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- Reciclagem total de misturas betuminosas usando óleo alimentar usado como rejuvenescedor e resíduos de plásticoPublication . Rodrigues, Carlos Renato Ramos; Santos, Luís Guilherme de Picado; Capitão, Silvino DiasNas últimas décadas, com as crescentes preocupações ambientais, as sociedades modernas e a indústria têm modificado os seus hábitos de consumo, a gestão dos resíduos e a eficiência na produção de bens e serviços. Reciclar e reutilizar materiais tornou-se imperativo, de forma a caminhar-se para uma economia circular e sustentável. A indústria de pavimentação tem apostado cada vez mais em soluções mais amigas do ambiente, visando diminuir a sua pegada ecológica. A produção de misturas betuminosas recuperadas (MBR), com a incorporação de altas taxas de material fresado é disso um exemplo. Este trabalho apresenta um estudo laboratorial, no qual se analisa o desempenho de duas misturas betuminosas utilizando três tipos de resíduos: material betuminoso fresado de pavimentos, óleo alimentar usado (OAU) e um subproduto plástico, o polietileno de baixa densidade (PEBD) proveniente de resíduos sólidos urbanos. Uma das misturas (100MBR) compreendeu a utilização integral de MBR à qual se adicionou 18% de OAU como rejuvenescedor, 1% de betume novo e 6% de PEBD como polímero modificador do ligante. A outra mistura (85MBR) consistiu numa variante da composição inicial, tendo-se incorporado 15% de agregado novo e 1,5% de betume. Os resultados obtidos no desempenho das misturas em estudo foram satisfatórios. As deformações obtidas no ensaio de compressão de Marshall estão abaixo de 4 mm, valor este considerado como o limite aceitável nos cadernos de encargos da administração rodoviária portuguesa. O comportamento das misturas face à ação da água obteve valores bastante satisfatórios de resistência conservada em tração indireta de 89 % para a mistura de 100MBR e de 107,4% para a mistura 85MBR. Os módulos de rigidez obtidos a 20º C e para a frequência de 10Hz (que correspondente a uma velocidade de 63 km/h) foram de 4572 MPa e de 2569 MPa, para as misturas 100MBR e 85MBR, respetivamente. A nível da resistência à fadiga, ambas as misturas apresentaram no estudo valores bastantes satisfatórios, sendo capazes de suportar mais ciclos de cargas que as misturas convencionais utilizadas como referências. Embora seja necessário prosseguir os estudos, com a análise laboratorial realizada, verificou- se que as misturas estudadas, com incorporação total de MBR, podem considerar-se uma solução económica e viável, particularmente para estradas com tráfego pesado baixo a moderado. As misturas em estudo constituem uma solução de pavimentação orientada pelos princípios da economia circular.
- Tinnitus healthcare: a survey revealing extensive variation in opinion and practices across EuropePublication . Cima, RF; Kikidis, D; Mazurek, B; Haider, HS; Cederroth, CR; Norena, A; Lapira, A; Bibas, A; Hoare, DJTinnitus remains a scientific and clinical problem whereby, in spite of increasing knowledge on effective treatment and management for tinnitus, very little impact on clinical practice has been observed. There is evidence that prolonged, obscure and indirect referral trajectories persist in usual tinnitus care. OBJECTIVE: It is widely acknowledged that efforts to change professional practice are more successful if barriers are identified and implementation activities are systematically tailored to the specific determinants of practice. The aim of this study was to administer a health service evaluation survey to scope current practice and knowledge of standards in tinnitus care across Europe. The purpose of this survey was to specifically inform the development process of a European clinical guideline that would be implementable in all European countries. DESIGN: A health service evaluation survey was carried out. SETTING: The survey was carried out online across Europe. PARTICIPANTS: Clinical experts, researchers and policy-makers involved in national tinnitus healthcare and decision-making. OUTCOME MEASURES: A survey was developed by the study steering group, piloted on clinicians from the TINNET network and underwent two iterations before being finalised. The survey was then administered to clinicians and policy-makers from 24 European countries. RESULTS: Data collected from 625 respondents revealed significant differences in national healthcare structures, use of tinnitus definitions, opinions on characteristics of patients with tinnitus, assessment procedures and particularly in available treatment options. Differences between northern and eastern European countries were most notable. CONCLUSIONS: Most European countries do not have national clinical guidelines for the management of tinnitus. Reflective of this, clinical practices in tinnitus healthcare vary dramatically across countries. This equates to inequities of care for people with tinnitus across Europe and an opportunity to introduce standards in the form of a European clinical guideline. This survey has highlighted important barriers and facilitators to the implementation of such a guideline.
- KAsH Score predicts long term mortality after acute myocardialPublication . Monteiro, Joel Ponte; Sousa, João Adriano; Sousa Mendonça, Flávio; Neto, Micaela; Rodrigues, Ricardo; Gomes Serrão, Marco; Silva, Bruno; Mendonça, Maria Isabel; Faria, Ana Paula; Henriques, Eva; Drumond Freitas, AntónioIntroduction: Complex risk scores have limited applicability in the assessment of patients with myocardial infarction (MI). In this work, the authors aimed to develop a simple to use clinical score to stratify the in-hospital mortality risk of patients with MI at first medical contact. Methods: In this single-center prospective registry assessing 1504 consecutively admitted patients with MI, the strongest predictors of in-hospital mortality were selected through multivariate logistic regression. The KAsH score was developed according to the following formula: KAsH=(Killip class×Age×Heart rate)/systolic blood pressure. Its predictive power was compared to previously validated scores using the DeLong test. The score was categorized and further compared to the Killip classification. Results: The KAsH score displayed excellent predictive power for in-hospital mortality, superior to other well-validated risk scores (AUC: KAsH 0.861 vs. GRACE 0.773, p<0.001) and robust in subgroup analysis. KAsH maintained its predictive capacity after adjustment for multiple confounding factors such as diabetes, heart failure, mechanical complications and bleeding (OR 1.004, 95% CI 1.001-1.008, p=0.012) and reclassified 81.5% of patients into a better risk category compared to the Killip classification. KAsH’s categorization displayed excellent mortality discrimination (KAsH 1: 1.0%, KAsH 2: 8.1%, KAsH 3: 20.4%, KAsH 4: 55.2%) and better mortality prediction than the Killip classification (AUC: KAsH 0.839 vs. Killip 0.775, p<0.0001). Conclusion: KAsH, an easy to use score calculated at first medical contact with patients with MI, displays better predictive power for in-hospital mortality than existing scores. © 2019 Sociedade Portuguesa de Cardiologia. Published by Elsevier Espa˜na, S.L.U. This is na open access article under the CC BY-NC-ND license