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The Anthomyiidae (Insecta, Diptera) include 1,941 species in 53 genera that are found in a wide range of habitats (forests, cities, agricultural fields). Herein, the anthomyiid fauna of the Atlantic Forest of Palmas (south of the state of Paraná) was surveyed using Malaise traps at altitudes higher than 1,000 meters. The collection of these flies was conducted in Palmas Grasslands Wildlife Refuge (PGWR) that is a full protection conservation unit (CU) surrounded by degraded areas and with high levels of endemism. A total of 12 species of anthomyiid flies (42.3% of Brazilian species) and 7 genera (58.3% of Brazilian genera) were identified, including 9 new records to Paraná ( Anthomyia plurinervis (Albuquerque, 1958), A. xanthopyga (Albuquerque, 1959), Calythea comis (Stein, 1911), Coenosopsia ferrari Nihei & de Carvalho, 2004, Emmesomyia auricollis (Stein, 1918), E. sobria (Albuquerque & Couri, 1981), Leucophora maculipennis (Albuquerque, 1953), Pegomya bruchi (Shannon & Del Pont, 1926) and P. poeciloptera Malloch, 1921). Also, we examined some specimens deposited in the Department of Zoology, Universidade Federal do Paraná, the Museu Nacional, Universidade Federal do Rio de Janeiro, and the Museu de Zoologia da Universidade de São Paulo in order to update species’ distribution, leading to a new record for Rio Grande do Sul ( Pegomya poeciloptera Malloch, 1921) and 3 new records for Santa Catarina ( Anthomyia pluripunctata (Albuquerque, 1959), Calythea comis (Stein, 1911), Leucophora maculipennis (Albuquerque, 1953)). A key to the local genera and diagnoses of species are provided.

Introduction: Traditionally, the healthcare system has been organized in a fragmented manner with lack of connection among the different levels and departments. This problem leads to contradictory messages about diagnosis, treatment and prognosis. Moreover, it duplicates visits and creates greater expenditure in diagnostic tests and prescription changes. Most importantly, it generates a disruption feeling in the user.    Short description of practice change implemented: Creation of connection mechanisms between primary care and other specialties Aim and theory of change: Integration of the primary care and hospital specialists is essential in the new demographic situation with an ageing population with more chronic diseases Targeted population and stakeholders: Chronic multi-pathological patients Patients under diagnostic pathways Diabetic patients managed among primary care, nephrology, vascular surgery and endocrinology. Surgical complex patients Timeline: - 2012 Creation of an integrated health organization - 2012 Pathways for decompensated chronic patients - 2013 Monthly meetings between primary and a referral internist - 2014 Non presential interconsultations - 2015 Assessment of patient’s feedback - 2017 Connection with primary care through Microsoft Lync  Highlights (innovation, Impact and outcomes): - Decompensated chronic patients:  a severity assessment is made and alarms are generated accordingly leading to telephonic attention, early appointment with GP, referral internist visit at the hospital or direct admission. - Monthly meetings between referral internist and primary care: complex cases are discussed and critical points of the pathways are discussed to generate new solutions - Non presential interconsultations: generated by the GP through the electronic medical record. A referral internist makes written recommendations about diagnostic or therapeutic issues or creates an appointment - Patients’ feedback:  A qualitative study about patients’ perception was done through interviews in deep - Use of Microsoft Lync for written conversations between referral internist and GP - Outcomes: Better coordination in the management of multi-pathological patients, reduction of hospital admissions, reduction of days spent at the hospital and ED visits. Reduction of face-to-face consultations. 1600 non presential consultations per year. Comments on sustainability: Integration likely to increase cost-effectiveness by reducing ED visits, hospital admissions and face-to-face consultations while increasing electronic consultations.  Comments on transferability: Technology and protocols are available to all and easily transferable to other settings.  The change has been made with existing resources. Conclusions: Integration improves control of patients, reduces time of answer of interconsultations between the levels and is likely to reduce cost because of fewer face-to-face consultations and days spent at the hospital. Discussions: Integration is especially beneficial when increasing complexity of patients and it facilitates case management strategies, the sessions among  primary and internist and non presential interconsultations have helped to minimize the contradictory messages/actions (since these problems are treated in the sessions). Lessons learned: A higher level of integration is possible when the tools and technology are available. Success depends   also in the will of change of the healthcare workers who may initially be reluctant to new strategies. Patients’ feedback is clear about the benefits and that should drive stakeholders to overcome the implementation barriers.

