13 resultados para Clinical reasoning process

em Universidad Politécnica de Madrid


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El tema de la presente tesis es la valoración del patrimonio y en ella se considera que el patrimonio es un proceso cultural interesado en negociar, crear y recrear recuerdos, valores y significados culturales. Actualmente el patrimonio como proceso se está consolidando en la literatura científica, aunque la idea de que es una ‘cosa’ es dominante en el debate internacional y está respaldada tanto por políticas como prácticas de la UNESCO. El considerar el patrimonio como un proceso permite una mirada crítica, que subraya la significación. Es decir, supone el correlato que conlleva definir algo como ‘patrimonio’, o hacer que lo vaya siendo. Esta visión del concepto permite la posibilidad de comprender no sólo lo que se ha valorado, sino también lo que se ha olvidado y el porqué. El principal objetivo de esta investigación es explorar las características de un proceso de razonamiento visual para aplicarlo en el de valoración del patrimonio. Éste que se presenta, implica la creación de representaciones visuales y sus relaciones, además su meta no está centrada en producir un ambiente que sea indiferenciado de la realidad física. Con él se pretende ofrecer la posibilidad de comunicar la dimensión ‘poliédrica’ del patrimonio. Para que este nuevo proceso que propongo sea viable y sostenible, existe la necesidad de tener en cuenta el fin que se quiere lograr: la valoración. Es importante considerar que es un proceso en el cual las dinámicas de aprendizaje, comportamientos y exploración del patrimonio están directamente relacionadas con su valoración. Por lo tanto, hay que saber cómo se genera la valoración del patrimonio, con el fin de ser capaces de desarrollar el proceso adaptado a estas dinámicas. La hipótesis de esta tesis defiende que un proceso de razonamiento visual para la valoración del patrimonio permite que las personas involucradas en el proceso inicien un proceso de interacción con un elemento patrimonial y su imagen mental para llegar a ciertas conclusiones con respecto a su valor y significado. El trabajo describe la metodología que da lugar al proceso de razonamiento visual para el patrimonio, que ha sido concebido sobre un modelado descriptivo de procesos, donde se han caracterizado tres niveles: meta-nivel, de análisis y operacional. En el modelado del proceso los agentes, junto con el patrimonio, son los protagonistas. El enfoque propuesto no es sólo sobre el patrimonio, sino sobre la compleja relación entre las personas y el patrimonio. Los agentes humanos dan valor a los testimonios de la vida pasada y les imbuyen de significado. Por lo tanto, este enfoque de un proceso de razonamiento visual sirve para detectar los cambios en el valor del patrimonio, además de su dimensión poliédrica en términos espaciales y temporales. Además se ha propuesto una nueva tipología de patrimonio necesaria para sustentar un proceso de razonamiento visual para su valoración. Esta tipología está apoyada en la usabilidad del patrimonio y dentro de ella se encuentran los siguientes tipos de patrimonio: accesible, cautivo, contextualizado, descontextualizado, original y vicarial. El desarrollo de un proceso de razonamiento visual para el patrimonio es una propuesta innovadora porque integra el proceso para su valoración, contemplando la dimensión poliédrica del patrimonio y explotando la potencialidad del razonamiento visual. Además, los posibles usuarios del proceso propuesto van a tener interacción de manera directa con el patrimonio e indirecta con la información relativa a él, como por ejemplo, con los metadatos. Por tanto, el proceso propuesto posibilita que los posibles usuarios se impliquen activamente en la propia valoración del patrimonio. ABSTRACT The subject of this thesis is heritage valuation and it argues that heritage is a cultural process that is inherited, transmitted, and transformed by individuals who are interested in negotiating, creating and recreating memories and cultural meanings. Recently heritage as a process has seen a consolidation in the research, although the idea that heritage is a ‘thing’ is dominant in the international debate and is supported by policies and practice of UNESCO. Seeing heritage as a process enables a critical view, underscoring the significance. That is, it is the correlate involved in defining something as ‘heritage’, or converting it into heritage. This view of the concept allows the possibility to understand not only what has been valued, but also what has been forgotten and why. The main objective of this research is to explore the characteristics of a visual reasoning process in order to apply it to a heritage valuation. The goal of the process is not centered on producing an environment that is undifferentiated from physical reality. Thus, the objective of the process is to provide the ability to communicate the ‘polyhedral’ dimension of heritage. For this new process to be viable and sustainable, it is necessary to consider what is to be achieved: heritage valuation. It is important to note that it is a process in which the dynamics of learning, behavior and exploration heritage are directly related to its valuation. Therefore, we need to know how this valuation takes place in order to be able to develop a process that is adapted to these dynamic. The hypothesis of this thesis argues that a visual reasoning process for heritage valuation allows people involved in the process to initiate an interaction with a heritage and to build its mental image to reach certain conclusions regarding its value and meaning. The thesis describes the methodology that results in a visual reasoning process for heritage valuation, which has been based on a descriptive modeling process and have characterized three levels: meta, analysis and operational -level. The agents are the protagonists in the process, along with heritage. The proposed approach is not only about heritage but the complex relationship between people and heritage. Human operators give value to the testimonies of past life and imbue them with meaning. Therefore, this approach of a visual reasoning process is used to detect changes in the value of heritage and its multifaceted dimension in spatial and temporal terms. A new type of heritage required to support a visual reasoning process for heritage valuation has also been proposed. This type is supported by its usability and it covers the following types of heritage: available, captive, contextualized, decontextualized, original and vicarious. The development of a visual reasoning process for heritage valuation is innovative because it integrates the process for valuation of heritage, considering the multifaceted dimension of heritage and exploiting the potential of visual reasoning. In addition, potential users of the proposed process will have direct interaction with heritage and indirectly with the information about it, such as the metadata. Therefore, the proposed process enables potential users to be actively involved in their own heritage valuation.

