Happiness, hope, and affection as predictors of quality of life and functionality of individuals with heart failure at three-month follow-up

The scientific evidence supporting the management of the chronically ill in a positive psychological perspective in opposition to traditional pathological approach is scarce. This study examines issues associated with recovery of health status in heart failure, in particular hope, affection, and happiness. We use a longitudinal study of 128 symptomatic patients who after medical intervention reported improved quality of life and function at 3-month follow-up. We evaluated the contribution of happiness, hope and affection, individually and as a whole, in the quality of life and functionality of individuals with heart failure. Happiness (Subjective Happiness Scale), Hope (HOPE Scale), and affection (PANAS (positive and negative affect schedule)) were determined before medical intervention. Individually, we found that happiness is correlated with the quality of life and functionality, hope to self-efficacy dimension of the quality of life scale, positive affect to functionality and negative affect with symptoms dimension, quality of life dimension, and overall sum of the quality of life scale. Overall, we found that happiness has a unique contribution to the quality of life, except in self-efficacy dimension where hope takes this contribution and positive affect has a unique contribution to the functionality in this short-term follow-up. The results highlight the importance of positive variables to health outcomes for people with heart failure and should be considered in intervention programs for this syndrome.

Environmental sustainability in superior education: case study of Lisbon College of Health Technology

Over the centuries there has been a growing trend of societies and it is possible to verify their economic growth. This growth has provided an increased pressure on natural resources, often over-reaching the boundaries of each country, which has called into question the level of environmental sustainability in different countries. Sustainability is understood as a complex concept involving ecological, social, economic dimensions and temporal urban processes. Therefore, Firmino (2009) suggests that the ecological footprint (EF) allows people to establish dependency relations between human activities and the natural resources required for such activities and for the absorption of waste generated. According to Bergh & Verbruggen (1999) the EF is an objective, impartial and one-dimensional indicator that enables people to assess the sustainability. The Superior Schools have a crucial role in building the vision of a sustainable future as a reality, because in transmitting values and environmental principles to his students, are providing that they, in exercising his professional activity, make decisions weighing the environmental values. This ensures improved quality of life. The present study aims to determine the level of environmental sustainability of the Academic Community of Lisbon College of Health Technology (ESTeSL), by calculating the EF, and describe whether a relation between Footprint and various socio-demographic characteristics of the subjects.

Controlo de qualidade do processamento histológico em histotecnologia: a realidade de 12 hospitais portugueses

Mestrado em Gestão e Avaliação de Tecnologias em Saúde

Improved matching criterion for frame rate upconversion with trilateral filtering

Frame rate upconversion (FRUC) is an important post-processing technique to enhance the visual quality of low frame rate video. A major, recent advance in this area is FRUC based on trilateral filtering which novelty mainly derives from the combination of an edge-based motion estimation block matching criterion with the trilateral filter. However, there is still room for improvement, notably towards reducing the size of the uncovered regions in the initial estimated frame, this means the estimated frame before trilateral filtering. In this context, proposed is an improved motion estimation block matching criterion where a combined luminance and edge error metric is weighted according to the motion vector components, notably to regularise the motion field. Experimental results confirm that significant improvements are achieved for the final interpolated frames, reaching PSNR gains up to 2.73 dB, on average, regarding recent alternative solutions, for video content with varied motion characteristics.

Maintaining image quality for paediatric chest CTs while lowering dose: FBP versus SAFIRE

Objectives: Children have a greater risk from radiation, per unit dose, due to increased radiosensitivity and longer life expectancies. It is of paramount importance to reduce the radiation dose received by children. This research concerns chest CT examinations on paediatric patients. The purpose of this study was to compare the image quality and the dose received from imaging with images reconstructed with filtered back projection (FBP) and five strengths of Sinogram-Affirmed Iterative Reconstruction (SAFIRE). Methods: Using a multi-slice CT scanner, six series of images were taken of a paediatric phantom. Two kVp values (80 and 110), 3 mAs values (25, 50 and 100) and 2 slice thicknesses (1 mm and 3 mm) were used. All images were reconstructed with FBP and five strengths of SAFIRE. Ten observers evaluated visual image quality. Dose was measured using CT-Expo. Results: FBP required a higher dose than all SAFIRE strengths to obtain the same image quality for sharpness and noise. For sharpness and contrast image quality ratings of 4, FBP required doses of 6.4 and 6.8 mSv respectively. SAFIRE 5 required doses of 3.4 and 4.3 mSv respectively. Clinical acceptance rate was improved by the higher voltage (110 kV) for all images in comparison to 80 kV, which required a higher dose for acceptable image quality. 3 mm images were typically better quality than 1 mm images. Conclusion: SAFIRE 5 was optimal for dose reduction and image quality.

