Irish Dancing Injuries and Associated Risk Factors: A Systematic Review.

Irish dance is growing in popularity, evolving to a more athletic and demanding dance style. The aim of this study is to conduct a systematic review, previously registered with PROSPERO, to identify the prevalence, incidence, and the injury pattern among Irish dancers and analyse the associated risk factors. Six online databases and two dance-specific science publications were searched systematically. Studies were included if the patterns of injuries among Irish dancers were evaluated or the factors associated with injury were analysed, published in English or Portuguese, in peer-reviewed scientific journals. Four reviewers assessed the quality and level of evidence using the Downs and Black criteria and a modified Oxford Centre of Evidence-Based Medicine 2009 model, respectively. Eleven articles were included, eight of Level 3c (cross-sectional) and three of Level 3b (prospective). Mean DB percentage score was 63% ± 7.2%. Prevalence ranged from 72.2% to 92.6%, affecting mostly the foot/ankle complex. Only two articles reported incidence, which ranged from 3.4 to 10.6 injuries/1000 h danced depending on injury definition. Psychological factors, elite level, and insufficient/poor sleep were associated with musculoskeletal injury. Injury prevalence and incidence is high in Irish dancers, with the foot and ankle being more affected. Due to heterogeneity in injury definitions, methods, and populations, along with the need for improvement in studies quality, recommendations were made for future research.

Comparison of different waste bin monitoring approaches: An exploratory study.

Waste bin monitoring solutions are an essential step towards smart cities. This study presents an exploratory analysis of two waste bin monitoring approaches: (1) ultrasonic sensors installed in the bins and (2) visual observations (VO) of the waste collection truck drivers. Bin fill level data was collected from a Portuguese waste management company. A comparative statistical analysis of the two datasets (VO and sensor observations) was performed and a predictive model based on Gaussian processes was applied to enable a trade-off analysis of the number of collections versus the number of overflows for each monitoring approach. The results demonstrate that the VO are valuable and reveal that significant improvements can be achieved for either of the monitoring approaches in relation to the current situation. A monitoring approach based on VO combined with a predictive model is shown to be viable and leads to a considerable reduction in the number of collections and overflows. This approach can enable waste collection companies to improve their collection operations with minimal investment costs during their transition to fully sensorized bins.

A responsiveness metric for the design and planning of resilient supply chains.

Supply Chain Management is in constant evolution, and Supply Chain Resilience (SCR) appears as a recent offspring result of changes in how companies do business. Research efforts on the topic have led to a focus on the basic concepts of SCR, leaving a relevant research gap on the modelling and quantification of the SCR behaviour. In fact, there is not yet a consensus on SCR metrics or on how to quantify SCR. Most SCR models fail to incorporate relevant characteristics of the supply chain's performance, as are the impacts perceived by downstream customers. This work addresses such gaps, and a new resilient SC metric is proposed, which is incorporated into a developed optimisation model, where economic and responsiveness objectives are maximised when designing and planning resilient SC considering all SC entities. The model is applied to a case study that shows that decision-makers should avoid adopting universal strategies when managing their SC and instead should define the best plan for their SC operation. The impacts perceived by downstream customers are analysed. Moreover, it can be concluded that there is a correlation between the SC performance and the new SCR metric, easing the process of designing and planning the SC when resilience concerns are at stake.

Preeclampsia risk in oocyte donation versus double gamete donation pregnancies: A systematic review and meta-analysis.

The number of pregnancies achieved through gamete donation has escalated over the last decades. It has been hypothesized that double gamete donation pregnancies would have a higher risk of preeclampsia compared to single gamete donation pregnancies due to cumulative risk of preeclampsia in oocyte donation pregnancies and the separate risk associated with sperm donation. Therefore, a systematic review and meta-analysis was conducted to explore the association between double gamete donation pregnancies and the development of preeclampsia and gestational hypertension, comparing it with oocyte donation alone. A systematic search of five databases was conducted and meta-analysis was performed using a random-effects model. Of 795 screened articles, five met our selection criteria for a systematic review, and four were included in the meta-analysis.No statistically significant differences were found in the risk of preeclampsia between study subgroups (odds ratio [OR] 0.82; 95% confidence interval [95%CI] 0.29-2.36), even after subgroup analysis considering only high-quality studies (OR 1.30; 95%CI 0.61-2.76; I2 = 0%). Regarding gestational hypertension risk, neither the pooled analysis (OR 0.52; 95%CI 0.18-1.49; I2 = 84%) nor the high-quality studies subgroup analysis (OR 0.67; 95%CI 0.33-1.35; I2 = 0%) find any significant differences between oocyte donation or double gamete donation pregnancies. There appears to be little difference in gestational hypertension or preeclampsia risk between pregnancies resulting from double gamete donation and those from oocyte donation alone. Strict obstetrical surveillance should be considered standard of care for these women, in an attempt to perform early diagnosis and management of hypertensive disorders.

