Resumo: Na transposição de directivas europeias, os Estados-Membros dispõem de liberdade quanto à escolha do instrumento que melhor se ajusta à prossecução dos objectivos traçados. Não obstante a transposição ter que ocorrer através de um acto legislativo, a forma como a política pública em questão é realizada internamente pode beneficiar do recurso a “nudges”, a par de outros instrumentos mais tradicionais. A eficácia revelada pelos “nudges” tem, contudo, como contraponto, algumas questões éticas e políticas que suscitam, nomeadamente acerca da transparência na relação entre cidadãos e representantes. Além disso, pode questionar-se a sua conformidade com o princípio da proporcionalidade, especialmente quando os “nudges” implicam comportamentos contrários ao livre exercício de liberdades e direitos fundamentais. Os “nudges” podem ser prima facie menos restritivos, na comparação com estratégias normativas mais tradicionais, mas também podem implicar uma forma de instrumentalização que instancie a aplicação do princípio da dignidade humana.

Abstract: Member States transposing Directives can choose the methods for such transposition but should elect such practices which are best suited to ensure the attainment of the Directive’s goals. Notwithstanding the fact that a legislative act is needed in order to transpose EU law into national law, the goals addressed by the directive can often be attained through the use of “nudges”. The efficacy they reveal comes, some will argue, with the downside of some ethical and political concerns, namely concerning transparency in the relationship between citizens and representatives. Also, nudges can be seen as contrary to the principle of proportionality, especially if they induce individuals to act in a way that is contrary to fundamental rights and freedoms. Nudges can be prima facie less restrictive comparing to more traditional strategies, but they can also implicate a form of instrumentalization, which may trigger the application of the principle of human dignity.

ABSTRACT An outbreak of bloodstream infection (BSI) caused by members of the Burkholderia cepacia complex (Bcc) took place from March 2012 until April 2014 involving thirteen patients. Aim. To describe an outbreak investigation of BSI Bcc and showing how genetic sequencing tools contributed to confirm the hypothesis of extrinsic contamination proposed by an observational study. Methods. The Infection Control Department revised and reinforced good practices of infusion therapy and catheter care, visits to affected wards, a case control study, and environmental screening based on the case-control findings. Results. Data from the case-control study found an association of cases with central venous catheter (OR 1.36; CI 1.15-1.67) and intravenous cisatracurium use (OR 10.75; CI 1.67-68.89). Visits to the operatory block revealed problems related to the cold chain used for the preservation of thermolabile cisatracurium. We could not retrieve Bcc from environmental samples using classic microbiology. New samples from the same surfaces were obtained for genetic sequencing. Bcc was identified in the cooler box, refrigerator and reusable ice packages. Conclusion. Environmental screening using genetic sequencing proved to be a useful tool for confirming our hypothesis of extrinsic contamination raised by the case-control study.

ABSTRACT The present investigation was conducted from March 2017 to April 2018, developed mainly because of the interest that has been aroused by Social Sciences and Gender Studies in the way in which gender inequality is expressed in heterosexual couple relationships. The limited existence of studies with a gender approach in Angola and the marked situation of inequality experienced by Angolan women, motivated the authors to develop a research that focuses on gender inequalities in relationships in order to determine what are the ways in which gender inequality manifests itself in the relationships of Angolan students' couples at the Central University “Martha Abreu” of Las Villas. The methodology used in the research, taking into account the object of analysis, was methodological convergence; as a result, questionnaires, in-depth interviews were applied, and scientific observation was made. The novelty of the research consists of carrying out a study with a gender approach in Angolan students, residing outside their country of origin, but bearers of a patriarchal culture apprehended through their socialization process. The main results showed the existence of manifestations of gender inequality in the relationships of the couples studied, as well as an advance in terms of the conception of life as a couple and coexistence at present.

RESUMEN La presente investigación se realizó de marzo del 2017 a abril del 2018, desarrollada fundamentalmente en virtud del interés de las ciencias sociales y de los estudios de género por el modo en que la desigualdad de género se expresa en las relaciones de pareja heterosexuales. La escasa existencia de estudios con enfoque de género en Angola y la marcada situación de desigualdad que viven las mujeres angolanas, motivó a las autoras a desarrollar la investigación, con el objetivo de determinar cuáles son las formas en que se manifiesta la desigualdad de género en las relaciones de pareja de estudiantes angolanos de la Universidad Central “Martha Abreu” de Las Villas. La metodología usada en la investigación -teniendo en cuenta el objeto de análisis- fue la de convergencia metodológica, en consecuencia, se aplicaron cuestionarios, entrevistas en profundidad, y se realizó observación científica. La novedad del estudio consiste en realizar un estudio con enfoque de género en estudiantes angolanos, residentes fuera de su país de origen, pero portadores de una cultura patriarcal aprehendida mediante su proceso de socialización. Los principales resultados de la investigación arrojaron la existencia de manifestaciones de desigualdad de género en las relaciones de las parejas estudiadas, así como un avance en cuanto a la concepción de la vida en pareja y la convivencia en la actualidad.

