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- The use of Machine Learning in diabetes preventionPublication . Lopes, M.; Fialho, Joana; Wanzeller, Cristina; Autor correspondente: Fialho, Joana.; Fialho, Joana; Wanzeller Guedes de Lacerda, Ana CristinaIntrodução: A Diabetes Mellitus é uma das doenças crónicas que mais crescem no mundo. Diante disso, técnicas de Aprendizagem de Máquina (Machine Learning - ML) oferecem potencial para a identificação de padrões relevantes ao controle da doença. Objetivo: Analisar o impacto de técnicas de ML e a utilização de técnicas de seleção de características na predição da diabetes, utilizando o conjunto de dados “Diabetes Health Indicators”. Métodos: Aplicou-se a metodologia CRISP-DM. Os dados foram equilibrados com a técnica de subamostragem NearMiss. Utilizaram-se a Eliminação Recursiva de Características (RFE) e a Análise de Componentes Principais (PCA) para a seleção de atributos. Foram testados seis modelos: Random Forest, Gradient Boosting, KNN, Regressão Logística, Perceptron Multicamadas (MLP) e Redes Neurais Recorrentes (RNN). Resultados: A RNN destacou-se com acurácia de 86,8% e F1-score de 0,868 em dados balanceados. A combinação de RFE com MLP também apresentou desempenho robusto. O equilíbrio de classes melhorou significativamente os resultados. Conclusão: As técnicas de ML e DL são promissoras para a triagem clínica e políticas públicas. É necessário aumentar a representatividade dos dados, incorporar IA explicável e calibrar limiares para reduzir os falsos negativos, que são essenciais para aplicações práticas.
- Emerging Trends in Higher Education: Technological Progress, Shifts in Student Populations, and Changing Workforce NeedsPublication . Peixoto, Cristina; Cecília Agostinho; Fialho, Joana; Márcio Nascimento; Antunes, Maria JoséThe higher education sector is undergoing significant changes driven by technological advancements, changing student demographics, and evolving workforce demands. Emerging trends shaping the future of higher education include personalized learning powered by adaptive technologies and artificial intelligence, the rise of short-term skill-specific certifications, virtual and augmented reality enhancing learning experiences, data- driven decision-making, interdisciplinary programs fostering critical thinking, global collaboration through online platforms, competency-based education prioritizing mastery, artificial intelligence and machine learning. This will enable personalized learning, lifelong learning initiatives supporting continuous education, increased focus on mental health and well- being, and alternative funding models like income share agreements and corporate partnerships. While these trends offer promising opportunities, they also present challenges related to equity, privacy, and balancing market demands with academic integrity. The aim of this study is to explore each of these trends, understand their implications, and evaluate the impact of the transformations they bring to the future of higher education.
- SLE-DAS enables an accurate definition of severe lupus disease activity: derivation and validation in a post hoc study of anifrolumab phase II and III studiesPublication . Diogo Jesus; Matos, Ana; Henriques, Carla; Andrea Doria; Luis Sousa InesObjectives This study aimed to derive and validate a cutoff for severe disease activity (SDA) using the SLE Disease Activity Score (SLE-DAS) and compare its accuracy and impact on health-related quality of life (HR-QoL) with the British Isles Lupus Assessment Group 2004 (BILAG-2004) and SLE Disease Activity Index 2000 (SLEDAI-2K). Methods We performed a post hoc analysis of pooled placebo arm data from the MUSE (A Phase II, Randomized Study to Evaluate the Efficacy and Safety of MEDI-546 in Subjects with Systemic Lupus Erythematosus), TULIP-1 and TULIP-2 (Treatment of Uncontrolled Lupus via the Interferon Pathway) trials, including 438 patients with moderate-to-severe SLE. SLE-DAS was scored retrospectively, and a cut-off for SDA was derived using receiver operating characteristic (ROC) curves against the BILAG-2004 numerical score >11 as gold standard. Multiple linear regression analysis and Cohen’s d effect size were applied to evaluate the effectiveness of SLEDAS, BILAG-2004 and SLEDAI-2K SDA classifications in capturing HR-QoL patient-reported outcomes (PROs). Results The optimal SLE-DAS cut-off for SDA was >9.90 (area under the ROC curve=0.847, sensitivity=77.8%, specificity=79.6%). Patients classified as SDA by both SLE-DAS and BILAG-2004 or only by SLE-DAS exhibited similar disease activity, while those classified by BILAG-2004 alone had less severe disease and better HR-QoL. The SLE-DAS cut-off was associated with worse HR-QoL across multiple PROs more consistently than BILAG-2004 or SLEDAI-2K. Conclusion The SLE-DAS cut-off for SDA provides an accurate definition of SDA in SLE, with good discriminative power and consistent associations with worse HR-QoL. This SLE-DAS definition enhances disease activity classification and offers a practical tool for guiding treatment decisions in clinical practice, as well as selecting patients with SDA for inclusion in clinical trials.
