Relatório de estágio em terapia manual ortopédica

Este estudo visa descrever o caso de um paciente de 63 anos que recorreu aos serviços de Fisioterapia após uma crise de lombalgia com 3 dias de evolução. O doente apresentava dor intensa situada entre a zona lombar e sacro-ilíaca direita (7/10-EVA), irradiando pelas cristas ilíacas, virilha e face anterior da coxa direita. A intervenção dividiu-se em duas fases: aguda e sub-aguda. A primeira exigiu uma abordagem limitada e essencialmente orientada para a mecânica articular, em que foram utilizadas técnicas de terapia manual. A segunda, com um quadro clínico menos doloroso, permitiu avaliar o comprometimento de outras estruturas, nomeadamente miofasciais e neurológicas. Entre as várias etiologias possíveis, foram encontrados sinais e sintomas consistentes com síndroma miofascial do músculo Psoas ilíaco. A intervenção incluiu técnicas de terapia manual, exercício terapêutico e educação do paciente. No final de 9 semanas de tratamento o paciente mantém limitações mínimas relacionadas com a mecânica articular que se traduzem pela sensibilidade em L4-L5 (3/10), e observa-se uma atitude menos sedentária comparativamente ao que se apurou antes desta ocorrência. A abordagem terapêutica foi fundamentada pela anatomia, biomecânica e raciocínio clínico, tendo em conta a evidência científica, experiência clínica e factores psico-sociais.

O impacto de um programa de exercícios com o Inspirómetro de Incentivo na função pulmonar em doentes com Escoliose Idiopática

Introdução: A escoliose é uma deformidade vertebral muito comum e de grande importância social. A etiologia da escoliose idiopática da adolescência é desconhecida e descrita como multifatorial. Segundo a literatura existe uma forte correlação entre a função pulmonar anormal e a gravidade da deformidade da coluna vertebral. Tem sido proposto como abordagem terapêutica o uso de Inspirómetro de Incentivo, contudo, ainda se encontra incerto a sua eficácia nesta patologia. Objetivo: Analisar o impacto de um programa de exercícios domiciliários com o Inspirómetro de Incentivo em doentes com Escoliose Idiopática nos volumes pulmonares e na força muscular dos músculos respiratórios. Metodologia: Foram avaliados, por meio de um estudo experimental, 12 indivíduos do sexo feminino (com média e desvio padrão correspondentes a 15,1 e 1,6 respetivamente) com diagnóstico de Escoliose Idiopática antes e 3meses após a cirurgia corretiva e 12 indivíduos saudáveis também do sexo feminino (com média e desvio padrão correspondentes a 15,2 e 1,4 respetivamente). A função pulmonar foi avaliada através do espirómetro computorizado Spinolab®, a força dos músculos respiratórios avaliou-se através da mensuração da PImáx e PEmáx com o Microrpm®. Para finalizar a avaliação o participante foi sujeito a aplicação do THRESHOLD® com 30% da PImáx obtida. O protocolo domiciliário, referente à parte experimental, baseou-se no uso bi-diário do Inspirómetro de Incentivo Respiflo FS®, que foi fornecido aos participantes no dia da alta hospitalar. Resultados: Foram encontrados valores menores da função respiratória e força muscular (p<0,05) no grupo de doentes com Escoliose em relação ao grupo dos Saudáveis, excepto em relação ao Índice de Tiffeneau (p=0,17). No entanto, quando se comparou o grupo Controlo e o Grupo Experimental não severificaram diferenças estatisticamente significativas em relação às variáveis estudadas. Por fim, na análise dos parâmetros nos dois momentos de avaliação (inicial e final) entre o grupo dos Saudáveis e grupo Experimental verificou-se que existiam diferenças estatisticamente significativas ao nível da CFV (pi=0,02; pf=0,00), FEV1 (pi=0,01; pf=0,00) e PImáx inicial (p=0,02) e PImáx th inicial (p=0,03). Conclusão: A função pulmonar e a força dos músculos respiratórios em indivíduos com diagnóstico de Escoliose Idiopática encontra-se diminuída quando comparada com uma população saudável. Dentro das condições propostas no presente estudo, verificou-se que a aplicação de um programa de exercícios com o Inspirómetro de Incentivo com duração de 3 meses não revela resultados significativos ao nível da função pulmonar e da força dos músculos respiratórios.