Wet Mount Microscopy of the Vaginal Milieu Does Not Predict the Outcome of Fertility Treatments: A Cross-sectional Study.

OBJECTIVE: The aim of the study was to evaluate whether vaginal dysbiosis (bacterial vaginosis [BV] or moderate/severe aerobic vaginitis [AV]/desquamative inflammatory vaginitis) in women subjected to intrauterine insemination (IUI) or in vitro fertilization/intracytoplasmic sperm injection influences the rates of pregnancy. MATERIALS AND METHODS: This is a cross-sectional study involving 392 women who underwent IUI or in vitro fertilization/intracytoplasmic sperm injection at a fertility clinic. All had a slide collected for phase contrast wet mount microscopy (WMM), which was classified according to the International Society for the Study of Vulvovaginal Disease recommendations. Correlation between flora patterns and the rate of pregnancy were evaluated. RESULTS: There were no differences in any of the groups in terms of pregnancy rate (biochemical, clinical, at first trimester ultrasound, or live birth) after stratifying for the presence of BV, moderate or severe (ms) AV, BV and/or moderate or severe AV, cytolysis, or abnormal vaginal flora (lactobacillary grade ≥ IIb). The presence of Candida species, cocci, or bacilli morphotypes other than lactobacilli also showed no differences. CONCLUSIONS: The vaginal flora assessment by WMM at the time of IUI or oocyte retrieval was not predictive of the success of fertility treatments.The absence of differences may be due to intrinsic limitations of WMM (i.e., identifying only bacterial morphotypes), a positive impact of the treatments in the vaginal flora or because the sperm and embryo transfer is made directly into the uterine cavity, thus overcoming any cervical or vaginal dysbiosis disadvantage. Future studies should focus on the endometrial milieu, rather than in the vaginal and/or cervical one.

Frozen Embryo Transfer and Preeclampsia Risk.

Worldwide, the use of Assisted Reproductive Technology (ART) has been steadily rising over recent years. With the continuous improvements in cryopreservation techniques and the growing practice of single embryo transfer, the proportion of frozen embryo transfer (FET) cycles has been increasing, therefore raising concern about the safety of this ART technique to both mothers and infants. This review aims to summarize the current evidence regarding the risk of preeclampsia in singleton pregnancies achieved by autologous FET compared to fresh embryo transfer, and to discuss the influence of different protocols used for endometrium preparation in frozen cycles on the risk of this obstetric complication. Several studies have reported a higher risk of hypertensive disorders, including preeclampsia, in pregnancies following FET compared with fresh embryo transfer. Recently, artificial FET cycles, which preclude the development of a corpus luteum, were shown to be associated with an increased preeclampsia risk in comparison with natural and stimulated cycles. Importantly, no difference was found between FET in a modified natural cycle and spontaneous conception. It has been proposed that the absence of the corpus luteum in artificial cycles may, at least partly, contribute to the observed increased risk of preeclampsia. Indeed, the corpus luteum secretes vasoactive hormones, such as relaxin, which are not replaced in artificial cycles, thereby compromising maternal cardiovascular adaptations to pregnancy, resulting in an increased risk of preeclampsia. If these findings are confirmed by a randomized controlled trial, natural, modified natural or stimulated cycles might be preferred over artificial cycles in eligible patients.

Infertility management in women with polycystic ovary syndrome: a review.

