Protocolo de fisioterapia, com auxílio de biofeedback electromiográfico, em utentes com disfunções do ombro: efeitos na dor, funcionalidade e estabilidade dinâmica

RESUMO: Introdução: A dor e disfunções do movimento no complexo articular do ombro (CAO) são comuns e debilitantes. O uso de exercícios segundo os pressupostos de estabilidade dinâmica (ED), com auxílio de Biofeedback electromiográfico (BEMG) tem vindo a ser referido, como uma forma de aumentar a efectividade da intervenção nas disfunções do complexo articular do ombro (DCAO)Objectivo Principal: Estudar os efeitos de um protocolo de intervenção, com BEMG, cujas finalidades foram abolir a dor, aumentar a funcionalidade e a ED da omoplata, em utentes com DCAO. Objectivos secundários: Comparar os subgrupos e quanto às características, resultados, tempos de intervenção total e até atingir critérios de alta; Comparar os resultados nos momentos inicial e final. Métodos: Foi realizado um coorte clínico, longitudinal, retrospectivo, observacional, analítico. A amostra foi constituída por 82 sujeitos, divididos em dois subgrupos (n=53 SCSA e n=29 IGU). Os instrumentos de medida utilizados foram a EVA, o DASH, o SPADI e o BEMG. Foi seguido o protocolo de ED proposto por Santos e Matias (2007), de acordo com as 3 fases de intervenção por eles descritas, realizando uma sessão semanal, monitorizando exercícios que seguem estes princípios, com BEMG. Foram avaliadas as variáveis dor, postura, padrão de recrutamento, controlo motor, posição inicial da omoplata (PIO), amplitudes articulares (AA’s), força muscular (FM) e postura. Para analisar os dados, recorreu-se a estatística descritiva e inferencial. Resultados: A intervenção foi efectiva na abolição da dor no momento (0,43 para 0,00/10EVA no subgrupo SCSA e 0,66 para 0,00/10EVA no subgrupo IGU) na pior dor (5,47/10EVA para 0,06/10EVA no subgrupo SCSA e 5,28/10 para 0,14/10 no subgrupo IGU), no aumento da função (28,57 para 0,66/100DASH e 39,00 para 0,63/100SAPDI no subgrupo SCSA e 25,80 para 0,38/100DASH e 28,19 para 0,39/100 no subgrupo IGU) e no aumento da ED da omoplata com normalização do padrão de recrutamento, controlo motor, PIO dentro do espectro de normalidade e boa capacidade de controlar a sua posição, ao longo do movimento do membro superior (MS). A intervenção proporcionou, ainda a normalização das AA’s, FM e autocorrecção postural. O tempo médio de intervenção foi de 6,45semanas no subgrupo SCSA e 5,83sem no subgrupo IGU. Estes resultados são semelhantes comparativamente a estudos que utilizaram uma intervenção baseada nos mesmos princípios (Matias e Cruz, 2004; Cunha e Matias, 2006; Santos e Matias, 2007; Rodrigues e Matias, 2009). Conclusão: O protocolo de intervenção aplicado, com uso de exercícios baseados nos princípios da ED e uso de BEMG, permitiu o alcance dos objectivos, junto de utentes com DCAO (SCSA e IGU). Verificou-se que, independentemente da condição, os resultados foram idênticos em ambos subgrupos, não apresentando diferenças significativas entre as variáveis de medida final, o tempo total de intervenção e os tempos até atingir os critérios de alta, expecto para a Dor, sendo este superior no subgrupo SCSA.---------------------------------------- ABSTRACT:Introduction: Movement disorders and pain in the shoulder joint complex (SJC) are common and debilitating. The use of exercises under the premises of dynamic stability (DS), with the aid of electromyographic biofeedback (EMGBF) has been mentioned as a way to increase the effectiveness of the intervention in disorders of the shoulder joint complex (DSJC) Main Objective: To evaluate the results of an intervention protocol, with EMGBF whose aims were to abolish the pain, increase functionality and DS of the scapula in patients with DSJC. Objectives: To compare the subgroups and the characteristics, outcomes, and total intervention times to reach discharge criteria; to compare the results at the beginning and at the end. Methods: We conducted a clinical cohort, longitudinal, retrospective, observational analysis. The sample consisted of 82 subjects, divided into two subgroups (n = 53 shoulder impingement syndrome SIS n = 29 shoulder joint instability SJI). The measurement instruments used were the VAS, DASH, SPADI, and EMGBF. It was followed the DS protocol proposed by Santos and Matias (2007), according to the three phases of intervention, described by performing a weekly session, monitoring exercises that follow these principles, with EMGBF. The variables were pain, posture, recruitment pattern, motor control, the initial position of the scapula (IPS), range of motion (ROM), muscular strength (MS) and posture. To analyze the data, we used the descriptive and inferential statistics. Results: The intervention was effective in abolishing the pain at the time (0.43 to 0.00/10 VAS in the SIS subgroup and 0.66 to 0.00/10 VAS in the SJI subgroup) in worst pain (5.47 to 0,06/10 VAS in the SIS subgroup and 5.28/ to 0.14/10 VAS in the SJI subgroup), increasing the function (28,57 to 0,66/100 DASH and 39,00 to 0,63/100 SAPDI in the SIS subgroup and 25,80 to 0,38/100 DASH and 28,19 to 0,39/100 SPADI in the SJI subgroup) and the increase in DS of the scapula with normalization of the pattern recruitment, motor control, IPS within the spectrum of normalcy and good ability to control its position along the movement of the upper limb (UL). The intervention provided, although the normalization of ROM, MS and self-correcting posture. The average length of intervention was 6.45 weeks in the SIS subgroup and 5.83 in the IS subgroup. These results are comparable with similar studies that used an intervention based on the same principles (Matias e Cruz, 2004; Cunha e Matias, 2006; Santos e Matias, 2007; Rodrigues e Matias, 2009). Conclusion: The intervention protocol implemented with the use of exercises based on the principles of DS and the use of EMGBF was effective, allowing the accomplishment of goals, in patients with DSJC (SIS and SJI). It was found that, regardless of condition, the results were identical in both groups, showing no significant differences between the variables of the final measure, the total time of intervention and the times to reach discharge criteria, except for pain, which was higher in the SIS subgroup.

