Agencification in Latin countries: Portugal

This chapter provides a broad look at the Portuguese process of agencification in the last two decades. As with most of the remaining chapters in this book, we cover the basics by describing the administrative landscape, its changes in organizational make-up, the delicate balance between control and autonomy in the ministry-agency relationship, perceptual changes in efficiency and performance measurement in public management, based on a comprehensive survey (COBRA survey of the CRIPO research group) sent to all public-sector organizations under public law with some degree of autonomy (see Chapter 1, Table 1.1). Portugal is undergoing the most pervasive politico-economic crisis in its short democratic history. The administrative mapping conducted in 2007 which served as the basis for the administration of the COBRA survey is already undergoing change.

Preliminary clinical trial in percutaneous nephrolithotomy using a real-time navigation system for percutaneous kidney access

Background: Precise needle puncture of renal calyces is a challenging and essential step for successful percutaneous nephrolithotomy. This work tests and evaluates, through a clinical trial, a real-time navigation system to plan and guide percutaneous kidney puncture. Methods: A novel system, entitled i3DPuncture, was developed to aid surgeons in establishing the desired puncture site and the best virtual puncture trajectory, by gathering and processing data from a tracked needle with optical passive markers. In order to navigate and superimpose the needle to a preoperative volume, the patient, 3D image data and tracker system were previously registered intraoperatively using seven points that were strategically chosen based on rigid bone structures and nearby kidney area. In addition, relevant anatomical structures for surgical navigation were automatically segmented using a multi-organ segmentation algorithm that clusters volumes based on statistical properties and minimum description length criterion. For each cluster, a rendering transfer function enhanced the visualization of different organs and surrounding tissues. Results: One puncture attempt was sufficient to achieve a successful kidney puncture. The puncture took 265 seconds, and 32 seconds were necessary to plan the puncture trajectory. The virtual puncture path was followed correctively until the needle tip reached the desired kidney calyceal. Conclusions: This new solution provided spatial information regarding the needle inside the body and the possibility to visualize surrounding organs. It may offer a promising and innovative solution for percutaneous punctures.