Polycystic ovary syndrome is the most common endocrine disorder in women and a major cause of anovulatory infertility. Various medical options are used, alone or in combination, to treat subfertility associated with polycystic ovary syndrome. This narrative review was conducted to provide an update and summarize the available evidence on the management of polycystic ovary syndrome related infertility. A wide literature search was performed and preferably randomized controlled trials and systematic reviews were included. Management is often centered on lifestyle changes. Pharmacological ovulation induction is the next step, with recommended use of letrozole, clomiphene citrate or gonadotropins. When it fails, assisted reproductive technologies or laparoscopic ovarian drilling are frequently advised. Combination treatment with metformin is often recommended. More recent alternative and adjunctive treatments have been suggested, like inositol, vitamin D, bariatric surgery and acupuncture, but further research is needed for recommendation.

Primary Dysmenorrhea: Assessment and Treatment.

Primary dysmenorrhea is defined as menstrual pain in the absence of pelvic disease. It is characterized by overproduction of prostaglandins by the endometrium, causing uterine hypercontractility that results in uterine muscle ischemia, hypoxia, and, subsequently, pain. It is the most common gynecological illness in women in their reproductive years and one of the most frequent causes of pelvic pain; however, it is underdiagnosed, undertreated, and even undervalued by women themselves, who accept it as part of the menstrual cycle. It has major implications for quality of life, such as limitation of daily activities and psychological stress, being one of the main causes of school and work absenteeism. Its diagnosis is essentially clinical, based on the clinical history and normal physical examination. It is important to exclude secondary causes of dysmenorrhea. The treatment may have different approaches (pharmacological, non-pharmacological and surgical), but the first line of treatment is the use of nonsteroidal anti-inflammatory drugs (NSAIDs), and, in cases of women who want contraception, the use of hormonal contraceptives. Alternative treatments, such as topical heat, lifestyle modification, transcutaneous electrical nerve stimulation, dietary supplements, acupuncture, and acupressure, may be an option in cases of conventional treatments' contraindication. Surgical treatment is only indicated in rare cases of women with severe dysmenorrhea refractory to treatment.

Dismenorreia primária é definida como dor menstrual na ausência de patologia pélvica. Caracteriza-se pelo excesso de produção de prostaglandinas pelo endométrio que provocam hipercontractilidade uterina, resultando em isquemia e hipoxia do músculo uterino e, subsequentemente, dor. É a patologia ginecológica mais comum em mulheres em idade fértil e uma das causas mais frequentes de dor pélvica; contudo, é subdiagnosticada, subtratada, e até desvalorizada pelas próprias mulheres, que a aceitam como parte do ciclo menstrual. A dismenorreia tem grandes implicações na qualidade de vida, como limitação das atividades diárias e estresse psicológico, sendo uma das principais causas de absentismo escolar e laboral. O seu diagnóstico é essencialmente clínico, baseando-se na história clínica e num exame físico sem alterações. É importante excluir causas secundárias de dismenorreia. O tratamento pode ter diferentes abordagens (farmacológica, não farmacológica e cirúrgica), sendo que a primeira linha de tratamento consiste na utilização de anti-inflamatórios não esteroides (AINEs) e, em casos de mulheres que desejem contracepção, no uso de anticoncepcionais hormonais. Tratamentos alternativos, como a utilização de calor tópico, modificação do estilo de vida, estimulação elétrica nervosa transcutânea, suplementos alimentares, acupuntura e acupressão, podem ser uma opção nos casos de contraindicação da utilização dos tratamentos convencionais. O tratamento cirúrgico apenas se encontra indicado em casos raros de mulheres com dismenorreia grave e refratária aos tratamentos.

Life Cycle Assessment for the Design of Chemical Processes, Products, and Supply Chains.

Design in the chemical industry increasingly aims not only at economic but also at environmental targets. Environmental targets are usually best quantified using the standardized, holistic method of life cycle assessment (LCA). The resulting life cycle perspective poses a major challenge to chemical engineering design because the design scope is expanded to include process, product, and supply chain. Here, we first provide a brief tutorial highlighting key elements of LCA. Methods to fill data gaps in LCA are discussed, as capturing the full life cycle is data intensive. On this basis, we review recent methods for integrating LCA into the design of chemical processes, products, and supply chains. Whereas adding LCA as a posteriori tool for decision support can be regarded as established, the integration of LCA into the design process is an active field of research. We present recent advances and derive future challenges for LCA-based design.

