Challenges and Recommendations for Placebo Controls in Randomized Trials in Physical and Rehabilitation Medicine A Report of the International Placebo Symposium Working Group

Compared with other specialties, the field of physical and rehabilitation medicine has not received the deserved recognition from clinicians and researchers in the scientific community. One of the reasons is the lack of sound evidence to support the traditional physical and rehabilitation medicine treatments. The best way to change this disadvantage is through a well conducted clinical research, such as standard placebo- or sham-controlled randomized clinical trials. Therefore, having placebo groups in clinical trials is essential to improve the level of evidence-based practice in physical and rehabilitation medicine that ultimately translates to better clinical care. To address the challenges for the use of placebo in physical and rehabilitation medicine and randomized clinical trials and to create useful recommendations, we convened a working group during the inaugural International Symposium in Placebo (February 2009, in Sao Paulo, Brazil) in which the following topics were discussed: (1) current status of randomized clinical trials in physical and rehabilitation medicine, (2) challenges for the use of placebo in physical and rehabilitation medicine, (3) bioethics, (4) use of placebo in acupuncture trials and for the treatment of low-back pain, (5) mechanisms of placebo, and (6) insights from other specialties. The current article represents the consensus report from the working group.

Algoritmo de controlo inteligente de microprodução para regulação de tensão em redes de baixa tensão

Com o constante desenvolvimento da sociedade, o consumo de energia elétrica tem aumentado gradualmente, por outro lado a preocupação com o meio ambiente e a necessidade de um desenvolvimento sustentável, faz com que a legislação atual favoreça a introdução de fontes de energia de origem renovável em detrimento de fontes de energia de origem fóssil. Cada vez mais têm surgido incentivos para a implementação de pequenos sistemas de produção em instalações de utilização, estes consumidores/produtores são denominados de prosumers, sendo este tipo de produtores ligados à rede elétrica de baixa tensão. Com a introdução deste tipo de produtores é necessário dotar a rede elétrica de meios que permitam ao operador da rede monitorizar e controlar em tempo real o estado da rede assim como destes novos produtores. No âmbito desta dissertação, foi desenvolvido um algoritmo de controlo inteligente de microprodução. Avaliando o consumo, a produção, entre outros parâmetros de gestão da rede, este algoritmo calculará um conjunto de set-points que deverão ser enviados para os microprodutores de modo a limitar a potência injetada na rede e assim controlar a tensão. Também foi realizado um estudo económico do impacto que as medidas propostas teriam do ponto de vista dos gestores da rede bem como do ponto de vista dos microprodutores.

Desenvolvimento de ferramenta de apoio ao dimensionamento de sistemas de autoconsumo fotovoltaico em ambiente doméstico