Drugs in ads and news: educating people in the nineteenth century press

This research aims at finding out how scientific knowledge reached the common people in nineteenth century Portugal, using newspapers as the main source of information. Collecting news on science and technology is part of a larger research project focused on producing a History of the Popularization of Science and Technology in Portugal, following a model already developed in the UK and the USA (Bauer 2007). This source was probably the most widespread vehicle to divulge the latest scientific news at the time to an unspecialised audience. The following themes are approached: Drug advertisements in the nineteenth century. How did scientific knowledge on diseases and treatments reach the consumer? How did newspapers deal with epidemics? What were the prevention measures and the known treatments at the time? And what was the role of newspapers as educators? Ads show us the interest on divulging new products and the role of publicity as moulder of minds. All these questions introduce us to the role of the media on the subject of social perception of science and technology and the way scientific knowledge reached the common citizen.

Automatic learning for the classification of chemical reactions and in statistical thermodynamics

This Thesis describes the application of automatic learning methods for a) the classification of organic and metabolic reactions, and b) the mapping of Potential Energy Surfaces(PES). The classification of reactions was approached with two distinct methodologies: a representation of chemical reactions based on NMR data, and a representation of chemical reactions from the reaction equation based on the physico-chemical and topological features of chemical bonds. NMR-based classification of photochemical and enzymatic reactions. Photochemical and metabolic reactions were classified by Kohonen Self-Organizing Maps (Kohonen SOMs) and Random Forests (RFs) taking as input the difference between the 1H NMR spectra of the products and the reactants. The development of such a representation can be applied in automatic analysis of changes in the 1H NMR spectrum of a mixture and their interpretation in terms of the chemical reactions taking place. Examples of possible applications are the monitoring of reaction processes, evaluation of the stability of chemicals, or even the interpretation of metabonomic data. A Kohonen SOM trained with a data set of metabolic reactions catalysed by transferases was able to correctly classify 75% of an independent test set in terms of the EC number subclass. Random Forests improved the correct predictions to 79%. With photochemical reactions classified into 7 groups, an independent test set was classified with 86-93% accuracy. The data set of photochemical reactions was also used to simulate mixtures with two reactions occurring simultaneously. Kohonen SOMs and Feed-Forward Neural Networks (FFNNs) were trained to classify the reactions occurring in a mixture based on the 1H NMR spectra of the products and reactants. Kohonen SOMs allowed the correct assignment of 53-63% of the mixtures (in a test set). Counter-Propagation Neural Networks (CPNNs) gave origin to similar results. The use of supervised learning techniques allowed an improvement in the results. They were improved to 77% of correct assignments when an ensemble of ten FFNNs were used and to 80% when Random Forests were used. This study was performed with NMR data simulated from the molecular structure by the SPINUS program. In the design of one test set, simulated data was combined with experimental data. The results support the proposal of linking databases of chemical reactions to experimental or simulated NMR data for automatic classification of reactions and mixtures of reactions. Genome-scale classification of enzymatic reactions from their reaction equation. The MOLMAP descriptor relies on a Kohonen SOM that defines types of bonds on the basis of their physico-chemical and topological properties. The MOLMAP descriptor of a molecule represents the types of bonds available in that molecule. The MOLMAP descriptor of a reaction is defined as the difference between the MOLMAPs of the products and the reactants, and numerically encodes the pattern of bonds that are broken, changed, and made during a chemical reaction. The automatic perception of chemical similarities between metabolic reactions is required for a variety of applications ranging from the computer validation of classification systems, genome-scale reconstruction (or comparison) of metabolic pathways, to the classification of enzymatic mechanisms. Catalytic functions of proteins are generally described by the EC numbers that are simultaneously employed as identifiers of