A partir da análise de Maimom Schwarzschild sobre a doutrina da questão política e a descrição dos respectivos casos judiciais, surge-me imediatamente uma questão metateorética: existe mesmo uma doutrina da questão política ou aqueles que a referem estão somente a falar de fenómenos jurídicos já conhecidos? No meu comentário, partindo da análise de Henkin e Seidman e recorrendo a conceitos jurídicos tais como discricionariedade e a derrotabilidade, procurarei perceber se, mediante a apreciação de três possibilidades resultantes da jurisprudência da Supremo Tribunal Norte-Americano e das ideias de Ely e Bickel, se justifica o isolamento de uma doutrina da questão política.

From Maimom Schwarzschild’s analysis of the political question doctrine and the respective judicial cases’ description, a metatheoretical question immediately arises to my mind: is there truly a political question doctrine or are judges and scholars just talking about already known phenomena? In my commentary, starting from Henkin and Seidman’s analysis and resorting to legal concepts such as discretion and defeasibility, I will try to briefly address this question by assessing if some of the three possibilities arising from the Supreme Court jurisprudence as well as Ely and Bickel’s ideas can justify an autonomous political question doctrine.

RESUMO Introdução: O complexo Acinetobacter calcoaceticus-baumannii (ABC) inclui cinco espécies, sendo A. baumannii a mais importante clinicamente por carrear muitos mecanismos de resistência aos carbapenêmicos, sobretudo as oxacilinases. Objetivos: Os objetivos deste estudo foram identificar as espécies do complexo ABC, avaliar o perfil de suscetibilidade e investigar a presença de oxacilinases em isolados resistentes aos carbapenêmicos provenientes de quatro estados brasileiros. Métodos: No período do estudo, foram coletados 92 isolados do Rio Grande do Sul (RS), do Rio de Janeiro (RJ), do Paraná (PR) e de São Paulo (SP). Os isolados foram identificados por matrix-assisted laser desorption ionization-time of fight mass spectrometry (MALDI-TOF MS) e sequenciamento do gene gyrB. A avaliação da suscetibilidade foi realizada por disco-difusão e microdiluição de caldo. A presença de oxacilinases foi realizada por reação em cadeia da polimerase (PCR) multiplex in house. Resultados: Noventa e um (99%) isolados foram identificados como A. baumannii por MALDI-TOF e pelo sequenciamento. A maioria dos isolados (56; 61%) apresentou resistência aos seis agentes antimicrobianos testados. Três isolados foram resistentes à polimixina B [concentração inibitória mínima (CIM) ≥ 4 µg/ml). Oitenta (87%) isolados foram positivos para OXA-23 e 12, (13%) para OXA-24. Conclusão: Nossos resultados confirmam a disseminação do gene blaOXA-23 no Brasil e sugerem a recente emergência e disseminação do gene blaOXA-24, uma vez que ele foi identificado em três dos quatro estados amostrados.

ABSTRACT Introduction: The Acinetobacter calcoaceticus-baumannii (ABC) complex includes five species, and the A. baumannii is the most important of them because it carries mechanisms of carbapenems resistance, especially the oxacillinases. Objectives: The objectives of this study were to identify the species of the ABC complex, to evaluate the susceptibility profile and to investigate the presence of oxacillinases in carbapenems-resistant isolates from four Brazilian States. Methods: In the study period, 92 isolates from Rio Grande do Sul (RS), Rio de Janeiro (RJ), Paraná (PR) and São Paulo (SP) were collected. The isolates were identified by matrix-assisted laser desorption ionization-time of fight mass spectrometry (MALDI-TOF MS) and sequencing of gyrB gene. Evaluation of susceptibility was performed by disk diffusion and broth microdilution. The presence of oxacillinases was performed by in-house multiplex polymerase chain reaction (PCR). Results: Ninety-one (99%) isolates were identified as A. baumannii by MALDI-TOF and sequencing. The majority of isolates (56; 61%) showed resistance to the six antimicrobial agents tested. Three isolates were resistant to polymyxin B [minimum inhibitory concentration (MIC) ≥ 4 µg/ml). Eighty (87%) isolates were positive to OXA-23-like, and twelve (13%) isolates to OXA-24-like. Conclusion: Our findings confirm the knowledge about the dissemination of the blaOXA-23 gene in Brazil and suggest the recent emergence and spread of blaOXA-24 gene, since it was identified in three of the four sampled states.

