97 resultados para REACH-järjestelmä
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Dissertação para obtenção do Grau de Mestre em Engenharia Química e Bioquímica
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RESUMO - O presente estudo pretende contribuir a nível de saúde pública para o planeamento de estratégias orientadas para a prevenção, rastreio e tratamento do VIH/Sida em trabalhadores sexuais em contexto de interior. Esta é uma população de difícil acesso, particularmente vulnerável à infeção por VIH, e associada a fatores de risco que incluem a pobreza, discriminação e desigualdade de género, estigma e exclusão social, condicionando o seu acesso a serviços de saúde. Analisaram-se 272 questionários aplicados no âmbito do estudo PREVIH na área da Grande Lisboa no período entre Agosto de 2011 e Setembro de 2012 a pessoas que fazem trabalho sexual em contexto de interior. Foi realizada uma abordagem analítica permitindo a descrição do fenómeno e a análise da relação entre variáveis sociodemográficas e variáveis sobre o acesso a saúde para informação, prevenção e teste na área do VIH/Sida. Verificou-se que nesta amostra maioritariamente feminina existe elevada presença dos outros dois géneros e os indivíduos são maioritariamente migrantes. O trabalho sexual é uma forma exclusiva de trabalho, sendo exercido a tempo inteiro e em apartamentos. Foram detetados condicionamentos no acesso a serviços de saúde nas populações minoritárias e mais suscetíveis a discriminação, tanto na questão do género como da nacionalidade. Estes resultados apontam para a necessidade de planear intervenções nesta área que permitam uma abordagem participativa e de proximidade com as populações mais vulneráveis e também a necessidade de dar continuidade à investigação nesta área no sentido de reforçar políticas de saúde pública aplicadas a trabalhadores sexuais.
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A Work Project, presented as part of the requirements for the Award of a Masters Degree in Management from the NOVA – School of Business and Economics
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A Work Project, presented as part of the requirements for the Award of a Masters Degree in Management from the NOVA – School of Business and Economics
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A Work Project, presented as part of the requirements for the Award of a Masters Degree in Management from the NOVA – School of Business and Economics
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A Work Project, presented as part of the requirements for the Award of a Masters Degree in Management from the NOVA – School of Business and Economics
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RESUMO: Enquadramento teórico - Os estudos epidemiológicos demonstram que apesar de todo o progresso científico, muitas pessoas continuam sem acesso aos Serviços de Saúde Mental (SSM) e que, em muitos casos, os cuidados não têm a qualidade suficiente. A experiência de vários países mostra que os processos de implementação de modelos de intervenção terapêutica, como é o da Gestão de Cuidados, são lentos e complexos, não dependendo somente do grau de efectividade ou da complexidade das práticas a implementar. O Modelo de Gestão de Cuidados (MGC), é definido como uma prática baseada na evidência, utilizada para ajudar os doentes nos seus processos de recuperação. As estratégias para implementar práticas baseadas na evidência são críticas para a melhoria dos serviços. Existem, apesar de toda a evidência, muitas barreiras à implementação. Ao constatarmos que as práticas validadas pela ciência estão longe de estar claramente disseminadas nos serviços de saúde mental, fundamentamos a necessidade de utilizar metodologia de implementação que, além da efectividade das práticas, permita uma efectividade da implementação. Para responder às necessidades de formação e no âmbito da implementação do Plano Nacional de Saúde Mental, foram formados, em Portugal, 170 profissionais de saúde mental provenientes de serviços públicos e do sector social, de todas as regiões de Portugal Continental. Considerando que estes profissionais adquiriram competências específicas no MGC, através de um programa de formação nacional idêntico para todos os serviços de saúde mental, investigámos o grau de implementação deste modelo, bem como os facilitadores e as barreiras à sua correcta implementação. Existem vários estudos internacionais sobre as barreiras e os facilitadores à implementação de práticas baseadas na evidência, embora a maior parte desses estudos seja baseado em entrevistas semi-estruturadas a profissionais. Por outro lado, não existem, em Portugal, estudos sobre as barreiras e os facilitadores à implementação de práticas de saúde mental. Objectivos 1. Estimar o grau da implementação do MGC nos serviços de saúde mental portugueses 2. Caracterizar as regiões onde a implementação do MGC tenha ocorrido em maior grau. 3. Identificar os factores facilitadores e as barreiras à implementação do MGC, entre as regiõesde saúde do país. 4. Explorar as relações entre a fidelidade da implementação, as barreiras e os facilitadores da implementação, a cultura organizacional e as características dos serviços de saúde mental. Metodologia Estudo observacional, transversal e descritivo, com características exploratórias. População: