Early Warning of Suspected Doping from Biological Passport Based on Multivariate Trends.

The indirect identification of doping in sports can be performed by assessing athletes' hematological perturbations from the analysis of blood collected on different occasions. Because prosecution for doping based on this information requires expensive and time-consuming interpretation of blood analysis results by various expert hematologists, mathematical data screening is performed to decide which cases should be forwarded to hematologists. The current Bayesian and univariate screening of data does not process the multivariate trends of blood parameters or take the time interval between samplings into account. This work presents a computational tool that overcomes these limitations by calculating a single score, the hematological perturbation index (HPIx), for which a threshold is defined above which hematologists should be asked to assess the athlete's biological passport. The doping detection from this index, normalized for days difference between samplings based on 3, 4 or 5 consecutive samplings, is associated with true positive result rates (TP) not below 98% and false positive result rates (FP) less than 0.9%. Therefore, this tool can be useful as an early warning system of hematological perturbations to decide which athletes should be more closely monitored and which biological passports should be forwarded to hematologists for medical interpretation of data.

Convergence insufficiency and accommodative insufficiency in children.

PURPOSE: Convergence and accommodative insufficiency represent the main cause of complaints during close visual work and can reduce visual performance and comfort. Knowing their prevalence among schoolchildren is fundamental to define strategies for action. The purpose of this study was to estimate the frequency of these conditions in children in 5th and 6th school years in inland Portugal and to assess the impact that each visual condition has on their quality of life, based on the level of visual symptoms. METHODS: a cross-sectional study was carried out with children enrolled in the 5th and 6th school years. 372 children (192 girls) were assessed, with average ages of 10.9 ± 0.9 years. Refractive error and binocular vision assessment, integrating accommodative parameters, were used to analyse the visual condition. Symptoms were quantified using the Portuguese version of the CISS (Convergence Insufficiency Symptom Survey). RESULTS: The prevalence of definite Convergence Insufficiency (CI) in the children assessed was 2%. A prevalence of 6,8% could be considered if clinically significant CI (high suspect and definite categories) cases are accounted. In relation to Accommodative Insufficiency (AI), a frequency rate of 10% was recorded, with 3% of the evaluated children presenting AI and CI simultaneously. The symptoms score was higher in AI than in CI. CONCLUSIONS: A frequency of approximately 10% was found for each one of the visual syndromes, and it was verified that visual discomfort is common among teenagers who carry these conditions. In cases of asthenopia, such as headaches and loss of concentration, associated with near vision activities, there is a requirement to evaluate the quality of binocular vision.

New Lectins from Mediterranean Flora. Activity against HT29 Colon Cancer Cells.

Experiments conducted in vitro and in vivo, as well as some preclinical trials for cancer therapeutics, support the antineoplastic properties of lectins. A screening of antitumoral activity on HT29 colon cancer cells, based on polypeptide characterization and specific lectin binding to HT29 cells membrane receptors, was performed in order to assess the bioactivities present in four Mediterranean plant species: Juniperus oxycedrus subsp. oxycedrus, Juniperus oxycedrus subsp. badia, Arbutus unedo and Corema album. Total leaf proteins from each species were evaluated with respect to cell viability and inhibitory activities on HT29 cells (cell migration, matrix metalloproteinase -MMP proteolytic activities). A discussion is presented on a possible mechanism justifying the specific binding of lectins to HT29 cell receptors. All species revealed the presence of proteins with affinity to HT29 cell glycosylated receptors, possibly explaining the differential antitumor activity exhibited by the two most promising species, Juniperus oxycedrus subsp. badia and Arbutus unedo.

Implementation of non-vitamin K antagonist oral anticoagulants in daily practice: the need for comprehensive education for professionals and patients.

