Clinical Education - a fundamental curricular unit for all health practitioners

Clinical education is recognized as being crucial for the training of health professionals. This subject is debated amongst teachers, students and professionals. Besides the clinical and research skills, we look for other competencies such as oratory, creative thinking or leadership. We present the results of a study with 4th graders. It’s a exploratory study; the main purpose was to evaluate the outcomes of a unit of clinical education prepared according a new set of competencies and methodologies. The competencies were seen as valuable. Organization, leading or supporting a colleague, rethinking a program to serve client and family are equally important.

A hybrid recommendation approach for a tourism system

Many current e-commerce systems provide personalization when their content is shown to users. In this sense, recommender systems make personalized suggestions and provide information of items available in the system. Nowadays, there is a vast amount of methods, including data mining techniques that can be employed for personalization in recommender systems. However, these methods are still quite vulnerable to some limitations and shortcomings related to recommender environment. In order to deal with some of them, in this work we implement a recommendation methodology in a recommender system for tourism, where classification based on association is applied. Classification based on association methods, also named associative classification methods, consist of an alternative data mining technique, which combines concepts from classification and association in order to allow association rules to be employed in a prediction context. The proposed methodology was evaluated in some case studies, where we could verify that it is able to shorten limitations presented in recommender systems and to enhance recommendation quality.

Reliability of nasal auscultation and their relation to middle ear condition – a clinical interest to pediatrics respiratory physiotherapy

Background: Acute respiratory infections are usual in children under three years old occurring in upper respiratory tract, having an impact on child and caregiver’s quality of life predisposing to otitis media or bronchiolitis. There are few valid and reliable measures to determine the child’s respiratory condition and to guide the physiotherapy intervention. Aim: To assess the intra and inter rater reliability of nasal auscultation, to analyze the relation between sounds’ classification and middle ear’s pressure and compliance as well as with the Clinical Severity Score. Methods: A cross-sectional observational study was composed by 125 nursery children aged up to three years old. Tympanometry, pulmonary and nasal auscultation and application of Clinical Severity Score were performed to each child. Nasal auscultation sounds’ were recorded and sent to 3 blinded experts, that classified, as “obstructed” and “unobstructed”, with a 48 hours interval, in order to analyze inter and intra rater reliability. Results: Nasal auscultation revealed a substantial inter and intra rater reliability (=0,749 and evaluator A - K= 0,691; evaluator B - K= 0,605 and evaluator C - K= 0,724, respectively). Both ears’ pressure was significantly lower in children with an "unobstructed" nasal sound when compared with an “obstructed” nasal sound (t=-3,599, p<0,001 in left ear; t=-2,258, p=0,026 in right ear). Compliance in both ears was significantly lower in children with an "obstructed" nasal sound when compared with “unobstructed” nasal sound (t=-2,728, p=0,007 in left ear; t=-3,830, p<0,001 in right ear). There was a statistically significant association between sounds’ classification and tympanograms types in both ear’s (=11,437, p=0,003 in left ear; =13,535, p=0,001 in right ear). There was a trend to children with an "unobstructed" nasal sound that had a lower clinical severity score when compared with “obstructed” children. Conclusion: It was observed a good intra and substantial inter reliability for nasal auscultation. Nasal auscultation sounds’ classification was related to middle ears’ pressure and compliance.

Dosimetria das exposições em imagiologia clínica

A importância da radiação ionizante na prática médica, nãoo só como diagnóstico mas também como terapia, ganhou, no último meio século, uma importância fulcral. Devido aos efeitos secundários da radiação ao ser humano, torna-se fundamental definir regras para aumentar a segurança de todos os seus utilizadores, surgindo assim a radioprotecção. Nesse sentido a Comunidade Europeia da Energia Atómica (EURATOM) define directrizes para os países membros da Comunidade Europeia de forma a poder orientá-los nesse processo. Torna-se assim importante registar e monitorizar os valores de dose de radiação num exame radiológico para o aumento de segurança dos pacientes e técnicos. O presente trabalho desenvolvido no âmbito da disciplina anual Dissertação/Projecto/ Estágio Profissional do Mestrado em Computação e Instrumentação Médica teve como objectivo registar esses valores através da comunicação com medidores de doses. A luz do dia-a-dia da Dr. Campos Costa - Consultório de Tomogra a Computarizada S.A, é apresentada nesta tese uma aplicação computacional capaz de obter os valores de dose de um estudo radiológico a um paciente e guardá-los numa base de dados projectada exclusivamente para esse fim. Os resultados obtidos são animadores uma vez que provam ser possível automatizar a monitorização desses valores através de aplicações com ferramentas capazes de auxiliar os responsáveis por essa monitorização em qualquer centro clínico.