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Los recientes avances tecnológicos han encontrado un potencial campo de explotación en la educación asistida por computador. A finales de los años 90 surgió un nuevo campo de investigación denominado Entornos Virtuales Inteligentes para el Entrenamiento y/o Enseñanza (EVIEs), que combinan dos áreas de gran complejidad: Los Entornos Virtuales (EVs) y los Sistemas de Tutoría Inteligente (STIs). De este modo, los beneficios de los entornos 3D (simulación de entornos de alto riesgo o entornos de difícil uso, etc.) pueden combinarse con aquéllos de un STIs (personalización de materias y presentaciones, adaptación de la estrategia de tutoría a las necesidades del estudiante, etc.) para proporcionar soluciones educativas/de entrenamiento con valores añadidos. El Modelo del Estudiante, núcleo de un SIT, representa el conocimiento y características del estudiante, y refleja el proceso de razonamiento del estudiante. Su complejidad es incluso superior cuando los STIs se aplican a EVs porque las nuevas posibilidades de interacción proporcionadas por estos entornos deben considerarse como nuevos elementos de información clave para el modelado del estudiante, incidiendo en todo el proceso educativo: el camino seguido por el estudiante durante su navegación a través de escenarios 3D; el comportamiento no verbal tal como la dirección de la mirada; nuevos tipos de pistas e instrucciones que el módulo de tutoría puede proporcionar al estudiante; nuevos tipos de preguntas que el estudiante puede formular, etc. Por consiguiente, es necesario que la estructura de los STIs, embebida en el EVIE, se enriquezca con estos aspectos, mientras mantiene una estructura clara, estructurada, y bien definida. La mayoría de las aproximaciones al Modelo del Estudiante en STIs y en IVETs no consideran una taxonomía de posibles conocimientos acerca del estudiante suficientemente completa. Además, la mayoría de ellas sólo tienen validez en ciertos dominios o es difícil su adaptación a diferentes STIs. Para vencer estas limitaciones, hemos propuesto, en el marco de esta tesis doctoral, un nuevo mecanismo de Modelado del Estudiante basado en la Ingeniería Ontológica e inspirado en principios pedagógicos, con un modelo de datos sobre el estudiante amplio y flexible que facilita su adaptación y extensión para diferentes STIs y aplicaciones de aprendizaje, además de un método de diagnóstico con capacidades de razonamiento no monótono. El método de diagnóstico es capaz de inferir el estado de los objetivos de aprendizaje contenidos en el SIT y, a partir de él, el estado de los conocimientos del estudiante durante su proceso de aprendizaje. La aproximación almodelado del estudiante propuesta ha sido implementada e integrada en un agente software (el agente de modelado del estudiante) dentro de una plataforma software existente para el desarrollo de EVIEs denominadaMAEVIF. Esta plataforma ha sido diseñada para ser fácilmente configurable para diferentes aplicaciones de aprendizaje. El modelado del estudiante presentado ha sido implementado e instanciado para dos tipos de entornos de aprendizaje: uno para aprendizaje del uso de interfaces gráficas de usuario en una aplicación software y para un Entorno Virtual para entrenamiento procedimental. Además, se ha desarrollado una metodología para guiar en la aplicación del esta aproximación de modelado del estudiante a cada sistema concreto.---ABSTRACT---Recent technological advances have found a potential field of exploitation in computeraided education. At the end of the 90’s a new research field emerged, the so-called Intelligent Virtual Environments for Training and/or Education (IVETs), which combines two areas of great complexity: Virtual Environments (VE) and Intelligent Tutoring Systems (ITS). In this way, the benefits of 3D environments (simulation of high risk or difficult-to-use environments, etc.) may be combined with those of an ITS (content and presentation customization, adaptation of the tutoring strategy to the student requirements, etc.) in order to provide added value educational/training solutions. The StudentModel, core of an ITS, represents the student’s knowledge and characteristics, and reflects the student’s reasoning process. Its complexity is even higher when the ITSs are applied on VEs because the new interaction possibilities offered by these environments must be considered as new key information pieces for student modelling, impacting all the educational process: the path followed by the student during their navigation through 3D scenarios; non-verbal behavior such as gaze direction; new types of hints or instructions that the tutoring module can provide to the student; new question types that the student can ask, etc. Thus, it is necessary for the ITS structure, which is embedded in the IVET, to be enriched by these aspects, while keeping a clear, structured and well defined architecture. Most approaches to SM on ITSs and IVETs don’t consider a complete enough taxonomy of possible knowledge about the student. In addition, most of them have validity only in certain domains or they are hard to be adapted for different ITSs. In order to overcome these limitations, we have proposed, in the framework of this doctoral research project, a newStudentModeling mechanism that is based onOntological Engineering and inspired on pedagogical principles, with a wide and flexible data model about the student that facilitates its adaptation and extension to different ITSs and learning applications, as well as a rich diagnosis method with non-monotonic reasoning capacities. The diagnosis method is able to infer the state of the learning objectives encompassed by the ITS and, fromit, the student’s knowledge state during the student’s process of learning. The proposed student modelling approach has been implemented and integrated in a software agent (the student modeling agent) within an existing software platform for the development of IVETs called MAEVIF. This platform was designed to be easily configurable for different learning applications. The proposed student modeling has been implemented and it has been instantiated for two types of learning environments: one for learning to use the graphical user interface of a software application and a Virtual Environment for procedural training. In addition, a methodology to guide on the application of this student modeling approach to each specific system has been developed.

