A eficácia e segurança da fisioterapia respiratória no tratamento da bronquiolite aguda em crianças até 2 anos de idade: revisão sistemática

Contexto: a bronquiolite aguda é a principal patologia a afectar a criança nos primeiros 2 anos de vida, a fisioterapia respiratória é uma intervenção terapêutica utilizada com a intenção de melhorar o curso desta doença mantendo-se a incerteza sobre a sua eficácia. Objectivo: determinar a eficácia e segurança da fisioterapia respiratória em crianças com menos de 2 anos com bronquiolite aguda. Fontes de Informação: Medline (1966 a Agosto 2010), EMBASE(1990 a Agosto 2010), Pedro e Lilacs (1982 a Agosto 2010). Outra fonte de informação incluiu a bibliografia dos estudos obtidos. Selecção de estudos: estudos experimentais comparando a fisioterapia respiratória com cuidados habituais, em crianças com menos de 2 anos e bronquiolite aguda, em ventilação espontânea, em qualquer contexto. Estudos pré-experimentais ou observacionais com os mesmos participantes e intervenções foram admitidos complementarmente aos experimentais. Extracção de dados e análise: um investigador extraiu os dados dos artigos obtidos e avaliou o risco de viés. A eficácia e segurança da fisioterapia respiratória foram determinadas pelos seguintes outcomes: duração do internamento hospitalar ou do evento, variação de scores de severidade clínica, saturação periférica e suplementação de oxigénio, recidivas, recurso a antibióticos e efeitos deletérios ou deterioração clínica reportada. Síntese de dados: 6 estudos experimentais foram admitidos. As suas amostras provinham de criança internadas em hospital. As técnicas de fisioterapia respiratória foram comparadas com cuidados habituais. Nenhum estudo evidenciou melhoria dos outcomes de interesse na comparação entre grupos, excepto avaliações de curta duração da saturação periférica de oxigénio e scores de severidade clínica. 1 estudo reportou uma percentagem significativamente maior no grupo submetido a fisioterapia respiratória de crianças que vomitaram, tiveram uma desestabilização respiratória transitória, e na percepção de stress da criança pelos cuidadores. São relatadas ainda fracturas costais a causa de fisioterapia respiratória. Limitações: o risco de viés era alto em 2 estudos, baixo num estudo e indeterminado nos restantes. Conclusões: aparentemente a fisioterapia respiratória não é eficaz e pode produzir efeitos deletérios importantes, mas a evidência é pobre, carecendo de novos estudos.

Intelligent supervisory control system for home devices using a cyber physical approach

Although we have many electric devices at home, there are just few systems to evaluate, monitor and control them. Sometimes users go out and leave their electric devices turned on what can cause energy wasting and dangerous situations. Therefore most of the users may want to know the using states of their electrical appliances through their mobile devices in a pervasive way. In this paper, we propose an Intelligent Supervisory Control System to evaluate, monitor and control the use of electric devices in home, from outside. Because of the transferring data to evaluate, monitor and control user's location and state of home (ex. nobody at home) may be opened to attacks leading to dangerous situations. In our model we include a location privacy module and encryption module to provide security to user location and data. Intelligent Supervising Control System gives to the user the ability to manage electricity loads by means of a multi-agent system involving evaluation, monitoring, control and energy resource agents.

Adaptable control for electrical generation at irregural wind speeds

The main aims of this work are the development and the validation of one generic algorithm to provide the optimal control of small power wind generators. That means up to 40 kW and blades with fixed pitch angle. This algorithm allows the development of controllers to fetch the wind generators at the desired operational point in variable operating conditions. The problems posed by the variable wind intensity are solved using the proposed algorithm. This is done with no explicit measure of the wind velocity, and so no special equipment or anemometer is required to compute or measure the wind velocity.

Genetic algorithm methodology applied to intelligent house control

In recent years the use of several new resources in power systems, such as distributed generation, demand response and more recently electric vehicles, has significantly increased. Power systems aim at lowering operational costs, requiring an adequate energy resources management. In this context, load consumption management plays an important role, being necessary to use optimization strategies to adjust the consumption to the supply profile. These optimization strategies can be integrated in demand response programs. The control of the energy consumption of an intelligent house has the objective of optimizing the load consumption. This paper presents a genetic algorithm approach to manage the consumption of a residential house making use of a SCADA system developed by the authors. Consumption management is done reducing or curtailing loads to keep the power consumption in, or below, a specified energy consumption limit. This limit is determined according to the consumer strategy and taking into account the renewable based micro generation, energy price, supplier solicitations, and consumers’ preferences. The proposed approach is compared with a mixed integer non-linear approach.

Intelligent behavior in a Cyber-Ambient training system for control center operators

This paper deals with the application of an intelligent tutoring approach to delivery training in diagnosis procedures of a Power System. In particular, the mechanisms implemented by the training tool to support the trainees are detailed. This tool is part of an architecture conceived to integrate Power Systems tools in a Power System Control Centre, based on an Ambient Intelligent paradigm. The present work is integrated in the CITOPSY project which main goal is to achieve a better integration between operators and control room applications, considering the needs of people, customizing requirements and forecasting behaviors.

