Parental predictors of poor visual outcome with occlusion treatment for unilateral amblyopia

Aim: Visual acuity outcome of amblyopia treatment depends on the compliance. This study aimed to determine parental predictors of poor visual outcome with occlusion treatment in unilateral amblyopia and identify the relationship between occlusion recommendations and the patient's actual dose of occlusion reported by the parents. Methods: This study comprised three phases: refractive adaptation for a period of 18 weeks after spectacle correction; occlusion of 3 to 6 hours per day during a period of 6 months; questionnaire administration and completion by parents. Visual acuity as assessed using the Sheridan-Gardiner singles or Snellen acuity chart was used as a measure of visual outcome. Correlation analysis was used to describe the strength and direction of two variables: prescribed occlusion reported by the doctor and actual dose reported by parents. A logistic binary model was adjusted using the following variables: severity, vulnerability, self-efficacy, behaviour intentions, perceived efficacy and treatment barriers, parents' and childrens' age, and parents' level of education. Results: The study included 100 parents (mean age 38.9 years, SD approx 9.2) of 100 children (mean age 6.3 years, SD approx 2.4) with amblyopia. Twenty-eight percent of children had no improvement in visual acuity. The results showed a positive mild correlation (kappa = 0.54) between the prescribed occlusion and actual dose reported by parents. Three predictors for poor visual outcome with occlusion were identified: parents' level of education (OR = 9.28; 95%CI 1.32-65.41); treatment barriers (OR = 2.75; 95%CI 1.22-6.20); interaction between severity and vulnerability (OR = 3.64; 95%CI 1.21-10.93). Severity (OR = 0.07; 95%CI 0.00-0.72) and vulnerability (OR = 0.06; 95%CI 0.05-0.74) when considered in isolation were identified as protective factors. Conclusions: Parents frequently do not use the correct dosage of occlusion as recommended. Parents' educational level and awareness of treatment barriers were predictors of poor visual outcome. Lower levels of education represented a 9-times higher risk of having a poor visual outcome with occlusion treatment.

Femtosecond laser ablation of dentin

The surface morphology, structure and composition of human dentin treated with a femtosecond infrared laser (pulse duration 500 fs, wavelength 1030 nm, fluences ranging from 1 to 3 J cm(-2)) was studied by scanning electron microscopy, x-ray diffraction, x-ray photoelectron spectroscopy and Fourier transform infrared spectroscopy. The average dentin ablation threshold under these conditions was 0.6 +/- 0.2 J cm(-2) and the ablation rate achieved in the range 1 to 2 mu m/pulse for an average fluence of 3 J cm(-2). The ablation surfaces present an irregular and rugged appearance, with no significant traces of melting, deformation, cracking or carbonization. The smear layer was entirely removed by the laser treatment. For fluences only slightly higher than the ablation threshold the morphology of the laser-treated surfaces was very similar to the dentin fracture surfaces and the dentinal tubules remained open. For higher fluences, the surface was more porous and the dentin structure was partially concealed by ablation debris and a few resolidified droplets. Independently on the laser processing parameters and laser processing method used no sub-superficial cracking was observed. The dentin constitution and chemical composition was not significantly modified by the laser treatment in the processing parameter range used. In particular, the organic matter is not preferentially removed from the surface and no traces of high temperature phosphates, such as the beta-tricalcium phosphate, were observed. The achieved results are compatible with an electrostatic ablation mechanism. In conclusion, the high beam quality and short pulse duration of the ultrafast laser used should allow the accurate preparation of cavities, with negligible damage of the underlying material.

A influência da reeducação vestibular nas medidas objetivas e subjetivas em pacientes com défice vestibular periférico unilateral

Mestrado em Fisioterapia.

Morphology and structure of particles produced by femtosecond laser ablation of fused silica

The aim of the present work was to study the morphology and structure of the nanoparticles produced by femtosecond laser ablation of fused silica. Ultrashort laser pulses of 1030 nm wavelength and 550 fs duration were tightly focused by a high numerical aperture microscope objective at the surface of fused silica samples while scanning the sample in relation to the stationary laser beam. Laser tracks were created with pulse energies in the range 5-100 mu J, resulting in ablation debris of different morphologies. The debris were examined by scanning and transmission electron microscopy for their morphology and crystal structure in relation to the incident laser pulse energy. Ejected particles with sizes ranging from a few nanometers to a few microns were found. Their morphologies can be broadly classified into three categories: very fine round nanoparticles with diameters lower than 20 nm, nanoparticles with intermediate sizes between 50 and 200 nm, and big irregular particles with typical size between 0.5 and 1.5 mu m. The fine nanoparticles of the first category are predominantly observed at higher pulse energies and tend to aggregate to form web-like and arborescent-like structures. The nanoparticles with intermediate sizes are observed for all pulse energies used and may appear isolated or aggregated in clusters. Finally, the larger irregular particles of the third category are observed for all energies and appear normally isolated.