Non-vitamin K antagonist oral anticoagulants (NOACs) are increasingly used for the prevention and treatment of venous thromboembolism and for stroke prevention in patients with atrial fibrillation. NOACs do not require routine coagulation monitoring, creating a challenge to established systems for patient follow-up based on regular blood tests. Healthcare professionals (HCPs) are required to cope with a mixture of patients receiving either a vitamin K antagonist or a NOAC for the same indications, and both professionals and patients require education about the newer drugs. A European working group convened to consider the challenges facing HCPs and healthcare systems in different countries and the educational gaps that hinder optimal patient management. Group members emphasised the need for regular follow-up and noted national, regional and local variations in set-up and resources for follow-up. Practical incorporation of NOACs into healthcare systems must adapt to these differences, and practical follow-up that works in some systems may not be able to be implemented in others. The initial prescriber of a NOAC should preferably be a true anticoagulation specialist, who can provide initial patient education and coordinate the follow-up. The long-term follow-up care of patients can be managed through specialist coagulation nurses, in a dedicated anticoagulation clinic or by general practitioners trained in NOAC use. The initial prescriber should be involved in educating those who perform the follow-up. Specialist nurses require access to tools, potentially including specific software, to guide systematic patient assessment and workflow. Problem cases should be referred for specialist advice, whereas in cases for which minimal specialist attention is required, the general practitioner could take responsibility for patient follow-up. Hospital departments and anticoagulation clinics should proactively engage with all downstream HCPs (including pharmacists) to ensure their participation in patient management and reinforcement of patient education at every opportunity. Ideally, (transmural) protocols for emergency situations should be developed. Last but not least, patients should be well-informed about their condition, the treatment, possible risk scenarios, including the consequences of non-adherence to prescribed therapy, and the organisation of follow-up care.

Immune cell imaging using multi-spectral optoacoustic tomography.

Multispectral optoacoustic tomography (MSOT) offers the potential to image in high-resolution cells tagged with optical labels. In contrast to single wavelength imaging, multispectral excitation and spectral unmixing can differentiate labeled moieties over tissue absorption in the absence of background measurements. This feature can enable longitudinal cellular biology studies well beyond the depths reached by optical microscopy. However, the relation between spectrally resolved fluorescently labeled cells and optoacoustic detection has not been systematically investigated. Herein, we measured titrations of fluorescently labeled cells and establish the optoacoustic signal generated by these cells as a function of cell number and across different cell types. We then assess the MSOT sensitivity to resolve cells implanted in animals.

Functional motor recovery from brain ischemic insult by carbon nanotube-mediated siRNA silencing.

Stroke is the second cause of death worldwide with ischemic stroke accounting for 80% of all stroke insults. Caspase-3 activation contributes to brain tissue loss and downstream biochemical events that lead to programmed cell death after traumatic brain injury. Alleviation of symptoms following ischemic neuronal injury can be potentially achieved by either genetic disruption or pharmacological inhibition of caspases. Here, we studied whether silencing of Caspase-3 using carbon nanotube-mediated in vivo RNA interference (RNAi) could offer a therapeutic opportunity against stroke. Effective delivery of siRNA directly to the CNS has been shown to normalize phenotypes in animal models of several neurological diseases. It is shown here that peri-lesional stereotactic administration of a Caspase-3 siRNA (siCas 3) delivered by functionalized carbon nanotubes (f-CNT) reduced neurodegeneration and promoted functional preservation before and after focal ischemic damage of the rodent motor cortex using an endothelin-1 induced stroke model. These observations illustrate the opportunity offered by carbon nanotube-mediated siRNA delivery and gene silencing of neuronal tissue applicable to a variety of different neuropathological conditions where intervention at well localized brain foci may offer therapeutic and functional benefits.

Cytogenetic evaluation and the association with polymorphisms of the CPY1A1 and NR1I3 genes in individuals exposed to BTEX.

