Fatores de prognóstico para os resultados de sucesso da fisioterapia multimodal em utentes com dor cervical crónica

RESUMO: Introdução: O conhecimento acerca da influência das características dos indivíduos com dor cervical crónica (DCC) no prognóstico dos resultados alcançados com a Fisioterapia é ainda inconsistente, sendo escassos os estudos desenvolvidos neste âmbito. Objetivo: Este relatório pretende determinar se um modelo baseado em fatores de prognóstico é capaz de prever os resultados de sucesso da Fisioterapia, a curto prazo, em utentes com DCC, ao nível da incapacidade funcional, intensidade da dor e perceção global de melhoria. Metodologia: Trata-se de estudo de coorte prospetivo com 112 participantes. Os utentes foram avaliados na primeira semana de tratamento e sete semanas após o início da intervenção. Os instrumentos utilizados foram o Neck Disability Index–Versão Portuguesa (NDI-PT) e a Escala Numérica da Dor (END) nos dois momentos de avaliação, um Questionário de Caracterização Sociodemográfica e Clínica da Amostra na baseline e a Patient Global Impression Change Scale–Versão Portuguesa (PGIC-PT) no follow-up. As características sociodemográficas e clínicas foram incluídas como potenciais fatores de prognóstico e estes foram definidos com base nas diferenças mínimas clinicamente importantes (DMCI) dos instrumentos NDIPT (DMCI≥6) e END (DMCI≥2) e no critério de pontuação ≥5 na PGIC-PT. A análise dos dados foi realizada através do método de regressão logística (backward conditional procedure) para identificar as associações entre os indicadores e as variáveis de resultado (p<0.05). Resultados: Dos 112 participantes incluídos no estudo, 108 completaram o follow-up (média de idade: 51.76±10.19). No modelo multivariado relativo à incapacidade funcional, os resultados de sucesso encontram-se associados a elevados níveis de incapacidade na baseline (OR=1.123; 95% IC 1.056–1.194) e a duração da dor inferior a 12 meses (OR=2.704; 95% IC 1.138–6.424). Este modelo explica 30.0% da variância da melhoria da funcionalidade e classifica corretamente 74.1% dos utentes (sensibilidade: 75.9%; especificidade: 72.0%). O modelo relativo à intensidade da dor identificou apenas a associação do outcome com níveis elevados de intensidade da dor na baseline (OR=1.321; 95% IC 1.047–1.668), explicando 7.5% da variância da redução da mesma e classificando corretamente 68.2% dos utentes (sensibilidade: 94.4%; especificidade: 16.7%). O modelo final referente à perceção global de melhoria apresentou uma associação com a intensidade da dor na baseline (OR=0.621; 95% IC 0.465–0.829), com a presença de cefaleias e/ou tonturas (OR=2.538; 95% IC 0.987–6.526) e com a duração da dor superior a 12 meses (OR=0.279; 95% IC 0.109–0.719). Este modelo explica 27.5% da variância dos resultados de sucesso para este outcome e classifica corretamente 73.1% dos utentes (sensibilidade: 81.8%; especificidade: 59.5%). Conclusões: Utentes com DCC com elevada incapacidade na baseline e queixas de dor há menos de 12 meses apresentam maior probabilidade de obter melhorias ao nível da incapacidade funcional. Elevados níveis de intensidade da dor na baseline predizem resultados de sucesso na redução da dor após sete semanas de tratamento. Utentes com DCC com baixos níveis de dor na baseline, com cefaleias e/ou tonturas e com queixas de dor há mais de 12 meses apresentam maior probabilidade de obter uma melhor perceção de melhoria.--------------- ABSTRACT:Introduction: The influence of the characteristics of individuals with chronic neck pain (CNP) on the prognosis of physiotherapy outcomes is still inconsistent, there being few studies developed in this context. Aim: This study seeks to determine whether a model based on prognostic factors can predict the short-term physiotherapy successful outcomes in CNP patients, regarding functional disability, pain intensity and perceived recovery. Methodology: This is a prospective cohort study with 112 participants. Patients were assessed during the first week of treatment and seven weeks after the start of the intervention. The instruments used were the Neck Disability Index–Portuguese Version (NDI-PT) and the Numerical Rating Scale (NRS) at both moments of assessment, a Sample Sociodemographic and Clinical Characterization Questionnaire at baseline and Patient Global Impression Change Scale–Portuguese Version (PGIC-PT) at the follow-up. The sociodemographic and clinical characteristics were included as potential predictors of successful outcomes, and these were defined on the basis of minimal clinically important differences (MCID) of NDI-PT (MCID≥6) and END (MCID≥2) and the criteria score ≥5 on the PGIC-PT. Data analysis was performed using logistic regression (backward conditional procedure) to identify associations between predictors and outcomes (p<0.05). Results: Of the 112 participants included in the study, 108 completed the follow-up (mean age: 51.76±10.19). In the multivariate model of functional disability, the successful outcomes are associated with high levels of disability at baseline (OR = 1.123; 95% CI 1.056-1.194), and pain duration shorter than 12 months (OR=2.704; 95% CI 1.138–6.424). This model explains 30.0% of the variance of improved functional capacity and correctly classifies 74.1% of the patients (sensitivity: 75.9%, specificity: 72.0%). The model for pain intensity solely identified an outcome association with high pain intensity at baseline (OR=1.321; 95% CI 1.047-1.668), explaining 7.5% of the variance of pain reduction and correctly classifying 68.2% of the patients (sensitivity: 94.4%, specificity: 16.7%). The final model of perceived recovery showed an association with pain intensity at baseline (OR=0.621; 95% CI 0465-0829), with the presence of headache and/or dizziness (OR=2.538; 95% CI 0.987-6.526) and the duration of pain over 12 months (OR=0.279; 95% CI 0.109-0.719). This model explains 27.5% of the variance of successful outcomes and correctly classifies 73.1% of the patients (sensitivity: 81.8%, specificity: 59.5%). Conclusions: Patients with CNP with high disability at baseline and complaints of pain for less than 12 months are more likely to obtain improvements in functional disability. High levels of pain intensity at baseline predict successful outcomes in pain reduction after seven weeks of treatment. Patients with CNP with low levels of pain at baseline, with headache and/or dizziness and with pain complaints for more than 12 months are more likely to get a better perceived recovery.