- Mechanical and surface properties of a 3D-printed dental resin reinforced with graphenePublication . Salgado, Helena; Fialho, Joana; Marques, Marco; Vaz, Mário; Figueiral, Maria; Mesquita, PedroObjectives: Commercial photocurable polymers used in dental additive manufacturing still have mechanical limitations. The incorporation of graphene may provide interesting advantages in this field. This study aimed to evaluate in vitro the effect of adding graphene nanoparticles to a 3D-printed polymethylmethacrylate dental resin in terms of surface roughness, flexural properties, and hardness. Methods: A 3D-printed dental resin (Dental Sand, Harz Lab) was loaded with four different graphene nanoplatelet (Graphenest) concentrations: 0.01wt%, 0.1wt%, 0.25wt%, and 0.5wt%. The neat resin was used as the control group. The surface roughness was measured with a contact profilometer using bar-shaped specimens (50x10x4mm). The flexural strength of specimens (80x10x4mm) from each group was calculated using the 3-point bending test in a Universal Test Machine. Hardness shore D was measured using a manual durometer on round-shaped specimens (12x6mm). Data were evaluated using the Kruskall-Wallis test followed by post-hoc Bonferroni corrected pairwise inter-group comparisons. Statistical significance was set at p<0.05. Results: Graphene improved 3D-printed PMMA resin hardness with statistical significance at a concentration of 0.01wt% (p=0.043). Surface roughness increased with graphene concentrations above 0.01wt%, with statistically significant differences at 0.25wt% (p=0.006) and 0.5wt% (p=0.005) concentrations. Flexural properties worsened with increased graphene concentrations, and these differences were significant in the concentrations of 0.25wt% (p=0.028) and 0.5wt% (p=0.006). Conclusions: The use of graphene as a mechanical reinforcement nanomaterial seems to be viable at low concentrations without prejudice to the surface roughness of a 3D-printed polymethylmethacrylate resin. (Rev Port Estomatol Med Dent Cir Maxilofac. 2023;64(1):12-19)
- SLE-DAS remission and low disease activity states discriminate drug from placebo and better health-related quality of lifePublication . Jesus, Diogo; Henriques, Carla; Matos, Ana; Doria, Andrea; Inês, Luís S.Objective. Our objective was to evaluate the ability of Systemic Lupus Erythematosus Disease Activity Score (SLE-DAS) remission and low disease activity (LDA) to discriminate active drug from placebo and to discriminate outcomes in the patients’ perspective (health-related quality of life [HR-QoL]) in SLE trials. Methods. This was a post hoc analysis of the pooled Belimumab in Subjects With SLE (BLISS)-52 (NCT00424476) and BLISS-76 (NCT00410384) trials data. SLE-DAS remission and LDA attainment and discrimination between belimumab and placebo at 52 weeks were compared using chi-square tests. At week 52, 36-item Short Form Health Survey (SF-36) and Functional Assessment of Chronic Illness Therapy Fatigue (FACIT-F) scores were compared between patients attaining SLE-DAS remission versus nonremission and SLE-DAS LDA versus non-LDA using the ttest and Mann-Whitney test. Mean changes from week 0 to 52 in SF-36 and FACIT-F scores were compared between groups using multivariate regression analysis adjusted for baseline scores. Results. At week 52, significantly more patients attained SLE-DAS LDA taking belimumab 1 mg/kg (17.9% vs 13.0%; P = 0.023; odds ratio [OR] 1.459; relative risk [RR] 1.377; number needed to treat [NNT] 20.4) and 10 mg/kg (21.7% vs 13.0%; P < 0.001; OR 1.853; RR 1.668; NNT 11.5) compared with placebo. Likewise, more patients attained SLE-DAS remission taking belimumab 10 mg/kg compared to placebo (14.7% vs 10.1%; P = 0.019; OR 1.532; RR 1.454; NNT 21.7). At week 52, patients attaining SLE-DAS remission and LDA presented higher SF-36 domain and summary scores (all P < 0.001) and FACIT-F scores (both P < 0.001). Mean improvements from baseline in SF-36 and FACIT-F scores were significantly higher in patients achieving SLE-DAS remission and LDA. Conclusion. SLE-DAS remission and LDA showed discriminant ability for identifying patients receiving active drug in SLE clinical trials. Attainment of these SLE-DAS targets are associated with better HR-QoL.