profissionais dos serviços de saúde mental públicos e do sector social que frequentaram o Programa Nacional de Formação em Saúde Mental Comunitária no curso “Cuidados Integrados e Recuperação”, da Coordenação Nacional para a Saúde Mental / Ministério da Saúde, entre Outubro de 2008 e Dezembro de 2009, (n=71). Avaliação Fidelidade de implementação do Modelo de Gestão de Cuidados - IMR-S (Illness Management and Recovery Scale); Qualidade das guidelines utilizadas na implementação do Modelo de Gestão de Cuidados - AGREE II-PT (Appraisal of Guidelines, for Research and Evaluation); Avaliação das Barreiras e Facilitadores à implementação do MGC - BaFAI (Barriers and Facilitators Assessment Instrument); Avaliação da Cultura Organizacional dos serviços de saúde mental - CVF-I (Competing Values Framework Instrument). Análise Estatística Para a descrição dos dados foram aplicados métodos de estatística descritiva. Para a comparação de subgrupos foram utilizados os testes de Mann Whitney e Kruskall-Wallis. Para a investigação de associações foram utilizados os métodos de correlação de Spearman e a Regressão Múltipla. O tratamento e análise dos dados foram realizados utilizando o programa estatístico IBM SPSS Statistics® para Mac/Apple® nas versões 19 e 20. Resultados Serviços: A articulação com os cuidados de saúde primários existe na maioria dos serviços (56.34%) e 77.46% dos serviços têm autonomia para definir os cuidados a prestar. A maioria dos serviços (63.38%) realiza duas ou mais reuniões clínicas por mês e a quase totalidade (95.77%) recebe estagiários e/ou internos. A área da investigação tem níveis considerados baixos, quando comparados com outros países da Europa, tanto para a globalidade das áreas de investigação (25.35%), como para as áreas psicossociais (22.54%). Considerando componentes fundamentais para a implementação de modelos de gestão de cuidados, os resultados nacionais indicam que 66.20% dos serviços fazem registos em processo clínico único. As percentagens de utilização de planos individuais de cuidados são globalmente baixas (46.48%). Por seu turno, a utilização de guidelines, nos serviços do país, tem uma percentagem média nacional de 57.75%. Profissionais: São, na sua maioria, do sexo feminino (69.01%), com idades entre os 25 e os 56 anos (média 38.9, ± 7.41). Pertencem, maioritariamente, aos grupos profissionais da enfermagem (23.94%) e da psicologia (49.30%). A formação dos profissionais é de nível superior em todos os grupos, com uma percentagem total de licenciados de 80.3%, tendo os restantes uma formação ao nível do mestrado. Apesar dos valores baixos (17%) de formação prévia em modelos de gestão de cuidados, 39% dos profissionais indicou utilizar algumas vertentes destes modelos na sua prática. Apesar de 97,18% dos profissionais ter participado em dois ou mais encontros científicos, num período de dois anos, apenas 38.03% apresentou alguma comunicação científica no mesmo intervalo. Guideline: Os resultados da avaliação da guideline do MGC indicaram percentagens mais altas, quanto à qualidade do seu desenvolvimento, nos Domínios 1 (Objectivo e finalidade, com 72.2%) e 4 (Clareza de Apresentação, 77.7%). O Domínio 5 (Aplicabilidade) foi pontuado no limite inferior do desenvolvimento com qualidade suficiente (54.1%), ao passo que a guideline obteve uma pontuação negativa nos Domínios 2 (Envolvimento das partes interessadas, com 41.6%) e 3 (Rigor do Desenvolvimento, com 28.1%). Adicionalmente não foi possível às avaliadoras cotar o Domínio 6 (Independência editorial), por ausência de referências neste contexto. A guideline teve uma avaliação global positiva (66%), com recomendação de aceitação com modificações. Cultura Organizacional: O perfil de liderança com maior frequência nos serviços de saúde mental portugueses foi o de Mentor (45.61%). As percentagens mais baixas pertenceram aos perfis Monitor e Inovador (3.51%). Na perspectiva da cultura organizacional dos serviços, apontuação mais alta foi a da Cultura das Relações Humanas (74.07%). A estratégia de liderança, com predomínio em todas as regiões, foi a estratégia de Flexibilidade (66.10%). Os resultados mostram que a única associação positivamente significativa com o grau da implementação do MGC é a do perfil Produtor, com um peso específico de 14.55% na prevalência dos perfis de liderança nos serviços de saúde mental portugueses. Barreiras: As barreiras à implementação da prática do MGC, identificadas pelos profissionais dos serviços de saúde mental, com percentagens mais altas nos totais do país, foram: o tempo (57.7%), o conhecimento sobre o modelo e a motivação (40.8%), a colaboração dos outros profissionais (33.7%), o número de contactos reduzidos com os doentes (35.2%), as insuficiências do ponto de vista dos espaços (70.4%) e dos instrumentos disponíveis (69%) para implementar o MGC. Existiu uma variação entre as regiões de saúde do país. Os resultados mostram que houve uma correlação negativa, de forma significativa, entre a implementação do MGC e as barreiras: da resistência à utilização de protocolos, do formato da prática, da necessidade de mais treino e da não cooperação dos profissionais. Foram encontradas diferenças estatisticamente significativas entre as barreiras à implementação e as características dos serviços, dos profissionais e da cultura organizacional. Implementação: A média nacional da