Nanotechnology and antioxidant therapy: An emerging approach for neurodegenerative diseases

The efficacy, cellular uptake and specific transport of dietary antioxidants to target organs, tissues and cells remains the most important setback for their application in the treatment of oxidative-stress related disorders and in particular in neurodegenerative diseases, as brain targeting remains a still unsolved challenge. Nanotechnology based delivery systems can be a solution for the above mentioned problems, specifically in the case of targeting dietary antioxidants with neuroprotective activity. Nanotechnology-based delivery systems can protect antioxidants from degradation, improve their physicochemical drug-like properties and in turn their bioavailability. The impact of nanomedicine in the improvement of the performance of dietary antioxidants, as protective agents in oxidative- stress events, specifically through the use of drug delivery systems, is highlighted in this review as well as the type of nanomaterials regularly used for drug delivery purposes. From the data one can conclude that the research combining (dietary) antioxidants and nanotechnology, namely as a therapeutic solution for neurodegenerative diseases, is still in a very early stage. So, a huge research area remains to be explored that hopefully will yield new and effective neuroprotective therapeutic agents in a foreseeable future.

Thinking over b‐learning strategy: the MIPO model approach

This article describes the main research results in a new methodology, in which the stages and strategies of the technology integration process are identified and described. A set of principles and recommendations are therefore presented. The MIPO model described in this paper is a result of the effort made regarding the understanding of the main success features of good practices, in the web environment, integrated in the information systems/information technology context. The initial model has been created, based on experiences and literature review. After that, it was tested in the information and technology system units at higher school and also adapted as a result of four cycles of an actionresearch work combined with a case study research. The information, concepts and procedures presented here give support to teachers and instructors, instructional designers and planning teams – anyone who wants to develop effective b‐learning instructions.

Representations of gender in the writings of St. Francis Xavier: an interdisciplinary approach

Francis Xavier’s Letters and Writings are eloquent narratives of a journey that absorbed the Saint’s entire life. His experiences and idiosyncrasies, values and categorizations are presented in a clear literate discourse. The missionary is rarely neutral in his opinions as he sustains his unmistakable and omnipresent objective: the conversion of peoples and the expansion of the Society of Jesus. Parallel with this objective, the reader is introduced to the individuals that Xavier meets or that he summons in his epistolary discourse. Letters and Writings presents us with a structured narrative peopled by all those who are subject to and objects of Xavier’s apostolic mission, by helpful and unhelpful persons of influence, and by leading and secondary actors. What is then the position of women, in the collective sense as well as in the individual sense, in the travels and goals that are the centre of Xavier’s Letters and Writings? What is the role of women, that secondary and suppressed term in the man/woman binomial, a dichotomy similar to the civilized/savage and European/native binomials that punctuate Xavier’s narratives and the historic context of his letters? Women are not absent from his writings, but it would be naïve to argue in favour of the author’s misogyny as much as of his “profound knowledge of the female heart”, to quote from Paulo Durão in "Women in the Letters of Saint Francis Xavier" (1952), the only paper on this subject published so far. We denote four great categories of women in the Letters and Writings: European Women, Converted Women, Women Who Profess another Religion, and Women as the Agents and Objects of Sin, the latter of which traverses the other three categories. They all depend on the context, circumstances and judgements of value that the author chooses to highlight and articulate.