Reducing effective dose to a paediatric phantom by using different combinations of kVp, mAs and additional filtration whilst maintaining image quality

Purpose: To determine whether using different combinations of kVp and mAs with additional filtration can reduce the effective dose to a paediatric phantom whilst maintaining diagnostic image quality. Methods: 27 images of a paediatric AP pelvis phantom were acquired with different kVp, mAs and additional copper filtration. Images were displayed on quality controlled monitors with dimmed lighting. Ten diagnostic radiographers (5 students and 5 experienced radiographers) had eye tests to assess visual acuity before rating the images. Each image was rated for visual image quality against a reference image using 2 alternative forced choice software using a 5-point Likert scale. Physical measures (SNR and CNR) were also taken to assess image quality. Results: Of the 27 images rated, 13 of them were of acceptable image quality and had a dose lower than the image with standard acquisition parameters. Two were produced without filtration, 6 with 0.1mm and 5 with 0.2mm copper filtration. Statistical analysis found that the inter-rater and intra-rater reliability was high. Discussion: It is possible to obtain an image of acceptable image quality with a dose that is lower than published guidelines. There are some areas of the study that could be improved. These include using a wider range of kVp and mAs to give an exact set of parameters to use. Conclusion: Additional filtration has been identified as amajor tool for reducing effective dose whilst maintaining acceptable image quality in a 5 year old phantom.

Effect of explosive mixture on quality of explosive welds of copper to aluminium

The aim of this research is to investigate the influence of explosive ratio and type of sensitizer on the quality of explosive welds between copper and aluminium alloy plates. The welds were performed on a partially overlapping joint configuration using an emulsion explosive (EE) with two different sensitizers, hollow glass microspheres (HGMS) and expanded polystyrene spheres (EPS). Welds with an improved surface were achieved by using the HGMS sensitizer. A higher wave amplitude was registered in welds produced with the EPS sensitizer. In turn, the dimension of the molten pockets was influenced by the explosive ratio, increasing in size with increases in the values of this parameter. The intermetallic content of these zones varied according to the sensitizer type. Unlike the CuAl2 phase, the Cu-richer phases CuAl and Cu9Al4 were only identified in welds performed using the EPS sensitizer. An increase in hardness was observed at the interface of all welds, which resulted from both the presence of intermetallic phases and the plastic deformation of the materials promoted by the impact. This effect was most evident on the aluminium alloy side. All the welds had a greater strength than copper, i.e. the weakest material of the joint. (C) 2016 Elsevier Ltd. All rights reserved.

A supervised versus home-based program effects on liver transplanted familial amyloidotic polyneuropathy patients: walking, fatigue and quality of life

Purpose: To evaluate the effects of a six months exercise training program on walking capacity, fatigue and health related quality of life (HRQL). Relevance: Familial amyloidotic polyneuropathy disease (FAP) is an autossomic neurodegenerative disease, related with systemic deposition of amyloidal fibre mainly on peripheral nervous system and mainly produced in the liver. FAP often results in severe functional limitations. Liver transplantation is used as the only therapy so far, that stop the progression of some aspects of this disease. Transplantation requires aggressive medication which impairs muscle metabolism and associated to surgery process and previous possible functional impairments, could lead to serious deconditioning. Reports of fatigue are common feature in transplanted patients. The effect of supervised or home-based exercise training programs in FAP patients after a liver transplant (FAPTX) is currently unknown.