fidelidade de implementação do MGC (41.48) teve valores aproximados aos de estudos similares. Na pontuação por regiões, a implementação com maior fidelidade ocorreu no Alentejo. Se considerarmos a implementação com fidelidade esta ocorreu em 57.75% dos serviços e uma boa implementação em 15.49%. Os métodos de regressão permitiram confirmar a capacidade preditiva das barreiras e da cultura organizacional quanto à fidelidade da implementação do MGC. Discussão: No universo das hipóteses inicialmente colocadas foi possível verificar a variação da implementação do MGC entre as regiões do país. O estudo permitiu, adicionalmente, concluir pela existência de denominadores comuns de maior sucesso da implementação do MGC. Foi ainda possível verificar uma relação significativa, existente entre o grau de implementação e as dimensões das barreiras, a cultura organizacional e os recursos dos SSM (aqui definidos pelas características dos serviços e dos profissionais). De uma forma mais conclusiva podemos afirmar que existem outros factores, que não estão relacionados com a avaliação restrita dos recursos financeiros ou humanos, associados à qualidade da implementação de práticas baseadas na evidência, como o MGC. Exemplo disso são os achados referentes à região de saúde do Alentejo, onde a distância dos grandes centros urbanos e as conhecidas dificuldades de acessibilidade, combinadas com os problemas conhecidos da falta de recursos, não impediram que fosse a região com os valores mais altos da fidelidade de implementação. Conclusões: Foram encontradas inúmeras barreiras à implementação do MGC. Existem barreiras diferentes entre regiões, que resultam das características dos serviços, dos profissionais e da cultura organizacional. Para existir implementação é necessária a consideração de metodologias próprias que vão para além dos tradicionais programas de formação. As práticas baseadas na evidência, amplamente defendidas, exigem implementações baseadas na evidência.-------------ABSTRACT: Introduction - Several epidemiological studies show that, despite all scientific progress, many people still continue to have no access to mental health services and in many situations the quality of care is poor. The experiences of several countries show that progress towards case management implementation is slow and complex, depending not only from the degree of effectiveness or the complexity of the practice. Case management is defined as an evidence-based practice used to help patients in the recovery process. Strategies to implement evidence-based practices are critical to services improvement. There are many barriers to their implementation, despite all available evidence. Realising that practices of proved scientific value are far from being clearly implemented, justifies the need to use implementation methodologies that, beyond practice effectiveness, allow implementation effectiveness. To answer training needs and in the framework of the National Mental Health Plan implementation, 170 mental health (MH) professionals from portuguese public and private sectors were trained. Considering that case management skills were acquired, as a result of this training programme, we decided to study the degree of implementation in the services.Barriers and facilitators to the implementation were studied as well. There are several studies related with barriers and facilitators to the implementation of evidence-based practices, but most of them use semi-structured interviews with professionals. Additionally, there are no studies in Portugal related with barriers and facilitators to the implementation of mental health practices. Objectives1. Estimate the degree of case management implementation in Portuguese MH Services. 2.Describe regions where implementation occurred with higher fidelity degree. 3. Identify barriers and facilitators to case management implementation across country regions. 4. Explore the relationships between implementation, barriers and facilitators, organisational culture and services characteristics. Methodology - Cross sectional, descriptive study. Assessments - Implementation fidelity - IMR-S (Illness Management and Recovery Scale); Guideline quality - AGREE II-PT (Appraisal of Guidelines, for Research and Evaluation); Barriers and facilitators assessment - BaFAI (Barriers and Facilitators Assessment Instrument); Organisational culture assessment - CVF-I (Competing Values Framework Instrument). Statistical analysis - Descriptives and cross-tabs. Subgroups comparison: Mann-Witney and Kruskall-Wallis. Associations between variables were calculated using Spearman correlation's and Multiple Regression. Results - Services: Liaison with primary care is done in most services (56.34%) and 77.46% have autonomy to determine care. Most services have regular clinical meetings and almost all give internship training (95.77%). Research activity is low compared with other European countries, for both general and psychosocial research. Considering key components for the case management implementation, 66.20% of all services use single clinical records. The use of individual care plans is globally low (46.48%) and there is a use of guidelines in 57.75% of services. Human Resources: most are women (69.01%), with age ranging from 25-56 (average 39.9, SD 7.41). The majority are psychologists (49.30%) and nurses (23.94%). All have a university degree, 19.7% have a masters degree and 83% didn’t have any case management training before the above mentioned national training. Despite the low levels of preceding case management training, 39% have used model components in day-to-day practice and although 97.18% of the workforce have attended scientific meetings in the last 2 years, only 38.03% presented communications in the same period. Guideline: Results show that higher scores were obtained in Domain 1. Scope and Purpose (72.2.