Programas de self-management em pacientes com DPOC: uma revisão sistemática

Introdução: Programas de self-management têm como objectivo habilitar os pacientes com estratégias necessárias para levar a cabo procedimentos específicos para a patologia. A última revisão sistemática sobre selfmanagament em DPOC foi realizada em 2007, concluindo-se que ainda não era possível fornecer dados claros e suficientes acerca de recomendações sobre a estrutura e conteúdo de programas de self-managament na DPOC. A presente revisão tem o intuito de complementar a análise da revisão anterior, numa tentativa de inferir a influência do ensino do self-management na DPOC. Objectivos: verificar a influência dos programas de self-management na DPOC, em diversos indicadores relacionados com o estado de saúde do paciente e na sua utilização dos serviços de saúde. Estratégia de busca: pesquisa efectuada nas bases de dados PubMed e Cochrane Collaboration (01/01/2007 – 31/08/2010). Palavras-chave: selfmanagement education, self-management program, COPD e pulmonary rehabilitation. Critérios de Selecção: estudos randomizados sobre programas de selfmanagement na DPOC. Extracção e Análise dos Dados: 2 investigadores realizaram, independentemente, a avaliação e extracção de dados de cada artigo. Resultados: foram considerados 4 estudos randomizados em selfmanagement na DPOC nos quais se verificaram benefícios destes programas em diversas variáveis: qualidade de vida a curto e médio prazo, utilização dos diferentes recursos de saúde, adesões a medicação de rotina, controle das exacerbações e diminuição da sintomatologia. Parece não ocorrer alteração na função pulmonar e no uso de medicação de emergência, sendo inconclusivo o seu efeito na capacidade de realização de exercício. Conclusões: programas de self-management aparentam ter impacto positivo na qualidade de vida, recurso a serviços de saúde, adesão à medicação, planos de acção e níveis de conhecimento da DPOC. Discrepâncias nos critérios de selecção das amostras utilizadas, períodos de seguimento desiguais, consistência das variáveis mensuradas, condicionam a informação disponibilizada sobre este assunto.

Using attractor dynamics to generate decentralized motion control of two mobile robots transporting a long object in coordination

Dynamical systems theory is used here as a theoretical language and tool to design a distributed control architecture for a team of two mobile robots that must transport a long object and simultaneously avoid obstacles. In this approach the level of modeling is at the level of behaviors. A “dynamics” of behavior is defined over a state space of behavioral variables (heading direction and path velocity). The environment is also modeled in these terms by representing task constraints as attractors (i.e. asymptotically stable states) or reppelers (i.e. unstable states) of behavioral dynamics. For each robot attractors and repellers are combined into a vector field that governs the behavior. The resulting dynamical systems that generate the behavior of the robots may be nonlinear. By design the systems are tuned so that the behavioral variables are always very close to one attractor. Thus the behavior of each robot is controled by a time series of asymptotically stable states. Computer simulations support the validity of our dynamic model architectures.

Meta-heuristics self-parameterization in a multi-agent scheduling system using case-based reasoning

This paper proposes a novel agent-based approach to Meta-Heuristics self-configuration. Meta-heuristics are algorithms with parameters which need to be set up as efficient as possible in order to unsure its performance. A learning module for self-parameterization of Meta-heuristics (MH) in a Multi-Agent System (MAS) for resolution of scheduling problems is proposed in this work. The learning module is based on Case-based Reasoning (CBR) and two different integration approaches are proposed. A computational study is made for comparing the two CBR integration perspectives. Finally, some conclusions are reached and future work outlined.

Stabilization constraints from different-average public debt levels in a Monetary Union with country-size asymmetry

In the sequence of the recent financial and economic crisis, the recent public debt accumulation is expected to hamper considerably business cycle stabilization, by enlarging the budgetary consequences of the shocks. This paper analyses how the average level of public debt in a monetary union shapes optimal discretionary fiscal and monetary stabilization policies and affects stabilization welfare. We use a two-country micro-founded New-Keynesian model, where a benevolent central bank and the fiscal authorities play discretionary policy games under different union-average debt-constrained scenarios. We find that high debt levels shift monetary policy assignment from inflation to debt stabilization, making cooperation welfare superior to noncooperation. Moreover, when average debt is too high, welfare moves directly (inversely) with debt-to-output ratios for the union and the large country (small country) under cooperation. However, under non-cooperation, higher average debt levels benefit only the large country.