Nos últimos anos, tem-se assistido a uma maior preocupação com o meio ambiente, a atual conjuntura mundial está cada vez mais direcionada para a eficiência energética e para a utilização de fontes de energias renováveis. Os principais governos mundiais, incluindo o português, já perceberam a necessidade de enveredar por esse caminho e nesse sentido aplicam medidas que direcionam e consciencializam a população para a eficiência energética e para as energias renováveis. Em Portugal, o setor das energias renováveis assume atualmente uma posição de extrema importância, resultante da expressão que governo português tem vindo a implementar no panorama energético nacional, da qual resulta uma importante contribuição para o desenvolvimento económico, na criação de riqueza e geração de emprego. Neste contexto, e no caso particular da energia fotovoltaica têm sido implementadas medidas que incentivam a aposta nesta tecnologia, prova disso é o Decreto-Lei n.º 153/2014 aprovado em conselho de ministros em Setembro de 2014, que promove essencialmente o autoconsumo. O autoconsumo consiste na utilização de painéis fotovoltaicos para produção de energia elétrica para consumo próprio com ou sem recurso a equipamentos de acumulação. Em termos práticos, este sistema permite que os consumidores produzam a sua própria energia através de uma fonte renovável ao invés de adquirir essa energia na rede elétrica de serviço público. As políticas de incentivo ao autoconsumo proporcionam uma oportunidade para os consumidores interessados em investir na produção da própria energia elétrica, neste sentido e de forma a ajudar no dimensionamento de unidades de produção de autoconsumo foi desenvolvida, no âmbito desta tese, uma ferramenta de apoio ao dimensionamento de sistemas de autoconsumo fotovoltaico sem acumulação em ambiente doméstico, com o objetivo de estimar as necessidades de potência fotovoltaica a instalar em habitações de baixa tensão normal. Na base da construção desta ferramenta estiveram essencialmente os perfis de consumo, aprovados pela Entidade Reguladora dos Serviços Energéticos, de todos os clientes finais que não dispõem de equipamento de medição com registo de consumos e também a estimativa de produção fotovoltaica desenvolvida pelo Centro Comum de Investigação da Comissão Europeia. A aplicação desenvolvida tem como principal funcionalidade proporcionar ao utilizador o dimensionamento de unidades de produção de autoconsumo fotovoltaico, mediante a introdução de alguns dados tais como o distrito, a potência contratada, a tarifa e o consumo energético anual. Esta aplicação apresenta resultados relativos ao dimensionamento do sistema, como é o caso da potência a instalar e da estimativa de produção fotovoltaica anual, e resultados relativos à análise económica do sistema como é o caso do valor atual líquido, da taxa interna de rentabilidade e do payback do investimento.

Transimpedance amplifier for early detection of breast cancer

Breast cancer is the most common type of cancer worldwide. The effectiveness of its treatment depends on early stage detection, as well as on the accuracy of its diagnosis. Recently, diagnosis techniques have been submitted to relevant breakthroughs with the upcoming of Magnetic Resonance Imaging, Ultrasound Sonograms and Positron Emission Tomography (PET) scans, among others. The work presented here is focused on studying the application of a PET system to a Positron Emission Mammography (PEM) system. A PET/PEM system works under the principle that a scintillating crystal will detect a gamma-ray pulse, originated at the cancerous cells, converting it into a correspondent visible light pulse. The latter must then be converted into an electrical current pulse by means of a Photo- -Sensitive Device (PSD). After the PSD there must be a Transimpedance Amplifier (TIA) in order to convert the current pulse into a suitable output voltage, in a time period lower than 40 ns. In this Thesis, the PSD considered is a Silicon Photo-Multiplier (SiPM). The usage of this recently developed type of PSD is impracticable with the conventional TIA topologies, as it will be proven. Therefore, the usage of the Regulated Common-Gate (RCG) topology will be studied in the design of the amplifier. There will be also presented two RCG variations, comprising a noise response improvement and differential operation of the circuit. The mentioned topology will also be tested in a Radio-Frequency front-end, showing the versatility of the RCG. A study comprising a low-voltage self-biasing feedback TIA will also be shown. The proposed circuits will be simulated with standard CMOS technology (UMC 130 nm), using a 1.2 V power supply. A power consumption of 0.34 mW with a signal-to-noise ratio of 43 dB was achieved.

Numerical prediction of diffusion and electric field-induced iron nanoparticle transport

Zero valent iron nanoparticles (nZVI) are considered very promising for the remediation of contaminated soils and groundwaters. However, an important issue related to their limited mobility remains unsolved. Direct current can be used to enhance the nanoparticles transport, based on the same principles of electrokinetic remediation. In this work, a generalized physicochemical model was developed and solved numerically to describe the nZVI transport through porous media under electric field, and with different electrolytes (with different ionic strengths). The model consists of the Nernst–Planck coupled system of equations, which accounts for the mass balance of ionic species in a fluid medium, when both the diffusion and electromigration of the ions are considered. The diffusion and electrophoretic transport of the negatively charged nZVI particles were also considered in the system. The contribution of electroosmotic flow to the overall mass transport was included in the model for all cases. The nZVI effective mobility values in the porous medium are very low (10−7–10−4 cm2 V−1 s−1), due to the counterbalance between the positive electroosmotic flow and the electrophoretic transport of the negatively charged nanoparticles. The higher the nZVI concentration is in the matrix, the higher the aggregation; therefore, low concentration of nZVI suspensions must be used for successful field application.