%),and Domain 4. Clarity of presentation (77.7%). Domain 5. pplicability scored near low boundary (54.1%) and negative scores were found in Domain 2. Stakeholder Involvement (41.6%) and Domain 3. Rigour of Development (28.1%). Global score was 66% and the guideline was recommended with modifications. Organisational Culture: The most frequent leadership profile was the Mentor profile (45.61%). Lower scores belonged to Innovator and Monitor profiles (3.51%). On the organisational culture overall, higher scores were found in the Human Relations culture (74.07%). The higher leadership strategy was the strategy of flexibility (66.10%). The results additionally showed that the only leadership profile associated with case management implementation was the Producer profile, representing 14.55% of all leadership profiles in the country.Barriers: The barriers identified by MH professionals, with high percentages, were: lack of time (57.7%), knowledge and motivation (40.8%), other colleagues cooperation (33.7%), low number of contacts with patients (35.2%), lack of facilities (70.4%) and lack of instruments (69%) to implement case management, varying across regions. Results show that there was a negative correlation between implementation and the following barriers: using protocols, practice format, need for more training and lack of cooperation from colleagues. Additionally, statistical differences were found between barriers to implementation and: services characteristics, workforce characteristics, organisational culture. Implementation: The national average results of case management implementation fidelity was (41.48), close to values found in similar studies. In the regional scores South Region Alentejo had the highest implementation score. If we look at minimum scores to assume implementation fidelity, these occurred in 57.75% of services and a good implementation occurred in 15.49% of these. Regression methods allowed to confirm that implementation score prediction was possible using the combination of barriers and organisational culture scores. Discussion - Considering the initial study hypotheses, it was possible to confirm the variation of case management implementation across country regions. Additionally, we could conclude that common denominators exist when successful implementation occurred. It was possible to observe a significant relationship between implementation degree and the dimensions of barriers, organisational culture and services resources (defined as professionals and services characteristics). In a more conclusive way, we can say that there are factors, other than financial and human resources, that are associated with evidence based practices implementation like case management. An example is the Alentejo region, were the distance from urban centres, and the known difficulties associated with accessibility, plus the lack of financial and human resources, have not impeded the regional higher score on implementation. Conclusions: Case management implementation had several barriers to implementation. There are different barriers across country regions, resulting from organisational culture, services and professionals characteristics. To reach implementation it is necessary to consider specific methodologies that go beyond traditional training programs and evident practices, widely promoted. Evidence-based practices require evidence-based implementations.
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Microblogging in the workplace as a functionality of Enterprise Social Networking (ESN) platforms is a relatively new phenomenon of which the use in knowledge work has not yet received much attention from research. In this cross-sectional study, I attempt to shed light on the role of microblogging in knowledge work. I identify microblogging use practices of knowledge workers on ESN platforms, and I identify its role in supporting knowledge work performance. A questionnaire is carried out among a non-representative sample of knowledge workers. The results shed light on the purposes of the microblogging messages that knowledge workers write. It also helps us find out whether microblogging supports them in performing their work. The survey is based on existing theory that supplied me with possible microblog purposes as well as theory on what the actions of knowledge workers are. The results reveal that “knowledge & news sharing”, “crowd sourcing”, “socializing & networking” and “discussion & opinion” are frequent microblog purposes. The study furthermore shows that microblogging benefits knowledge workers’ work. Microblogging seems to be a worthy addition to the existing means of communication in the workplace, and is especially useful to let knowledge, news and social contact reach a further and broader audience than it would in a situation without this social networking service.