Introduction: The PAMI program is a multipronged management strategy for the complex patients.  During the last decade, it has been implemented from a pilot scale to more than 8000 people of the San Sebastian area.  The program warrants intense follow up with clinical visits interspersed with telephone calls using specific questionnaires and activates prescription changes, early appointments or even direct hospital admissions when needed. It involves tight coordination of a case management nurse, GP and a referral internist.  Since it was implemented significant reductions have been achieved in ED visits and days spent at the hospital, making the health system friendlier to patients of complex needs. Description of practice change implemented: Scaling up of a multipronged management strategy for patients of complex needs Aim: Improving quality of life and perceived quality of health assistance Training patients and healthcare providers Reducing length of stay and Emergency Department (ED) visits Respecting patients’ will on intensity of treatment and place of care provision Target population: - Multi-pathological patients with high readmission rates (mainly heart failure and COPD) - Home-dependent patients - Nursing home residents - End of life patients Timeline: 2005: Prediction rule development and validation for readmission risk 2006: Before and after study with a multipronged strategy (PAMI) targeting patients with high readmission rates. 2010: Comparative study of telemedicine vs PAMI 2010: Cluster randomized clinical trial of PAMI in nursing homes 2014: Implementation of the program in the primary care 2017: Complementary support of a call center Highlights: - Case management of complex patients with process-specific questionnaires - Successful extension of the program to more than 8000 complex patients - 30-50% of direct admissions (avoiding ED visit). - Days spent at the hospital reduction by 25% for nursing home residents, 55% for home-dependents, 58% for heart failure patients, and 25% for patients with COPD -ED visits made by each group was also reduced by 58%, 70%, 70% and 45% respectively. -Complementary patient management trough call center further improving outcomes. -80-100% found training satisfactory -90-100% rated the hospital accessibility “excellent” -90-100% perceived significant improvements in the global management of the process. Sustainability: Huge reduction in EDs visits and days spent at the hospital likely to improve cost-effectiveness Transferability: The technology and protocols are available to all in the Basque Country. Geographical differences exist in hospital accessibility. Conclusions: This strategy improved perceived quality of life and length of stay while avoiding many ED visits. The main achievement is the scaling up of such a program from a pilot study to a population of 8000 complex patients. Discussion: Case management strategies can be successfully scaled up if integration tools are available. The scaled up version of PAMI had a slight loss of effectiveness compared to the pilot, but this has been overcame adding  call center support in the follow up. Lessons learned: Anticipation of problems, new technologies and integrated assistance focused on the user will be the keys of the future care.

Despite the publication of great number of tools to aid decisions in COVID-19 patients, there is a lack of good instruments to predict clinical deterioration. COVID19-Osakidetza is a prospective cohort study recruiting COVID-19 patients. We collected information from baseline to discharge on: sociodemographic characteristics, comorbidities and associated medications, vital signs, treatment received and lab test results. Outcome was need for intensive ventilatory support (with at least standard high-flow oxygen face mask with a reservoir bag for at least 6 h and need for more intensive therapy afterwards or Optiflow high-flow nasal cannula or noninvasive or invasive mechanical ventilation) and/or admission to a critical care unit and/or death during hospitalization. We developed a Catboost model summarizing the findings using Shapley Additive Explanations. Performance of the model was assessed using area under the receiver operating characteristic and prediction recall curves (AUROC and AUPRC respectively) and calibrated using the Hosmer–Lemeshow test. Overall, 1568 patients were included in the derivation cohort and 956 in the (external) validation cohort. The percentages of patients who reached the composite endpoint were 23.3% vs 20% respectively. The strongest predictors of clinical deterioration were arterial blood oxygen pressure, followed by age, levels of several markers of inflammation (procalcitonin, LDH, CRP) and alterations in blood count and coagulation. Some medications, namely, ATC AO2 (antiacids) and N05 (neuroleptics) were also among the group of main predictors, together with C03 (diuretics). In the validation set, the CatBoost AUROC was 0.79, AUPRC 0.21 and Hosmer–Lemeshow test statistic 0.36. We present a machine learning-based prediction model with excellent performance properties to implement in EHRs. Our main goal was to predict progression to a score of 5 or higher on the WHO Clinical Progression Scale before patients required mechanical ventilation. Future steps are to externally validate the model in other settings and in a cohort from a different period and to apply the algorithm in clinical practice. Registration: ClinicalTrials.gov Identifier: NCT04463706.