Curso clínico da dor lombar crónica após alta da fisioterapia : trajetórias de dor no follow-up aos quatro e seis meses

RESUMO:Introdução: O conhecimento acerca da influência das características dos indivíduos com dor cervical crónica (DCC) no prognóstico dos resultados alcançados com a Fisioterapia é ainda inconsistente, sendo escassos os estudos desenvolvidos neste âmbito. Objetivo: Este relatório pretende determinar se um modelo baseado em fatores de prognóstico é capaz de prever os resultados de sucesso da Fisioterapia, a curto prazo, em utentes com DCC, ao nível da incapacidade funcional, intensidade da dor e perceção global de melhoria. Metodologia: Trata-se de estudo de coorte prospetivo com 112 participantes. Os utentes foram avaliados na primeira semana de tratamento e sete semanas após o início da intervenção. Os instrumentos utilizados foram o Neck Disability Index–Versão Portuguesa (NDI-PT) e a Escala Numérica da Dor (END) nos dois momentos de avaliação, um Questionário de Caracterização Sociodemográfica e Clínica da Amostra na baseline e a Patient Global Impression Change Scale–Versão Portuguesa (PGIC-PT) no follow-up. As características sociodemográficas e clínicas foram incluídas como potenciais fatores de prognóstico e estes foram definidos com base nas diferenças mínimas clinicamente importantes (DMCI) dos instrumentos NDIPT (DMCI≥6) e END (DMCI≥2) e no critério de pontuação ≥5 na PGIC-PT. A análise dos dados foi realizada através do método de regressão logística (backward conditional procedure) para identificar as associações entre os indicadores e as variáveis de resultado (p<0.05). Resultados: Dos 112 participantes incluídos no estudo, 108 completaram o follow-up (média de idade: 51.76±10.19). No modelo multivariado relativo à incapacidade funcional, os resultados de sucesso encontram-se associados a elevados níveis de incapacidade na baseline (OR=1.123; 95% IC 1.056–1.194) e a duração da dor inferior a 12 meses (OR=2.704; 95% IC 1.138–6.424). Este modelo explica 30.0% da variância da melhoria da funcionalidade e classifica corretamente 74.1% dos utentes (sensibilidade: 75.9%; especificidade: 72.0%). O modelo relativo à intensidade da dor identificou apenas a associação do outcome com níveis elevados de intensidade da dor na baseline (OR=1.321; 95% IC 1.047–1.668), explicando 7.5% da variância da redução da mesma e classificando corretamente 68.2% dos utentes (sensibilidade: 94.4%; especificidade: 16.7%). O modelo final referente à perceção global de melhoria apresentou uma associação com a intensidade da dor na baseline (OR=0.621; 95% IC 0.465–0.829), com a presença de cefaleias e/ou tonturas (OR=2.538; 95% IC 0.987–6.526) e com a duração da dor superior a 12 meses (OR=0.279; 95% IC 0.109–0.719). Este modelo explica 27.5% da variância dos resultados de sucesso para este outcome e classifica corretamente 73.1% dos utentes (sensibilidade: 81.8%; especificidade: 59.5%). Conclusões: Utentes com DCC com elevada incapacidade na baseline e queixas de dor há menos de 12 meses apresentam maior probabilidade de obter melhorias ao nível da incapacidade funcional. Elevados níveis de intensidade da dor na baseline predizem resultados de sucesso na redução da dor após sete semanas de tratamento. Utentes com DCC com baixos níveis de dor na baseline, com cefaleias e/ou tonturas e com queixas de dor há mais de 12 meses apresentam maior probabilidade de obter uma melhor perceção de melhoria.