Finite element analysis of pectus carinatum surgical correction via a minimally invasive approach

Pectus carinatum (PC) is a chest deformity caused by a disproportionate growth of the costal cartilages compared to the bony thoracic skeleton, pulling the sternum towards, which leads to its protrusion. There has been a growing interest on using the ‘reversed Nuss’ technique as minimally invasive procedure for PC surgical correction. A corrective bar is introduced between the skin and the thoracic cage and positioned on top of the sternum highest protrusion area for continuous pressure. Then, it is fixed to the ribs and kept implanted for about 2–3 years. The purpose of this work was to (a) assess the stresses distribution on the thoracic cage that arise from the procedure, and (b) investigate the impact of different positioning of the corrective bar along the sternum. The higher stresses were generated on the 4th, 5th and 6th ribs backend, supporting the hypothesis of pectus deformities correction-induced scoliosis. The different bar positioning originated different stresses on the ribs’ backend. The bar position that led to lower stresses generated on the ribs backend was the one that also led to the smallest sternum displacement. However, this may be preferred, as the risk of induced scoliosis is lowered.

Portugal’s Minho-Lima region as a tourist destination: tourism operators’ attitudes towards its management and promotion

The success of tourism development depends on the capacity of a region’s tourism agents to establish and sustain networks, involving both private-sector companies and the public sector. Creating an attractive destination able to compete with others that are better positioned and consolidated requires cooperative behaviour among the various agents involved. This behaviour will facilitate both external and internal competition, which in turn will assure better product quality, continuous product renewal, a strong offer of unique experiences and the efficient use of endogenous resources. In this paper, the authors discuss the results of a survey of restaurant owners and of interviews conducted with the main institutional agents concerned with tourism promotion and the economic development of the Minho–Lima region. Such an approach, the authors argue, can be valuable in identifying the strengths and weaknesses of the area in question with regard to future tourism development. The authors work from the premise that the commitment of tourism agents constitutes a precondition for the success of the strategy to be defined. This is especially applicable to Minho–Lima, which to date has suffered from an absence of commitment and coordination on the part of those agents.