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Enabling Subject Matter Experts (SMEs) to formulate knowledge without the intervention of Knowledge Engineers (KEs) requires providing SMEs with methods and tools that abstract the underlying knowledge representation and allow them to focus on modeling activities. Bridging the gap between SME-authored models and their representation is challenging, especially in the case of complex knowledge types like processes, where aspects like frame management, data, and control flow need to be addressed. In this paper, we describe how SME-authored process models can be provided with an operational semantics and grounded in a knowledge representation language like F-logic in order to support process-related reasoning. The main results of this work include a formalism for process representation and a mechanism for automatically translating process diagrams into executable code following such formalism. From all the process models authored by SMEs during evaluation 82% were well-formed, all of which executed correctly. Additionally, the two optimizations applied to the code generation mechanism produced a performance improvement at reasoning time of 25% and 30% with respect to the base case, respectively.

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This article proposes a MAS architecture for network diagnosis under uncertainty. Network diagnosis is divided into two inference processes: hypothesis generation and hypothesis confirmation. The first process is distributed among several agents based on a MSBN, while the second one is carried out by agents using semantic reasoning. A diagnosis ontology has been defined in order to combine both inference processes. To drive the deliberation process, dynamic data about the influence of observations are taken during diagnosis process. In order to achieve quick and reliable diagnoses, this influence is used to choose the best action to perform. This approach has been evaluated in a P2P video streaming scenario. Computational and time improvements are highlight as conclusions.