-----------ABSTRACT: Introduction: The influence of the characteristics of individuals with chronic neck pain (CNP) on the prognosis of physiotherapy outcomes is still inconsistent, there being few studies developed in this context. Aim: This study seeks to determine whether a model based on prognostic factors can predict the short-term physiotherapy successful outcomes in CNP patients, regarding functional disability, pain intensity and perceived recovery. Methodology: This is a prospective cohort study with 112 participants. Patients were assessed during the first week of treatment and seven weeks after the start of the intervention. The instruments used were the Neck Disability Index–Portuguese Version (NDI-PT) and the Numerical Rating Scale (NRS) at both moments of assessment, a Sample Sociodemographic and Clinical Characterization Questionnaire at baseline and Patient Global Impression Change Scale–Portuguese Version (PGIC-PT) at the follow-up. The sociodemographic and clinical characteristics were included as potential predictors of successful outcomes, and these were defined on the basis of minimal clinically important differences (MCID) of NDI-PT (MCID≥6) and END (MCID≥2) and the criteria score ≥5 on the PGIC-PT. Data analysis was performed using logistic regression (backward conditional procedure) to identify associations between predictors and outcomes (p<0.05). Results: Of the 112 participants included in the study, 108 completed the follow-up (mean age: 51.76±10.19). In the multivariate model of functional disability, the successful outcomes are associated with high levels of disability at baseline (OR = 1.123; 95% CI 1.056-1.194), and pain duration shorter than 12 months (OR=2.704; 95% CI 1.138–6.424). This model explains 30.0% of the variance of improved functional capacity and correctly classifies 74.1% of the patients (sensitivity: 75.9%, specificity: 72.0%). The model for pain intensity solely identified an outcome association with high pain intensity at baseline (OR=1.321; 95% CI 1.047- 1.668), explaining 7.5% of the variance of pain reduction and correctly classifying 68.2% of the patients (sensitivity: 94.4%, specificity: 16.7%). The final model of perceived recovery showed an association with pain intensity at baseline (OR=0.621; 95% CI 0465-0829), with the presence of headache and/or dizziness (OR=2.538; 95% CI 0.987-6.526) and the duration of pain over 12 months (OR=0.279; 95% CI 0.109- 0.719). This model explains 27.5% of the variance of successful outcomes and correctly classifies 73.1% of the patients (sensitivity: 81.8%, specificity: 59.5%). Conclusions: Patients with CNP with high disability at baseline and complaints of pain for less than 12 months are more likely to obtain improvements in functional disability. High levels of pain intensity at baseline predict successful outcomes in pain reduction after seven weeks of treatment. Patients with CNP with low levels of pain at baseline, with headache and/or dizziness and with pain complaints for more than 12 months are more likely to get a better perceived recovery.

