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- Artificial Intelligence in refractive errorsPublication . Lança, Carla; Emamian, Mohammad Hassan; Grzybowski, Andrzej; Grzybowski, AndrzejUncorrected refractive errors (URE) are a leading cause of visual impairment (VI) and blindness. Big data acquisition and computer technology analysis are expanding quickly. By combining traditional techniques with artificial intelligence (AI) based tools, several studies have shown great potential in the detection, prediction, and risk stratification of URE, especially myopia. Continued improvement of imaging techniques and methods to measure refraction, coupled with the application of new AI algorithms, may be the future of clinical practice and standard of care for the diagnosis and prognosis of refractive errors. This chapter reviews how AI can be applied to the field of URE and discusses challenges to implementation into clinical practice and future directions.
- Patient engagement in hybrid imagingPublication . Abreu, Carla; Grilo, Ana; Pereira, Luísa Roldão; Camoni, Luca; Mansi, LuigiPatient engagement is essential for ensuring quality and safe care in nuclear medicine. It is linked to higher compliance in terms of following the procedure itself as well as the associated radiation protection instructions, directly contributing to the quality of the final imaging results and foremost leading to overall improved patient experiences and satisfaction. Patient engagement is influenced by factors related not only to patients, but also to health professionals and departmental practices. In this chapter, the authors, including Nuclear Medicine Technologists and Radiographers (hereafter referred to as “Nuclear Medicine Practitioners”), describe critical aspects of patient engagement. These include patient education and information, effective communication and interaction, holistically ensuring patient comfort and a positive experience, maintaining patient safety, and demonstrating cultural sensitivity. At the end of the chapter, a checklist is provided to help professionals assess their skills in engaging with each patient.
- Paediatric patient managementPublication . Santos, Andrea; Grilo, Ana; Albano, Domenico; Camoni, Luca; Mansi, LuigiThis chapter provides a comprehensive guide to paediatric patient management in hybrid imaging, integrating technical considerations with family-centred approaches from scheduling the procedure to patient discharge. It starts with best practices for scheduling, followed by techniques for creating a welcoming, child-friendly environment that fosters trust and rapport. Patient preparation is discussed, focusing on technical requirements and methods to explain procedures to children and parents/caregivers. Strategies for minimizing discomfort during the injection are explored alongside reassuring communication. The image acquisition section highlights obtaining high-quality hybrid and non-hybrid images, with a best practice attitude, while maintaining the child’s comfort and cooperation through child-friendly language and immobilization devices. Finally, the discharge process emphasizes clear communication about post-procedure radioprotection and care and addressing concerns to ensure a positive experience. The chapter concludes with a checklist proposal for NM practitioners to self-evaluate communication with children and parents/caregivers. Overall, it provides strategies for best practice imaging and also practical insights and best strategies to improve the care and comfort of young patients, ultimately leading to better outcomes and higher satisfaction.
- Artificial Intelligence in the diagnosis of dry eyePublication . Emamian, Mohammad Hassan; Aliyari, Roqayeh; Lança, Carla; Grzybowski, Andrzej; Grzybowski, AndrzejDry eye is a multifactorial disease, and its prevalence reaches 50% in some regions of the world. The disease is characterized by several signs and symptoms, and there are various diagnostic methods. However, diagnostic methods available have limitations, with some tests having poor reliability and reproducibility. So far, there is no gold standard test for diagnosing dry eye disease (DED), as there is no linear association between signs and symptoms, and often patients who have multiple signs of the disease report few symptoms or even have no symptoms. The above issues have led to difficulties in diagnosing DED. New imaging modalities, such as anterior segment optical coherence tomography (OCT), infrared meibography, in vivo confocal microscopy, tear interferometry, and non-invasive tear break-up time (TBUT), have emerged to allow objective measurements. However, the interpretation of results is based on subjective judgment. Artificial intelligence (AI) can help to solve these problems and contribute to decision-making by interpreting the results objectively. During the past years and especially after 2014, several research studies on the use of AI in the diagnosis, classification, and monitoring of DED have been published, and the results seem promising. Machine learning and deep learning methods have shown high sensitivity, specificity, and accuracy. Implementation of AI has significantly increased the speed of diagnosing DED and its causes; however, it has not yet been integrated into clinical practice. AI will play an important role in diagnosing and managing dry eye soon. AI can also be used for analysis of big data, which may predict estimates of DED prevalence and its risk factors. This will be a big step to identify individual risk factors for upscaling precision medicine in DED.