The factors that predispose an individual to a higher risk of death from COVID-19 are poorly understood. The goal of the study was to identify factors associated with risk of death among patients with COVID-19. This is a retrospective cohort study of people with laboratory-confirmed SARS-CoV-2 infection from February to May 22, 2020. Data retrieved for this study included patient sociodemographic data, baseline comorbidities, baseline treatments, other background data on care provided in hospital or primary care settings, and vital status. Main outcome was deaths until June 29, 2020. In the multivariable model based on nursing home residents, predictors of mortality were being male, older than 80 years, admitted to a hospital for COVID-19, and having cardiovascular disease, kidney disease or dementia while taking anticoagulants or lipid-lowering drugs at baseline was protective. The AUC was 0.754 for the risk score based on this model and 0.717 in the validation subsample. Predictors of death among people from the general population were being male and/or older than 60 years, having been hospitalized in the month before admission for COVID-19, being admitted to a hospital for COVID-19, having cardiovascular disease, dementia, respiratory disease, liver disease, diabetes with organ damage, or cancer while being on anticoagulants was protective. The AUC was 0.941 for this model’s risk score and 0.938 in the validation subsample. Our risk scores could help physicians identify high-risk groups and establish preventive measures and better follow-up for patients at high risk of dying.ClinicalTrials.gov Identifier: NCT04463706

The invasion and the multiplication of microorganisms like bacteria, viruses and parasites that are not commonly found on the human body may cause infections. Regarding incidence it is important to point out the urinary tract infections (UTI), the second most common kind of infection, making of utmost importance its early detection, diagnosis and swift identification of the most appropriate customized treatment. These infections can be detected using urinalysis that can also handle the diagnosis of conditions such as kidney and liver disorders and diabetes.The diagnostic methods currently used for detection of UTI are the dipsticks, microscopic examination, urine culture and automated urinalysis that require urine collection and analysis, often a painful and time-consuming procedure.During the last two decades, novel approaches based on miniaturized devices have been conceived. In this dissertation, a paper-based microfluidic device fabricated with inexpensive materials for urinalysis was designed, fabricated and tested. This device is attached on a diaper and aims to collect urine samples and determine quantitatively the amount of specific urine components such as blood, leukocyte esterase, glucose, proteins and nitrite.This new design is proposed to overcome the unmet limitations of existing technologies such as the isolation of the analytical device from the external environment and the communication between reagent pads. The solution for the first problem was attempted through the implementation of a swelling-based “self-locking” mechanism; as for the second issue, hydrophobic channels on filter paper and a layer with frames were created.The performance of device was tested by placing it in a surface, mimetizing its application in the diaper and water was dropped on top of it. It was possible to demonstrate that the “self-locking” mechanism was effective; on the other hand, interferences arise between reagent pads, probably due to capillary flow between the layers. In order to optimize this design a second generation of the device has been conceived and is presented.Overall, the approach used seems promising, since a single devices is able to collect, detect and analyze a urine sample in a short period, making the patients’ life more comfortable, being in addition portable and easy to operate.

Este estudo teve como objetivo analisar, longitudinalmente, a adaptação ao stress em estudantes do ensino superior, considerando o papel mediador da avaliação cognitiva primária (i.e., perceção de ameaça/desafio) e secundária (i.e., coping) na relação entre o stress e oburnout. Participaram 175 estudantes, com idades entre os 17 e os 42 anos (M = 21.19 anos; DP = 3.95), sendo 155 do sexo feminino (89%), 18 do sexo masculino (10%) e 2 não identificaram informação sobre o sexo (1%). O estudo decorreu em três momentos (Mto). O Mto1 incluiu o Questionário Sociodemográfico, o Questionário de Stress em Estudantes, a Escala de Avaliação Cognitiva e o Inventário de Coping Reduzido. Os Mto2 e Mto3 incluíram a Medida de Burnout de Shirom-Melamed. Os resultados indicaram que o stress e a avaliação cognitiva são preditores de burnout, obtendo-se um valor preditivo melhor quando a avaliação cognitiva mediou a relação stress - burnout.Os estudantes devem estar conscientes sobre o modo como percebem e lidam com as diferentes fontes de stress.