Desenvolvimento de um Range Extender para Veículo Elétrico

Dissertação de mestrado integrado em Engenharia Eletrónica Industrial e de Computadores

Comparison of Methods for Evaluation of the Bactericidal Activity of Copper-Sputtered Surfaces against Methicillin-Resistant Staphylococcus aureus.

Bacteria can survive on hospital textiles and surfaces, from which they can be disseminated, representing a source of health care-associated infections (HCAIs). Surfaces containing copper (Cu), which is known for its bactericidal properties, could be an efficient way to lower the burden of potential pathogens. The antimicrobial activity of Cu-sputtered polyester surfaces, obtained by direct-current magnetron sputtering (DCMS), against methicillin-resistant Staphylococcus aureus (MRSA) was tested. The Cu-polyester microstructure was characterized by high-resolution transmission electron microscopy to determine the microstructure of the Cu nanoparticles and by profilometry to assess the thickness of the layers. Sputtering at 300 mA for 160 s led to a Cu film thickness of 20 nm (100 Cu layers) containing 0.209% (wt/wt) polyester. The viability of MRSA strain ATCC 43300 on Cu-sputtered polyester was evaluated by four methods: (i) mechanical detachment, (ii) microcalorimetry, (iii) direct transfer onto plates, and (iv) stereomicroscopy. The low efficacy of mechanical detachment impeded bacterial viability estimations. Microcalorimetry provided only semiquantitative results. Direct transfer onto plates and stereomicroscopy seemed to be the most suitable methods to evaluate the bacterial inactivation potential of Cu-sputtered polyester surfaces, since they presented the least experimental bias. Cu-polyester samples sputtered for 160 s by DCMS were further tested against 10 clinical MRSA isolates and showed a high level of bactericidal activity, with a 4-log(10) reduction in the initial MRSA load (10(6) CFU) within 1 h. Cu-sputtered polyester surfaces might be of use to prevent the transmission of HCAI pathogens.

Non-pharmacological interventions for chronic pain in people with spinal cord injury.

BACKGROUND: Chronic pain is frequent in persons living with spinal cord injury (SCI). Conventionally, the pain is treated pharmacologically, yet long-term pain medication is often refractory and associated with side effects. Non-pharmacological interventions are frequently advocated, although the benefit and harm profiles of these treatments are not well established, in part because of methodological weaknesses of available studies. OBJECTIVES: To critically appraise and synthesise available research evidence on the effects of non-pharmacological interventions for the treatment of chronic neuropathic and nociceptive pain in people living with SCI. SEARCH METHODS: The search was run on the 1st March 2011. We searched the Cochrane Injuries Group's Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (OvidSP), Embase (OvidSP), PsycINFO (OvidSP), four other databases and clinical trials registers. In addition, we manually searched the proceedings of three major scientific conferences on SCI. We updated this search in November 2014 but these results have not yet been incorporated. SELECTION CRITERIA: Randomised controlled trials of any intervention not involving intake of medication or other active substances to treat chronic pain in people with SCI. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data and assessed risk of bias in the included studies. The primary outcome was any measure of pain intensity or pain relief. Secondary outcomes included adverse events, anxiety, depression and quality of life. When possible, meta-analyses were performed to calculate standardised mean differences for each type of intervention. MAIN RESULTS: We identified 16 trials involving a total of 616 participants. Eight different types of interventions were studied. Eight trials investigated the effects of electrical brain stimulation (transcranial direct current stimulation (tDCS) and cranial electrotherapy stimulation (CES); five trials) or repetitive transcranial magnetic stimulation (rTMS; three trials). Interventions in the remaining studies included exercise programmes (three trials); acupuncture (two trials); self-hypnosis (one trial); transcutaneous electrical nerve stimulation (TENS) (one trial); and a cognitive behavioural programme (one trial). None of the included trials were considered to have low overall risk of bias. Twelve studies had high overall risk of bias, and in four studies risk of bias was unclear. The overall quality of the included studies was weak. Their validity was impaired by methodological weaknesses such as inappropriate choice of control groups. An additional search in November 2014 identified more recent studies that will be included in an update of this review.For tDCS the pooled mean difference between intervention and control groups in pain scores on an 11-point visual analogue scale (VAS) (0-10) was a reduction of -1.90 units (95% confidence interval (CI) -3.48 to -0.33; P value 0.02) in the short term and of -1.87 (95% CI -3.30 to -0.45; P value 0.01) in the mid term. Exercise programmes led to mean reductions in chronic shoulder pain of -1.9 score points for the Short Form (SF)-36 item for pain experience (95% CI -3.4 to -0.4; P value 0.01) and -2.8 pain VAS units (95% CI -3.77 to -1.83; P value < 0.00001); this represented the largest observed treatment effects in the included studies. Trials using rTMS, CES, acupuncture, self-hypnosis, TENS or a cognitive behavioural programme provided no evidence that these interventions reduce chronic pain. Ten trials examined study endpoints other than pain, including anxiety, depression and quality of life, but available data were too scarce for firm conclusions to be drawn. In four trials no side effects were reported with study interventions. Five trials reported transient mild side effects. Overall, a paucity of evidence was found on any serious or long-lasting side effects of the interventions. AUTHORS' CONCLUSIONS: Evidence is insufficient to suggest that non-pharmacological treatments are effective in reducing chronic pain in people living with SCI. The benefits and harms of commonly used non-pharmacological pain treatments should be investigated in randomised controlled trials with adequate sample size and study methodology.