Primary dysmenorrhea: assessment and treatment / Dismenorreia primária: avaliação e tratamento

Abstract Primary dysmenorrhea is defined asmenstrual pain in the absence of pelvic disease. It is characterized by overproduction of prostaglandins by the endometrium, causing uterine hypercontractility that results in uterine muscle ischemia, hypoxia, and, subsequently, pain. It is the most common gynecological illness in women in their reproductive years and one of the most frequent causes of pelvic pain; however, it is underdiagnosed, undertreated, and even undervalued by women themselves, who accept it as part of themenstrual cycle. It hasmajor implications for quality of life, such as limitation of daily activities and psychological stress, being one of themain causes of school and work absenteeism. Its diagnosis is essentially clinical, based on the clinical history and normal physical examination. It is important to exclude secondary causes of dysmenorrhea. The treatment may have different approaches (pharmacological, nonpharmacological and surgical), but the first line of treatment is the use of nonsteroidal anti-inflammatory drugs (NSAIDs), and, in cases of women who want contraception, the use of hormonal contraceptives. Alternative treatments, such as topical heat, lifestyle modification, transcutaneous electrical nerve stimulation, dietary supplements, acupuncture, and acupressure, may be an option in cases of conventional treatments' contraindication. Surgical treatment is only indicated in rare cases of women with severe dysmenorrhea refractory to treatment.

Resumo Dismenorreia primária é definida como dormenstrual na ausência de patologia pélvica. Caracteriza-se pelo excesso de produção de prostaglandinas pelo endométrio que provocam hipercontractilidade uterina, resultando em isquemia e hipoxia do músculo uterino e, subsequentemente, dor. É a patologia ginecológica mais comum em mulheres em idade fértil e uma das causas mais frequentes de dor pélvica; contudo, é subdiagnosticada, subtratada, e até desvalorizada pelas próprias mulheres, que a aceitam como parte do ciclo menstrual. A dismenorreia tem grandes implicações na qualidade de vida, como limitação das atividades diárias e estresse psicológico, sendo uma das principais causas de absentismo escolar e laboral. O seu diagnóstico é essencialmente clínico, baseando-se na história clínica e num exame físico sem alterações. É importante excluir causas secundárias de dismenorreia. O tratamento pode ter diferentes abordagens (farmacológica, não farmacológica e cirúrgica), sendo que a primeira linha de tratamento consiste na utilização de anti-inflamatórios não esteroides (AINEs) e, em casos de mulheres que desejem contracepção, no uso de anticoncepcionais hormonais. Tratamentos alternativos, como a utilização de calor tópico, modificação do estilo de vida, estimulação elétrica nervosa transcutânea, suplementos alimentares, acupuntura e acupressão, podem ser uma opção nos casos de contraindicação da utilização dos tratamentos convencionais. O tratamento cirúrgico apenas se encontra indicado em casos raros de mulheres com dismenorreia grave e refratária aos tratamentos.

Preimplantation genetic testing for Huntington disease: the perspective of one Portuguese center.

BACKGROUND: Huntington disease (HD) is an autosomal dominant late-onset neurodegenerative disease caused by an unstable cytosine-adenine-guanine trinucleotide repeat expansion in the huntingtin (HTT) gene. Preimplantation genetic testing (PGT) is a diagnostic procedure available for these individuals, because they carry a high risk of transmitting this genetic condition to their offspring. METHODS: Information about 15 HD couples referred for PGT and 21 cycles performed from 2009 to 2018 was collected retrospectively. PGT provide direct testing of embryos obtained after intracytoplasmic sperm injection, using polymerase chain reaction multiplex as the genetic testing protocol. RESULTS: PGT for HD was performed in 15 couples, with no history of previous attempts, in a total of 21 cycles. The mean number of biopsied embryos per cycle was 4.9. The amplification efficiency in blastomeres was 87.4%. From the 90 amplified embryos, 32 were normal and suitable for transfer. The mean number of transferred embryos per couple was 1.2.Overall, 3 positive human chorionic gonadotropin tests were obtained in 3 couples, resulting in 2 clinical pregnancies. The 2 ongoing clinical pregnancies had normal evolution, and culminated in 2 deliveries, resulting in the birth of 2 healthy children. CONCLUSIONS: PGT for HD is considered an effective and safe reproductive option for couples who are at risk of transmitting HD, when proper genetic and reproductive counseling is warranted.