The gas station attendants are exposed daily to chemical agents that compose gasoline, such as BTEX (benzene, toluene, ethylbenzene, and xylene), and the exposure to these agents can cause a variety of effects on the human health. Among the various possible cell alterations associated with these exposures are the formation of micronuclei and of binucleated cells which are used as indicators of clastogenic action. Benzene, the main carcinogenic agent, is metabolized to more soluble forms and easily excreted by isoenzymes of cytochrome P450, such as CYP1A1. The CYP1A1 gene is highly polymorphic and one of its allele variations can be detected by the use of restriction endonucleasis MspI and is originated by the transition of a thymine by a cytosine (3798T>C), resulting in the polymorphic allele CYP1A1*2A. The objective of this study was to evaluate the cytogenetic damage induced by the exposure to BTEX and to associate it with the polymorphisms of the CYP1A1 and NR1I3 genes. Samples of exfoliated cells from the oral mucosa of 27 gas station attendants and from a control group were collected. The results found show that the group exposed to BTEX presents significantly higher alterations than those in the control group for micronuclei (MN; 6.85 ± 1.33 vs. 2.96 ± 1.91, P < 0.001) and for the total of nuclear alterations observed (MN + binucleated cells (BNC); 9.59 ± 4.73 vs. 5.07 ± 2.21, P < 0.001). When comparing the cytological alterations and the genotypes among the exposed individuals for the polymorphism 3798T>C of the CYP1A1 gene, homozygotes TT present MN + BNC significantly higher than carriers of the allele C (10.88 ± 5.36 vs. 5.33 ± 2.52, P = 0.028). No association was observed in the control group or for the NR1I3 gene. These results show that molecular and cytogenetic data can be used in the future as tools to monitor individuals exposed to such compounds.

Eye discomfort at close work in Portuguese university students: A comparative analysis between the pre-COVID and confinement period.

BACKGROUND: Many individuals experience visual symptoms associated with near work. The level of discomfort appears to increase with the amount of digital screen use. OBJECTIVE: To study the eye discomfort with near tasks in university students in the pre-COVID period and in the period of confinement due to the pandemic. METHODS: Two independent samples of students, aged between 18 and 35 years, were used to assess symptomatic behaviour with the Convergence Insufficiency Symptom Survey (CISS) questionnaire. In the pre-COVID period the sample had 342 participants, 64.6% females and in the COVID period 322 students participated, 71.4% females. The study of differences was carried out by the Mann-Whitney U test. The interpretation of the statistical inference was performed for a significance level≤0.05. RESULTS: There was an increase in the number of symptomatic cases in the COVID period without statistical evidence of differences in the frequency of symptoms reported in the two periods. The dimensions "somatic sensations" and "cognitive performance" were the typology of symptoms that most contributed to visual complaints with near vision. There was a significantly different symptomatic behaviour between genders in the period of confinement (p = 0.001), worsening in females and improving in males. CONCLUSION: These findings suggest that females and males exposed to digital environments, over time, may exhibit different symptomatic behaviour. Our results suggest that boys adapt more quickly than girls. Factors that predispose to these changes, aetiology and potential intervention actions still need further study.

[Adaptation of the Standardized Patient Evaluation of Eye Dryness Questionnaire to European Portuguese (SPEED-Vp) in a Non-Clinical Sample]. / Adaptação do Questionário Standardized Patient Evaluation of Eye Dryness para Português (SPEED-Vp) numa População Não Clínica.

INTRODUCTION: The aim of this study was to translate and adapt the Standardized Patient Evaluation of Eye Dryness questionnaire to European Portuguese, as well as assess the psychometric performance of the translated version, including repeatability and agreement. MATERIAL AND METHODS: The original Standardized Patient Evaluation of Eye Dryness - SPEED questionnaire was translated and adapted to the Portuguese cultural context by following a scientifically valid methodology commonly used in the process of adapting tools to other cultures and languages. The questionnaire resulting from the translation into the new language was subject to a pre-test where the comments of the participants were written and considered for the final version of the questionnaire. For the scale validation of the final version of the translated questionnaire, 89 subjects from a non-clinical population, aged 18 to 84 years, were asked to answer the questionnaire (61% were women). One week later, the same questionnaire was repeated by 63 subjects. The internal reliability of the questionnaire was analyzed by Cronbach's alpha, temporal stability by test-retest, and analysis of agreement between measures by the Bland-Altman method. RESULTS: The internal consistency of the translated questionnaire, SPEED-vP was high (α = 0.871) and all questionnaire items contributed to an increase in this index. This consistency was also confirmed to be high in the retest (α = 0.856) and when the sample was stratified by age and sex. The SPEED-complete questionnaire also showed high consistency (α = 0.88). The repeatability of the instrument was high (ICC 0.933; 95% CI: 0.899 and 0.960) and the Bland-Altman plot revealed good agreement between measures. CONCLUSION: The Standardized Patient Evaluation of Eye Dryness in Portuguese (SPEED-vP) showed good psychometric properties for the Portuguese population. Therefore, the translated version of the SPEED-vP questionnaire could be used to quantitatively measure the presence of dry eye symptoms in the Portuguese population.