reactions, enzymes, and enzyme genes, thus linking metabolic and genomic information. Different methods should be available to automatically compare metabolic reactions and for the automatic assignment of EC numbers to reactions still not officially classified. In this study, the genome-scale data set of enzymatic reactions available in the KEGG database was encoded by the MOLMAP descriptors, and was submitted to Kohonen SOMs to compare the resulting map with the official EC number classification, to explore the possibility of predicting EC numbers from the reaction equation, and to assess the internal consistency of the EC classification at the class level. A general agreement with the EC classification was observed, i.e. a relationship between the similarity of MOLMAPs and the similarity of EC numbers. At the same time, MOLMAPs were able to discriminate between EC sub-subclasses. EC numbers could be assigned at the class, subclass, and sub-subclass levels with accuracies up to 92%, 80%, and 70% for independent test sets. The correspondence between chemical similarity of metabolic reactions and their MOLMAP descriptors was applied to the identification of a number of reactions mapped into the same neuron but belonging to different EC classes, which demonstrated the ability of the MOLMAP/SOM approach to verify the internal consistency of classifications in databases of metabolic reactions. RFs were also used to assign the four levels of the EC hierarchy from the reaction equation. EC numbers were correctly assigned in 95%, 90%, 85% and 86% of the cases (for independent test sets) at the class, subclass, sub-subclass and full EC number level,respectively. Experiments for the classification of reactions from the main reactants and products were performed with RFs - EC numbers were assigned at the class, subclass and sub-subclass level with accuracies of 78%, 74% and 63%, respectively. In the course of the experiments with metabolic reactions we suggested that the MOLMAP / SOM concept could be extended to the representation of other levels of metabolic information such as metabolic pathways. Following the MOLMAP idea, the pattern of neurons activated by the reactions of a metabolic pathway is a representation of the reactions involved in that pathway - a descriptor of the metabolic pathway. This reasoning enabled the comparison of different pathways, the automatic classification of pathways, and a classification of organisms based on their biochemical machinery. The three levels of classification (from bonds to metabolic pathways) allowed to map and perceive chemical similarities between metabolic pathways even for pathways of different types of metabolism and pathways that do not share similarities in terms of EC numbers. Mapping of PES by neural networks (NNs). In a first series of experiments, ensembles of Feed-Forward NNs (EnsFFNNs) and Associative Neural Networks (ASNNs) were trained to reproduce PES represented by the Lennard-Jones (LJ) analytical potential function. The accuracy of the method was assessed by comparing the results of molecular dynamics simulations (thermal, structural, and dynamic properties) obtained from the NNs-PES and from the LJ function. The results indicated that for LJ-type potentials, NNs can be trained to generate accurate PES to be used in molecular simulations. EnsFFNNs and ASNNs gave better results than single FFNNs. A remarkable ability of the NNs models to interpolate between distant curves and accurately reproduce potentials to be used in molecular simulations is shown. The purpose of the first study was to systematically analyse the accuracy of different NNs. Our main motivation, however, is reflected in the next study: the mapping of multidimensional PES by NNs to simulate, by Molecular Dynamics or Monte Carlo, the adsorption and self-assembly of solvated organic molecules on noble-metal electrodes. Indeed, for such complex and heterogeneous systems the development of suitable analytical functions that fit quantum mechanical interaction energies is a non-trivial or even impossible task. The data consisted of energy values, from Density Functional Theory (DFT) calculations, at different distances, for several molecular orientations and three electrode adsorption sites. The results indicate that NNs require a data set large enough to cover well the diversity of possible interaction sites, distances, and orientations. NNs trained with such data sets can perform equally well or even better than analytical functions. Therefore, they can be used in molecular simulations, particularly for the ethanol/Au (111) interface which is the case studied in the present Thesis. Once properly trained, the networks are able to produce, as output, any required number of energy points for accurate interpolations.