First trimester ß-hCG and estradiol levels in singleton and twin pregnancies after assisted reproduction.

Objective To compare levels of ß-hCG and estradiol collected during the first trimester in singleton and twin pregnancies following assisted reproduction technologies (ART). Methods We prospectively evaluated 50 singleton and 47 dichorionic twin pregnancies that eventually ended in live births. Patients were recruited from a single ART center with standard treatment protocols followed by fresh embryo transfers. Hormone measurements were performed within a narrow gestational age range and analyzed in a single laboratory thus minimizing inter- and intra-assay variability. We measured serum ß-hCG at 13 days after embryo transfer as well as samples of ß-hCG and estradiol at 8-9 weeks+6 days. Results No significant differences existed between singletons and twins in respect to demographic and cycle characteristics. ß-hCG and estradiol were all significantly higher in twins (P<0.05). Conclusion The data confirms the higher levels of ß-hCG and estradiol in twins, pointing to the potential role of these placental hormones in early support of a twin pregnancy.

Can early ß-human chorionic gonadotropin predict birth of singletons and twins after in vitro fertilization?

OBJECTIVE: To assess the predictive value for clinical pregnancy outcome of ß-hCG level at 13 d after embryo transfer. METHODS: Retrospective study of IVF clinical pregnancies diagnosed at 6 weeks. We calculated the value of ß-hCG level at 13 d after embryo transfer to predict live births. RESULTS: We analyzed 177 IVF cycles between 2009 and 2014 (50 singleton births, 50 twin births, 27 sets with a vanishing twin, 43 first trimester singleton pregnancy loss and seven first trimester total twin pregnancy loss). Singleton pregnancies with a ß-hCG concentration <85 mIU/mL had an 89% risk of having a first trimester loss whereas a concentration >386 mU/mL had a 91% chance of a live birth. Twin pregnancies with a concentration <207 mIU/mL had only a 33% chance of delivering twins and a 55% risk of having a vanishing twin; whereas a level >768 mIU/mL was associated with a 81% chance of live twin birth and a low risk (19%) of having a vanishing twin. Age, type and duration of infertility, body mass index (BMI) and number of fertilized oocytes did not affect these calculations. CONCLUSIONS: ß-hCG level at 13 d after embryo transfer might predict outcomes in clinical singleton and twin pregnancies following IVF.

[Assisted Reproductive Technology in Female Transplant Recipients: Experience of a Reproductive Medicine Unit and Literature Review]. / Procriação Assistida em Mulheres Transplantadas: Experiência de uma Unidade de Medicina da Reprodução e Revisão da Literatura.

Diseases in end stage typically occur with hypothalamic-pituitary-ovarian axis disorders, with consequent anovulation and infertility. The solid organ transplantation increased survival of patients with end-stage organs disease and the vast majority of women improve their reproductive capacity after transplantation. Although adoption can always be a possibility, the transplanted infertile woman has the right to self-reproductive determination using assisted reproductive techniques. While it is known that pregnancies in transplantedwomen are at high risk, there is no evidence of differences in pregnancy outcome in pregnant transplanted subject to technical, compared with spontaneous pregnancies. The use of assisted reproductive techniques in transplanted women is a medical, ethical and psychosocial challenge, whose approach must be multidisciplinary, to ensure reproductive success without compromising the function of the transplanted organ or maternal health, allowing the birth of a healthy child. The literature remains scarce. Three clinical cases are presented.

Doenças em estádio terminal cursam tipicamente com distúrbios do eixo hipotálamo-hipófise-ovário, com consequente anovulação e infertilidade. A transplantação de órgãos sólidos aumentou a sobrevida e melhorou a capacidade reprodutiva das mulheres com este tipo de patologia. Embora a adopção seja uma possibilidade, a mulher transplantada infértil tem direito à sua autodeterminação reprodutiva com recurso a técnicas de procriação medicamente assistida. As gravidezes em mulheres transplantadas são de alto risco, mas não parece existir evidência de diferenças no desfecho obstétrico e neonatal nas grávidas transplantadas sujeitas a procriação assistida, comparativamente a gravidezes espontâneas. A utilização de técnicas de procriação assistida em mulheres transplantadas constitui um desafio médico, ético e psicossocial, cuja abordagem deve ser multidisciplinar, para assegurar o sucesso reprodutivo sem comprometer a função do órgão transplantado ou a saúde materna, permitindo o nascimento de uma criança saudável. A literatura existente mantém-se escassa. São apresentados três casos clínicos.

