Monitorización de la temperatura del pie como herramienta en la neuropatía diabética

Objteivo: Valorar si existe relación entre el aumento de temperatura en el pie y la neuropatía diabética periférica. Métodos: La muestra fueron 27 pacientes diabéticos a que se le realizó una exploración neurológica y vascular, además, haciendo uso de un termómetro infrarrojo medimos la temperatura en distintos puntos anatómicos de la planta del pie. Resultados: La temperatura es mayor los pacientes con neuropatía con una diferencia de 2,24ºC (p=0,454) en el pie derecho y 0,86ºC (p=0,589) en el pie izquierdo. Conclusión: Los resultados sugieren que la automonitorización de la temperatura del pie por parte del paciente diabético podría ayudar a reducir la alta incidencia de complicaciones en el pie diabético.

Computerised Diagnostic Decision Support System for the Classification of Pre-Invasive Cervical Squamous Lesions.

Previous studies have revealed considerable interobserver and intraobserver variation in the histological classification of preinvasive cervical squamous lesions. The aim of the present study was to develop a decision support system (DSS) for the histological interpretation of these lesions. Knowledge and uncertainty were represented in the form of a Bayesian belief network that permitted the storage of diagnostic knowledge and, for a given case, the collection of evidence in a cumulative manner that provided a final probability for the possible diagnostic outcomes. The network comprised 8 diagnostic histological features (evidence nodes) that were each independently linked to the diagnosis (decision node) by a conditional probability matrix. Diagnostic outcomes comprised normal; koilocytosis; and cervical intraepithelial neoplasia (CIN) 1, CIN II, and CIN M. For each evidence feature, a set of images was recorded that represented the full spectrum of change for that feature. The system was designed to be interactive in that the histopathologist was prompted to enter evidence into the network via a specifically designed graphical user interface (i-Path Diagnostics, Belfast, Northern Ireland). Membership functions were used to derive the relative likelihoods for the alternative feature outcomes, the likelihood vector was entered into the network, and the updated diagnostic belief was computed for the diagnostic outcomes and displayed. A cumulative probability graph was generated throughout the diagnostic process and presented on screen. The network was tested on 50 cervical colposcopic biopsy specimens, comprising 10 cases each of normal, koilocytosis, CIN 1, CIN H, and CIN III. These had been preselected by a consultant gynecological pathologist. Using conventional morphological assessment, the cases were classified on 2 separate occasions by 2 consultant and 2 junior pathologists. The cases were also then classified using the DSS on 2 occasions by the 4 pathologists and by 2 medical students with no experience in cervical histology. Interobserver and intraobserver agreement using morphology and using the DSS was calculated with K statistics. Intraobserver reproducibility using conventional unaided diagnosis was reasonably good (kappa range, 0.688 to 0.861), but interobserver agreement was poor (kappa range, 0.347 to 0.747). Using the DSS improved overall reproducibility between individuals. Using the DSS, however, did not enhance the diagnostic performance of junior pathologists when comparing their DSS-based diagnosis against an experienced consultant. However, the generation of a cumulative probability graph also allowed a comparison of individual performance, how individual features were assessed in the same case, and how this contributed to diagnostic disagreement between individuals. Diagnostic features such as nuclear pleomorphism were shown to be particularly problematic and poorly reproducible. DSSs such as this therefore not only have a role to play in enhancing decision making but also in the study of diagnostic protocol, education, self-assessment, and quality control. (C) 2003 Elsevier Inc. All rights reserved.

Large body size for winning and large swords for winning quickly in swordtail males, Xiphophorus helleri

Contestants can either assess their own resource-holding potential relative to their opponent (mutual assessment) or rely solely on the assessment of their own fighting ability (self-assessment). To discriminate between these possibilities, we staged dyadic territorial contests between 'size-matched' male swordtails. These contests consist of a combination of ritualized displays and direct fighting. Although size differences were small, winners were larger than losers and smaller fish tended to be winners only when the size difference was negligible. Body size, however, did not influence contest duration and there was no increase in contest duration with mean body size; thus, there is no support for self-assessment in these animals. We also examined the effects of the sword, which comprises a sexually selected extension used in female choice that reduces swimming efficiency but increases acceleration. The length of the sword (adjusted for body size) did not differ between winners and losers; however, losers conceded earlier if the opponent had a large sword for its body size but this decision was independent of the loser's own sword length. Losers thus assessed the swords of winners, which precludes self-assessment; however, because winners appeared not to assess the swords of losers, this does not fully support the idea of mutual assessment. (c) 2008 The Association for the Study of Animal Behaviour. Published by Elsevier Ltd. All rights reserved.

