A critical look at the Portuguese public-private partnerships in healthcare.

The pre-conceived idea that contracts in a public-private partnership (PPP) regime, in healthcare or in any other economic sector, are, as a rule, ruinous and appealing for only a share of the stakeholders, lacks a solid basis that confirms it. This idea, outset and nurtured by the media, has been instigating the distrust of the users who, in turn, demand a more rigorous and efficient utilisation of public resources. Being Portugal in the top of countries that resort to PPPs, it is urgent to inquire if its respective contracts originated an inefficient and ineffective management of resources. It is precisely this discussion that we address in this paper, focusing our efforts in the Portuguese healthcare sector.

Sporotrichosis: A Clinicopathologic Study of 89 Consecutive Cases, Literature Review, and New Insights About Their Differential Diagnosis.

BACKGROUND: Sporotrichosis is the most common and least severe of deep mycoses. This disease has varied clinic presentation as well as several differential diagnosis. METHODS: A cross-sectional and retrospective, individually based, observational study, based on records from the dermatopathology service of a university hospital in Brazil. A total of 175 patients were identified with clinical suspicion of sporotrichosis, from 2009 to 2017. Statistical analysis using prevalence ratios was conducted to characterize the clinicopathologic and epidemiological aspects. RESULTS: The disease was suspected in 175 patients given the clinical presentation. Of these, 86 cases (49.14%) were sporotrichosis, 39 (22.29%) chronic granulomatous inflammatory processes of unidentified etiology, and 5 squamous cell carcinomas (2.86%). The majority of cases (52 or 60.46%) occurred in the upper limbs. A total of 40 samples presented a suppurative chronic granulomatous inflammatory process (46.51%). Only 5 samples (12.50%) showed positive staining (periodic-Schiff acid or GROCOTT). CONCLUSIONS: The sporotrichosis cases underwent both cumulative and linear growth, especially in the group above 60 years. Squamous cell carcinomas appeared several times as a misdiagnosis of sporotrichosis by dermatologists, so it should be considered as an important differential diagnose due to the current context of skin cancers.

Joining of Polyethylene Using a Non-Conventional Friction Stir Welding Tool.

The objective of the current study was to butt-weld 6 mm-thick polyethylene (PE) plates by friction stir welding (FSW) using a non-conventional stationary shoulder tool. The welds were performed with an unheated shoulder and with a shoulder temperature of 85 °C. Additionally, rotational speeds of 870, 1140 and 1500 rpm; welding speeds of 60 and 120 mm/min; and plunge depths of 5.5 and 5.7 mm were used. The influence of these parameters on morphology, hardness, ultimate tensile strength, elongation at break and fracture modes was evaluated. Shoulder heating proved to be crucial for the optimization of PE joints by FSW, as it clearly improved joint efficiency. Furthermore, shoulder heating promoted the reduction in internal and external defects, such as porosity and surface burning. Defect-free weld seams were obtained with higher rotational speeds and a lower welding speed. A maximum joint efficiency of about 97% was achieved with a shoulder temperature of 85 °C, a rotational speed of 1500 rpm, a welding speed of 60 mm/min and a plunge depth of 5.7 mm. A weld with the average joint efficiency of 92% was produced at 120 mm/min, which based on the literature found is the highest welding speed reported that achieved a joint efficiency above 90%.

Effect of Friction Stir Welding Techniques and Parameters on Polymers Joint Efficiency-A Critical Review.

The objective of current work is to analyse the influence of different welding techniques and welding parameters on the morphology and mechanical strength of friction stir welds (FSW) in polymers, based on data collected in the literature. In the current work, only articles that provide data on the joint efficiency, or sufficient information to estimate it are considered. The process using conventional tool is presented and compared with new procedures developed for FSW of polymers, such as those using tools with heated stationary shoulder, preheating of the polymer or double-side passage of the tool. The influence of tool rotational speed (w), welding speed (v), tilt angle and geometry of the pin are discussed. This work focuses on the polymers most studied in the literature, polyethylene (PE) and polypropylene (PP). The use of external heating and tools with stationary shoulder proved to be of great importance in improving the surface finish, reducing defects, and increasing the mechanical strength of the welds. The increase in the w/v ratio increased the joint efficiency, especially when using conventional tools on PE. A trend was obtained for conventional FSW, but it was difficult to establish mathematical relationships, because of the variability of welding conditions.

Rapid activation of inwardly rectifying potassium channels by immobile G-protein-coupled receptors.

G-protein-coupled receptors (GPCRs) mediate slow synaptic transmission and many other effects of small molecule and peptide neurotransmitters. In the standard model of GPCR signaling, receptors and G-proteins diffuse laterally within the plane of the plasma membrane and encounter each other by random collision. This model predicts that signaling will be most efficient if both GPCRs and G-proteins are free to diffuse, thus maximizing collision frequency. However, neuronal GPCRs are often recruited to and enriched at specific synaptic locations, suggesting receptor mobility is restricted in these cells. Here, we test the hypothesis that restricting GPCR mobility impairs signaling in neurons by limiting the frequency of collisions between receptors and G-proteins. Mu-opioid receptors (MORs) were immobilized on the surface of cerebellar granule neurons by avidin-mediated cross-linking, and inwardly rectifying potassium (GIRK) channels were used as rapid indicators of G-protein activation. Mobile and immobile MORs activated GIRK channels with the same onset kinetics and agonist sensitivity in these neurons. In a heterologous expression system, GFP (green fluorescent protein)-tagged G alpha(oA) subunits remained mobile after cross-linking, but their mobility was reduced in the presence of immobile MORs, suggesting that these receptors and subunits were transiently precoupled. In addition, channel activation could be reconstituted with immobile GPCRs, G-protein heterotrimers, and GIRK channels. These results show that collision frequency is not rate-limiting for G-protein activation in CNS neurons, and are consistent with the idea that signaling components are compartmentalized or preassembled.

Sudden death and variant angina.

Variant angina is defined by chest pain occurring at rest associated with transitory ST segment elevation on ECG, and is caused by a spasm of a coronary artery. Frequently, variant angina is associated with atherosclerotic coronary obstruction and patients with normal coronary arteries are rare. Patients with variant angina and normal coronary arteries have good prognosis, and the development of ventricular arrhythmias or sudden death is rare. The authors present two cases of sudden cardiac death in patients with variant angina and normal coronary arteries.