Optimização de um método de avaliação simultânea da dissolução e permeabilidade de fármacos

Englobado na temática do desenvolvimento de métodos in vitro para avaliação da biodisponibilidade de fármacos, este trabalho de investigação teve como objectivo a optimização de um método para avaliar em simultâneo a dissolução e permeabilidade de fármacos usando uma célula de fluxo bilateral com membranas de Polyvinylidene Fluoride (PVDF). Através de uma avaliação inicial, na qual se testou o efeito de diversas variáveis na permeabilidade da cafeína e do ácido acetilsalicílico, obtiveram-se resultados que permitiram concluir que os ensaios realizados são mais reprodutíveis, quando a célula de fluxo é utilizada em circulação unilateral no lado dador e com agitação do lado aceitador. Observou-se ainda que o método permite detectar a influência do pH (Papp da cafeína a pH 7,4 e 4,5: 4,84±1,57x105cm.s-1 e 6,00±0,70x105cm.s app do ácido acetilsalicílico a pH 7,4 e 4,5: 3,85±0,38x10-5cm.s-1 e 5,1 1±0,65x105cm.s-1) e dos excipientes (Papp da cafeína isoladamente e em presença de excipientes: 6,76±1,22 x 10-5cm.s1 e 5,84±0,43x10-5cm.s-1 app do ácido acetilsalicílico isoladamente e em presença de excipientes: 7,07±1,56x105 cm.s e 5,19±0,23x10-5cm.s1) na permeabilidade dos compostos. Na avaliação da dissolução testou-se um método descrito na United States Pharmacopeia (USP) com meio de dissolução a pH 4,5 e um método com meio de dissolução a pH 7,4 pois na perspectiva de no futuro se realizarem ensaios com membranas celulares Caco-2, foi necessário testar um meio compatível com estas. As percentagens de dissolução dos ensaios a pH 7,4 foram de 96,3% para a cafeína e de 87,1% para o ácido acetilsalicílico, o que permitiu a utilização deste meio, visto ter sido superior ao limite mínimo de 80% estabelecido pela USP. Após estabelecimento das metodologias de dissolução e permeabilidade individuais, passou-se ao acoplamento das duas técnicas, tendo sido realizados ensaios de dissolução/permeabilidade com uma forma farmacêutica contendo os dois compostos em estudo (Melhoral®), nos quais se obtiveram permeabilidades aparentes de 3,97±0,37x105cm.s1 e 3,69±0,29 x105cm.s para a cafeína e ácido acetilsalicílico a pH 4,5 e de 3,77±0,40x105cm.s e 4,08± 0,04x1 05cm.s1 para a cafeína e ácido acetilsalicílico a pH 7,4, resultados estes que foram reprodutíveis e descriminativos e que perspectivam a possibilidade da utilização do sistema para futuros trabalhos envolvendo membranas de culturas celulares (Caco-2) ou tecidos (pele ou intestino).

Factors influencing amblyopia rehabilitation in occlusive therapy

Amblyopia develops in an early period and is a decrease of visual acuity (unilateral or bilateral) caused by a deprivation of vision or abnormal binocular interaction. Prognosis of Amblyopia is better when occlusive treatment is implemented in an early stage. Visual acuity of amblyopic eye does not improve without effective occlusive therapy. The aim of this study is to identify potential risk factors of noncompliance with treatment when it is implemented by parents in amblyopic children.

Relationship of balance to function independence in stroke survivors

Cerebral vascular disease is the primary cause of permanent disability in Portugal. Impaired stability is considered an important feature after stroke as it is related with higher risk of falls and functional dependence. Physiotherapy intervention usually starts early after stroke in order to direct motor recovery and help patients to improve their ability to perform activities of daily living (ADL). Purpose: to investigate the relationship of balance to functionality in acute stroke patients. Methods: 16 subjects (8 women and 8 men), mean age 63,62 ± 2,16y, with unilateral ischemic stroke in the middle cerebral artery territory, who were admitted to physiotherapy department of Fernando Fonseca Hospital in Portugal, within the first month after stroke were recruited to participate in this study. All subjects have no cognitive impairment according to Mini Mental State, no history of lower extremity orthopedic problems and no other disease that could interfere with treatments. All patients gave their inform consent to participate in this study. Subjects were assessed with the Modified Barthel Index (MBI) and the Berg Balance Scale (BBS).