Relatório de estágio em terapia manual

Objectivo: descrever a intervenção em fisioterapia numa paciente com diagnóstico de epicondilalgia. Participantes e Métodos: estudo de caso de uma paciente que desenvolveu um quadro doloroso no cotovelo esquerdo no início de Janeiro de 2010 e em que a intervenção de fisioterapia teve início no princípio de Fevereiro de 2010. Foi utilizada uma variedade de técnicas articulares, nomeadamente a mobilização com movimento de Mulligan, aplicação de tape e manipulação cervical. O tratamento foi realizado em dias alternados e teve a duração total de duas semanas. Resultados: logo no final da primeira sessão a paciente referiu melhoria na dor à preensão. Na segunda sessão a paciente demonstrou capacidade de realizar auto-mobilização com movimento em casa. A regressão dos sintomas foi muito rápida durante as duas primeiras sessões, passou por uma fase de estabilização da terceira à quinta sessão, até à completa remissão no fim da sexta sessão. Conclusão: o processo de raciocínio clínico desenvolvido pelo fisioterapeuta durante as seis sessões de tratamento foi salientado. Após a recolha dos dados relativos à história e sua interpretação levantaram-se as primeiras hipóteses: epicondilalgia, disfunção cervical ou sindroma do túnel radial. No exame objectivo foram realizados testes para permitir a obtenção do diagnóstico diferencial – epicondilalgia; elaborou-se então um plano de intervenção em colaboração a paciente, que se mostrou eficaz, com resultados acima das expectativas.

Influência da actividade do tronco inferior na sequência de activação muscular proximal durante o passo (fase de apoio) - em crianças com quadro motor diplegia

A marcha assegura uma progressão do corpo, compatível com o equilíbrio dinâmico e adaptada a potenciais factores destabilizadores, de um ponto de vista antecipatório, através de sinergias coordenadas entre os MSs, o tronco e os MIs. O tronco inferior tem um papel preponderante na marcha, sobretudo na estabilização necessária durante a fase de apoio. Esta actividade implica mobilidade pélvica e alongamento activo dos abdominais para conseguir a relação comprimento-tensão muscular óptima entre quadricípite e isquiotibiais, permitindo uma correcta sequência, timing e amplitude de activação. Nas crianças com alterações neuromotoras existem alterações no controlo do movimento e na estrutura do próprio movimento, alterando todo este processo. Como tal, este estudo tem como principal objectivo determinar a influência da actividade do tronco inferior na activação muscular proximal durante a fase de apoio da marcha, em crianças com quadro motor de diplegia, caracterizada por uma dificuldade na relação entre os membros e entre estes e o tronco. Para responder a este objectivo realizou-se um estudo de série de casos, com 2 crianças com quadro motor de diplegia. Efectuou-se EMG dos músculos abdominais, quadricípite e isquiotibiais e análise de imagem (para amplitude da CF) durante a marcha, em ambos os membros e em dois momentos de avaliação, separados por 2 meses, nos quais se realizou um protocolo de intervenção terapêutica adequado a cada caso. Os resultados indicam que a variação de amplitude da CF desde a fase de ataque ao solo à fase média de apoio é aproximadamente igual em M0e M1; concretamente, a amplitude inicial é inferior à de referência (pouca flexão) (melhor em M0) e a amplitude final é superior à de referência (pouca extensão) (melhor em M1). Estes resultados são idênticos em ambos os casos. Na EMG verificou-se uma actividade mais global e sincronizada de todos os músculos, mantendo-se aproximadamente a mesma percentagem de activação em M1, sobretudo no caso 1. No caso 2 verificou-se uma maior eficiência na variação da percentagem de activação dos abdominais, em M1, e dos isquiotibiais, à direita. Em conclusão, pode dizer-se que, em crianças com alterações neuromotoras (quadro motor de diplegia), uma actividade mais eficiente e sincronizada no tempo do tronco inferior, nomeadamente dos abdominais, contribui para uma maior capacidade de extensão da CF, durante a fase de apoio.

Abordagem ao risco de crédito no âmbito do acordo de Basileia III em Portugal

Dissertação para a obtenção do Grau de Mestre em Contabilidade e Finanças Orientador: Mestre Adalmiro Álvaro Malheiro de Castro Andrade Pereira

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.

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.

Case-based reasoning for meta-heuristics self-parameterization in a multi-agent scheduling system

A novel agent-based approach to Meta-Heuristics self-configuration is proposed in this work. Meta-heuristics are examples of algorithms where parameters need to be set up as efficient as possible in order to unsure its performance. This paper presents a learning module for self-parameterization of Meta-heuristics (MHs) in a Multi-Agent System (MAS) for resolution of scheduling problems. The learning is based on Case-based Reasoning (CBR) and two different integration approaches are proposed. A computational study is made for comparing the two CBR integration perspectives. In the end, some conclusions are reached and future work outlined.