Cultural innovation and transmission of tool use in wild chimpanzees:evidence from field experiments

Animal Cognition, V.6, pp. 213-223

A stratigraphic framework for the Miocene from the lower Tagus Basin (Lisbon, Setúbal Península, Portugal) Depositional sequences, biostratigraphy and isotopic ages

Rev. Soc. Geol. España, 12(1), ano 1999

Miocene sediments from Foz da Fonte and Penedo sections (Lower Tagus basin): clay minerals and isotopic data

Eight depositional sequences (DS) delimited by regional disconformities had been recognized in the Miocene of Lisbon and Setúbal Peninsula areas. In the case of the western coast of the Setúbal Peninsula, outcrops consisting of Lower Burdigalian to Lower Tortonian sediments were studied. The stratigraphic zonography and the environmental considerations are mainly supported on data concerning to foraminifera, ostracoda, vertebrates and palynomorphs. The first mineralogical and geochemical data determined for Foz da Fonte, Penedo Sul and Penedo Norte sedimentary sequences are presented. These analytical data mainly correspond to the sediments' fine fractions. Mineralogical data are based on X-ray diffraction (XRD), carried out on both the less than 38 nm and 2 nm fractions. Qualitative and semi-quantitative determinations of clay and non-clay minerals were obtained for both fractions. The clay minerals assemblages complete the lithostratigraphic and paleoenvironmental data obtained by stratigraphic and palaeontological studies. Some palaeomagnetic and isotopic data are discussed and correlated with the mineralogical data. Multivariate data analysis (Principal Components Analysis) of the mineralogical data was carried out using both R-mode and Q-mode factor analysis.

Historically accurate reconstructions and characterisation of chrome yellow pigments

Dissertation presented at the Faculty of Sciences and Technology of the New University of Lisbon in fulfillment of the requirements for the Master degree in Conservation Science

Report of a traineeship : audit of antidepressant prescribing in Primary and Mental Care: how to address appropriateness and keep a curb on costs. A tool suitable for all contexts?