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ABSTRACT Background Mental health promotion is supported by a strong body of knowledge and is a matter of public health with the potential of a large impact on society. Mental health promotion programs should be implemented as soon as possible in life, preferably starting during pregnancy. Programs should focus on malleable determinants, introducing strategies to reduce risk factors or their impact on mother and child, and also on strengthening protective factors to increase resilience. The ambition of early detecting risk situations requires the development and use of tools to assess risk, and the creation of a responsive network of services based in primary health care, especially maternal consultation during pregnancy and the first months of the born child. The number of risk factors and the way they interact and are buffered by protective factors are relevant for the final impact. Maternal-fetal attachment (MFA) is not yet a totally understood and well operationalized concept. Methodological problems limit the comparison of data as many studies used small size samples, had an exploratory character or used different selection criteria and different measures. There is still a lack of studies in high risk populations evaluating the consequences of a weak MFA. Instead, the available studies are not very conclusive, but suggest that social support, anxiety and depression, self-esteem and self-control and sense of coherence are correlated with MFA. MFA is also correlated with health practices during pregnancy, that influence pregnancy and baby outcomes. MFA seems a relevant concept for the future mother baby interaction, but more studies are needed to clarify the concept and its operationalization. Attachment is a strong scientific concept with multiple implications for future child development, personality and relationship with others. Secure attachment is considered an essential basis of good mental health, and promoting mother-baby interaction offers an excellent opportunity to intervention programmes targeted at enhancing mental health and well-being. Understanding the process of attachment and intervening to improve attachment requires a comprehension of more proximal factors, but also a broader approach that assesses the impact of more distal social conditions on attachment and how this social impact is mediated by family functioning and mother-baby interaction. Finally, it is essential to understand how this knowledge could be translated in effective mental health promoting interventions and measures that could reach large populations of pregnant mothers and families. Strengthening emotional availability (EA) seems to be a relevant approach to improve the mother-baby relationship. In this review we have offered evidence suggesting a range of determinants of mother-infant relationship, including age, marital relationship, social disadvantages, migration, parental psychiatric disorders and the situations of abuse or neglect. Based on this theoretical background we constructed a theoretical model that included proximal and distal factors, risk and protective factors, including variables related to the mother, the father, their social support and mother baby interaction from early pregnancy until six months after birth. We selected the Antenatal Psychosocial Health Assessment (ALPHA) for use as an instrument to detect psychosocial risk during pregnancy. Method Ninety two pregnant women were recruited from the Maternal Health Consultation in Primary Health Care (PHC) at Amadora. They had three moments of assessment: at T1 (until 12 weeks of pregnancy) they filed out a questionnaire that included socio-demographic data, ALPHA, Edinburgh post-natal Depression Scale (EDPS), General Health Questionnaire (GHQ) and Sense of Coherence (SOC); at T2 (after the 20th weeks of pregnancy) they answered EDPS, SOC and MFA Scale (MFAS), and finally at T3 (6 months after birth), they repeated EDPS and SOC, and their interaction with their babies was videotaped and later evaluated using EA Scales. A statistical analysis has been done using descriptive statistics, correlation analysis, univariate logistic regression and multiple linear regression. Results The study has increased our knowledge on this particular population living in a multicultural, suburb community. It allow us to identify specific groups with a higher level of psychosocial risk, such as single or divorced women, young couples, mothers with a low level of education and those who are depressed or have a low SOC. The hypothesis that psychosocial risk is directly correlated with MFAS and that MFA is directly correlated with EA was not confirmed, neither the correlation between prenatal psychosocial risk and mother-baby EA. The study identified depression as a relevant risk factor in pregnancy and its higher prevalence in single or divorced women, immigrants and in those who have a higher global psychosocial risk. Depressed women have a poor MFA, and a lower structuring capacity and a higher hostility to their babies. In average, depression seems to reduce among pregnant women in the second part of their pregnancy. The children of immigrant mothers show a lower level of responsiveness to their mothers what could be transmitted through depression, as immigrant mothers have a higher risk of depression in the beginning of pregnancy and six months after birth. Young mothers have a low MFA and are more intrusive. Women who have a higher level of education are more sensitive and their babies showed to be more responsive. Women who are or have been submitted to abuse were found to have a higher level of MFA but their babies are less responsive to them. The study highlights the relevance of SOC as a potential protective factor while it is strongly and negatively related with a wide range of risk factors and mental health outcomes especially depression before, during and after pregnancy. Conclusions ALPHA proved to be a valid, feasible and reliable instrument to Primary Health Care (PHC) that can be used as a total sum score. We could not prove the association between psychosocial risk factors and MFA, neither between MFA and EA, or between psychosocial risk and EA. Depression and SOC seems to have a clear and opposite relevance on this process. Pregnancy can be considered as a maturational process and an opportunity to change, where adaptation processes occur, buffering risk, decreasing depression and increasing SOC. Further research is necessary to better understand interactions between variables and also to clarify a better operationalization of MFA. We recommend the use of ALPHA, SOC and EDPS in early pregnancy as a way of identifying more vulnerable women that will require additional interventions and support in order to decrease risk. At political level we recommend the reinforcement of Immigrant integration and the increment of education in women. We recommend more focus in health care and public health in mental health condition and psychosocial risk of specific groups at high risk. In PHC special attention should be paid to pregnant women who are single or divorced, very young, low educated and to immigrant mothers. This study provides the basis for an intervention programme for this population, that aims to reduce broad spectrum risk factors and to promote Mental Health in women who become pregnant. Health and mental health policies should facilitate the implementation of the suggested measures.
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Malaria, a disease caused by Plasmodium, represents a major health problem with a still disconcertingly high mortality rate (655 000 malaria deaths were estimated by the World Health Organization in 2012), mainly in Africa [1]. After a bite by an infected Anopheles mosquito occurs, Plasmodium sporozoites reach their target organ, the liver, within minutes. After traversing several hepatocytes, the parasite invades a final one and establishes a parasitophorous vacuole, where it replicates exponentially generating thousands of infective merozoites, the red blood cell infectious forms that are released in the blood stream. The liver stage is the first obligatory phase of malaria infection and, although no symptoms are associated with it, it is absolutely crucial to the establishment of a successful infection.(...)