Wetting response of KrF laser ablated polyimide surfaces

The wettability of polyimide surfaces microstructured using KrF laser radiation at fluences above the material ablation threshold was studied by static contact angle measurements. The laser-treated surfaces present a morphology consisting of conical features whose dimensions and areal density depend on the fluence. The effect of these parameters on the surface apparent contact angle depends on the wetting regime. When wetting occurs in the homogeneous regime, the apparent contact angle of the treated surfaces increases with the radiation fluence because the cone dimensions increase. In contrast, when wetting occurs in the heterogeneous regime, the apparent contact angle increases with the radiation fluence because the average distance between cones increases. The apparent water contact angle of the laser-treated surfaces can reach values as high as 162 degrees, as compared to 75 degrees for virgin polyimide.

Multi-scaled femtosecond laser structuring of stationary titanium surfaces

The evolution of the topography of titanium surfaces treated with femtosecond laser radiation in stationary conditions as a function of radiation fluence and number of laser pulses is investigated. Depending on the processing parameters, ripples, microcolumns, wavy or smooth surfaces can be obtained. The ripples predominate for fluences near the damage threshold of titanium (0.2+/-0.1) J/cm(2), while microcolumns form during the first 200 pulses for fluences between (0.6+/-0.2) and (1.7+/-0.2) J/cm(2). A wavy topography develops for fluences and number of pulses higher than (1.7+/-0.2) J/cm(2) and 300, respectively. A bimodal surface topography consisting of surface ripples overlapping a microcolumnar topography can be obtained if the surfaces are firstly treated to create microcolumns followed by laser treatment with a lower fluence near the ablation threshold of the material, in order to generate periodic ripple

Study and comparison of physiological response with Harmony® suspension system and suspension with pin

The purpose of this study is a cross-qualitative and quantitative gait analysis in 3 traumatic unilateral amputees using prosthesis with pin suspension compared to the use of prosthesis with a high vacuum suspension, the Harmony® system. In Portugal, there aren’t many studies made in the field of orthotic and prosthetic and knowledge about the number of amputees in the country. The only know is that the major cause of lower limb amputation is diabetes mellitus, being the most affected population the older age groups. The combination of technological developments with daily needs of the amputees is becoming more and more important for they better quality of life. This work was done during the curricular unit “Investigation in Prosthetics and Orthotics” class, in the 4th year of Health Technology School of Lisbon, in Portugal. This study analyzes if the change of suspension in transtibial prosthesis will influence some physiological response in amputees.

Diferenciação curricular para a inclusão de alunos com necessidade educativas especiais no 1º Ciclo do Ensino Básico

Um dos grandes desafios da atualidade reside em construir uma escola inclusiva para todos, respeitando as diferenças entre os alunos e procurando dar resposta a todas as suas necessidades educativas, através do acesso igualitário a uma educação de qualidade, no sentido de uma preparação para a vida social e profissional ao longo da vida. Desta forma, é necessária uma mudança não só na maneira de pensar como também nas práticas dos agentes educativos, no sentido de adequarem o currículo às necessidades educativas especiais dos alunos. O presente estudo constitui, pois, uma tentativa de conhecer não apenas as conceções dos professores do 1º Ciclo do Ensino Básico sobre a inclusão e as adaptações curriculares para alunos com NEE, mas também as práticas curriculares que desenvolvem quando têm estes alunos nas suas turmas. O trabalho desenvolveu-se através de um estudo de caso, incidindo sobre 6 professores do 1º CEB e respetivas turmas com alunos com NEE incluídos. Como metodologia de recolha de dados utilizámos as técnicas da entrevista, da análise documental e da observação naturalista em contexto de sala de aula. Articulando os resultados das entrevistas com os das observações em sala de aula, podemos concluir que, para que a escola seja efetivamente inclusiva, não basta que os professores adotem este conceito. Algumas das maiores dificuldades que se colocaram aos professores foram a gestão do tempo e a adequação de estratégias no atendimento a todos os alunos, o que decorre da forma de organização do ensino, uma vez que os professores continuam a percecionar o seu papel como transmissores de conteúdos e executores de programas, apostando num ensino unilateral e homogéneo. No entanto, foi possível também verificar algumas formas de diferenciação pedagógica, sobretudo através da adequação da estrutura dos trabalhos individuais, do apoio individualizado do professor aos alunos com mais dificuldades ou da tutoria interpares e da realização de diferentes atividades consoante as necessidades específicas de cada aluno.- ABSTRACT One of today´s main challenges lies on building an inclusive school for everyone, respecting students’ differences, giving an answer to their educational needs through equal access to qualified education, preparing them to their professional future and social life. Consequently, a change is necessary, not only in the way of thinking but also in the practices of the educational agents, to adequate the curriculum to the special educational students’ needs. The present study is an attempt to understand not only the conceptions of the elementary school teachers about the inclusion and the curricular adjustments for students with special educational needs, but also the curricular practices they develop when those students are included in their classes. This work was developed through a study case focused on six elementary school teachers and their respective classes with students with special educational needs included. The data collection methods used were interview techniques, documental analysis and context observation in classroom. Articulating the interview results with the classroom observations we can conclude that for a school to be effectively inclusive, the adoption of those conceptions are not enough. Some of the major difficulties that appear to the teachers were time management and adequate strategies on attending all students, which follows from their teaching organization, since teachers are still carrying their role as pure contents transmitters and programs implementers, investing in a unilateral and homogeneous education. However, it was also possible to ascertain some pedagogical differentiation strategies, mainly through individual work adaptation, direct and individualized teacher’s support to students with more difficulties or by peer tutoring as well as carrying out different activities depending on the specific needs of each student.