Gestão de carreiras dos profissionais de saúde

Com a reforma da Administração Pública, implementada de forma mais integrada e abrangente pelo Governo socialista de José Sócrates (XVII Governo Constitucional), foi iniciada a reformulação das carreiras dos profissionais de saúde, nomeadamente a carreira médica e a carreira de enfermagem, continuando-se a aguardar a reformulação das carreiras dos técnicos superiores de saúde e dos técnicos de diagnóstico e terapêutica. As inúmeras mudanças que decorrem destas reformulações têm criado por sua vez um clima de receio e expectativa junto dos profissionais de saúde, o que aliado a um período de contingência e recessão económica, tem causado uma certa instabilidade. Embora fosse de reconhecimento geral que a anterior forma como se geria as carreiras dos profissionais de saúde, utilizando como critérios de progressão mecanismos automatizados com foco na antiguidade, não fosse a mais correcta, uma vez que não cumpria princípios de justiça e meritocracia, são agora levantadas inúmeras dúvidas com estas reformulações. A questão principal é se efectivamente virão dar resposta à necessidade de uma maior flexibilidade na evolução profissional, mais adequada aos contributos de cada colaborador, potenciando o desenvolvimento de competências. Concluiu-se então que as reformulações efectuadas nas carreiras dos profissionais de saúde não incentivam totalmente o desenvolvimento de competências ao longo da carreira, mas permitem de alguma forma uma maior flexibilidade na evolução profissional; possibilitando que esta se desenvolva de acordo com os contributos de cada colaborador, apesar de grandes entraves na aplicação à prática. A verdade é que não se conseguem atingir resultados somente através de resoluções por decreto, falta a transformação deste sistema meritocrático, existente no plano formal, numa prática social meritocrática. Para isso em todas as reformulações que ocorram deve-se, primeiro de tudo, sensibilizar os colaboradores para essa necessidade, informar e esclarecer dúvidas, ouvir as suas sugestões e incluí-los no processo de mudança. Só dessa forma se irá conseguir a sua aceitação, o seu apoio e implementar efectivamente novas práticas. Nesse sentido, espera-se que este trabalho contribua para um maior conhecimento acerca da gestão de carreiras, gestão de competências, avaliação de desempenho e meritocracia, bem como das alterações legislativas que têm vindo a ocorrer, sensibilizando para a necessidade de se efectuarem realmente reformulações nas carreiras dos profissionais de saúde, mas também promovendo o desenvolvimento de uma atitude pró-activa para que estas sejam mais meritocráticas.

An heuristic approach for optimal location of gas supply units in transportation system

The best places to locate the Gas Supply Units (GSUs) on a natural gas systems and their optimal allocation to loads are the key factors to organize an efficient upstream gas infrastructure. The number of GSUs and their optimal location in a gas network is a decision problem that can be formulated as a linear programming problem. Our emphasis is on the formulation and use of a suitable location model, reflecting real-world operations and constraints of a natural gas system. This paper presents a heuristic model, based on lagrangean approach, developed for finding the optimal GSUs location on a natural gas network, minimizing expenses and maximizing throughput and security of supply.The location model is applied to the Iberian high pressure natural gas network, a system modelised with 65 demand nodes. These nodes are linked by physical and virtual pipelines – road trucks with gas in liquefied form. The location model result shows the best places to locate, with the optimal demand allocation and the most economical gas transport mode: by pipeline or by road truck.

A real time pricing approach to deal with excessive wind power situations

The introduction of wind power generation in several countries around the world, including in European countries, where energy policy directives have encouraged the use of renewables, led to several changes in market and power systems operation. The intensive integration of these sources has led to situations in which the demand is lower than the available renewable resources. In these situations a part of the available generation is wasted if not used for storage or to supply additional demand. This paper proposes a real time demand response methodology based on changing the electricity price for the consumers expecting an increase in the demand in the periods in which that demand is lower than the available renewable generation. The consumers response to the changes in electricity price is characterized by their price elasticity of demand considered distinct for each consumer type. The proposed methodology is applied to the Portuguese power system, in the context of the Iberian electricity market (MIBEL). The renewable-based producers are considered as special producers, with special tariffs, and so it is important to use the energy available as it will be paid anyway. In this context, consumers are entities actively participating in the operation of the market.