RESUMO: Este é o relatório de um estágio realizado na Autoridade de Saúde Local de Bolonha com o objectivo de desenvolver capacidades e competências na área de projectos orientados para a avaliação com base epidemiológica. As prescrições de anti-depressivos aumentaram consideravelmente em todo o mundo durante as últimas décadas. O uso cada vez maior dos agentes mais dispendiosos desempenha um papel na subida do custo dos tratamentos. A Autoridade de Saúde Local de Bolonha implementou um processo de auditoria com o objectivo de melhorar a adequação das prescrições de pacientes externos, centrando-se em dois anti-depressivos de marca ainda protegidos por patente, Escitalopram e Duloxetine. Os Departamentos de Cuidados de Saúde Primários e de Cuidados de Saúde Mental, assim como o Departamento Farmacêutico e a Unidade de Gestão Clínica, estiveram envolvidos na fase de planeamento da auditoria. O grupo da auditoria, maioritariamente composto por médicos de clínica geral e psiquiatras, reuniu e analisou provas da eficácia e segurança dos anti-depressivos. Os dados sobre as prescrições das Unidades de Cuidados de Saúde Primários e dos Centros de Saúde Mental Comunitários da Autoridade de Saúde Local (866.294 habitantes) foram comparados, em particular as taxas de consumo de Escitalopram e Duloxetine. O grupo da auditoria definiu os standards a serem abordados, os indicadores a serem avaliados e as medidas a empreender para atingir os objectivos definidos. As directrizes do NICE sobre a depressão foram escolhidas como referência. O objectivo da auditoria foi definido como evitar o Escitalopram e Duloxetine como medicamentos de primeira escolha num tratamento anti-depressivo. De modo a verificar a eficácia das medidas empreendidas foi seleccionado um indicador, consistindo numa redução de 25% das prescrições de ambos os anti-depressivos na prática clínica de pacientes externos e numa redução de 20% da variabilidade nas Unidades de Cuidados de Saúde Primários. O relatório retrospectivo pré-auditoria (Janeiro a Abril de 2012) revelou que os tratamentos com anti-depressivos para pacientes externos eram prescritos pelos médicos de clínica geral em mais de90% dos casos. As medidas da auditoria foram implementadas entre Novembro de 2012 e Maio de 2013. Algumas medidas relevantes foram integradas com a revisão da auditoria, tais como reuniões educacionais de pequena escala com os médicos de clínica geral e psiquiatras, visitas de apoio do assessor de prescrições da Autoridade de Saúde Local aos médicos de clínica geral e Centros de Saúde Mental Comunitários, panfletos para profissionais com informação retirada das directrizes clínicas do NICE, implementação de um serviço de consulta na Web para médicos de clínica geral sobre provas relativas a anti-depressivos. O relatório de feedback é aguardado em Novembro de 2013 depois de se verificar nos standards atingidos a eficácia das medidas implementadas. Foi realizada uma análise SWOT para comprovar as forças e fraquezas, as oportunidades e ameaças do processo. Como identificação de fraquezas poderá ser útil identificar estratégias relevantes para melhoria interna, para que o conhecimento das ameaças possa amortizar factores que possam ter impactos adversos que fujam ao controlo do Departamento de Saúde Mental. Uma melhor compreensão das forças e das oportunidades facilita a consecução dos objectivos estabelecidos no projecto. O primeiro, mas não o último, resultado deste processo consistiu numa maior integração entre os Cuidados de Saúde Primários e de Saúde Mental, permitindo assim que a Autoridade de Saúde Local coloque as alterações em prática.------------ABSTRACT: This is the report of a traineeship held in the Local Health Authority of Bologna with the aim to develop skills and competencies in the field of epidemiogically based evaluation oriented projects. Antidepressants prescriptions have considerably increased all over the world in the last decades. The increasing use of the most expensive agents plays a part in the rising cost of treatments. The Local Health Authority of Bologna has implemented an audit process aimed at improving the appropriateness of outpatient prescriptions focusing on the two branded antidepressants still protected by patent, Escitalopram and Duloxetine. The Primary Care and the Mental Health Care Departments, as well as the Pharmaceutical Department and the Clinical Governance Unit, were involved in the planning phase of the audit. The audit group, mainly composed of general practitioners and psychiatrists, collected and analyzed scientific evidence on effectiveness and safety of antidepressants. Data on prescriptions of Primary Care Units and Community Mental Health Centers of the Local Health Authority (866.294 inhabitants) were compared, in particular consumption rates of Escitalopram and Duloxetine. The audit group defined the standards to be addressed, the indicators to be evaluated and the actions aimed at reaching the defined goals. NICE guidelines on depression were chosen as reference. The aim of the audit was settled as avoiding Escitalopram and Duloxetine as first choice drugs starting an AD treatment. In order to check the efficacy of the actions undertaken an indicator was selected, consisting in a reduction of 25% of prescriptions of both ADs in outpatient practice and in a 20% reduction of To develop skills and competencies across Primary Care Units. The pre-audit retrospective report (January-April 2012) showed that outpatient antidepressant treatments were prescribed by GPs in over 90% of cases. Audit actions were implemented between November 2012 and May 2013. Some relevant actions have been integrated with the audit review, such as small-scale educational meetings with GPs and psychiatrists, outreach visits of the LHA prescribing adviser to GPs and CMHCs,leaflets for professionals with information extracted from NICE clinical guidelines, implementation of a web consultation service for GPs about evidence on antidepressants. The feedback report is expected in November 2013 after checking through the standards attained the effectiveness of actions implemented. A SWOT Analysis was carried out to evidence the strengths and weaknesses, opportunities and threats of the process. As identification of weaknesses may be useful to identify relevant strategies for internal improvement, so the knowledge of threats can amortize factors that may have adverse impacts beyond the control of the Mental Health Department. Better understanding of the strengths and the opportunities facilitates the achievement of the goals set in the project. The first and not least upshot of this process has consisted in further integration between Primary and Mental Health Care, thus enabling the LHA to put the change into practice.