Strength, muscle quality and functional capacity in liver transplanted familial amyloidotic polineuropathy patients

Liver transplantation is the unique treatment for several end-stage diseases. Familial Amiloidotic Polineuropathy (FAP) is a neurodegenerative disease related with systemic deposition of amyloidal fiber mainly on peripheral nervous system, clinically translated by an autonomous sensitive-motor neuropathy with severe functional limitations in some cases. The unique treatment for FAP disease is a liver transplant with a very aggressive medication to muscle metabolism and force production. To our knowledge there are no quantitative characterizations of body composition, strength or functional capacity in this population.

A supervised versus home-based program effects on liver transplanted familial amyloidotic polyneuropathy patients: walking, fatigue and quality of life

Familial amyloidotic polyneuropathy is a systemic deposition of amyloidal fibre mainly on peripheral nervous system (but also in other systems like heart, gastrointestinal tract, kidneys, etc) and mainly produced in the liver. Purpose of this study: to evaluate the effects of a six months exercise training program(supervised or home-based) on walking capacity, fatigue and health related quality of life (HRQL) on Familial Amyloidotic Polyneuropathy patients submitted to a liver transplant.

Analysis of constructed wetland performance for irrigation reuse

Most of the wastewater treatment systems in small rural communities of the Cova da Beira region (Portugal) consist of constructed wetlands (CW) with horizontal subsurface flow (HSSF). It is believed that those systems allow the compliance of discharge standards as well as the production of final effluents with suitability for reuse. Results obtained in a nine-month campaign in an HSSF bed pointed out that COD and TSS removal were lower than expected. A discrete sampling also showed that removal of TC, FC and HE was not enough to fulfill international irrigation goals. However, the bed had a very good response to variation of incoming nitrogen loads presenting high removal of nitrogen forms. A good correlation between mass load and mass removal rate was observed for BOD5, COD, TN, NH4-N, TP and TSS, which shows a satisfactory response of the bed to the variable incoming loads. The entrance of excessive loads of organic matter and solids contributed for the decrease of the effective volume for pollutant uptake and therefore, may have negatively influenced the treatment capability. Primary treatment should be improved in order to decrease the variation of incoming organic and solid loads and to improve the removal of COD, solids and pathogenic. The final effluent presented good physical-chemical quality to be reused for irrigation, which is the most likely application in the area.

Design of improved rail-to-rail low-distortion and low-stress switches in advanced CMOS technologies

This paper describes the efficient design of an improved and dedicated switched-capacitor (SC) circuit capable of linearizing CMOS switches to allow SC circuits to reach low distortion levels. The described circuit (SC linearization control circuit, SLC) has the advantage over conventional clock-bootstrapping circuits of exhibiting low-stress, since large gate voltages are avoided. This paper presents exhaustive corner simulation results of a SC sample-and-hold (S/H) circuit which employs the proposed and optimized circuits, together with the experimental evaluation of a complete 10-bit ADC utilizing the referred S/H circuit. These results show that the SLC circuits can reduce distortion and increase dynamic linearity above 12 bits for wide input signal bandwidths.

Health related quality of life in patients with refractory chronic heart failure undergoing cardiac resynchronization: type of therapeutic response

The benefits of cardiac resynchronization therapy (CRT) in the health-related quality of life (HRQL) are largely demonstrated in selected patients with severe congestive heart failure (CHF). However, the differences between responders and non-responders, with regard to the effect of CRT in the various dimensions that constitute HRQL are still a matter of discussion. Objective: To evaluate the impact of CRT on the HRQL of patients with CHF refractory to optimal pharmacological therapy, within 6 months after CRT. Methods: 43 patients, submitted to successful implantation of CRT, were evaluated in hospital just before intervention and in the outpatient clinic within 6 months after CRT. HRQL was analyzed based on the Kansas City Cardiomyopathy Questionnaire (KCCQ). Patients were classified as super-responders (ejection fraction of left ventricle - LVEF - ≥45% post-CRT), n=15, responders (sustained improvement in functional class and LVEF increased by 15%), n=19, and non-responders (no clinical or LVEF improvement), n=9. Results: In the group of super-responders, CRT was associated with an improvement in HRQL for the various fields and sums assessed (ρ<0.05); in responders, CRT has been associated with an improvement of HRQL in the various fields and sums, except in the self-efficacy dimension (ρ<0.05); in non-responders, CRT was not associated with improvement of HRQL. Conclusion: In a population with severe CHF undergoing CRT, the patients with clinical and echocardiographic positive response, obtained a favorable impact in all dimensions of HRQL, while the group without response to CRT showed no improvement. These data reinforces the importance of HRQL as a multidimensional tool for assessment of benefits in clinical practice.