Diferenciação curricular para a inclusão de alunos com necessidades educativas especiais no 1º ciclo do Ensino Básico

Um dos grandes desafios da atualidade reside em construir uma escola inclusiva para todos, respeitando as diferenças entre os alunos e procurando dar resposta a todas as suas necessidades educativas, através do acesso igualitário a uma educação de qualidade, no sentido de uma preparação para a vida social e profissional ao longo da vida. Desta forma, é necessária uma mudança não só na maneira de pensar como também nas práticas dos agentes educativos, no sentido de adequarem o currículo às necessidades educativas especiais dos alunos. O presente estudo constitui, pois, uma tentativa de conhecer não apenas as conceções dos professores do 1º Ciclo do Ensino Básico sobre a inclusão e as adaptações curriculares para alunos com NEE, mas também as práticas curriculares que desenvolvem quando têm estes alunos nas suas turmas. O trabalho desenvolveu-se através de um estudo de caso, incidindo sobre 6 professores do 1º CEB e respetivas turmas com alunos com NEE incluídos. Como metodologia de recolha de dados utilizámos as técnicas da entrevista, da análise documental e da observação naturalista em contexto de sala de aula. Articulando os resultados das entrevistas com os das observações em sala de aula, podemos concluir que, para que a escola seja efetivamente inclusiva, não basta que os professores adotem este conceito. Algumas das maiores dificuldades que se colocaram aos professores foram a gestão do tempo e a adequação de estratégias no atendimento a todos os alunos, o que decorre da forma de organização do ensino, uma vez que os professores continuam a percecionar o seu papel como transmissores de conteúdos e executores de programas, apostando num ensino unilateral e homogéneo. No entanto, foi possível também verificar algumas formas de diferenciação pedagógica, sobretudo através da adequação da estrutura dos trabalhos individuais, do apoio individualizado do professor aos alunos com mais dificuldades ou da tutoria interpares e da realização de diferentes atividades consoante as necessidades específicas de cada aluno.

Wetting behaviour of femtosecond laser textured Ti-6Al-4V surfaces

The aim of the present work was to investigate the wetting behaviour of biomedical grade Ti-6Al-4V alloy surfaces textured by a femtosecond laser treatment. The material was treated in ambient atmosphere using an Yb: KYW chirped-pulse-regenerative amplification laser with a wavelength of 1030 nm and a pulse duration of 500 fs. Four main types of surface textures were obtained depending on the processing parameters and laser treatment method. These textures consist of: (1) nanoscale laser-induced periodic surface structures (LIPSS); (2) nanopillars; (3) a bimodal roughness distribution texture formed of LIPSS overlapping microcolumns; (4) a complex texture formed of LIPSS overlapping microcolumns with a periodic variation of the columns size in the laser scanning direction. The wettability of the surfaces was evaluated by the sessile drop method using distilled-deionized (DD) water and Hank's balanced salt solution (HBSS) as testing liquids. The laser treated surfaces present a hydrophilic behaviour as well as a high affinity for the saline solution, with equilibrium contact angles in the ranges 24.1-76.2. for DD water and 8.4-61.8. for HBSS. The wetting behaviour is anisotropic, reflecting the anisotropy of the surface textures. (c) 2012 Elsevier B.V. All rights reserved.

Sub-micron structuring of silicon using femtosecond laser interferometry

We report the fabrication of planar sub-micron gratings in silicon with a period of 720 nm using a modified Michelson interferometer and femtosecond laser radiation. The gratings consist of alternated stripes of laser ablated and unmodified material. Ablated stripes are bordered by parallel ridges which protrude above the unmodified material. In the regions where ridges are formed, the laser radiation intensity is not sufficient to cause ablation. Nevertheless, melting and a significant temperature increase are expected, and ridges may be formed due to expansion of silicon during resolidification or silicon oxidation. These conclusions are consistent with the evolution of the stripes morphology as a function of the distance from the center of the grating. (C) 2013 Elsevier Ltd. All rights reserved.

Alterações da curvatura da coluna vertebral: influência da fisioterapia, a nível neuromuscular

Mestrado em Fisioterapia