O crescente número e variedade de soluções deonline dating disponíveis, sejam no formato site ou aplicação, é acompanhado pelo volume de utilizadores. Não obstante o número de utilizadores portugueses que afirma ter conta em redes deonline dating,o estudo do fenómeno em contexto português é incipiente resultando num desconhecimento em dimensões como representações, motivações ou práticas.O objetivo desta investigação foi situar as plataformas de online dating no quotidiano dos seus utilizadores e a pergunta de partida estabelecida: Como se caracterizam os utilizadores portugueses de plataformas de online dating, que dimensões explicam o recurso a estas plataformas e como gerem a utilização das mesmas?Mobilizaram-se procedimentos de recolha de dados assentes numa metodologia mista, com recuso a entrevistas, observação não participante, análise documental, aplicação do walkthrough methode aplicação de questionários. O produto foi a realização de cinco estudos que culminaram na publicação de cinco artigos científicos. O primeiro estudo contribuiu para conhecer como é que os utilizadores se apresentavam nas plataformas deonline dating. O segundo estudo forneceu informações sobre como a lógica de funcionamento do Tinder era percecionada pelos utilizadores. O terceiro estudo explorou os acontecimentos na vida dos utilizadores que conduziram ao uso do Tinder e as motivações subjacentes. O quarto estudo caracterizou as práticas dos utilizadores portugueses identificando três tipos de perfis. O quinto estudo explorou padrões pelos quais os eventos eram representados nos media.Os resultados permitiram concluir que as aplicações de online datingsão espaços onde a intimidade se manifesta em função do significado atribuído às plataformas pelos utilizadores e pelo contexto. Esse significado reflete normas e padrões culturais, mas é também produto das motivações, vontades e expectativas individuais dos utilizadores, variando em função das suas histórias de vida e recursos diferenciados. A reunião do conjunto desses fatores e variáveis propulsiona transformações em como a intimidade é construída, exposta e vivenciada em contextos de online dating. Mais, essas transformações da intimidade são também produto resultante de valores e modelos de negócio intrínsecos a tais plataformas, cujas regras e estruturas foram definidas por terceiros.

No contexto atual de crise financeira, de aumento da exclusão social e de envelhecimento da população, a economia social é cada vez mais essencial ao funcionamento da sociedade. Pelas dificuldades orçamentais do Governo mas também pelos novos desafios sociais emergentes do contexto de crise, os projetos de cariz social e empreendedor tornam-se fulcrais para a satisfação das necessidades dos grupos mais fragilizados da sociedade.O empreendedorismo social, promovido por organizações sem fins lucrativos, tem como objetivo propor soluções a problemas sociais de forma inovadora e sustentável, através de mecanismos que forneçam apoio ou visem a prevenção de diversas situações de fragilidade, exclusão ou carência humana e com o intuito de promover a inclusão social, bem como o desenvolvimento local. É neste contexto que se apresenta o presente trabalho final de mestrado, na forma de proposta de um projeto social para a implementação de uma rede de ligação entre instituições de apoio à terceira idade e à deficiência com instituições de apoio animal nos concelhos da Covilhã e Fundão – a Rede Vinculum Hominis Animalli (VHA) – através da realização de Atividades Assistidas por Animais (AAA) de cariz lúdico, direcionadas para os utentes das instituições. Pretende-se que esta iniciativa de caráter associativo, funcione como parte dinamizadora dos seus parceiros contribuindo, por um lado, para uma melhoria de qualidade de vida dos idosos e de outras pessoas com limitações e incapacidades e, por outro lado, para a promoção da responsabilidade social para com os animais.Para a prossecução dos objetivos do projeto, recorre-se ao trabalho de voluntários sendo, assim, um ponto essencial a ter em conta no planeamento e delineamento deste modelo organizacional, funcionando como a força motriz da rede e sem a qual o seu funcionamento será dificultado pelo que, a sua gestão tem toda a relevância.Dado o cariz inovador do projeto no contexto nacional e, por isso, o grande nível de desconhecimento e incerteza que lhe está associado, o projeto é estruturado com base num modelo organizacional elaborado a partir do modelo Canvas – modelo que permite um planeamento mais dinâmico e menos “fechado” em comparação com o “plano de negócios” - adaptado ao setor social. É com base neste modelo que são apresentadas as diversas componentes do modelo organizacional da Rede VHA. Conclui-se apresentando uma análise SWOT do projeto numa lógica de gestão do risco.