- The relationship between acute pain and other types of suffering in pre-hospital trauma victims: An observational studyPublication . Mota, Mauro; Melo, Filipe; Henriques, Carla; Matos, Ana; Castelo-Branco, Miguel; Monteiro, Mariana; Reis Santos, Margarida; Madalena Jesus Cunha Nunes, MariaBackground: Acute pain is an important complaint reported by trauma victims, however, the relationship between it and other types of discomfort, such as discomfort caused by cold, discomfort caused by immobilization, and psychological distress such as fear, anxiety, and sadness is limitedly studied and documented. Aim: To assess the relationship between acute trauma pain and other types of suffering in pre-hospital trauma victims. Methods: This is a prospective multicentre cohort study conducted in Immediate Life Support Ambulances in Portugal. All adult trauma victims with a mechanism of blunt and penetrating injuries, falls, road accidents and explosions, were included. Results: 605 trauma victims were included, mainly male, with a mean age of 53.4 years. Before the intervention of the rescue teams, 90.5 % of the victims reported some level of pain, 39.0 % reported discomfort caused by cold, while 15.7 % felt fear, 8.4 % sadness, 49.8 % anxiety and 4.5 % apathy. Victims with high discomfort caused by cold tend to have higher pain levels. Significantly higher pain intensity were observed in victims with fear and anxiety. Univariate and multivariate analysis indicates that immobilization is associated with increased pain levels. Conclusions: There is a statistically significant relationship between acute trauma pain, anxiety, fear, cold and immobilization.
- Enhancing Pinus pinaster Wood Durability Through Citric Acid ImpregnationPublication . Gonçalves Oliveira Valente da Cruz-Lopes, Luísa Paula; Mariana Sell; A. Lopes, Rogério; Esteves, BrunoCitric acid (CA), a naturally occurring compound in fruits, mainly citrus, has gained attention for its eco-friendly potential in wood modification. Through esterification, citric acid reacts with wood polymers to form bonds that improve adhesion, dimensional stability, and durability while reducing moisture absorption and susceptibility to decay. This study evaluated the efficacy of CA as an eco-friendly wood treatment. Wood samples were treated with solutions at varying concentrations (5%, 10%, and 15%) and assessed for dimensional stability, mechanical properties, biological resistance, and ecotoxicity. CA treatments significantly improved dimensional stability, with higher concentrations yielding greater weight percent gain (WPG) and anti-swelling efficiency (ASE). Biological tests demonstrated exceptional termite resistance, with no survival and minimal mass loss in treated samples at higher concentrations. Similarly, fungal resistance improved, as citric acid inhibited fungal growth. Ecotoxicity tests showed relatively low phytotoxicity, with some decrease in germination indices (GI) at higher CA concentrations. These findings highlight CA as a sustainable wood treatment for enhanced durability and biodegradation resistance in construction and outdoor applications.