Introdução: O objetivo deste estudo foi traduzir e adaptar o questionário de avaliação padronizada do paciente com secura ocular para a língua portuguesa, bem como avaliar o desempenho psicométrico da escala da versão traduzida, incluindo a sua repetibilidade e concordância entre medidas. Material e Métodos: O questionário original Standardized Patient Evaluation of Eye Dryness ­ SPEED foi traduzido e adaptado à cultura portuguesa, seguindo uma metodologia cientificamente válida e habitualmente utilizada no processo de adaptação de ferramentas a outras culturas e línguas. O questionário resultante da tradução para a nova língua foi sujeito a um pré-teste onde se registaram os comentários dos participantes e estes foram considerados para a versão final do questionário. Para a validação da escala da versão final do questionário traduzido participaram 89 indivíduos de uma população não clínica, com idades compreendidas entre os 18 e os 84 anos, dos quais 61% eram mulheres. Uma semana depois, o mesmo questionário foi preenchido pela segunda vez por 63 indivíduos. A confiabilidade interna do questionário foi analisada pelo alfa de Cronbach, a estabilidade temporal pelo teste-reteste e a análise da concordância entre medidas pelo método Bland-Altman. Resultados: A consistência interna do questionário traduzido, SPEED-vP, foi alta (α = 0,871) e todos os itens do questionário contribuíram para um aumento deste índice. Esta consistência confirmou-se também alta no reteste (α = 0,856) e quando a amostra foi estratificada por idades e por sexo. O questionário SPEED-completo também apresentou alta consistência (α = 0,88). A repetibilidade do instrumento foi alta (ICC 0,933; 95% IC: 0,899 e 0,960) e o gráfico de Bland-Altman revela boa concordância entre medidas. Conclusão: O questionário Standardized Patient Evaluation of Eye Dryness, na língua portuguesa (SPEED-vP) demonstrou boas propriedades psicométricas na população portuguesa. Consequentemente, a versão traduzida do questionário SPEED poderá ser usada para medir quantitativamente a presença de sintomas de olho seco, na população portuguesa.

Development of a buccal in vitro permeation method - exploring aQbD implementation.

The buccal mucosa is arising within the pharmaceutical landscape as an attractive option for local and systemic drug delivery, mostly due to its high vascularization, inherent permeability and robustness. Still, one of the major challenges in bringing oromucosal preparations to market remains the accurate evaluation of permeability. During pre-clinical drug development, in vitro permeation assessment is essential, and methodologies, based on the selection of a proper membrane in a diffusion cell, have become appealing alternatives to the conventional cell-based models. The development of such methods is being constrained by the number of variables - related to study conditions, setup and formulation - that need to be optimized to accurately estimate buccal permeation. The gap of knowledge over the mentioned variables may lead to long costly developments and poorly accurate methods, especially if the empirical analytical approach is used. In this paper, a systematic risk-based analytical quality by design approach was applied to the development of a buccal in vitro permeation method, ensuring that all sources of variability affecting permeation process were identified, explained and managed by appropriate measures. Researchers are guided through a step by step model, successfully demonstrating with experimental data the impact of critical variables on method's performance.

Length-dependent retention of carbon nanotubes in the pleural space of mice initiates sustained inflammation and progressive fibrosis on the parietal pleura.