Unusual voltage sag event detection in power systems

Three multivariate statistical tools (principal component analysis, factor analysis, analysis discriminant) have been tested to characterize and model the sags registered in distribution substations. Those models use several features to represent the magnitude, duration and unbalanced grade of sags. They have been obtained from voltage and current waveforms. The techniques are tested and compared using 69 registers of sags. The advantages and drawbacks of each technique are listed

Bipolar pulsed excitation of erbium-doped nanosilicon light emitting diodes

High quantum efficiency erbium doped silicon nanocluster (Si-NC:Er) light emitting diodes (LEDs) were grown by low-pressure chemical vapor deposition (LPCVD) in a complementary metal-oxide-semiconductor (CMOS) line. Erbium (Er) excitation mechanisms under direct current (DC) and bipolar pulsed electrical injection were studied in a broad range of excitation voltages and frequencies. Under DC excitation, Fowler-Nordheim tunneling of electrons is mediated by Er-related trap states and electroluminescence originates from impact excitation of Er ions. When the bipolar pulsed electrical injection is used, the electron transport and Er excitation mechanism change. Sequential injection of electrons and holes into silicon nanoclusters takes place and nonradiative energy transfer to Er ions is observed. This mechanism occurs in a range of lower driving voltages than those observed in DC and injection frequencies higher than the Er emission rate.

Polarization strategies to improve the emission of a Si-based light source emitting at 1.55 um

We present a electroluminescence (EL) study of the Si-rich silicon oxide (SRSO) LEDs with and without Er3+ ions under different polarization schemes: direct current (DC) and pulsed voltage (PV). The power efficiency of the devices and their main optical limitations are presented. We show that under PV polarization scheme, the devices achieve one order of magnitude superior performance in comparison with DC. Time-resolved measurements have shown that this enhancement is met only for active layers in which annealing temperature is high enough (>1000 ◦C) for silicon nanocrystal (Si-nc) formation. Modeling of the system with rate equations has been done and excitation cross-sections for both Si-nc and Er3+ ions have been extracted.

Nanoscale electrical conductivity of the purple membrane monolayer

Nanoscale electron transport through the purple membrane monolayer, a two-dimensional crystal lattice of the transmembrane protein bacteriorhodopsin, is studied by conductive atomic force microscopy. We demonstrate that the purple membrane exhibits nonresonant tunneling transport, with two characteristic tunneling regimes depending on the applied voltage (direct and Fowler-Nordheim). Our results show that the purple membrane can carry significant current density at the nanometer scale, several orders of magnitude larger than previously estimated by macroscale measurements.