Understanding how animals fight with Lloyd Morgan's canon

Various game theory models have been used to explain animal contests. Here we attend to the presumed cognitive abilities required by these models with respect to information gathering and consequent decision making. Some, such as the hawk/dove game and self-assessment models require very limited cognitive ability. By contrast, the broadly accepted sequential assessment model requires that contestants know their own abilities and compare them with information gathered about their opponent to determine which has the greater resource-holding power. However, evidence for assessment of relative abilities is sparse and we suggest that this complex ability is probably beyond most animals. Indeed, perceptual limitations may restrict information about an individual's own displays and thus preclude comparison. We take a parsimonious view and conclude that simple summation of causal factors accounts for changes in fight motivation without requiring mutual evaluation of relative abilities. © 2012 The Association for the Study of Animal Behaviour.

The efficacy of a CDIO based integrated curriculum as preparation for professional practice in product design and development

The School of Mechanical and Aerospace Engineering at Queen’s University Belfast started BEng and MEng degree programmes in Product Design and Development (PDD) in 2004. Intended from the outset to be significantly different from the existing programmes within the School the PDD degrees used the syllabus and standards defined by the CDIO Initiative as the basis for an integrated curriculum. Students are taught in the context of conceiving, designing, implementing and operating a product. Fundamental to this approach is a core sequence of Design-Build-Test (DBT) experiences which facilitates the development of a range of professional skills as well as the immediate application of technical knowledge gained in strategically aligned supporting modules.
The key objective of the degree programmes is to better prepare students for professional practice. PDD graduates were surveyed using a questionnaire developed by the CDIO founders and interviewed to examine the efficacy of these degree programmes, particularly in this key objective. Graduate employment rates, self assessment of graduate attributes and examples of work produced by MEng graduates provided positive evidence that their capabilities met the requirements of the profession. The 24% questionnaire response rate from the 96 graduates to date did not however facilitate statistically significant conclusions to be drawn and particularly not for BEng graduates who were under represented in the response group. While not providing proof of efficacy the investigation did provide a good amount of useful data for consideration as part of a continuous improvement process.

Supporting active learning in an undergraduate geotechnical engineering course using group-based audience response systems quizzes

The use of audience response systems (ARSs) or ‘clickers’ in higher education has increased over the recent years, predominantly owing to their ability to actively engage students, for promoting individual and group learning, and for providing instantaneous feedback to students and teachers. This paper describes how group-basedARSquizzes have been integrated into an undergraduate civil engineering course on foundation design. Overall, theARSsummary quizzes were very well received by the students. Feedback obtained from the students indicates that the majority believed the group-based quizzes were useful activities, which helped to improve their understanding of course materials, encouraged self-assessment, and assisted preparation for their summative examination. Providing students with clickers does not, however, necessarily guarantee the class will be engaged with the activity. If an ARS activity is to be successful, careful planning and design must be carried out and modifications adopted where necessary, which should be informed by the literature and relevant student feedback.