The fibrous shape of carbon nanotubes (CNTs) raises concern that they may pose an asbestos-like inhalation hazard, leading to the development of diseases, especially mesothelioma. Direct instillation of long and short CNTs into the pleural cavity, the site of mesothelioma development, produced asbestos-like length-dependent responses. The response to long CNTs and long asbestos was characterized by acute inflammation, leading to progressive fibrosis on the parietal pleura, where stomata of strictly defined size limit the egress of long, but not short, fibers. This was confirmed by demonstrating clearance of short, but not long, CNT and nickel nanowires and by visualizing the migration of short CNTs from the pleural space by single-photon emission computed tomographic imaging. Our data confirm the hypothesis that, although a proportion of all deposited particles passes through the pleura, the pathogenicity of long CNTs and other fibers arises as a result of length-dependent retention at the stomata on the parietal pleura.

Application of carbon nanotubes in neurology: clinical perspectives and toxicological risks.

Nanomedicine is an emerging field that proposes the application of precisely engineered nanomaterials for the prevention, diagnosis and therapy of certain diseases, including neurological pathologies. Carbon nanotubes (CNT) are a new class of nanomaterials, which have been shown to be promising in different areas of nanomedicine. In this review, the application of CNT interfacing with the central nervous system (CNS) will be described, and representative examples of neuroprosthetic devices, such as neuronal implants and electrodes will be discussed. Furthermore, the possible application of CNT-based materials as regenerative matrices of neuronal tissue and as delivery systems for the therapy of CNS will be presented.

Degree of chemical functionalization of carbon nanotubes determines tissue distribution and excretion profile.

Getting rid of the tubes: An assessment of the retention of functionalized multi-walled carbon nanotubes (MWNTs) in the organs of mice was carried out using single photon emission computed tomography and quantitative scintigraphy (see scheme). Increasing the degree of functionalization on MWNTs enhanced renal clearance, while lower functionalization promoted reticuloendethelial system accumulation.

Oromucosal products - Market landscape and innovative technologies: A review.

Strategies that rely on oral mucosal administration have increased in the last decade and oromucosal products are paving the way to overcome specific challenges, namely improving drug bioavailability when compared with the conventional oral route, due to a reduction of the hepatic first-pass metabolism and pre-systemic degradation. Overall, the advantages of these products make oromucosal route of administration attractive for the development of value-added medicines, which can address more properly the unmet medical needs of specific patients. Generally, such products have an easy and convenient administration since they do not require water for ingestion, which may be particularly relevant for geriatric and pediatric groups, or non-cooperative patients. Usually, the development of these products aims to provide a faster onset of action, critical for acute or emergency treatments. Although oriented to achieve better therapeutic outcomes, today's drug development is primarily focused on patient-centered care, meaning that patients' specific characteristics/needs are an important driving force behind product-development efforts. In accordance, pharmaceutical innovation can rely not only on new drug substances but also on re-formulation of already approved ones or alternative routes of administration, enhancing patient convenience, treatment efficacy and/or safety. Throughout this review, the oromucosal drug products, approved in the last decade, and a retrospective analysis of their critical quality attributes and specifications will be described. Furthermore, trends and opportunities of the latest technologies in this field, as well as the number of ongoing clinical studies, will be presented and discussed.

[Dabigatran Reversal: A Practical Approach]. / Reversão do Dabigatrano: Abordagem Prática.

Dabigatran is a direct oral anticoagulant used to prevent stroke and systemic embolism in patients with atrial fibrillation. In situations that require the urgent reversal of its anticoagulant activity, such as in the case of severe bleeding that is life-threatening; urgent/ emergent surgery or invasive procedures with significant bleeding risk; and the need for thrombolysis in a patient with ischemic stroke, several measures can be taken, including the use of its specific reversal agent, idarucizumab. Based on the guidelines for the use of reversal agents for oral anticoagulants, and on the clinical experience of reversal of dabigatran, a practical guide is presented for use in clinical situations where reversal of dabigatran anticoagulation is required, including the use of idarucizumab. The adoption of this type of guideline contributes to therapeutic optimization and, consequently, greater reversal efficiency and a better resource management.