Using an ambient intelligent architecture for developing an intelligent tutoring system for training operators of power system control centres

This paper describes an architecture conceived to integrate Power Sys-tems tools in a Power System Control Centre, based on an Ambient Intelligent (AmI) paradigm. This architecture is an instantiation of the generic architecture proposed in [1] for developing systems that interact with AmI environments. This architecture has been proposed as a consequence of a methodology for the inclu-sion of Artificial Intelligence in AmI environments (ISyRAmI - Intelligent Sys-tems Research for Ambient Intelligence). The architecture presented in the paper will be able to integrate two applications in the control room of a power system transmission network. The first is SPARSE expert system, used to get diagnosis of incidents and to support power restoration. The second application is an Intelligent Tutoring System (ITS) incorporating two training tools. The first tutoring tool is used to train operators to get the diagnosis of incidents. The second one is another tutoring tool used to train operators to perform restoration procedures.

Training control centers' operators in incident diagnosis and power restoration using intelligent tutoring systems

The activity of Control Center operators is important to guarantee the effective performance of Power Systems. Operators’ actions are crucial to deal with incidents, especially severe faults like blackouts. In this paper, we present an Intelligent Tutoring approach for training Portuguese Control Center operators in tasks like incident analysis and diagnosis, and service restoration of Power Systems. Intelligent Tutoring System (ITS) approach is used in the training of the operators, having into account context awareness and the unobtrusive integration in the working environment. Several Artificial Intelligence techniques were criteriously used and combined together to obtain an effective Intelligent Tutoring environment, namely Multiagent Systems, Neural Networks, Constraint-based Modeling, Intelligent Planning, Knowledge Representation, Expert Systems, User Modeling, and Intelligent User Interfaces.

Cyber-ambient intelligent training of operators in power systems control centres

Cyber-Physical Systems and Ambient Intelligence are two of the most important and emerging paradigms of our days. The introduction of renewable sources gave origin to a completely different dimension of the distribution generation problem. On the other hand, Electricity Markets introduced a different dimension in the complexity, the economic dimension. Our goal is to study how to proceed with the Intelligent Training of Operators in Power Systems Control Centres, considering the new reality of Renewable Sources, Distributed Generation, and Electricity Markets, under the emerging paradigms of Cyber-Physical Systems and Ambient Intelligence. We propose Intelligent Tutoring Systems as the approach to deal with the intelligent training of operators in these new circumstances.

An intelligent tutoring system for operators’ training in power system control centres

The activity of Control Center operators is important to guarantee the effective performance of Power Systems. Operators’ actions are crucial to deal with incidents, especially severe faults, like blackouts. In this paper we present an Intelligent Tutoring approach for training Portuguese Control Centre operators in tasks like incident analysis and diagnosis, and service restoration of Power Systems. Intelligent Tutoring System (ITS) approach is used in the training of the operators, taking into account context awareness and the unobtrusive integration in the working environment.

Optimal intelligent supervisory control system in cyber-physical intelligence

This paper studies Optimal Intelligent Supervisory Control System (OISCS) model for the design of control systems which can work in the presence of cyber-physical elements with privacy protection. The development of such architecture has the possibility of providing new ways of integrated control into systems where large amounts of fast computation are not easily available, either due to limitations on power, physical size or choice of computing elements.

Intelligent training in control centres based on an ambient intelligence paradigm

This article describes a new approach in the Intelligent Training of Operators in Power Systems Control Centres, considering the new reality of Renewable Sources, Distributed Generation, and Electricity Markets, under the emerging paradigms of Cyber-Physical Systems and Ambient Intelligence. We propose Intelligent Tutoring Systems as the approach to deal with the intelligent training of operators in these new circumstances.

Intelligent SCADA for load control

A supervisory control and data acquisition (SCADA) system is an integrated platform that incorporates several components and it has been applied in the field of power systems and several engineering applications to monitor, operate and control a lot of processes. In the future electrical networks, SCADA systems are essential for an intelligent management of resources like distributed generation and demand response, implemented in the smart grid context. This paper presents a SCADA system for a typical residential house. The application is implemented on MOVICON™11 software. The main objective is to manage the residential consumption, reducing or curtailing loads to keep the power consumption in or below a specified setpoint, imposed by the costumer and the generation availability.

Combining artificial intelligence techniques for the training of power system control centre operators

Control Centre operators are essential to assure a good performance of Power Systems. Operators’ actions are critical in dealing with incidents, especially severe faults, like blackouts. In this paper we present an Intelligent Tutoring approach for training Portuguese Control Centre operators in incident analysis and diagnosis, and service restoration of Power Systems, offering context awareness and an easy integration in the working environment.

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.