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Monte Carlo (MC) method can accurately compute the dose produced by medical linear accelerators. However, these calculations require a reliable description of the electron and/or photon beams delivering the dose, the phase space (PHSP), which is not usually available. A method to derive a phase space model from reference measurements that does not heavily rely on a detailed model of the accelerator head is presented. The iterative optimization process extracts the characteristics of the particle beams which best explains the reference dose measurements in water and air, given a set of constrains

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Tool wear detection is a key issue for tool condition monitoring. The maximization of useful tool life is frequently related with the optimization of machining processes. This paper presents two model-based approaches for tool wear monitoring on the basis of neuro-fuzzy techniques. The use of a neuro-fuzzy hybridization to design a tool wear monitoring system is aiming at exploiting the synergy of neural networks and fuzzy logic, by combining human reasoning with learning and connectionist structure. The turning process that is a well-known machining process is selected for this case study. A four-input (i.e., time, cutting forces, vibrations and acoustic emissions signals) single-output (tool wear rate) model is designed and implemented on the basis of three neuro-fuzzy approaches (inductive, transductive and evolving neuro-fuzzy systems). The tool wear model is then used for monitoring the turning process. The comparative study demonstrates that the transductive neuro-fuzzy model provides better error-based performance indices for detecting tool wear than the inductive neuro-fuzzy model and than the evolving neuro-fuzzy model.

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In the SESAR Step 2 concept of operations a RBT is available and seen by all making it possible to conceive a different operating method than the current ATM system based on Collaborative Decisions Making processes. Currently there is a need to describe in more detail the mechanisms by which actors (ATC, Network Management, Flight Crew, airports and Airline Operation Centre) will negotiate revisions to the RBT. This paper introduces a negotiation model, which uses constraint based programing applied to a mediator to facilitate negotiation process in a SWIM enabled environment. Three processes for modelling the negotiation process are explained as well a preliminary reasoning agent algorithm modelled with constraint satisfaction problem is presented. Computational capability of the model is evaluated in the conclusion.

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Infrared thermography (IRT) is a safe and non-invasive tool used for examining physiological functions based on skin temperature (Tsk) control. The aim of this paper was to establish the probable thermal difference between the beginning and the end of the anterior cruciate ligament (ACL) rehabilitation process after surgery. For this purpose thermograms from 25 ACL surgically operated patients (2 women, 23 men) were taken on the first and last day of a six-week rehabilitation program. A FLIR infrared camera according to the protocol established by the International Academy of Clinical Thermology (IACT). The results showed significant temperature increases in the posterior thigh area between the first and the last week of the rehabilitation process probably due to a compensatory mechanism. According to this, we can conclude that temperature of the posterior area of the injured and non-injured leg has increased from the first to the last day of the rehabilitation process.

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BACKGROUND: Clinical Trials (CTs) are essential for bridging the gap between experimental research on new drugs and their clinical application. Just like CTs for traditional drugs and biologics have helped accelerate the translation of biomedical findings into medical practice, CTs for nanodrugs and nanodevices could advance novel nanomaterials as agents for diagnosis and therapy. Although there is publicly available information about nanomedicine-related CTs, the online archiving of this information is carried out without adhering to criteria that discriminate between studies involving nanomaterials or nanotechnology-based processes (nano), and CTs that do not involve nanotechnology (non-nano). Finding out whether nanodrugs and nanodevices were involved in a study from CT summaries alone is a challenging task. At the time of writing, CTs archived in the well-known online registry ClinicalTrials.gov are not easily told apart as to whether they are nano or non-nano CTs-even when performed by domain experts, due to the lack of both a common definition for nanotechnology and of standards for reporting nanomedical experiments and results. METHODS: We propose a supervised learning approach for classifying CT summaries from ClinicalTrials.gov according to whether they fall into the nano or the non-nano categories. Our method involves several stages: i) extraction and manual annotation of CTs as nano vs. non-nano, ii) pre-processing and automatic classification, and iii) performance evaluation using several state-of-the-art classifiers under different transformations of the original dataset. RESULTS AND CONCLUSIONS: The performance of the best automated classifier closely matches that of experts (AUC over 0.95), suggesting that it is feasible to automatically detect the presence of nanotechnology products in CT summaries with a high degree of accuracy. This can significantly speed up the process of finding whether reports on ClinicalTrials.gov might be relevant to a particular nanoparticle or nanodevice, which is essential to discover any precedents for nanotoxicity events or advantages for targeted drug therapy.