A transição para uma sociedade hipocarbónica prescrita pelo Acordo de Paris obriga a alterações profundas no domínio dos combustíveis para o sector dos transportes (responsável por cerca de 40% das emissões de gases com efeito de estufa). Após a análise dos prós e contras dos biocombustíveis alimentícios, passa-se em revista o quadro eurocomunitário sobre a matéria, para então se abordar o enquadramento da produção de biocombustíveis em Portugal. No final, deixam-se algumas pistas de evolução quanto à produção de biocombustíveis num futuro próximo. Sumário: 0. Biocombustíveis: revolução ou involução? 1. A matriz eurocomunitária; 1.1. A Directiva 2003/30/CE, do Parlamento Europeu e do Conselho, de 8 de Maio; 1.2. A Directiva 2009/28/CE, de 23 de Abril; 1.2.1. Os critérios de sustentabilidade ambiental; 1.2.2. Os critérios de sustentabilidade social; 1.3. A Directiva 2009/30/CE, de 23 de Abril; 1.4. A Directiva 2015/1513/UE, de 9 de Setembro; 1.5. Biocombustíveis e Política Agrícola Comum (PAC); 2. O Direito nacional; 2.1. A obrigação de incorporação de biocombustíveis; 2.2. A produção de biocombustíveis em Portugal: panorama geral; 2.3. Em especial, a valorização de resíduos para produção de biocombustíveis: breve referência ao(s) regime(s) de licenciamento; 2.4. O futuro dos biocombustíveis

The transition towards a hipocarbonic society which the Paris Agreement points out determines deep changes regarding biofuels in the transportation sector (40% of GHG emissions come from that sector). After presenting the pros and cons of biofuels made from feedstocks, we will go through the European framework on the subject, and from then on we proceed to the analysis of biofuel production in Portugal. In the end, some clues will be left concerning biofuel production in the near future. Summary: 0. Biofuels: revolution or involution? 1. A Eurocommunity matrix; 1.1. Directive 2003/30/EC of the European Parliament and of the Council of 8 May; 1.2. Directive 2009/28/EC, of 23 April; 1.2.1. The criteria of environmental sustainability; 1.2.2. The criteria of social sustainability; 1.3. Directive 2009/30/EC, of 23 April; 1.4. Directive 2015/1513/EU of 9 September; 1.5. Biofuels and the Common Agricultural Policy (CAP); 2. National law; 2.1. The obligation to incorporate biofuels; 2.2. The production of biofuels in Portugal: overview; 2.3. In particular, waste recovery for the production of biofuels: a brief reference to the licensing regime(s); 2.4. The future of biofuels

O presente comentário aborda o artigo apresentado por Maribel González Pascual, que procura desvendar o papel dos Tribunais Constitucionais Espanhol e Português no que se refere às chamadas “medidas de austeridade”, pelo que este texto se centra igualmente na argumentação de ambos os tribunais, versando sobre a análise do papel desempenhado pelo “direito da Euro-crise” na argumentação daqueles tribunais, bem como como sobre a influência da crise económica sobre a jurisprudência constitucional ligada a direitos sociais.

This comment addresses the paper presented by Maribel González Pascual which aims to reveal the Spanish and Portuguese Constitutional Courts' role regarding the so-called “austerity measures”, and therefore also focuses on the courts' judicial reasoning. It analyses the role that “Euro-crisis law” has played in both courts' reasoning, and the economic crisis' role in shaping case law regarding social rights in both countries.

ABSTRACT Objective: Our objective was to perform a systematic review and meta-analysis of the research literature assessing the effect of caffeine on athletic performance. Methods: A total of 13 studies published between 2010 and 2015 were included in the meta-analysis of the effects of caffeine on maximum running distance (2 studies), time trial performance (7 studies), and muscle power (4 studies). The effect sizes were calculated as standardized differences in means (std in means). Meta-analysis was completed using a random effects model. Results: Caffeine supplementation did not increase maximum running distance (effect size= 0.37, p= 0.14) and muscle power (effect size= 0.17, p= 0.36). However, improvements were observed in the time trial performance (effect size= −0.40, p< 0.01). Subgroup analyses revealed that the improvement in time trial results may be related to the use of the 6 mg/kg of body weight of caffeine dose (effect size= −0.45, p= 0.01). Conclusion: Our meta-analysis showed that caffeine intake does not improve performance in maximum running distance and muscle power, but it seems to improve time trial performance. The effect of caffeine on time trial performance related to dose.