O dabigatrano é um anticoagulante oral direto utilizado na prevenção do acidente vascular cerebral (AVC) e embolia sistémica em doentes com fibrilhação auricular. Em situações que implicam a reversão urgente da sua atividade anticoagulante, como em caso de hemorragia grave com risco de vida; cirurgia ou manobra invasiva urgente/ emergente com risco hemorrágico significativo; e necessidade de trombólise em doente com AVC isquémico, podem ser adotadas diversas medidas, nomeadamente o recurso ao seu agente de reversão específico, o idarucizumab. Com base nas orientações de utilização dos agentes de reversão dos anticoagulantes orais e na experiência clínica de reversão do dabigatrano, apresenta-se um guia prático de atuação em situações urgentes de necessidade de reversão da anticoagulação do dabigatrano, incluindo a utilização de idarucizumab. A adoção deste tipo de protocolos contribui para a otimização terapêutica e, consequentemente, uma reversão mais eficaz e uma melhor gestão dos recursos.

[Anemia in Chronic Kidney Disease: The State of the Art]. / Anemia da Doença Renal Crónica: O Estado da Arte.

The aging of the population has led to an increased prevalence of chronic diseases such as chronic kidney disease. Anemia is one of the most frequent complications of chronic kidney disease, with an impact not only on the quality of life but also on the patient's prognosis and associated costs. Knowledge in this therapeutic area has increased significantly: from the appearance of recombinant erythropoietin in 1989, through the use of increasing doses of parenteral iron and, more recently, to new molecules such as hypoxia-inducible factor inhibitors. The aim of this article is to present a pragmatic review of the state of the art in the epidemiology, pathophysiology, diagnosis and treatment of anemia associated with chronic kidney disease.

O envelhecimento populacional tem-se traduzido no aumento de prevalência de doenças crónicas como a doença renal crónica. A anemia é uma das complicações mais frequentes da doença renal crónica, com impacto não só na qualidade de vida como no prognóstico do doente e nos custos associados. O conhecimento nesta área terapêutica tem aumentado de forma significativa: desde o aparecimento da eritropoietina recombinante em 1989, passando pelo uso de doses crescentes de ferro parentérico e, mais recentemente, a novas moléculas como os inibidores do hypoxia-inducible factor. Os autores pretendem rever, de uma forma pragmática, o estado da arte da anemia associada à doença renal crónica, desde a epidemiologia, à fisiopatologia, ao diagnóstico e ao tratamento.

Clinical, economical and safety impact of ferric carboxymaltose use in Patient Blood Management programme in Portuguese National Health Service hospitals.

Ferric carboxymaltose (FCM) can be used in Patient Blood Management (PBM) to promote the optimization of preoperative haemoglobin (Hb), which aims to minimise the use of allogeneic blood components and improve clinical outcomes, with better cost-effectiveness. This was an observational study conducted in a retrospective and multicentre cohort with adults from elective orthopaedic, cardiac and colorectal surgeries, treated according to local standards of PBM with allogeneic blood product transfusions (ABTs) on demand and with FCM to correct iron deficiency with or without anaemia. In this work, only the first pillar of the PBM model issue by Directorate-General for Health (DGS) was evaluated, which involves optimising Hb in the preoperative period with iron treatment if it's necessary/indicated. Before the implementation of PBM in Portugal, most patients did not undergo preoperative laboratory evaluation with blood count and iron kinetics. Therefore, the existence of Iron Deficiency Anaemia (IDA) or Iron Deficiency (ID) without anaemia was not early detected, and there was no possibility of treating these patients with iron in order to optimise their Hb and/or iron stores. Those patients ended up being treated with ABTs on demand. A total of 405 patients from seven hospitals were included; 108 (26.7%) underwent FCM preoperatively and 197 (48.6%) were transfused with ABTs on demand. In the FCM preoperative cohort, there was an increase in patients with normal preoperative Hb, from 14.4 to 45.7%, before and after FCM, respectively, a decrease from 31.7 to 9.6% in moderate anaemia and no cases of severe anaemia after FCM administration, while 7.7% of patients were severely anaemic before FCM treatment. There were significant differences (p < 0.001) before and after correction of preoperative anaemia and/or iron deficiency with FCM in Hb, serum ferritin and transferrin saturation rate (TS). In the ABT group, there were significant differences between pre- and postoperative Hb levels (p < 0.001). Hb values tended to decrease, with 44.1% of patients moving from mild anaemia before transfusion to moderate anaemia in the postoperative period. Concerning the length of hospital stay, the group administered with ABTs had a longer hospital stay (p < 0.001). Regarding the clinical outcomes of nosocomial infection and mortality, there was no evidence that the rate of infection or mortality differed in each group (p = 0.075 and p = 0.243, respectively). However, there were fewer nosocomial infections in the FCM group (11.9% versus 21.2%) and mortality was higher in the transfusion group (21.2% versus 4.2%). Economic analysis showed that FCM could reduce allogenic blood products consumption and the associated costs. The economic impact of using FCM was around 19%. The preoperative Hb value improved when FMC was used. Patients who received ABTs appeared to have a longer hospital stay. The FCM group reported fewer infections during hospitalisation. The economic results showed savings of around €1000 for each patient with FCM administration. The use of FCM as part of the PBM program had a positive impact on patients' outcomes and on economic results. However, it will be essential to perform studies with a larger sample to obtain more robust and specific results.