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Saccharomyces cerevisiae as well as other microorganisms are frequently used in industry with the purpose of obtain different kind of products that can be applied in several areas (research investigation, pharmaceutical compounds, etc.). In order to obtain high yields for the desired product, it is necessary to make an adequate medium supplementation during the growth of the microorganisms. The higher yields are typically reached by using complex media, however the exact formulation of these media is not known. Moreover, it is difficult to control the exact composition of complex media, leading to batch-to-batch variations. So, to overcome this problem, some industries choose to use defined media, with a defined and known chemical composition. However these kind of media, many times, do not reach the same high yields that are obtained by using complex media. In order to obtain similar yield with defined media the addition of many different compounds has to be tested experimentally. Therefore, the industries use a set of empirical methods with which it is tried to formulate defined media that can reach the same high yields as complex media. In this thesis, a defined medium for Saccharomyces cerevisiae was developed using a rational design approach. In this approach a given metabolic network of Saccharomyces cerevisiae is divided into a several unique and not further decomposable sub networks of metabolic reactions that work coherently in steady state, so called elementary flux modes. The EFMtool algorithm was used in order to calculate the EFM’s for two Saccharomyces cerevisiae metabolic networks (amino acids supplemented metabolic network; amino acids non-supplemented metabolic network). For the supplemented metabolic network 1352172 EFM’s were calculated and then divided into: 1306854 EFM’s producing biomass, and 18582 EFM’s exclusively producing CO2 (cellular respiration). For the non-supplemented network 635 EFM’s were calculated and then divided into: 215 EFM’s producing biomass; 420 EFM’s producing exclusively CO2. The EFM’s of each group were normalized by the respective glucose consumption value. After that, the EFMs’ of the supplemented network were grouped again into: 30 clusters for the 1306854 EFMs producing biomass and, 20 clusters for the 18582 EFM’s producing CO2. For the non-supplemented metabolic network the respective EFM’s of each metabolic function were grouped into 10 clusters. After the clustering step, the concentrations of the other medium compounds were calculated by considering a reasonable glucose amount and by accounting for the proportionality between the compounds concentrations and the glucose ratios. The approach adopted/developed in this thesis may allow a faster and more economical way for media development.
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This study analyses financial data using the result characterization of a self-organized neural network model. The goal was prototyping a tool that may help an economist or a market analyst to analyse stock market series. To reach this goal, the tool shows economic dependencies and statistics measures over stock market series. The neural network SOM (self-organizing maps) model was used to ex-tract behavioural patterns of the data analysed. Based on this model, it was de-veloped an application to analyse financial data. This application uses a portfo-lio of correlated markets or inverse-correlated markets as input. After the anal-ysis with SOM, the result is represented by micro clusters that are organized by its behaviour tendency. During the study appeared the need of a better analysis for SOM algo-rithm results. This problem was solved with a cluster solution technique, which groups the micro clusters from SOM U-Matrix analyses. The study showed that the correlation and inverse-correlation markets projects multiple clusters of data. These clusters represent multiple trend states that may be useful for technical professionals.
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Research on Parkinson’s disease (PD) has mainly focused on the degeneration of the dopaminergic neurons of nigro-striatal (NS) pathway; also, post-mortem studies have demonstrated that the noradrenergic and the serotonergic transmitter systems are also affected (Jellinger, 1999). Degeneration of these neuronal cell bodies is generally thought to start prior to the loss of dopaminergic neurons in the NS pathway and precedes the appearance of the motor symptoms that are the “hallmark” of PD. Gastrointestinal (GI) motility is often disturbed in PD, manifesting chiefly as impaired gastric emptying and constipation. These GI dysfunction symptoms may be the result of a loss in noradrenergic and serotonergic innervation. GI deficits were evaluated using an organ bath technique. Groups treated with different combinations of neurotoxins (6-OHDA alone, 6-OHDA + pCA or 6-OHDA + DSP-4) presented significant differences in gut contractility compared to control groups. Since a substantial body of literature suggests the presence of an inflammatory process in parkinsonian state (Whitton, 2007), changes in pro-inflammatory cytokines in the gut were assessed using a cytokine microarray. It has been found in this work that groups with a combined dopaminergic and noradrenergic lesion have a significant increase in both expressions of IL-13 and VEGF. IL-6 also shows a decrease in treatment groups; however this decrease did not reach statistical significance. The therapeutic value of Exendin-4 (EX-4) was evaluated. It has been previously demonstrated that EX-4, a glucagon-like peptide-1 receptor (GLP-1R) agonist, is neuroprotective in rodent models of PD (Harkavyi et al., 2008). In this thesis it has been found that EX-4 was able to reverse a decrease in gut contractility obtained through intracerebral bilateral 6-OHDA injection. Although more studies are required, EX-4 could be used as a possible therapy for the GI symptoms prominent in the early stages of PD.