Cathodic Protection for a Continuous Box Girder Bridge Deck, HR-553, 1993

Bridge deck deterioration due to corrosive effect of deicers on reinforcing steel is a major problem facing many agencies. Cathodic protection is one method used to prevent reinforcing steel corrosion. The application of a direct current to the embedded reinforcing steel and a sacrificial anode protects the steel from corrosion. This 1992 project involved placing an Elgard Titanium Anode Mesh Cathodic Protection System on a bridge deck. The anode was fastened to the deck after the Class A repair-work and the overlay was placed using the Iowa Low Slump Dense Concrete System. The system was set up initially at 1 mA/sq ft.

Iowa System of Bridge Deck Rehabilitation with Cathodic Protection, HR-1044, 1986

Bridge deck and substructure deterioration due to the corrosive effects of deicing chemicals on reinforcing steel is a problem facing many transportation agencies. The main concern is protection of older bridges with uncoated reinforcing steel. Many different methods have been tried over the past years to repair bridge decks. The Iowa system of bridge deck rehabilitation has proven to be very effective. It consists of scarifying the deck surface, removing any deteriorated concrete, and overlaying with low slump dense concrete. Another rehabilitation method that has emerged is cathodic protection. It has been used for many years in the protection of underground pipelines and in 1973 was first installed on a bridge deck. Cathodic protection works by applying an external source of direct current to the embedded reinforcing steel, thereby changing the electrochemical process of corrosion. The corroding steel, which is anodic, is protected by changing it to a cathodic state. The technology involved in cathodic protection as applied to bridge decks has improved over the last 12 years. One company marketing new technology in cathodic protection systems is Raychem Corporation of Menlo Park, California. Their system utilizes a Ferex anode mesh that distributes the impressed direct current over the deck surface. Ferex mesh was selected because it seemed readily adaptable to the Iowa system of bridge deck rehabilitation. The bridge deck would be scarified, deteriorated concrete removed, Ferex anode mesh installed, and overlaid with low slump dense concrete. The Federal Highway Administration (FHWA) promotes cathodic protection under Demonstration Project No. 34, "Cathodic Protection for Reinforced Concrete Bridge Decks."

Moniensiöinen muuntaja taajuudenmuuttajakäytössä

Suuritehoisissa pumppu- ja puhallinkäytöissä käytetään usein suurnopeusmoottoria,jota syötetään välijännitteellä. Suurjännitetaajuudenmuuttajat ovat kalliita, eikä niitä ole aina edes mahdollista valmistaa. Tutkimuksen kohteena on rinnakkaisilla pienjännitetaajuudenmuuttajilla toteutettu sähkökäyttö, jossa pienjännite nostetaan moniensiöisellä muuntajalla suurjännitteeksi (6,6 kV) ja syötetään edelleen kuormana olevalle suurnopeusmoottorille. Opinnäytetyössä tutkitaan moniensiöisen muuntajan syöttöä rinnakkaisilla taajuudenmuuttajilla sekä niiden aiheuttamia häiriöitä toisilleen. Työssä tutkitaan myös harmonisten yliaaltojen vaikutuksia muuntajan häviöihin ja magnetointiominaisuuksiin. Taajuudenmuuttajan lähtöjännite ja -virta suodatetaan sinisuotimella, jonka parametreja simuloidaan Simulink- ohjelmistolla. Tavoite on löytää optimaaliset parametrit taajuudenmuuttajanlähtösuotimelle käyrämuotojen ja suotimeen jäävän tehon suhteen. Työssä tarkasteltiin sinisuodinta, johon jää 3 prosenttia syöttöjännitteestä. LC-suodin kompensoi sähkökäytön loistehon lähes kokonaan, joten taajuudenmuuttajien antotehon kannalta suotimet ovat perusteltuja. Taajuudenmuuttajan näennäisteho putoaa 22 prosenttia, joten taajuudenmuuttajat voidaan vastaavasti mitoittaa pienemmiksi.