- Tubulin acetylation: a critical regulator of microtubule functionPublication . Delgado, Inês L.; Carmona, Bruno; Nolasco, Sofia; Marques, Rita; Gonçalves, João; Soares, Helena; Halasa, M.; Wawruszak, A.The cytoskeleton is conserved throughout the eukaryotic lineage and consists of a complex dynamic network mainly composed of three distinct polymers: microtubules (MTs), actin filaments, and intermediate filaments. MTs are polymers of α/β-tubulin heterodimers, playing a myriad of distinct cellular functions, and are the main components of complex structures like the mitotic spindle, cilia, and centrioles. Post-translational modifications (PTMs) regulate the function and increase the complexity of the α/β-tubulin heterodimer pools. One of the PTMs that has been extensively studied is the acetylation of lysine 40 (K40) on α-tubulin, which specifically occurs inside the MT lumen. Acetylation plays a crucial role in controlling the stability and function of MTs in response to signals from within and outside the cell. It impacts the cytoplasm's 3D arrangement and important cellular activities like intracellular transport, cell division, polarity, and migration. Recent research has also emphasized the significance of this PTM in regulating the mechanical properties of MTs and cellular sensing. The levels and activity of MT acetyltransferases and deacetylases are tightly regulated through various transcriptional, post-transcriptional, and post-translational mechanisms, including miRNAs, phosphorylation, protein-protein interactions, and regulated localization between the nucleus and cytoplasm. These regulatory processes involve components of diverse signaling pathways, and their deregulation has been implicated in numerous diseases, including neurological disorders, cancer, and cardiac conditions.
- Tubulin acetylation and the cellular mechanosensing and stress responsePublication . Carmona, Bruno; Delgado, Inês L. S.; Nolasco, Sofia; Marques, Rita; Gonçalves, João; Soares, Helena; Halasa, M.; Wawruszak, A.Microtubule (MT) acetylation has emerged as a critical regulator of cellular stress responses, integrating mechanical and oxidative stimuli to support cellular adaptability and survival. This post-translational modification (PTM) enhances MT flexibility and resilience, enabling cells to withstand mechanical challenges such as changes in extracellular matrix stiffness and applied forces. Through its impact on MT physical properties, acetylation minimizes cytoskeletal breakage, reducing the need for constant remodeling and supporting cellular integrity under mechanical stress. Furthermore, tubulin acetylation regulates intracellular trafficking by modulating interactions with molecular motors, allowing for efficient cargo transport and precise spatial organization without disrupting the MT network. In the context of oxidative stress, tubulin acetylation responds to redox imbalances by stabilizing MTs and influencing cellular pathways that regulate reactive oxygen species (ROS). This modification is linked to enhanced antioxidant responses, autophagy regulation, and mitochondrial dynamics, highlighting its role in maintaining cellular homeostasis under oxidative conditions. The dual function of tubulin acetylation, responding to and integrating signals from mechanical and oxidative stress, acts as a bridging mechanism between physical and chemical signaling pathways. Consequently, it has the potential to be a therapeutic target in diseases characterized by dysregulated stress responses, including neurodegenerative disorders, cancer, and cardiovascular conditions. Despite significant progress having been made, unanswered questions persist, particularly regarding the molecular mechanisms by which acetylated MTs encode spatial and functional information and their interplay with other tubulin PTMs.
- Health 'is not rocket science': the general, nutritional, and oral health literacy of Portuguese adolescentsPublication . Almeida, Cristina Vaz de; Costa, Vânia; Montaño Rodríguez, Sandra Lucia; Rodrigues, Patrícia; Rodrigues, Manuela; Ribeiro Reis, Bruno Ribeiro; Belim, CéliaHealth literacy is a European public health challenge that should be taken seriously by policymakers, and the health literacy agenda in Europe needs to be accelerated. The World Health Organization (WHO) considers health literacy to be the level of knowledge, social skills, confidence, motivation, and competence to access, understand, and appraise health information. It comprises a set of strategies to improve health and well-being across the lifespan, from individual health literacy to organizational and public health literacy. Health literacy development begins in childhood and adolescence, where it should be supported in an integrated, inclusive, and multidisciplinary approach, promoting and developing competencies and, therefore, knowledge, skills, and attributes. Health literacy encompasses different areas of health, such as oral health and nutrition. In Europe, eight countries participated in the European health literacy questionnaire (HLS-EU 12) in 2014: Austria, Bulgaria, Germany, Greece, Ireland, the Netherlands, Poland, and Spain. Among the results obtained with random samples in the European population, at least one in ten (12%) registered insufficient health literacy, and nearly one in two (47%) had limited (insufficient or problematic) health literacy. The distribution of levels differed substantially across countries (29–62%). The HLS-EU contains several questions specifically about food and nutrition, but only in the HLS-PT, translated by Saboga-Nunes et al. and applied in Portugal, where a concern about oral health, including nutrition, is evident.