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RESUMO: O cancro de mama e o mais frequente diagnoticado a indiv duos do sexo feminino. O conhecimento cientifico e a tecnologia tem permitido a cria ção de muitas e diferentes estrat egias para tratar esta patologia. A Radioterapia (RT) est a entre as diretrizes atuais para a maioria dos tratamentos de cancro de mama. No entanto, a radia ção e como uma arma de dois canos: apesar de tratar, pode ser indutora de neoplasias secund arias. A mama contralateral (CLB) e um orgão susceptivel de absorver doses com o tratamento da outra mama, potenciando o risco de desenvolver um tumor secund ario. Nos departamentos de radioterapia tem sido implementadas novas tecnicas relacionadas com a radia ção, com complexas estrat egias de administra ção da dose e resultados promissores. No entanto, algumas questões precisam de ser devidamente colocadas, tais como: E seguro avançar para tecnicas complexas para obter melhores indices de conformidade nos volumes alvo, em radioterapia de mama? O que acontece aos volumes alvo e aos tecidos saudaveis adjacentes? Quão exata e a administração de dose? Quais são as limitações e vantagens das técnicas e algoritmos atualmente usados? A resposta a estas questões e conseguida recorrendo a m etodos de Monte Carlo para modelar com precisão os diferentes componentes do equipamento produtor de radia ção(alvos, ltros, colimadores, etc), a m de obter uma descri cão apropriada dos campos de radia cão usados, bem como uma representa ção geometrica detalhada e a composição dos materiais que constituem os orgãos e os tecidos envolvidos. Este trabalho visa investigar o impacto de tratar cancro de mama esquerda usando diferentes tecnicas de radioterapia f-IMRT (intensidade modulada por planeamento direto), IMRT por planeamento inverso (IMRT2, usando 2 feixes; IMRT5, com 5 feixes) e DCART (arco conformacional dinamico) e os seus impactos em irradia ção da mama e na irradia ção indesejada dos tecidos saud aveis adjacentes. Dois algoritmos do sistema de planeamento iPlan da BrainLAB foram usados: Pencil Beam Convolution (PBC) e Monte Carlo comercial iMC. Foi ainda usado um modelo de Monte Carlo criado para o acelerador usado (Trilogy da VARIAN Medical Systems), no c odigo EGSnrc MC, para determinar as doses depositadas na mama contralateral. Para atingir este objetivo foi necess ario modelar o novo colimador multi-laminas High- De nition que nunca antes havia sido simulado. O modelo desenvolvido est a agora disponí vel no pacote do c odigo EGSnrc MC do National Research Council Canada (NRC). O acelerador simulado foi validado com medidas realizadas em agua e posteriormente com c alculos realizados no sistema de planeamento (TPS).As distribui ções de dose no volume alvo (PTV) e a dose nos orgãos de risco (OAR) foram comparadas atrav es da an alise de histogramas de dose-volume; an alise estati stica complementar foi realizadas usando o software IBM SPSS v20. Para o algoritmo PBC, todas as tecnicas proporcionaram uma cobertura adequada do PTV. No entanto, foram encontradas diferen cas estatisticamente significativas entre as t ecnicas, no PTV, nos OAR e ainda no padrão da distribui ção de dose pelos tecidos sãos. IMRT5 e DCART contribuem para maior dispersão de doses baixas pelos tecidos normais, mama direita, pulmão direito, cora cão e at e pelo pulmão esquerdo, quando comparados com as tecnicas tangenciais (f-IMRT e IMRT2). No entanto, os planos de IMRT5 melhoram a distribuição de dose no PTV apresentando melhor conformidade e homogeneidade no volume alvo e percentagens de dose mais baixas nos orgãos do mesmo lado. A t ecnica de DCART não apresenta vantagens comparativamente com as restantes t ecnicas investigadas. Foram tamb em identi cadas diferen cas entre os algoritmos de c alculos: em geral, o PBC estimou doses mais elevadas para o PTV, pulmão esquerdo e cora ção, do que os algoritmos de MC. Os algoritmos de MC, entre si, apresentaram resultados semelhantes (com dferen cas at e 2%). Considera-se que o PBC não e preciso na determina ção de dose em meios homog eneos e na região de build-up. Nesse sentido, atualmente na cl nica, a equipa da F sica realiza medi ções para adquirir dados para outro algoritmo de c alculo. Apesar de melhor homogeneidade e conformidade no PTV considera-se que h a um aumento de risco de cancro na mama contralateral quando se utilizam t ecnicas não-tangenciais. Os resultados globais dos estudos apresentados confirmam o excelente poder de previsão com precisão na determinação e c alculo das distribui ções de dose nos orgãos e tecidos das tecnicas de simulação de Monte Carlo usados.