Climate change response in Europe: What's the reality? Analysis of adaptation and mitigation plans from 200 urban areas in 11 countries

Urban areas are pivotal to global adaptation and mitigation efforts. But how do cities actually perform in terms of climate change response? This study sheds light on the state of urban climate change adaptation and mitigation planning across Europe. Europe is an excellent test case given its advanced environmental policies and high urbanization. We performed a detailed analysis of 200 large and medium-sized cities across 11 European countries and analysed the cities' climate change adaptation and mitigation plans. We investigate the regional distribution of plans, adaptation and mitigation foci and the extent to which planned greenhouse gas (GHG) reductions contribute to national and international climate objectives. To our knowledge, it is the first study of its kind as it does not rely on self-assessment (questionnaires or social surveys). Our results show that 35 % of European cities studied have no dedicated mitigation plan and 72 % have no adaptation plan. No city has an adaptation plan without a mitigation plan. One quarter of the cities have both an adaptation and a mitigation plan and set quantitative GHG reduction targets, but those vary extensively in scope and ambition. Furthermore, we show that if the planned actions within cities are nationally representative the 11 countries investigated would achieve a 37 % reduction in GHG emissions by 2050, translating into a 27 % reduction in GHG emissions for the EU as a whole. However, the actions would often be insufficient to reach national targets and fall short of the 80 % reduction in GHG emissions recommended to avoid global mean temperature rising by 2 °C above pre-industrial levels. © 2013 Springer Science+Business Media Dordrecht.

Understanding the practice nurse’s role in the cancer care tapestry

Background: The are currently 2 million people in the UK living with or
after cancer, and this number is expected to double by 2030 (Maddams et
al, 2012). However, many report unmet physical and psychological needs.

Aim: To determine the learning needs of practice nurses to take on an
enhanced role with people affected by cancer, particularly after primary
treatment, and to develop a course to meet these needs.

Method: The Macmillan Steering Group designed and developed a course for practice
nurses to identify their learning needs, enabling participating practice
nurses to work collaboratively with each other and the course facilitator.
There was strong patient involvement throughout. The course was
evaluated by self-assessment of knowledge, skills and confidence, patient
satisfaction questionnaires and in-depth, qualitative telephone interviews
with the participants and their supporting GPs.

Results: The practice nurses reported changed practice, with increased confidence in discussing
issues relating to cancer and its treatment with patients and relatives.
They understood the importance of supported self-management and were
able to signpost patients to appropriate sources of information and
support. Many of the practice nurses started initiating and undertaking
Cancer Care Reviews, both as planned appointments and opportunistically.
Over the past year, a further nine pilots have been completed throughout
the UK, demonstrating that these results are reproducible in other settings.

Conclusions: With appropriate support and training and protected time
to include cancer care into their everyday work, practice nurses can take
on an important role in the support and care of people affected by cancer

QA and Enhancement Marketplace for HEIs – An Erasmus+ project

Improving European education and training system quality has been set as a key target in Europe’s strategy to become a smart, sustainable and inclusive economy by 2020 (European Commission, 2010). These objectives are more specifically defined in the so called Modernisation Agenda (European Commission, 2011). More specifically it sets a goal to improve the quality and relevance of higher education. In this process external evaluation and
Proceedings of the 11th International CDIO Conference, Chengdu University of Information Technology,
Chengdu, Sichuan, P.R. China, June 8-11, 2015.
self-assessment are seen in a key role! In the CDIO approach the 12 CDIO standards provide a framework for continuous improvement. Each institution/institutional department are encouraged to regularly do the self-evaluation using the CDIO Standards. Eight European universities identified a need for further enhancement of the self-evaluations and creation of processes with peers to reduce the inertia of heavy accreditations/evaluations in HEIs. In September 2014 these universities started an Erasmus+ project (QAEMarketPlace4HEI) aiming at
1. Developing a collaborative, comprehensive and accessible evaluation process model, methods and tools for HEIs to complement the accreditation systems.
2. Promoting, increasing and exploiting further the European collaboration in the evaluation processes and the exchange of best practices.
3. Disseminating the model, best practices and widen the cooperation to new HEIs in Europe through the partner networks.