Multipacket reception in the presence of in-band full-duplex communication

In-Band Full-DupleX (IB-FDX) is defined as the ability for nodes to transmit and receive signals simultaneously on the same channel. Conventional digital wireless networks do not implement it, since a node’s own transmission signal causes interference to the signal it is trying to receive. However, recent studies attempt to overcome this obstacle, since it can potentially double the spectral efficiency of current wireless networks. Different mechanisms exist today that are able to reduce a significant part of the Self- Interference (SI), although specially tuned Medium Access Control (MAC) protocols are required to optimize its use. One of IB-FDX’s biggest problems is that the nodes’ interference range is extended, meaning the unusable space for other transmissions and receptions is broader. This dissertation proposes using MultiPacket Reception (MPR) to address this issue and adapts an already existing Single-Carrier with Frequency-Domain Equalization (SC-FDE) receiver to IB-FDX. The performance analysis suggests that MPR and IB-FDX have a strong synergy and are able to achieve higher data rates, when used together. Using analytical models, the optimal transmission patterns and transmission power were identified, which maximize the channel capacity with the minimal energy consumption. This was used to define a new MAC protocol, named Full-duplex Multipacket reception Medium Access Control (FM-MAC). FM-MAC was designed for a single-hop cellular infrastructure, where the Access Point (AP) and the terminals implement both IB-FDX and MPR. It divides the coverage range of the AP into a closer Full-DupleX (FDX) zone and a farther Half-DupleX (HDX) zone and adds a tunable fairness mechanism to avoid terminal starvation. Simulation results show that this protocol provides efficient support for both HDX and FDX terminals, maximizing its capacity when more FDX terminals are used.

Cylindrical spinning rotor gauge — A new approach for vacuum measurement

The spinning rotor gauge (SRG) is one of the most interesting vacuum gauges ever made, covering a pressure range of over seven orders of magnitude, with minimal gas interference (no pumping, ionization or heating of the measured gas), and a great stability of less than 1% drift per year. But despite its remarkable properties, apparently the SRG has not been further developed since the eighties, when it gained commercial interest. In this context, this dissertation aims at providing a starting point for a new line of investigation regarding this instrument, focused on the rotor itself. A brief study of different rotor geometries is provided, including a comparison between a cylindrical rotor and a spherical one. A cylindrical spinning rotor gauge (CSRG) is then proposed, based on the original SRG, but requiring a completely new lateral damping system. A prototype was built and tested against a non calibrated reference gauge.

Analysis and Treatment of a male portrait in oil and a study of the size layer with reconstructions from Vibert’s recipe (1892)

This thesis project concentrated on both the study and treatment of an early 20th century male portrait in oil from Colecção Caixa Geral de Depósitos, Lisbon, Portugal. The portrait of Januário Correia de Almeida, exhibits a tear (approximately 4.0 cm by 2.3 cm) associated with paint loss on the right upper side, where it is possible to observe an unusually thick size layer (approximately 50 microns) and an open weave mesh canvas. Size layers made from animal glue remain subject to severe dimensional changes due to changes in relative humidity (RH), thereby affecting the stability of the painting. In this case, the response to moisture of the size layer is minimal and the painting is largely uncracked with very little active flaking. This suggests that the size layer has undergone pre-treatment to render it unresponsive to moisture or water. Reconstructions based on late nineteenth century recipes using historically appropriate materials are used to explore various options for modifying the characteristics of gelatine, some of which may relate to the Portrait’s size layer. The thesis is separated into two parts: Part 1: Describes the history, condition, materials and techniques of the painting. It also details the treatment of Januário Correia de Almeida as well as the choices made and problems encountered during the treatment. Part 2: Discusses the history of commercial gelatine production, the choice of the appropriate animal source to extract the collagen to produce reconstructions of the portrait’s size layer as well as the characterization of selected reconstructions. The execution of a shallow textured infill led to one publication and one presentation: Abstract accepted for presentation and publication, International Meeting on Retouching of Cultural Heritage (RECH3), Francisco Brites, Leslie Carlyle and Raquel Marques, ‘’Hand building a Low Profile Textured Fill for a Large Loss’’.