A multi-agent based approach for intelligent smart grid management

The spread and globalization of distributed generation (DG) in recent years has should highly influence the changes that occur in Electricity Markets (EMs). DG has brought a large number of new players to take action in the EMs, therefore increasing the complexity of these markets. Simulation based on multi-agent systems appears as a good way of analyzing players’ behavior and interactions, especially in a coalition perspective, and the effects these players have on the markets. MASCEM – Multi-Agent System for Competitive Electricity Markets was created to permit the study of the market operation with several different players and market mechanisms. MASGriP – Multi-Agent Smart Grid Platform is being developed to facilitate the simulation of micro grid (MG) and smart grid (SG) concepts with multiple different scenarios. This paper presents an intelligent management method for MG and SG. The simulation of different methods of control provides an advantage in comparing different possible approaches to respond to market events. Players utilize electric vehicles’ batteries and participate in Demand Response (DR) contracts, taking advantage on the best opportunities brought by the use of all resources, to improve their actions in response to MG and/or SG requests.

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.

Intelligent energy resource management considering vehicle-to-grid: A simulated annealing approach

This paper proposes a simulated annealing (SA) approach to address energy resources management from the point of view of a virtual power player (VPP) operating in a smart grid. Distributed generation, demand response, and gridable vehicles are intelligently managed on a multiperiod basis according to V2G user´s profiles and requirements. Apart from using the aggregated resources, the VPP can also purchase additional energy from a set of external suppliers. The paper includes a case study for a 33 bus distribution network with 66 generators, 32 loads, and 1000 gridable vehicles. The results of the SA approach are compared with a methodology based on mixed-integer nonlinear programming. A variation of this method, using ac load flow, is also used and the results are compared with the SA solution using network simulation. The proposed SA approach proved to be able to obtain good solutions in low execution times, providing VPPs with suitable decision support for the management of a large number of distributed resources.

An integrated approach for distributed energy resource short term scheduling in smart grids considering realistic power system simulation

The large increase of distributed energy resources, including distributed generation, storage systems and demand response, especially in distribution networks, makes the management of the available resources a more complex and crucial process. With wind based generation gaining relevance, in terms of the generation mix, the fact that wind forecasting accuracy rapidly drops with the increase of the forecast anticipation time requires to undertake short-term and very short-term re-scheduling so the final implemented solution enables the lowest possible operation costs. This paper proposes a methodology for energy resource scheduling in smart grids, considering day ahead, hour ahead and five minutes ahead scheduling. The short-term scheduling, undertaken five minutes ahead, takes advantage of the high accuracy of the very-short term wind forecasting providing the user with more efficient scheduling solutions. The proposed method uses a Genetic Algorithm based approach for optimization that is able to cope with the hard execution time constraint of short-term scheduling. Realistic power system simulation, based on PSCAD , is used to validate the obtained solutions. The paper includes a case study with a 33 bus distribution network with high penetration of distributed energy resources implemented in PSCAD .

An intelligent tutoring approach to support students and technicians in electrical installation design

Designing electric installation projects, demands not only academic knowledge, but also other types of knowledge not easily acquired through traditional instructional methodologies. A lot of additional empirical knowledge is missing and so the academic instruction must be completed with different kinds of knowledge, such as real-life practical examples and simulations. On the other hand, the practical knowledge detained by the most experienced designers is not formalized in such a way that is easily transmitted. In order to overcome these difficulties present in the engineers formation, we are developing an Intelligent Tutoring System (ITS), for training and support concerning the development of electrical installation projects to be used by electrical engineers, technicians and students.

A new approach for multi-agent coalition formation and management in the scope of electricity markets

This paper presents a new methodology for the creation and management of coalitions in Electricity Markets. This approach is tested using the multi-agent market simulator MASCEM, taking advantage of its ability to provide the means to model and simulate VPP (Virtual Power Producers). VPPs are represented as coalitions of agents, with the capability of negotiating both in the market, and internally, with their members, in order to combine and manage their individual specific characteristics and goals, with the strategy and objectives of the VPP itself. The new features include the development of particular individual facilitators to manage the communications amongst the members of each coalition independently from the rest of the simulation, and also the mechanisms for the classification of the agents that are candidates to join the coalition. In addition, a global study on the results of the Iberian Electricity Market is performed, to compare and analyze different approaches for defining consistent and adequate strategies to integrate into the agents of MASCEM. This, combined with the application of learning and prediction techniques provide the agents with the ability to learn and adapt themselves, by adjusting their actions to the continued evolving states of the world they are playing in.