The new economy: Essays in network economics and two-sided markets

Following the Introduction, which surveys existing literature on the technology advances and regulation in telecommunications and on two-sided markets, we address specific issues on the industries of the New Economy, featured by the existence of network effects. We seek to explore how each one of these industries work, identify potential market failures and find new solutions at the economic regulation level promoting social welfare. In Chapter 1 we analyze a regulatory issue on access prices and investments in the telecommunications market. The existing literature on access prices and investment has pointed out that networks underinvest under a regime of mandatory access provision with a fixed access price per end-user. We propose a new access pricing rule, the indexation approach, i.e., the access price, per end-user, that network i pays to network j is function of the investment levels set by both networks. We show that the indexation can enhance economic efficiency beyond what is achieved with a fixed access price. In particular, access price indexation can simultaneously induce lower retail prices and higher investment and social welfare as compared to a fixed access pricing or a regulatory holidays regime. Furthermore, we provide sufficient conditions under which the indexation can implement the socially optimal investment or the Ramsey solution, which would be impossible to obtain under fixed access pricing. Our results contradict the notion that investment efficiency must be sacrificed for gains in pricing efficiency. In Chapter 2 we investigate the effect of regulations that limit advertising airtime on advertising quality and on social welfare. We show, first, that advertising time regulation may reduce the average quality of advertising broadcast on TV networks. Second, an advertising cap may reduce media platforms and firms' profits, while the net effect on viewers (subscribers) welfare is ambiguous because the ad quality reduction resulting from a regulatory cap o¤sets the subscribers direct gain from watching fewer ads. We find that if subscribers are sufficiently sensitive to ad quality, i.e., the ad quality reduction outweighs the direct effect of the cap, a cap may reduce social welfare. The welfare results suggest that a regulatory authority that is trying to increase welfare via regulation of the volume of advertising on TV might necessitate to also regulate advertising quality or, if regulating quality proves impractical, take the effect of advertising quality into consideration. 3 In Chapter 3 we investigate the rules that govern Electronic Payment Networks (EPNs). In EPNs the No-Surcharge Rule (NSR) requires that merchants charge at most the same amount for a payment card transaction as for cash. In this chapter, we analyze a three- party model (consumers, merchants, and a proprietary EPN) with endogenous transaction volumes and heterogenous merchants' transactional benefits of accepting cards to assess the welfare impacts of the NSR. We show that, if merchants are local monopolists and the network externalities from merchants to cardholders are sufficiently strong, with the exception of the EPN, all agents will be worse o¤ with the NSR, and therefore the NSR is socially undesirable. The positive role of the NSR in terms of improvement of retail price efficiency for cardholders is also highlighted.