An electrochemical deamidated gliadin antibody immunosensor for celiac disease clinical diagnosis

The first electrochemical immunosensor (EI) for the detection of antibodies against deamidated gliadin peptides (DGP) is described here. A disposable nanohybrid screen-printed carbon electrode modified with DGP was employed as the transducer's sensing surface. Real serumsampleswere successfully assayed and the results were corroborated with an ELISA kit. The presented EI is a promising analytical tool for celiac disease diagnosis.

Root-locus practical sketching rules for fractional-order system

For integer-order systems, there are well-known practical rules for RL sketching. Nevertheless, these rules cannot be directly applied to fractional-order (FO) systems. Besides, the existing literature on this topic is scarce and exclusively focused on commensurate systems, usually expressed as the ratio of two noninteger polynomials. The practical rules derived for those do not apply to other symbolic expressions, namely, to transfer functions expressed as the ratio of FO zeros and poles. However, this is an important case as it is an extension of the classical integer-order problem usually addressed by control engineers. Extending the RL practical sketching rules to such FO systems will contribute to decrease the lack of intuition about the corresponding system dynamics. This paper generalises several RL practical sketching rules to transfer functions specified as the ratio of FO zeros and poles. The subject is presented in a didactic perspective, being the rules applied to several examples.

Geostatistical Prediction of Ocean Outfall Plume Characteristics Based on an Autonomous Underwater Vehicle

Geostatistics has been successfully used to analyze and characterize the spatial variability of environmental properties. Besides giving estimated values at unsampled locations, it provides a measure of the accuracy of the estimate, which is a significant advantage over traditional methods used to assess pollution. In this work universal block kriging is novelty used to model and map the spatial distribution of salinity measurements gathered by an Autonomous Underwater Vehicle in a sea outfall monitoring campaign, with the aim of distinguishing the effluent plume from the receiving waters, characterizing its spatial variability in the vicinity of the discharge and estimating dilution. The results demonstrate that geostatistical methodology can provide good estimates of the dispersion of effluents that are very valuable in assessing the environmental impact and managing sea outfalls. Moreover, since accurate measurements of the plume’s dilution are rare, these studies might be very helpful in the future to validate dispersion models.

Deregulated expression of selected histone methylases and demethylases in prostate carcinoma

Prostate cancer (PCa), a leading cause of cancer-related morbidity and mortality, arises through the acquisition of genetic and epigenetic alterations. Deregulation of histone methyltransferases (HMTs) or demethylases (HDMs) has been associated with PCa development and progression. However, the precise influence of altered HMTs or HDMs expression and respective histone marks in PCa onset and progression remains largely unknown. To clarify the role of HMTs and HDMs in prostate carcinogenesis, expression levels of 37 HMTs and 20 HDMs were assessed in normal prostate and PCa tissue samples by RT-qPCR. SMYD3, SUV39H2, PRMT6, KDM5A, and KDM6A were upregulated, whereas KMT2A-E (MLL1-5) and KDM4B were downregulated in PCa, compared with normal prostate tissues. Remarkably, PRMT6 was the histone modifier that best discriminated normal from tumorous tissue samples. Interestingly, EZH2 and SMYD3 expression levels significantly correlated with less differentiated and more aggressive tumors. Remarkably, SMYD3 expression levels were of independent prognostic value for the prediction of disease-specific survival of PCa patients with clinically localized disease submitted to radical prostatectomy. We concluded that expression profiling of HMTs and HDMs, especially SMYD3, might be of clinical usefulness for the assessment of PCa patients and assist in pre-therapeutic decision-making.

Influence of the cohesive law parameters on the strength prediction of adhesively-bonded joints

Adhesive joints are largely employed nowadays as a fast and effective joining process. The respective techniques for strength prediction have also improved over the years. Cohesive Zone Models (CZM’s) coupled to Finite Element Method (FEM) analyses surpass the limitations of stress and fracture criteria and allow modelling damage. CZM’s require the energy release rates in tension (Gn) and shear (Gs) and respective fracture energies in tension (Gnc) and shear (Gsc). Additionally, the cohesive strengths (tn0 for tension and ts0 for shear) must also be defined. In this work, the influence of the CZM parameters of a triangular CZM used to model a thin adhesive layer is studied, to estimate their effect on the predictions. Some conclusions were drawn for the accuracy of the simulation results by variations of each one of these parameters.