Influence of environmental temperature and humidity on the acute ventilatory response to exercise in asthmatic adolescents

Asthma is a chronic inflammatory disorder of the respiratory airways affecting people of all ages, and constitutes a serious public health problem worldwide (6). Such a chronic inflammation is invariably associated with injury and repair of the bronchial epithelium known as remodelling (11). Inflammation, remodelling, and altered neural control of the airways are responsible for both recurrent exacerbations of asthma and increasingly permanent airflow obstruction (11, 29, 34). Excessive airway narrowing is caused by altered smooth muscle behaviour, in close interaction with swelling of the airway walls, parenchyma retractile forces, and enhanced intraluminal secretions (29, 38). All these functional and structural changes are associated with the characteristic symptoms of asthma – cough, chest tightness, and wheezing –and have a significant impact on patients’ daily lives, on their families and also on society (1, 24, 29). Recent epidemiological studies show an increase in the prevalence of asthma, mainly in industrial countries (12, 25, 37). The reasons for this increase may depend on host factors (e.g., genetic disposition) or on environmental factors like air pollution or contact with allergens (6, 22, 29). Physical exercise is probably the most common trigger for brief episodes of symptoms, and is assumed to induce airflow limitations in most asthmatic children and young adults (16, 24, 29, 33). Exercise-induced asthma (EIA) is defined as an intermittent narrowing of the airways, generally associated with respiratory symptoms (chest tightness, cough, wheezing and dyspnoea), occurring after 3 to 10 minutes of vigorous exercise with a maximal severity during 5 to 15 minutes after the end of the exercise (9, 14, 16, 24, 33). The definitive diagnosis of EIA is confirmed by the measurement of pre- and post-exercise expiratory flows documenting either a 15% fall in the forced expiratory volume in 1 second (FEV1), or a ≥15 to 20% fall in peak expiratory flow (PEF) (9, 24, 29). Some types of physical exercise have been associated with the occurrence of bronchial symptoms and asthma (5, 15, 17). For instance, demanding activities such as basketball or soccer could cause more severe attacks than less vigorous ones such as baseball or jogging (33). The mechanisms of exercise-induced airflow limitations seem to be related to changes in the respiratory mucosa induced by hyperventilation (9, 29). The heat loss from the airways during exercise, and possibly its post-exercise rewarming may contribute to the exercise-induced bronchoconstriction (EIB) (27). Additionally, the concomitant dehydration from the respiratory mucosa during exercise leads to an increased interstitial osmolarity, which may also contribute to bronchoconstriction (4, 36). So, the risk of EIB in asthmatically predisposed subjects seems to be higher with greater ventilation rates and the cooler and drier the inspired air is (23). The incidence of EIA in physically demanding coldweather sports like competitive figure skating and ice hockey has been found to occur in up to 30 to 35% of the participants (32). In contrast, swimming is often recommended to asthmatic individuals, because it improves the functionality of respiratory muscles and, moreover, it seems to have a concomitant beneficial effect on the prevalence of asthma exacerbations (14, 26), supporting the idea that the risk of EIB would be smaller in warm and humid environments. This topic, however, remains controversial since the chlorified water of swimming pools has been suspected as a potential trigger factor for some asthmatic patients (7, 8, 20, 21). In fact, the higher asthma incidence observed in industrialised countries has recently been linked to the exposition to chloride (7, 8, 30). Although clinical and epidemiological data suggest an influence of humidity and temperature of the inspired air on the bronchial response of asthmatic subjects during exercise, some of those studies did not accurately control the intensity of the exercise (2, 13), raising speculation of whether the experienced exercise overload was comparable for all subjects. Additionally, most of the studies did not include a control group (2, 10, 19, 39), which may lead to doubts about whether asthma per se has conditioned the observed results. Moreover, since the main targeted age group of these studies has been adults (10, 19, 39), any extrapolation to childhood/adolescence might be questionable regarding the different lung maturation. Considering the higher incidence of asthma in youngsters (30) and the fact that only the works of Amirav and coworkers (2, 3) have focused on this age group, a scarcity of scientific data can be identified. Additionally, since the main environmental trigger factors, i.e., temperature and humidity, were tested separately (10, 28, 39) it would be useful to analyse these two variables simultaneously because of their synergic effect on water and heat loss by the airways (31, 33). It also appears important to estimate the airway responsiveness to exercise within moderate environmental ranges of temperature and humidity, trying to avoid extreme temperatures and humidity conditions used by others (2, 3). So, the aim of this study was to analyse the influence of moderate changes in air temperature and humidity simultaneously on the acute ventilatory response to exercise in asthmatic children. To overcome the above referred to methodological limitations, we used a 15 minute progressive exercise trial on a cycle ergometer at 3 different workload intensities, and we collected data related to heart rate, respiratory quotient, minute ventilation and oxygen uptake in order to ensure that physiological exercise repercussions were the same in both environments. The tests were done in a “normal” climatic environment (in a gymnasium) and in a hot and humid environment (swimming pool); for the latter, direct chloride exposition was avoided.