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The risks associated with gestational diabetes (GD) can be reduced with an active treatment able to improve glycemic control. Advances in mobile health can provide new patient-centric models for GD to create personalized health care services, increase patient independence and improve patients’ self-management capabilities, and potentially improve their treatment compliance. In these models, decision-support functions play an essential role. The telemedicine system MobiGuide provides personalized medical decision support for GD patients that is based on computerized clinical guidelines and adapted to a mobile environment. The patient’s access to the system is supported by a smartphone-based application that enhances the efficiency and ease of use of the system. We formalized the GD guideline into a computer-interpretable guideline (CIG). We identified several workflows that provide decision-support functionalities to patients and 4 types of personalized advice to be delivered through a mobile application at home, which is a preliminary step to providing decision-support tools in a telemedicine system: (1) therapy, to help patients to comply with medical prescriptions; (2) monitoring, to help patients to comply with monitoring instructions; (3) clinical assessment, to inform patients about their health conditions; and (4) upcoming events, to deal with patients’ personal context or special events. The whole process to specify patient-oriented decision support functionalities ensures that it is based on the knowledge contained in the GD clinical guideline and thus follows evidence-based recommendations but at the same time is patient-oriented, which could enhance clinical outcomes and patients’ acceptance of the whole system.

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Background: Early and effective identification of developmental disorders during childhood remains a critical task for the international community. The second highest prevalence of common developmental disorders in children are language delays, which are frequently the first symptoms of a possible disorder. Objective: This paper evaluates a Web-based Clinical Decision Support System (CDSS) whose aim is to enhance the screening of language disorders at a nursery school. The common lack of early diagnosis of language disorders led us to deploy an easy-to-use CDSS in order to evaluate its accuracy in early detection of language pathologies. This CDSS can be used by pediatricians to support the screening of language disorders in primary care. Methods: This paper details the evaluation results of the ?Gades? CDSS at a nursery school with 146 children, 12 educators, and 1 language therapist. The methodology embraces two consecutive phases. The first stage involves the observation of each child?s language abilities, carried out by the educators, to facilitate the evaluation of language acquisition level performed by a language therapist. Next, the same language therapist evaluates the reliability of the observed results. Results: The Gades CDSS was integrated to provide the language therapist with the required clinical information. The validation process showed a global 83.6% (122/146) success rate in language evaluation and a 7% (7/94) rate of non-accepted system decisions within the range of children from 0 to 3 years old. The system helped language therapists to identify new children with potential disorders who required further evaluation. This process will revalidate the CDSS output and allow the enhancement of early detection of language disorders in children. The system does need minor refinement, since the therapists disagreed with some questions from the CDSS knowledge base (KB) and suggested adding a few questions about speech production and pragmatic abilities. The refinement of the KB will address these issues and include the requested improvements, with the support of the experts who took part in the original KB development. Conclusions: This research demonstrated the benefit of a Web-based CDSS to monitor children?s neurodevelopment via the early detection of language delays at a nursery school. Current next steps focus on the design of a model that includes pseudo auto-learning capacity, supervised by experts.

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Context: This paper addresses one of the major end-user development (EUD) challenges, namely, how to pack today?s EUD support tools with composable elements. This would give end users better access to more components which they can use to build a solution tailored to their own needs. The success of later end-user software engineering (EUSE) activities largely depends on how many components each tool has and how adaptable components are to multiple problem domains. Objective: A system for automatically adapting heterogeneous components to a common development environment would offer a sizeable saving of time and resources within the EUD support tool construction process. This paper presents an automated adaptation system for transforming EUD components to a standard format. Method: This system is based on the use of description logic. Based on a generic UML2 data model, this description logic is able to check whether an end-user component can be transformed to this modeling language through subsumption or as an instance of the UML2 model. Besides it automatically finds a consistent, non-ambiguous and finite set of XSLT mappings to automatically prepare data in order to leverage the component as part of a tool that conforms to the target UML2 component model. Results: The proposed system has been successfully applied to components from four prominent EUD tools. These components were automatically converted to a standard format. In order to validate the proposed system, rich internet applications (RIA) used as an operational support system for operators at a large services company were developed using automatically adapted standard format components. These RIAs would be impossible to develop using each EUD tool separately. Conclusion: The positive results of applying our system for automatically adapting components from current tool catalogues are indicative of the system?s effectiveness. Use of this system could foster the growth of web EUD component catalogues, leveraging a vast ecosystem of user-centred SaaS to further current EUSE trends.