Numerical prediction of delamination onset in carbon/epoxy composites drilling

Despite the fact that their physical properties make them an attractive family of materials, composites machining can cause several damage modes such as delamination, fibre pull-out, thermal degradation, and others. Minimization of axial thrust force during drilling reduces the probability of delamination onset, as it has been demonstrated by analytical models based on linear elastic fracture mechanics (LEFM). A finite element model considering solid elements of the ABAQUS® software library and interface elements including a cohesive damage model was developed in order to simulate thrust forces and delamination onset during drilling. Thrust force results for delamination onset are compared with existing analytical models.

Strength prediction of adhesively-bonded scarf repairs in composite structures under bending

This work reports on the experimental and numerical study of the bending behaviour of two-dimensional adhesively-bonded scarf repairs of carbon-epoxy laminates, bonded with the ductile adhesive Araldite 2015®. Scarf angles varying from 2 to 45º were tested. The experimental work performed was used to validate a numerical Finite Element analysis using ABAQUS® and a methodology developed by the authors to predict the strength of bonded assemblies. This methodology consists on replacing the adhesive layer by cohesive elements, including mixed-mode criteria to deal with the mixed-mode behaviour usually observed in structures. Trapezoidal laws in pure modes I and II were used to account for the ductility of the adhesive used. The cohesive laws in pure modes I and II were determined with Double Cantilever Beam and End-Notched Flexure tests, respectively, using an inverse method. Since in the experiments interlaminar and transverse intralaminar failures of the carbon-epoxy components also occurred in some regions, cohesive laws to simulate these failure modes were also obtained experimentally with a similar procedure. A good correlation with the experiments was found on the elastic stiffness, maximum load and failure mode of the repairs, showing that this methodology simulates accurately the mechanical behaviour of bonded assemblies.

Strength prediction and experimental validation of adhesive joints including polyethylene, carbon-epoxy and aluminium adherends

Polyolefins are especially difficult to bond due to their non-polar, non-porous and chemically inert surfaces. Acrylic adhesives used in industry are particularly suited to bond these materials, including many grades of polypropylene (PP) and polyethylene (PE), without special surface preparation. In this work, the tensile strength of single-lap PE and mixed joints bonded with an acrylic adhesive was investigated. The mixed joints included PE with aluminium (AL) or carbon fibre reinforced plastic (CFRP) substrates. The PE substrates were only cleaned with isopropanol, which assured cohesive failures. For the PE CFRP joints, three different surfaces preparations were employed for the CFRP substrates: cleaning with acetone, abrasion with 100 grit sand paper and peel-ply finishing. In the PE AL joints, the AL bonding surfaces were prepared by the following methods: cleaning with acetone, abrasion with 180 and 320 grit sand papers, grit blasting and chemical etching with chromic acid. After abrasion of the CFRP and AL substrates, the surfaces were always cleaned with acetone. The tensile strengths were compared with numerical results from ABAQUS® and a mixed mode (I+II) cohesive damage model. A good agreement was found between the experimental and numerical results, except for the PE AL joints, since the AL surface treatments were not found to be effective.

Strength prediction of single- and double-lap joints by standard and extended finite element modelling

The structural integrity of multi-component structures is usually determined by the strength and durability of their unions. Adhesive bonding is often chosen over welding, riveting and bolting, due to the reduction of stress concentrations, reduced weight penalty and easy manufacturing, amongst other issues. In the past decades, the Finite Element Method (FEM) has been used for the simulation and strength prediction of bonded structures, by strength of materials or fracture mechanics-based criteria. Cohesive-zone models (CZMs) have already proved to be an effective tool in modelling damage growth, surpassing a few limitations of the aforementioned techniques. Despite this fact, they still suffer from the restriction of damage growth only at predefined growth paths. The eXtended Finite Element Method (XFEM) is a recent improvement of the FEM, developed to allow the growth of discontinuities within bulk solids along an arbitrary path, by enriching degrees of freedom with special displacement functions, thus overcoming the main restriction of CZMs. These two techniques were tested to simulate adhesively bonded single- and double-lap joints. The comparative evaluation of the two methods showed their capabilities and/or limitations for this specific purpose.