- Preliminary results concerning school staff personal exposure to microbial load: worry to be considered?Publication . Pena, Pedro; Cervantes, Renata; Dias, Marta; Gomes, Bianca; Riesenberger, Bruna; Marques, Liliana; Rodriguez, Margarida; Viegas, CarlaSchool environments are potential exposure scenarios to bioaerosols. Breading such contaminants can contribute to the development of respiratory infection. Most studies performed in schools regarding air quality focus on children’s health, neglecting the personal exposure of teachers and school staff. This study aims to provide a first insight into the personal exposure of teachers and school staff to bacteria and fungi in primary schools in Portugal. Personal air samples were collected from teachers and staff with an SKC Button Aerosol Sampler (2 h sampling at 4 L/min flow rate) with a polycarbonate filter from 10 schools located in the Metropolitan Lisbon Area. Extracts were inoculated onto TSA and VRBA (7 days incubation at 30 °C and 37 °C, respectively) for bacterial quantification and onto MEA and DG18 (5–7 days incubation at 27 °C) for fungal quantification. Results showed higher bacterial contamination in teacher samples. Fungal counts followed the same pattern. Although bacterial and fungal counts were below recommended thresholds, the possible presence of potentially harmful pathogens requires qualitative assessment. These preliminary findings underscore the need for comprehensive strategies to address microbial contamination in schools, ensuring the safety and well-being of the school community.
- Levels of fungi in the air of poultry farms following different stages of birds’ growth cyclePublication . Gomes, Bianca; Dias, Marta; Pena, Pedro; Cervantes, Renata; Rodriguez, Margarida; Marques, Liliana; Riesenberger, Bruna; Carolino, Elisabete; Viegas, CarlaPoultry production intensification might influence microbial development. Concerning fungal assessment, despite the limited number of studies, several fungi have already been found in poultry pavilions. Occupational health specialists frequently overlook worker safety and biological risk assessment due to a lack of systematic knowledge regarding the agents involved. Consequently, workers, exposed to organic dust are at risk of developing various respiratory diseases. This study aimed to analyze indoor and outdoor fungal load at different stages of the poultries growth cycle. The sampling campaign was conducted in Winter in 14 poultry pavilions. Air samples from indoor (n = 47) and outdoor (n = 20) were taken before bird placement (sanitary control), followed by 1st, 2nd and 3rd weeks. The impactor MAS-100 was set at 100 L/min for 5 min. Fungal loads indoors exceed the outdoor in all stages of the production cycle. Besides, fungal occurrence was also identified during sanitary control (5%). The acquired data can provide new insights into the variation in fungal air concentrations during different phases of poultry growth. The data obtained should be complemented with qualitative research. Together, this information will support the development of mitigation techniques aiming to protect workers, animals, and environmental health and thus following a One Health approach.
- Sampling protocol to assess Aspergillus section fumigati in woodworking environmentsPublication . Dias, Marta; Gomes, Bianca; Pena, Pedro; Cervantes, Renata; Rodriguez, Margarida; Riesenberger, Bruna; Marques, Liliana; Ribeiro, Edna; Viegas, CarlaAzole fungicides are commonly used in sawmills to protect wood against the wood-destroying basidiomycete fungi. Azole-resistant Aspergillus section Fumigati has previously been identified in these environments. Here we aimed to establish a sampling protocol to efficiently isolate Aspergillus section Fumigati in woodworking environments. The sampling campaign was conducted between December 2022 and November 2023 in 13 DIY stores and 6 sawmills. Both active and passive sampling methods were used. A total of 370 Aspergillus section Fumigati isolates were recovered from the accessed environments with particularly high efficiency using DG18 incubated at 37 °C. Both active and passive sampling media had a similar number of isolates. Regarding Andersen's six-stage air sampler, stage 5 had the highest number of isolates in both woodworking environments. Data presented in this study validated the used protocol to assess Aspergillus section Fumigati in woodworking environments to enable Occupational Health Services to prioritize interventions in these specific occupational environments to perform accurate exposure assessment and detailed risk assessment and management.