to create a healthy cavity within the orbit to support an implant or external prosthesis and to minimise any asymmetry with the opposite eye, using a pain-free implant/prosthesis. Choice of implant depends mostly on the surgeon’s preferences and its cost. These are discussed.

Summary The latest global economic and financial crisis has had adverse social consequences in many areas, including income and the social situation of households and their living conditions, especially when the housing phenomenon is addressed. The reality of this uncertainty has made the study of the housing phenomenon even more relevant, in particular from the perspective of an analysis of its evolution. In this context, we revisit EUROSTAT’s databases. This analysis was done for twelve Euro Area countries over five years, using the HJ-BIPLOT method developed by Galindo (1986). This multidimensional approach identified and represented twelve Eurozone sample countries in latent constructs of reduced dimensionality related to the housing policy problem. The simultaneous factorial representation identified (a) the most relevant variables to characterize these countries, (b) their trajectories during the period in analysis, and (c) the relations between variables, between countries, and between variables and countries. This approach also identified the most significant factors contributing to the countries' performance. This methodological approach can be useful in housing research, when studying data of a multivariate nature, and is also, by its visual interpretation, a potential tool for producing richer information not only for academia but also for policy makers.

In order to facilitate transfer of knowledge to and within tourism, it is necessary to understand research trends and to critically analyze their contributions to knowledge formation. This chapter examine articles published in Annals of Tourism Research, Journal of Travel Research, Tourism Management, and Journal of Travel & Tourism Marketing, between 2000 and 2010, using STATIS to explore the main changes and trends that occurred in terms of research themes. Study findings indicate similarities and differences between the four journals under analysis, providing clues for a better understanding of the objectives, limitations, and trends in tourism research as well as the positioning of each academic journal.

Modern competitiveness is tough, mainly due to new technologies and platforms. Managers must cope with these challenges to keep their businesses innovative and successful. An important step is to exploit the potential of open innovation. This work analyses where Portugal stands in terms of innovation in general, propensity for open innovation and innovation sustainability. A HJ-Biplot methodology was applied to a valid sample from the community innovation survey (CIS) for Portugal. The analysis suggests that Portuguese firms must cut back on activities that are not leading to the right outcomes. And the choice of right partners can cause more ideas to be executed and diffused. Innovation accelerators can help in this approach toward better innovation turnovers and country's innovation index. These issues are relevant to research in the face of fast trends such as the fourth industry (IoT, cyber-physical environments) and smart cities.

O objetivo do presente artigo é analisar o potencial das redes sociais no desempenho das pequenas e médias empresas da região do Algarve, tendo sido efectuado um questionário para o efeito. O estudo empírico realizado revela que os dados recolhidos (de 70 empresas) possuem boas qualidades psico-métricas. Procedeu-se a uma análise categórica de componentes principais, a qual identificou duas principais tipologias de objectivos nas redes sociais: redes sociais para interacção produto-cliente e pesquisa ou conhecimento; e redes sociais com potencial para o marketing. Uma análise suplementar - análise hierárquica de clusters (com recurso ao método de agrupamento de Ward) - identificou três padrões de empresas consoante o seu grau de envolvimento em redes sociais: cluster Social Tec Grau 1; cluster Social Tec Grau 2 e cluster Social Tec Grau 3. Estas análises permitem validar uma metodologia sustentável para este tipo de avaliação. The aim of present work is to analyse the potential of social networks in the performance of small and medium enterprises in Algarve region, having developed a questionnaire for this purpose. The empirical study reveals that the collected data (from 70 enterprises) have good psico-metric qualities. Then, a categorical principal component analysis was performed, which identified two main typologies of goals in using social networks: those for product-client interaction and search or knowledge; and those with potential for marketing. A supplementary analysis, hierarchical cluster analysis (using Ward's grouping method), identified three patterns of enterprises according to their level of social networks' involvement: cluster Social Tec Level 1; cluster Social Tec Level 2 and cluster Social Tec Level 3. These analyses validate a sustainable methodology for this kind of approach.

This study analyzes uses of social networks by small and medium-sized enterprises (SMEs) at the Algarve region in Portugal. Results suggest that some firms have integrated their business strategies with social networks, and have groups of professionals responsible for these platforms. Most managers perceive that social networks enhance business performance, but few measure the results. Firms that most frequently use social networks have managers with higher qualifications. This study identified two types of socialnetwork use: a) producteclient interaction and knowledge/(re) search, and b) marketing potential. A complementary analysis (cluster analysis) identified three behavioral patterns with varying involvement with social networks. These patterns relate with types of use, suggesting a level of social media involvement/ performance. Enhancing performance is likely related to knowledge-oriented social networks. This study also suggests an approach for measuring the gap between types of social network usebehavioral/ performance patterns and the reality in successful firms, which would be useful to apply or transfer to other firms and communities. (C) 2015 Elsevier Ltd. All rights reserved.

Purpose.To report a case of orbital myositis associated with Coxsackie virus and its medical and surgical approach.Methods.Complete ophthalmological examination and imaging and analytical investigation were performed.Results. A 6-year-old male presented with subacute painless binocular horizontal diplopia. Examination revealed bilateral best-corrected visual acuity (BCVA) of 20/20 and right eye 45-prism-dioptre (PD) esotropia in near and distance fixations, with no motility restrictions. Serologic screening was positive for Coxsackie virus acute infection and computerized tomography (CT) suggested right eye medial rectus orbital myositis. An oral corticosteroid 1.0 mg/kg/day regimen was started. A new CT after two months showed symmetrical lesions in both medial rectus muscles. Corticosteroids were increased to 1.5 mg/kg/day. After imagiological resolution on the 4th month, alternating 45 PD esotropia persisted. Bilateral 7 mm medial rectus recession was performed after 1 year without spontaneous recovery. At 1-year follow-up, the patient is orthophoric with 200′′ stereopsis and bilateral 20/20 BCVA.Conclusions. To our knowledge, this is the first reported case of orbital myositis associated with Coxsackie virus. This is also the first reported case of isolated strabismus surgery after orbital myositis in pediatric age, highlighting the favourable aesthetic and functional outcomes even in cases of late ocular motility disorders.

A 42-year-old woman presented with chronic history of left red eye for more than 12 months, treated with difference topical medication but without response. Ocular external examination demonstrated a firm palpable mass in the medial portion of the lower eyelid and slit-lamp evaluation of the lesion showed an ulcerated conjunctival nodule, keratin secretor. CT of the orbits revealed left-sided orbital mass located anteriorly, inferiorly and medially in the orbit, adjacent to the globe and orbit walls. Incisional biopsy of the lesion was consistent with invasive squamous cell carcinoma of the conjunctiva. As the tumour had no response to initial adjuvant systemic chemotherapy, exenteration of left orbit was performed due to advanced disease.