Improving Awareness about Patient Blood Management in Portugal: A Call for Action Arising from a Delphi Panel.

INTRODUCTION: Anaemia and iron deficiency are associated with increased mortality and poor surgical outcomes. Consensus in their definitions is expected to optimize their management, which is encompassed by patient blood management, providing patient-centred care while improving patient safety and clinical outcomes. Patient blood management implementation is even more relevant in contingency times and faces barriers due to lack of standardization, among others. The aim is to establish a consensus on these diagnoses and implement patient blood management principles in clinical practice in Portugal. MATERIAL AND METHODS: Eight experts in Transfusion Medicine, Haematology, Anaesthesiology, Internal Medicine, and Obstetrics/Gynaecology were assembled; a focus group was conducted, defining 33 statements. A Delphi panel was conducted, with experts from the clinical specialities named above as well as from General Surgery, Urology, and Orthopaedics. RESULTS: The Delphi panel's rounds had 70 (Round 1) and 46 (Round 2) respondents. Specialists were consensual in only two statements, on the existence of a preoperative patient blood management consultation for candidates to elective surgeries in which the use of blood derivatives is anticipated and, on the importance of the correction of postoperative anaemia and iron deficiency. Of the remaining 31 statements, 27 reached high agreement or disagreement by the respondents. CONCLUSION: Consensus was reached in only two (6%) of the 33 statements. There was a consensual agreement on the relevance of establishing patient blood management as the standard of care and of valuing preoperative and postoperative patient blood management interventions. Nevertheless, our results point to the lack of awareness regarding patient blood management principles - which could result in better postoperative outcomes, shorter hospitalizations, reduced costs and increased availability of beds. Training and literacy initiatives could help further implement patient blood management standards in Portuguese hospitals.