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Infrared thermography (IRT) is a safe and non-invasive tool used for examining physiological functions based on skin temperature (Tsk) control. Thermograms from 25 anterior cruciate ligament (ACL) surgically operated patients (2 female, 23 male) were taken with a FLIR infrared camera according to the protocol established by the International Academy of Clinical Thermology (IACT). This work consists of 4 studies. Studies 1 and 3 were related to establish the probable thermal difference among different moments of an ACL rupture after surgery: before starting the rehabilitation (P0), at the end of rehabilitation (P1) and 18 months from the end of rehabilitation (P2). For this purpose, on the other hand, studies 2 and 4 were related to establish the skin thermal difference (Tsk) between the injured and the non-injured leg in P0, P1 and P2. Results of the first study showed significant temperature increases in the posterior thigh area between P0 and P1 probably due to a compensatory mechanism. According to this, we can conclude that temperature of the posterior area of the injured and noninjured leg has increased from the first to the last day of the rehabilitation process. In the second study we found significant temperature differences between the injured and non-injured leg in both stages of rehabilitation (p<.01). On the one hand, the temperature of the injured leg is higher in the anterior view and the temperature of the non-injured leg is higher in the posterior view. By the time the patients had recovered from the reconstruction, thermal imbalances should have not been shown between symmetrical parts, but differences seemed to be still latent.. Study 3 shows that temperatures seem to be higher after a year and a half (P2) than in P1. Study 4 shows how thermal values 18 months later seemed to be normalized between both legs. No significant differences were found between the injured leg and the noninjured leg after one year and a half of the rehabilitation process. Considering results from Study 3 and 4 we can conclude that patients seemed to have recovered from a thermal point of view. The temperature in P2 was higher but symmetrical. RESUMEN La termografía infrarroja (IRT) es una herramienta segura y no invasiva utilizada para examinar funciones fisiológicas que se basan en el control de temperatura de la piel (Tsk). Termogramas de 25 pacientes intervenidos quirúrgicamente del ligamento cruzado anterior (LCA) (2 mujeres, 23 hombres) fueron tomadas con una cámara de infrarrojos FLIR de acuerdo con el protocolo establecido por la Academia Internacional de Termología Clínica (IACT). Este trabajo consiste en 4 estudios. Los estudios 1 y 3 describen la diferencia térmica entre los diferentes momentos tras la operación del ligamento cruzado anterior: antes de comenzar la rehabilitación (P0), al final de la rehabilitación (P1) y 18 meses tras finalizar la rehabilitación (P2). Por otra parte, los estudios 2 y 4 describen la diferencia de temperatura de la piel (Tsk) entre la pierna lesionada y la pierna no lesionada en P0, P1 y P2. Los resultados del primer estudio mostraron aumentos significativos de temperatura en la zona posterior de los muslos entre P0 y P1, probablemente debido a un mecanismo de compensación. De acuerdo con esto, se puede concluir que la temperatura de la zona posterior de la pierna lesionada y no lesionada se ha incrementado desde el primero hasta el último día del proceso de rehabilitación. En el segundo estudio se encontraron diferencias significativas de temperatura entre la pierna lesionada y no lesionada en ambas etapas de la rehabilitación (p<.01). Por un lado, la temperatura de la pierna lesionada es mayor en la vista anterior. Por otro lado, la temperatura de la pierna no lesionada es mayor en la vista posterior. Una vez que los pacientes se han recuperado de todo el proceso, no deberían existir desequilibrios térmicos entre partes simétricas del cuerpo, pero las diferencias todavía estaban latentes. El tercer estudio muestra que la temperatura es más alta en P2 que en P1. El cuarto estudio muestra cómo los valores térmicos entre ambas piernas en P2 se han normalizado entre ambas piernas. No se encontraron diferencias significativas entre la pierna lesionada y la pierna no lesionada después de 18 meses tras el proceso de rehabilitación. Considerando los resultados del studio 3 y 4, podemos concluir que se ha llegado a la recuperación total desde un punto de vista térmico. La temperatura es más elevada en P2 pero simétrica.