Radiological imaging in digital systems: the effect of exposure parameters in diagnostic quality and patient dose

Esta tese pretende contribuir para o estudo e análise dos factores relacionados com as técnicas de aquisição de imagens radiológicas digitais, a qualidade diagnóstica e a gestão da dose de radiação em sistema de radiologia digital. A metodologia encontra-se organizada em duas componentes. A componente observacional, baseada num desenho do estudo de natureza retrospectiva e transversal. Os dados recolhidos a partir de sistemas CR e DR permitiram a avaliação dos parâmetros técnicos de exposição utilizados em radiologia digital, a avaliação da dose absorvida e o índice de exposição no detector. No contexto desta classificação metodológica (retrospectiva e transversal), também foi possível desenvolver estudos da qualidade diagnóstica em sistemas digitais: estudos de observadores a partir de imagens arquivadas no sistema PACS. A componente experimental da tese baseou-se na realização de experiências em fantomas para avaliar a relação entre dose e qualidade de imagem. As experiências efectuadas permitiram caracterizar as propriedades físicas dos sistemas de radiologia digital, através da manipulação das variáveis relacionadas com os parâmetros de exposição e a avaliação da influência destas na dose e na qualidade da imagem. Utilizando um fantoma contraste de detalhe, fantomas antropomórficos e um fantoma de osso animal, foi possível objectivar medidas de quantificação da qualidade diagnóstica e medidas de detectabilidade de objectos. Da investigação efectuada, foi possível salientar algumas conclusões. As medidas quantitativas referentes à performance dos detectores são a base do processo de optimização, permitindo a medição e a determinação dos parâmetros físicos dos sistemas de radiologia digital. Os parâmetros de exposição utilizados na prática clínica mostram que a prática não está em conformidade com o referencial Europeu. Verifica-se a necessidade de avaliar, melhorar e implementar um padrão de referência para o processo de optimização, através de novos referenciais de boa prática ajustados aos sistemas digitais. Os parâmetros de exposição influenciam a dose no paciente, mas a percepção da qualidade de imagem digital não parece afectada com a variação da exposição. Os estudos que se realizaram envolvendo tanto imagens de fantomas como imagens de pacientes mostram que a sobreexposição é um risco potencial em radiologia digital. A avaliação da qualidade diagnóstica das imagens mostrou que com a variação da exposição não se observou degradação substancial da qualidade das imagens quando a redução de dose é efectuada. Propõe-se o estudo e a implementação de novos níveis de referência de diagnóstico ajustados aos sistemas de radiologia digital. Como contributo da tese, é proposto um modelo (STDI) para a optimização de sistemas de radiologia digital.

Statistical motion learning for improved transform domain Wyner-Ziv video coding

Wyner - Ziv (WZ) video coding is a particular case of distributed video coding (DVC), the recent video coding paradigm based on the Slepian - Wolf and Wyner - Ziv theorems which exploits the source temporal correlation at the decoder and not at the encoder as in predictive video coding. Although some progress has been made in the last years, WZ video coding is still far from the compression performance of predictive video coding, especially for high and complex motion contents. The WZ video codec adopted in this study is based on a transform domain WZ video coding architecture with feedback channel-driven rate control, whose modules have been improved with some recent coding tools. This study proposes a novel motion learning approach to successively improve the rate-distortion (RD) performance of the WZ video codec as the decoding proceeds, making use of the already decoded transform bands to improve the decoding process for the remaining transform bands. The results obtained reveal gains up to 2.3 dB in the RD curves against the performance for the same codec without the proposed motion learning approach for high motion sequences and long group of pictures (GOP) sizes.