Towards a Mobile Assistive Technology for Monitoring and Assessing Cognitive Fatigue in Individuals with Acquired Brain Injury

Those living with an acquired brain injury often have issues with fatigue due to factors resulting from the injury. Cognitive impairments such as lack of memory, concentration and planning have a great impact on an individual’s ability to carry out general everyday tasks, which subsequently has the effect of inducing cognitive fatigue. Moreover, there is difficulty in assessing cognitive fatigue, as there are no real biological markers that can be measured. Rather, it is a very subjective effect that can only be diagnosed by the individual. Consequently, the traditional way of assessing cognitive fatigue is to use a self-assessment questionnaire that is able to determine contributing factors. State of the art methods to evaluate cognitive! fa tigue employ cognitive tests in order to analyse performance on predefined tasks. However, one primary issue with such tests is that they are typically carried out in a clinical environment, therefore do not have the ability to be utilized in situ within everyday life. This paper presents a smartphone application for the evaluation of fatigue, which can be used daily to track cognitive performance in order to assess the influence of fatigue.

As TIC na educação de alunos com necessidades educativas especiais: proposta de um programa de formação para o ensino básico

Este trabalho visa investigar e desenhar uma proposta de um programa de formação contínua focalizado na utilização das TIC na Educação de Alunos com NEE, dirigido a Docentes de Educação Especial e a Coordenadores PTE, considerando que estes dois grupos profissionais podem desempenhar um papel preponderante na promoção de uma escola verdadeiramente inclusiva da qual a utilização de tecnologias com populações especiais é uma adjuvante. A facilitação do Acesso e Participação por meio das tecnologias carece de profissionais capacitados e cientes do potencial destas tecnologias, pelo que a formação obtida é um fator decisivo no balancear entre necessidades e competências. Para tal, e no enquadramento teórico, procurámos contextualizar o modo como se processa a educação dos alunos com Necessidades Educativas Especiais e todas as determinantes neste processo. A identificação do estado da arte da utilização das TIC na educação de todos os alunos é igualmente abordada de modo a estabelecer relações da sua utilização com os alunos que se desviam dos padrões usuais de Aprendizagem. Procurámos, igualmente, discriminar de que modo se processa a formação de professores no contexto nacional e qual o seu impacto para o estabelecimento de uma escola inclusiva. Do ponto de vista metodológico, desenvolveu-se um estudo descritivoexploratório, com o propósito de identificar as competências e necessidades das populações envolvidas, que se materializou num survey (inquérito) nacional por questionário para levantamento de necessidades de formação, seguindo-se um estudo de caso, no qual foi implementada uma ação de formação com base nos resultados obtidos. Para o estudo de caso foram utilizados três momentos de autoavaliação que, conjugados com a avaliação dos formandos e a avaliação da formação, nos permitiram especificar um modelo de formação. Este, e com base nos resultados alcançados, perspetiva o suporte efetivo das TIC à prática pedagógica que melhor se adequa às necessidades de formação teórica, conceptual, prática e atitudinal dos Docentes de Educação Especial (DAE) e/ou Docentes de Apoios Educativos e Coordenadores TIC que apoiam alunos com Necessidades Educativas Especiais.

Aprendizagem potenciada pela tecnologia no ensino superior : construção de um referencial de qualidade

A utilização da tecnologia como mediadora do processo de ensino e de aprendizagem tem sido um aspeto incontornável no Ensino Superior e nas prioridades institucionais. A sua utilização tem sido, no entanto, mais norteada por um paradigma de disponibilização em vez de ser norteada por um paradigma de potenciação. Este estudo procura discutir o papel da tecnologia como potenciadora da aprendizagem, através da introdução de um conceito de aprendizagem potenciada pela tecnologia. Nesse sentido o estudo procura apresentar um referencial de qualidade dos pressupostos para a existência de uma aprendizagem potenciada pela tecnologia que permita orientar os diversos atores para práticas de qualidade na utilização da tecnologia e facilitar o desenho de instrumentos de avaliação, autoavaliação e monitorização. Assente num método de Grounded Theory, sustentado em abordagens interpretativas e qualitativas, o estudo procura identificar os alicerces da aprendizagem potenciada pela tecnologia através da identificação de instâncias e da formulação de conceitos reveladores de práticas de qualidade. Paralelamente, o estudo desenha um quadro referencial de qualidade que procura identificar dimensões e indicadores que permitam avaliar a qualidade dos pressupostos fundamentais para a concretização de uma aprendizagem potenciada pela tecnologia. O quadro referencial, assim como a definição do conceito de aprendizagem potenciada pela tecnologia, foi sustentado metodologicamente em dois estudos: (i) um estudo teórico, no qual foram identificados os alicerces da aprendizagem potenciada pela tecnologia no Ensino Superior, assim como uma revisão de modelos e de instrumentos nacionais e internacionais; e (ii) um estudo empírico que inclui a realização de entrevistas individuais a docentes, membros de órgãos de gestão e staff de suporte; Focus-Group a estudantes; e entrevistas a