- Enhanced Properties of Cryptomeria japonica (Thunb ex L.f.) D.Don from the Azores Through Heat-TreatmentPublication . Esteves, Bruno; Nunes, Lina; A. Lopes, Rogério; Gonçalves Oliveira Valente da Cruz-Lopes, Luísa PaulaThis study evaluates the chemical, physical, mechanical, and biological properties of untreated and heat-treated Cryptomeria japonica (Thunb ex L.f.) D.Don wood from the Azores, Portugal. Heat treatment was performed at 212 ◦C for 2 h following the Thermo-D class protocol. Chemical analysis revealed an increase in ethanol soluble extractives and lignin content after heat treatment, attributed to hemicellulose degradation and condensation reactions. Dimensional stability improved significantly, as indicated by reduced swelling coefficients and higher anti-swelling efficiency (ASE), particularly in the tangential direction. Heat-treated wood demonstrated reduced water absorption and swelling, enhancing its suitability for applications requiring dimensional stability. Mechanical tests showed a decrease in bending strength by 19.6% but an increase in the modulus of elasticity (MOE) by 49%, reflecting changes in the wood’s structural integrity. Surface analysis revealed significant color changes, with darkening, reddening, and yellowing, aligning with trends observed in other heat-treated woods. Biological durability tests indicated that both untreated and treated samples were susceptible to subterranean termite attack, although heat-treated wood exhibited a higher termite mortality rate, suggesting potential long-term advantages. This study highlights the impact of heat treatment on Cryptomeria japonica wood, emphasizing its potential for enhanced stability and durability in various applications.
- Bank Credit and Trade Credit: The Case of Portuguese SMEs from 2010 to 2019Publication . Pinto, Pedro; Henriques, Carla; Cardoso, Carolina Esteves Oliveira da Silva; Neves, Maria Elisabete DuarteSmall companies face significant difficulties in accessing finance, and the use of bank credit and trade credit are the primary sources of financing, specifically in small countries, with little market liquidity, and focused on the banking system, as is the case of Portugal. The main objective of this article is to identify significant drivers of bank and trade credit, as well as investigate the complementary or substitutive relationship between them, considering that both constitute an essential source of financing for small and medium-sized enterprises (SMEs). The sample comprises 5860 companies, and the analysis was performed using panel data methodology (2010–2019). The results suggest that, during the period in which the financial crisis was most felt in the country (2010–2013), companies intensified their demand for trade credit, and in the following years for bank credit. Our evidence does support the substitution hypothesis between trade and bank credit.
- Motivation-Based Segmentation of Visitors to a UNESCO Global GeoparkPublication . Amaro, Suzanne; Balula Chaves, Naír; Henriques, Carla; Barroco, CristinaGiven the sustained growth that Geotourism has experienced worldwide, it is crucial to gain a better understanding of geotourists. Therefore, this study aims to examine visitors’ motivations for visiting geoparks, segment them accordingly, and characterize each segment. An online questionnaire was developed to collect information from visitors of the Arouca Geopark—UNESCO Global Geopark and was completed by 607 who had visited this park at least once. Respondents were asked about their motivations for visiting the park using 18 items that were combined into fve dimensions through exploratory factor analysis. These dimensions (Escape, Relaxation and Enjoyment, Novelty Seeking and Nature, Knowledge, Socialization, and Sports and Adrenaline) were the basis for a cluster analysis that revealed four segments of visitors: the Want it All Geotourists (representing 27% of the sample), that have the highest levels for all motivations; the True Geotourists (19.9%) which highest levels of motivations were on the three motivations that typically defne a geotourist: nature/adventure, knowledge seeking, and socialization; the Sensation Seekers (34.4%) whose strongest motivations were sports/adrenaline and escape from routine; the Accidental Geotourists (18.6%) who scored lowest for all motivations and are motivated essentially by the escape from routine and by nature/adventure. These segments were then further profled based on other variables such as age, gender, satisfaction, and quality of experience. The segmentation and description of each segment found in this study provide a better understanding of the typology of visitors to geoparks, which is crucial for better management of such places.