Self-managing agents for dynamic scheduling in manufacturing

The main purpose of this paper is to propose a Multi-Agent Autonomic and Bio-Inspired based framework with selfmanaging capabilities to solve complex scheduling problems using cooperative negotiation. Scheduling resolution requires the intervention of highly skilled human problem-solvers. This is a very hard and challenging domain because current systems are becoming more and more complex, distributed, interconnected and subject to rapidly changing. A natural Autonomic Computing (AC) evolution in relation to Current Computing is to provide systems with Self-Managing ability with a minimum human interference.

Construção de um robô trepador com locomoção através de rodas e adesão através de meios magnéticos

Mestrado em Engenharia Electrotécnica e de Computadores

Evaluation of ochratoxin A exposure degree in two Portuguese cities through wheat and maize bread consumption during the winter 2007

The occurrence of OTA in fresh and packed wheat and in maize bread and the evaluation of the exposure degree through their consumption in two Portuguese populations from Porto and Coimbra, during the winter of 2007, were studied. One hundred and sixty eight bread samples, 61 maize and 107 wheat, were analysed by liquid chromatography–fluorescence detection (LC–FD). The results showed that 84% of samples were contaminated, with a maximum level of 3.85 ng/g (above the EU maximum limit, 3 ng/g). Fresh wheat bread presented higher levels than packed wheat bread. Moreover, the traditional maize bread, in either city, was consistently more contaminated than wheat bread, 0.25 vs 0.19 ng/g, and 0.48 vs 0.34 ng/ g for Porto and Coimbra, respectively. Avintes maize bread showed the highest mean contamination and maximum levels. The higher estimated daily intake of OTA from both types of bread in the population of Coimbra compared to Porto reflects the higher average contamination of bread in the first city.

Influence of wearing an unstable shoe construction on compensatory control of posture

This study investigated the influence of wearing unstable shoe construction (WUS) on compensatory postural adjustments (CPA) associated with external perturbations. Thirty-two subjects stood on a force platform resisting an anterior-posterior horizontal force applied to a pelvic belt via a cable, which was suddenly released. They stood under two conditions: barefoot and WUS. The electromyographic (EMG) activity of gastrocnemius medialis, tibialis anterior, rectus femoris, biceps femoris, rectus abdominis, and erector spinae muscles and the center of pressure (CoP) displacement were acquired to study CPA. The EMG signal was used to assess individual muscle activity and latency, antagonist co-activation and reciprocal activation at joint and muscle group levels. Compared to barefoot, WUS led to: (1) increased gastrocnemius medialis activity, (2) increased total agonist activity, (3) decreased antagonist co-activation at the ankle joint and muscle group levels, (4) increased reciprocal activation at the ankle joint and muscle group levels, and (5) decrease in all muscle latencies. No differences were observed in CoP displacement between conditions. These findings demonstrate that WUS led to a reorganization of the postural control system associated to improved performance of some components of postural control responses.

Influence of long-term wearing of unstable shoes on compensatory control of posture: An electromyography-based analysis

Purpose: This study investigated the influence of long-term wearing of unstable shoes (WUS) on compensatory postural adjustments (CPA) to an external perturbation. Methods: Participants were divided into two groups: one wore unstable shoes while the other wore conventional shoes for 8 weeks. The ground reaction force signal was used to calculate the anterior– posterior (AP) displacement of the centre of pressure (CoP) and the electromyographic signal of gastrocnemius medialis (GM), tibialis anterior (TA), rectus femoris (RF) and biceps femoris (BF) muscles was used to assess individual muscle activity, antagonist co-activation and reciprocal activation at the joint (TA/GM and RF/(BF + GM) pairs) and muscle group levels (ventral (TA + RF)/dorsal (GM + BF) pair) within time intervals typical for CPA. The electromyographic signal was also used to assess muscle latency. The variables described were evaluated before and after the 8-week period while wearing the unstable shoes and barefoot. Results: Long-term WUS led to: an increase of BF activity in both conditions (barefoot and wearing the unstable shoes); a decrease of GM activity; an increase of antagonist co-activation and a decrease of reciprocal activation level at the TA/GM and ventral/dorsal pairs in the unstable shoe condition. Additionally, WUS led to a decrease in CoP displacement. However, no differences were observed in muscle onset and offset. Conclusion: Results suggest that the prolonged use of unstable shoes leads to increased ankle and muscle groups’ antagonist co-activation levels and higher performance by the postural control system.