---------ABSTRACT:Breast cancer is the most frequent in women. Scienti c knowledge and technology have created many and di erent strategies to treat this pathology. Radiotherapy (RT) is in the actual standard guidelines for most of breast cancer treatments. However, radiation is a two-sword weapon: although it may heal cancer, it may also induce secondary cancer. The contralateral breast (CLB) is a susceptible organ to absorb doses with the treatment of the other breast, being at signi cant risk to develop a secondary tumor. New radiation related techniques, with more complex delivery strategies and promising results are being implemented and used in radiotherapy departments. However some questions have to be properly addressed, such as: Is it safe to move to complex techniques to achieve better conformation in the target volumes, in breast radiotherapy? What happens to the target volumes and surrounding healthy tissues? How accurate is dose delivery? What are the shortcomings and limitations of currently used treatment planning systems (TPS)? The answers to these questions largely rely in the use of Monte Carlo (MC) simulations using state-of-the-art computer programs to accurately model the di erent components of the equipment (target, lters, collimators, etc.) and obtain an adequate description of the radiation elds used, as well as the detailed geometric representation and material composition of organs and tissues. This work aims at investigating the impact of treating left breast cancer using di erent radiation therapy (RT) techniques f-IMRT (forwardly-planned intensity-modulated), inversely-planned IMRT (IMRT2, using 2 beams; IMRT5, using 5 beams) and dynamic conformal arc (DCART) RT and their e ects on the whole-breast irradiation and in the undesirable irradiation of the surrounding healthy tissues. Two algorithms of iPlan BrainLAB TPS were used: Pencil Beam Convolution (PBC)and commercial Monte Carlo (iMC). Furthermore, an accurate Monte Carlo (MC) model of the linear accelerator used (a Trilogy R VARIANR) was done with the EGSnrc MC code, to accurately determine the doses that reach the CLB. For this purpose it was necessary to model the new High De nition multileaf collimator that had never before been simulated. The model developed was then included on the EGSnrc MC package of National Research Council Canada (NRC). The linac was benchmarked with water measurements and later on validated against the TPS calculations. The dose distributions in the planning target volume (PTV) and the dose to the organs at risk (OAR) were compared analyzing dose-volume histograms; further statistical analysis was performed using IBM SPSS v20 software. For PBC, all the techniques provided adequate coverage of the PTV. However, statistically significant dose di erences were observed between the techniques, in the PTV, OAR and also in the pattern of dose distribution spreading into normal tissues. IMRT5 and DCART spread low doses into greater volumes of normal tissue, right breast, right lung, heart and even the left lung than tangential techniques (f-IMRT and IMRT2). However,IMRT5 plans improved distributions for the PTV, exhibiting better conformity and homogeneity in target and reduced high dose percentages in ipsilateral OAR. DCART did not present advantages over any of the techniques investigated. Di erences were also found comparing the calculation algorithms: PBC estimated higher doses for the PTV, ipsilateral lung and heart than the MC algorithms predicted. The MC algorithms presented similar results (within 2% di erences). The PBC algorithm was considered not accurate in determining the dose in heterogeneous media and in build-up regions. Therefore, a major e ort is being done at the clinic to acquire data to move from PBC to another calculation algorithm. Despite better PTV homogeneity and conformity there is an increased risk of CLB cancer development, when using non-tangential techniques. The overall results of the studies performed con rm the outstanding predictive power and accuracy in the assessment and calculation of dose distributions in organs and tissues rendered possible by the utilization and implementation of MC simulation techniques in RT TPS.
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RESUMO - Hoje, facilmente se poderá constatar que as doenças orais possuem uma expressiva influência perante a saúde geral, não apenas pela presença da condição por si só, mas também a nível pessoal, social e económico. O seu reflexo traduz-se em parte, no absentismo escolar e laboral, diminuição considerável de produtividade e eficiência, falta de atenção e objetividade. Pelo que é então considerado, um grave problema de saúde pública, afetando de forma mais expressiva, grupos socioeconomicamente desfavorecidos. O acompanhamento e análise do desenvolvimento de iniciativas internacionais, no que ao seguimento das recomendações da Organização Mundial de Saúde diz respeito, poderá ser um ótimo beneficio e impulso para a identificação e aplicação de novos planos de ação. O presente projeto, pretendeu contribuir para a identificação de duas propostas de intervenção em saúde oral ajustadas ao alcance das recomendações da OMS que simultaneamente possam sejam proveitosas para a resolução dos problemas de saúde oral nacionais. Foi realizado um estudo observacional, descritivo e retrospetivo onde foram recolhidos dados acerca de 8 Sistemas de Saúde Oral europeus, previamente selecionados segundo critérios específicos, e iniciativas de saúde oral por eles desenvolvidas. Por fim, foram eleitas duas iniciativas de interesse, possíveis de aplicação futura. Os resultados do estudo apontam para a existência de diferentes iniciativas, enquadradas com as recomendações da OMS. De entre as mesmas, destaca-se uma implementada em 2009, na Suécia, que estando essencialmente assente num acessível subsidio anual fixo pago por cada indivíduo adulto, procura fundamentalmente preservar os esforços de prevenção aplicados nas últimas décadas.