RESUMEN Objetivo: Realizar una revisión sistemática y meta-análisis de la literatura de investigación que evalúa el efecto de la cafeína en el rendimiento atlético. Método: Un total de 13 estudios publicados entre 2010 y 2015 fueron incluidos en el meta-análisis de los efectos de la cafeína sobre la distancia máxima de carrera (2 estudios), el tiempo de prueba (7 estudios) y la potencia muscular (4 estudios). Los tamaños del efecto se calcularon como diferencias estandarizadas en las medias (std en los medias), y el meta-análisis se completó utilizando un modelo de efectos aleatorios. Resultados: La suplementación con cafeína no aumentó la distancia máxima de funcionamiento (tamaño del efecto= 0.37, p= 0.14) ni la potencia muscular (tamaño del efecto= 0.17, p= 0.36). Sin embargo, se observaron mejoras en el rendimiento del ensayo con tiempo (tamaño del efecto= −0.40, p< 0,01). Los análisis de subgrupos revelaron que la mejora en los resultados de los ensayos a tiempo podía estar relacionada con el uso de la dosis de 6 mg/kg de peso corporal de cafeína (tamaño del efecto= −0.45, p = 0.01). Conclusiones: El meta-análisis demostró que la ingesta de cafeína no mejora el rendimiento en la distancia máxima de carrera ni la potencia muscular, pero parece mejorar el rendimiento de la prueba de tiempo. Este efecto potencial de la cafeína en el rendimiento de la prueba de tiempo estuvo relacionado con la dosis.

ABSTRACT During the last 30 years there has been a dissemination of plasmid-mediated β-lactamases in Enterobacteriaceae in Brazil. Extended spectrum β-lactamases (ESBL) are widely disseminated in the hospital setting and are detected in a lower frequency in the community setting. Cefotaximases are the most frequently detected ESBL type and Klebsiella pneumoniae is the predominant species among ESBL producers. Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae became widely disseminated in Brazil during the last decade and KPC production is currently the most frequent resistance mechanism (96.2%) in carbapenem resistant K. pneumoniae. To date KPC-2 is the only variant reported in Brazil. Polymyxin B resistance in KPC-2-producing K. pneumoniae has come to an alarming rate of 27.1% in 2015 in São Paulo, the largest city in Brazil. New Delhi metallo-β-lactamase was detected in Brazil in 2013, has been reported in different Brazilian states but are not widely disseminated. Antimicrobial resistance in Enterobacteriaceae in Brazil is a very serious problem that needs urgent actions which includes both more strict adherence to infection control measures and more judicious use of antimicrobials.

Abstract Clostridium difficile is a leading cause of diarrhea in hospitalized patients worldwide. While metronidazole and vancomycin are the most prescribed antibiotics for the treatment of this infection, teicoplanin, tigecycline and nitazoxanide are alternatives drugs. Knowledge on the antibiotic susceptibility profiles is a basic step to differentiate recurrence from treatment failure due to antimicrobial resistance. Because C. difficile antimicrobial susceptibility is largely unknown in Brazil, we aimed to determine the profile of C. difficile strains cultivated from stool samples of inpatients with diarrhea and a positive toxin A/B test using both agar dilution and disk diffusion methods. All 50 strains tested were sensitive to metronidazole according to CLSI and EUCAST breakpoints with an MIC90 value of 2 μg/mL. Nitazoxanide and tigecycline were highly active in vitro against these strains with an MIC90 value of 0.125 μg/mL for both antimicrobials. The MIC90 were 4 μg/mL and 2 μg/mL for vancomycin and teicoplanin, respectively. A resistance rate of 8% was observed for moxifloxacin. Disk diffusion can be used as an alternative to screen for moxifloxacin resistance, nitazoxanide, tigecycline and metronidazole susceptibility, but it cannot be used for testing glycopeptides. Our results suggest that C. difficile strains from São Paulo city, Brazil, are susceptible to metronidazole and have low MIC90 values for most of the current therapeutic options available in Brazil.

Over the last decade, Acinetobacter baumannii resistant to carbapenems has emerged in many medical centres and has been commonly associated with high morbimortality. In Brazil, this resistance is mainly attributed to the spread of OXA-23-producing clones and, to a lesser extent, to OXA-143-producing clones. Here, we describe, for the first time, two OXA-72-producing A. baumannii isolates in southern Brazil to a broad spectrum of antibiotics, except polymyxin B and tigecycline. Molecular typing by multilocus sequence typing (MLST) demonstrated that both OXA-72-producing isolates belong to a new sequence type (ST), ST730, which was recently identified in OXA-23-producing A. baumannii isolates in São Paulo, Brazil. We demonstrate that the two A. baumannii ST730 isolates carrying blaOXA-72share a common ancestral origin with the blaOXA-23producers in Brazil. This observation reinforces the importance of strain-typing methods in order to clarify the dynamics of the emergence of new clones in a geographic region.