O entendimento do espaço em Ângelo de Sousa a dança‑minimalista e a experiência do observador‑experimentador

Ângelo de Sousa (1938-2011) mereceu a denominação de “experimentador”, e é sob a lente da “experimentação” que olhámos para o seu percurso, e mais especificamente para o filme experimental Chão de Cimento (1) (1972), em Super 8, com cerca de 4’43’’ (cor e sem som). Este ensaio é marcado por dois objectivos principais. Em primeiro lugar, procura perceber o que é a experimentação no trabalho de Ângelo de Sousa, partindo da definição de experimentação de José Gil, e entender qual a relação desta com Chão de Cimento (1). E em segundo lugar, procura ainda analisar a relação da arte minimal com o filme em estudo e com a restante produção artística de Ângelo de Sousa. Neste contexto, cumpre destacar que, tal como desenvolvido no ensaio “Art and Objecthood” (1976) de Michael Fried, a experiência do observador-experimentador no trabalho de Ângelo de Sousa é fundamental. As características-chave de Chão de Cimento (1) vinculam-se com as características da arte minimal e da sua interpenetração com outras disciplinas artísticas: a relação entre a dança, a escultura e os filmes; o carácter simplificado da forma; a relação do observador-experimentador com o movimento e o espaço vazio; e a persistência da imagem, num entendimento de repetição de movimento.

Orthogonal models, structure crossing, nesting and inference

We intend to study the algebraic structure of the simple orthogonal models to use them, through binary operations as building blocks in the construction of more complex orthogonal models. We start by presenting some matrix results considering Commutative Jordan Algebras of symmetric matrices, CJAs. Next, we use these results to study the algebraic structure of orthogonal models, obtained by crossing and nesting simpler ones. Then, we study the normal models with OBS, which can also be orthogonal models. We intend to study normal models with OBS (Orthogonal Block Structure), NOBS (Normal Orthogonal Block Structure), obtaining condition for having complete and suffcient statistics, having UMVUE, is unbiased estimators with minimal covariance matrices whatever the variance components. Lastly, see ([Pereira et al. (2014)]), we study the algebraic structure of orthogonal models, mixed models whose variance covariance matrices are all positive semi definite, linear combinations of known orthogonal pairwise orthogonal projection matrices, OPOPM, and whose least square estimators, LSE, of estimable vectors are best linear unbiased estimator, BLUE, whatever the variance components, so they are uniformly BLUE, UBLUE. From the results of the algebraic structure we will get explicit expressions for the LSE of these models.

Mark Rothko : Da origem mítica à refundação artística do mundo

Fenómeno assinalável no nosso século foi a emergência da chamada “arte global” (Belting), dando conta da crise do “mundo da arte” e a disseminação generalizada das práticas artísticas. Neste contexto a obra de Rothko ganha uma força inesperada. Sendo usualmente inscrito no “modernismo” com os seu valores de pureza e especificidade do meio, neste caso a pintura, a nossa investigação revela que o gesto Rothkoniano excede largamente esta representação, que levaria a distinguir radicalmente entre uma fase mítica e surrealista, uma fase abstracionista dos “colour field” e finalmente uma fase sublime das pinturas da Capela Ecuménica de Rothko. Existe uma continuidade evidente que remete para uma geoestética, onde a terra e a sua habitabilidade desempenham um papel crucial. Daí a necessidade de inscrever a obra de Rothko na geofilosofia contemporânea, tal com foi delineada por Gilles Deleuze e Félix Guattari. Procedeu-se, assim, a uma análise crítica da obra e da estética de Rothko, que profeticamente, mas inconscientemente, parece abrir o caminho para o pensamento de uma arte da terra. Trata-se de uma linha de continuidade que atravessa toda a obra de Rothko, refletindo uma picturação do mundo e a vontade de criar de um mundo pictórico e poético, reduzido a elementos mínimos, pós-figurativos mas onde se reconhece a incidência dos motivos como frame e abertura, linha de horizonte e pórticos e passagens. Num segundo momento, explora-se essa dimensão “inconsciente” num projeto artístico pessoal, que se desdobra em abordagens picturais, de pintura, de instalação e de vídeo, que denominamos por “A Terra como Acontecimento”. Este projeto prolonga o esforço Rothkoniano, ao mesmo tempo que o altera profundamente, nomeadamente pelo uso dos materiais, pela mutação no uso da cor, bem como pela maneira como os elementos figurativos são radicalmente alterados pela mera transposição da perspetiva usada. Se a ressonância rothkoniana está bem presente, não menos presente está a intenção de um confronto dialogante com a Obra de Mark Rothko. Aquilo que neste importante artista, era o inconsciente, marcado pelo mito e teologia, pela delimitação da linha de horizonte, bem clássica, e, acima de tudo, pela sua verticalidade marcadamente teológica, “A Terra como Acontecimento” é a matéria que é profundamente radicalizada, bem como a lógica concetual, a qual é preferentemente circular, sem orientação absoluta, e incompleta, o que implica uma outra visão da “abertura”/”fecho”, tão essencial na obra de Rothko. Desta investigação espera-se um contributo significativo para os debates atuais sobre a arte na contemporaneidade.