First transplantation of cryopreserved ovarian tissue in Portugal, stored for 10 years: an unexpected indication.

Ovarian tissue cryopreservation represents a valid strategy to preserve ovarian function in patients with a high risk of premature ovarian failure. We present a case of ovarian tissue cryopreservation carried out in an 18-year-old woman after a laparotomy for left adnexal mass with left adnexectomy. Congenital absence of the right ovary was observed during surgery. To preserve fertility, rescue cryopreservation of ovarian tissue was carried out under extreme conditions (without adopting the standard published protocol, not yet available at our centre). Ten years later, transplantation of cryopreserved ovarian tissue was carried out and, shortly after it, restoration of ovarian function was confirmed.

Research challenges in municipal solid waste logistics management.

During the last two decades, EU legislation has put increasing pressure on member countries to achieve specified recycling targets for municipal household waste. These targets can be obtained in various ways choosing collection methods, separation methods, decentral or central logistic systems, etc. This paper compares municipal solid waste (MSW) management practices in various EU countries to identify the characteristics and key issues from a waste management and reverse logistics point of view. Further, we investigate literature on modelling municipal solid waste logistics in general. Comparing issues addressed in literature with the identified issues in practice result in a research agenda for modelling municipal solid waste logistics in Europe. We conclude that waste recycling is a multi-disciplinary problem that needs to be considered at different decision levels simultaneously. A holistic view and taking into account the characteristics of different waste types are necessary when modelling a reverse supply chain for MSW recycling.

Planning waste cooking oil collection systems.

This research has been motivated by a real-life problem of a waste cooking oil collection system characterized by the existence of multiple depots with an outsourced vehicle fleet, where the collection routes have to be plan. The routing problem addressed allows open routes between depots, i.e., all routes start at one depot but can end at the same or at a different one, depending on what minimizes the objective function considered. Such problem is referred as a Multi-Depot Vehicle Routing Problem with Mixed Closed and Open Inter-Depot Routes and is, in this paper, modeled through a mixed integer linear programming (MILP) formulation where capacity and duration constraints are taken into account. The model developed is applied to the real case study providing, as final results, the vehicle routes planning where a decrease of 13% on mileage and 11% on fleet hiring cost are achieved, when comparing with the current company solution.

Modeling the demand for long-term care services under uncertain information.

Developing a network of long-term care (LTC) services is currently a health policy priority in many countries, in particular in countries with a health system based on a National Health Service (NHS) structure. Developing such a network requires proper planning and basic information on future demand and utilization of LTC services. Unfortunately, this information is often not available and the development of methods to properly predict demand is therefore essential. The current study proposes a simulation model based on a Markov cycle tree structure to predict annual demand for LTC services so as to inform the planning of these services at the small-area level in the coming years. The simulation model is multiservice, as it allows for predicting the annual number of individuals in need of each type of LTC service (formal and informal home-based, ambulatory and institutional services), the resources/services that are required to satisfy those needs (informal caregivers, domiciliary visits, consultations and beds) and the associated costs. The model developed was validated using past data and key international figures and applied to Portugal at the Lisbon borough level for the 2010-2015 period. Given data imperfections and uncertainties related to predicting future LTC demand, uncertainty was modeled through an integrated approach that combines scenario analysis with probabilistic sensitivity analysis using Monte Carlo simulation. Results show that the model provides information critical for informing the planning and financing of LTC networks.

Modelling a recovery network for WEEE: a case study in Portugal.

The European Union directive for electric and electronic waste, published in 2003, enforced all European countries to meet some targets concerning the recycling and recovery of these products. This directive was transposed to the Portuguese legislation in 2004. Following this, a group of EEE producers set up an organization (Amb3e) whose mission was to design and manage a nationwide recovery network for WEEE, which will be the subject matter of this work. A generic MILP model is proposed to represent this network, which is applied to its design and planning, where the best locations for collection and sorting centres are chosen simultaneously with the definition of a tactical network planning. Several analyses are performed to provide further insights regarding the selection of these alternative locations. The results gave support to the company strategic expansion plans for a high number of centres to be opened and to their location near the major WEEE sources.