Introdução: A anemia e ferropenia estão associadas a um aumento da mortalidade e a piores resultados no período pós-operatório. Consensualizar as suas definições permitirá otimizar a sua gestão. O patient blood management engloba essa gestão, com relevo acrescido em situações de contingência, focado nos cuidados centrados no doente e na melhoria da segurança e dos outcomes. As barreiras à implementação de princípios patient blood management prendem-se, entre outras, com falta de padronização. Pretende--se estabelecer um consenso sobre estes diagnósticos e implementação de patient blood management na prática clínica em Portugal. Material e Métodos: Foram reunidos oito especialistas em Imuno-hemoterapia, Hematologia Clínica, Anestesiologia, Medicina Interna e Obstetrícia/ Ginecologia. Foi realizado um focus group, onde foram definidas 33 afirmações. Além disso, foi realizado um painel Delphi, com especialistas das áreas mencionadas acima, assim como de Cirurgia Geral, Urologia e Ortopedia. Resultados: As duas rondas do painel Delphi tiveram, respetivamente, 70 e 46 respondedores. Estes foram consensuais em apenas duas afirmações, na existência de consulta pré-operatória de patient blood management para os candidatos a cirurgias eletivas em que se antecipa o uso de hemoderivados e, na importância da correção da anemia e ferropenia pós-operatórias. Das 31 afirmações restantes, 27 atingiram alta concordância ou discordância pelos respondentes. Conclusão: Foi alcançado consenso em apenas duas (6%) das 33 afirmações. Houve consenso sobre a relevância de estabelecer o patient blood management como standard of care e a valorização das intervenções de patient blood management pré e pós-operatórias. No entanto, os resultados indiciam falta de consciencialização sobre os princípios de patient blood management ­ que poderiam levar a melhores resultados pós-operatórios, com redução do tempo de hospitalização e dos custos e maior disponibilidade de camas. Iniciativas de formação e literacia poderiam ajudar a uma melhor implementação dos princípios de patient blood management nos hospitais portugueses.

Effects of Innovation, Total Quality Management, and Internationalization on Organizational Performance of Higher Education Institutions.

The aim of this research is to analyze the effects of innovation strategies, Total Quality Management (TQM) dimensions, and internationalization strategies that Higher Education Institutions (HEIs) might adopt, and their effects on their organizational performance. Due to globalization and the constant changes and demands that have taken place today, HEIs are forced to seek new quality assurance instruments in higher education, to ensure greater competitiveness in the markets and their survival. To examine the association between the independent variables, namely, TQM dimensions, innovation strategies, and internationalization strategies with the dependent variable, that is organizational performance of HEIs, we have chosen to use multiple linear regression analysis. A nine-predictor multiple linear regression model was proposed. The nine predictor variables are Communication, Involvement/teacher empowerment, Development/Teacher training, Continuous improvement, Leadership/Administration's Commitment, Data analysis/Measurement of results, Focus on students, Innovation Strategies, and Internationalization strategy. We conclude that some TQM variables have a significant association with the organizational performance of HEIs, namely, Involvement/teacher empowerment, and Development/teacher training. On the other hand, also the Innovation strategies and Internationalization strategy have a significant association with the organizational performance of HEIs. This research is of enormous importance for the study of HEIs, considering their role in the development of any country and its impact on society as creators of knowledge and science. Since these institutions increasingly must deal with extremely competitive market environments, knowledge of the factors that can assist in increasing the organizational performance of HEIs is of great relevance.

ATLANTIC ANTS: a data set of ants in Atlantic Forests of South America.

Ants, an ecologically successful and numerically dominant group of animals, play key ecological roles as soil engineers, predators, nutrient recyclers, and regulators of plant growth and reproduction in most terrestrial ecosystems. Further, ants are widely used as bioindicators of the ecological impact of land use. We gathered information of ant species in the Atlantic Forest of South America. The ATLANTIC ANTS data set, which is part of the ATLANTIC SERIES data papers, is a compilation of ant records from collections (18,713 records), unpublished data (29,651 records), and published sources (106,910 records; 1,059 references), including papers, theses, dissertations, and book chapters published from 1886 to 2020. In total, the data set contains 153,818 ant records from 7,636 study locations in the Atlantic Forest, representing 10 subfamilies, 99 genera, 1,114 ant species identified with updated taxonomic certainty, and 2,235 morphospecies codes. Our data set reflects the heterogeneity in ant records, which include ants sampled at the beginning of the taxonomic history of myrmecology (the 19th and 20th centuries) and more recent ant surveys designed to address specific questions in ecology and biology. The data set can be used by researchers to develop strategies to deal with different macroecological and region-wide questions, focusing on assemblages, species occurrences, and distribution patterns. Furthermore, the data can be used to assess the consequences of changes in land use in the Atlantic Forest on different ecological processes. No copyright restrictions apply to the use of this data set, but we request that authors cite this data paper when using these data in publications or teaching events.