Development of human central nervous system 3D in vitro models for preclinical research

Neurological disorders are a major concern in modern societies, with increasing prevalence mainly related with the higher life expectancy. Most of the current available therapeutic options can only control and ameliorate the patients’ symptoms, often be-coming refractory over time. Therapeutic breakthroughs and advances have been hampered by the lack of accurate central nervous system (CNS) models. The develop-ment of these models allows the study of the disease onset/progression mechanisms and the preclinical evaluation of novel therapeutics. This has traditionally relied on genetically engineered animal models that often diverge considerably from the human phenotype (developmentally, anatomically and physiologically) and 2D in vitro cell models, which fail to recapitulate the characteristics of the target tissue (cell-cell and cell-matrix interactions, cell polarity). The in vitro recapitulation of CNS phenotypic and functional features requires the implementation of advanced culture strategies that enable to mimic the in vivo struc-tural and molecular complexity. Models based on differentiation of human neural stem cells (hNSC) in 3D cultures have great potential as complementary tools in preclinical research, bridging the gap between human clinical studies and animal models. This thesis aimed at the development of novel human 3D in vitro CNS models by integrat-ing agitation-based culture systems and a wide array of characterization tools. Neural differentiation of hNSC as 3D neurospheres was explored in Chapter 2. Here, it was demonstrated that human midbrain-derived neural progenitor cells from fetal origin (hmNPC) can generate complex tissue-like structures containing functional dopaminergic neurons, as well as astrocytes and oligodendrocytes. Chapter 3 focused on the development of cellular characterization assays for cell aggregates based on light-sheet fluorescence imaging systems, which resulted in increased spatial resolu-tion both for fixed samples or live imaging. The applicability of the developed human 3D cell model for preclinical research was explored in Chapter 4, evaluating the poten-tial of a viral vector candidate for gene therapy. The efficacy and safety of helper-dependent CAV-2 (hd-CAV-2) for gene delivery in human neurons was evaluated, demonstrating increased neuronal tropism, efficient transgene expression and minimal toxicity. The potential of human 3D in vitro CNS models to mimic brain functions was further addressed in Chapter 5. Exploring the use of 13C-labeled substrates and Nucle-ar Magnetic Resonance (NMR) spectroscopy tools, neural metabolic signatures were evaluated showing lineage-specific metabolic specialization and establishment of neu-ron-astrocytic shuttles upon differentiation. Chapter 6 focused on transferring the knowledge and strategies described in the previous chapters for the implementation of a scalable and robust process for the 3D differentiation of hNSC derived from human induced pluripotent stem cells (hiPSC). Here, software-controlled perfusion stirred-tank bioreactors were used as technological system to sustain cell aggregation and dif-ferentiation. The work developed in this thesis provides practical and versatile new in vitro ap-proaches to model the human brain. Furthermore, the culture strategies described herein can be further extended to other sources of neural phenotypes, including pa-tient-derived hiPSC. The combination of this 3D culture strategy with the implemented characterization methods represents a powerful complementary tool applicable in the drug discovery, toxicology and disease modeling.

Opa e fusão

Control of a public company can be obtained through several ways, of which the tender offer and the merger are only two. We attempt to understand what are the risks involved in the appearance of a control position. Such underlying risks justify the rationality of the mandatory bid rule, as well as the consequences of said rule. Finally, we attempt to understand if the interests of the minority shareholders are duly defended in the case of control being acquired through merger, since that is the understanding of the legislator.