Ritmos biológicos, cronotipo e funções cognitivas : um estudo de campo

Os primeiros estudos onde se tentava avaliar os melhores horários para se lecionar de forma a se poderem otimizar os horários escolares são já muito antigos. O primeiro a estabelecer uma relação sistemática entre performance cognitiva, Cronobiologia e sono foi Kleitman, evidenciando uma paralelismo entre o ritmo circadiano da temperatura central e a altura do dia em que eram realizadas tarefas simples de repetição. Após este primeiro estudo, muitos outros se seguiram, contudo a maioria apenas encontrou ritmos em protocolos de rotina constante e dessincronização forçada desprovidos de validade ecológica. Acresce ainda o facto de neste tipo de estudos não haver uma manipulação sistemática do efeito do padrão individual de distribuição dos parâmetros circadianos no nictómero, designado na literatura como Cronotipo. Perante isto, o presente estudo pretende avaliar a influência do Cronotipo nos ritmos cognitivos, utilizando um protocolo de rotina normal (Ecológico), onde também se manipula o efeito fim-de-semana. Para testar as premissas supramencionadas, utilizou-se uma amostra de 16 alunos universitários, que numa primeira fase responderam ao questionário de Matutinidade e Vespertinidade de Horne&Östberg, para caracterização do Cronotipo, e posteriormente andaram 15-17 dias consecutivos com tempatilumis (actímetros) para análise de ritmos de temperatura e atividade, com iPads onde realizavam ao longo do dia várias tarefas cognitivas e com o Manual de Registo Diário, onde respondiam ao diário de sono e de atividade. A análise de dados denotou a inexistência de expressão de ritmos na maioria dos parâmetros cognitivos inviabilizando a verificação de diferenças significativas entre indivíduos matutinos e vespertinos nestes parâmetros. Esta ausência de visualização da expressão rítmica pode ser explicada pelo facto de os participantes não terem aderido da forma desejada e exigida, à realização das tarefas cognitivas, ou pelo facto de termos usado um protocolo de rotina normal, em detrimento dos protocolos de rotina constate e dessincronização forçada, não controlando assim algumas variáveis que influenciam o desempenho cognitivo, podendo estas mascarar ou mesmo eliminar o ritmo. Ainda assim e apesar destas contingências observaram-se ritmos circadianos nas variáveis de autoavaliação, mesmo com o paradigma ecológico. Verificou-se ainda um efeito da hora do dia em vários parâmetros de tarefas cognitivas e motoras medidas objetivamente, assim como uma diminuição da performance cognitiva nos vespertinos, comparativamente aos matutinos, na janela temporal das 6h às 12 horas, que coincide com a maior concentração de horas de aulas por dia na Universidade onde o estudo foi realizado. Outros estudos serão necessários para consolidar a influência do Cronotipo nos ritmos cognitivos, utilizando o protocolo de rotina normal para garantir a validade ecológica, salvaguardando uma participação mais ativa na execução das tarefas cognitivas por parte dos sujeitos em estudo.

Auto-avaliação : um dispositivo de conhecimento ao serviço da melhoria da escola : a participação dos actores-chave da comunidade educativa

Trabalho de projecto de mestrado, Ciências da Educação (Administração Educacional), Universidade de Lisboa, Instituto de Educação, 2011

Desenvolvimento de indicadores de comunicação em cuidados farmacêuticos : estudo piloto da sua aplicabilidade em farmácias comunitárias europeias

Tese de mestrado, Cuidados Farmacêuticos, Universidade de Lisboa, Faculdade de Farmácia, 2013