Segurança do doente e boas práticas de consentimento esclarecido na realização de exames de tomografia computorizada

RESUMO - O presente trabalho pretende centrar-se no estudo da Segurança do Doente e das boas práticas de Consentimento Esclarecido na realização de exames de Tomografia Computorizada. Nos dias de hoje, a assinatura do documento de Consentimento Esclarecido tem-se mostrado um ato banal, sem a merecida atenção que entidades de saúde, Médicos e Técnicos de Radiologia lhe deviam conceder, uma vez que os Eventos Adversos, aquando da realização de uma TC com Meio de Contraste, poderão ser vários e complicados; por outro lado, o doente muitas vezes não está preparado nem devidamente informado sobre os seus efeitos e as medidas necessárias que deverão ser acionadas para os combater. A necessidade da veiculação de uma informação capaz, de uma elucidação total para o doente pôr em prática a sua autonomia, fruto da consciência que tem dos factos, revela-se fundamental, mas para que tal aconteça é urgente ultrapassar obstáculos respeitantes às práticas profissionais de entidades de saúde, Médicos e Técnicos de Radiologia, assim como aspetos sociais, linguísticos, idade, vulnerabilidade individual, entre outros. Neste contexto, a apresentação de boas práticas de Consentimento Esclarecido revela-se de extrema importância para o desenvolvimento desta dissertação. Para consubstanciar as ideias a desenvolver, para além da pesquisa bibliográfica, revelou-se importante a recolha de dados através de uma entrevista e de um inquérito a elementos que participam neste processo, nomeadamente, doentes, Médicos e Técnicos de Radiologia e, posteriormente, uma análise dos conteúdos dos resultados obtidos e a sua integração nos princípios teóricos do estudo.

Schistosomiasis mansoni in urban Northeast Brazil: influence of rainfall regime on the population dynamics of Biomphalaria sp.

Introduction Our objective was to evaluate the influence of rainfall regime on the population dynamics of Biomphalaria in a potential urban focus of schistosomiasis in Aracaju, Brazil, during 2009-2010. Methods Snails were collected monthly and were counted, measured and identified; the level of infection and fecal contamination at the sampling sites was determined; rainfall data were obtained. Results High levels of fecal contamination were observed, and the abundance of Biomphalaria glabrata increased during the rainy and post-rainy seasons. The snails' size was variable, and infected snails were identified independently of rainfall. Conclusions These results provide evidence of anthropogenic and climate interference in an urban focus of schistosomiasis in the Aracaju metropolitan area.

As concepções das famílias no envolvimento parental

Dissertação de Mestrado apresentada ao ISPA - Instituto Universitário

Leptospirosis in animals and human contacts in Egypt: broad range surveillance

INTRODUCTION: Leptospirosis is a re-emerging zoonotic disease of humans and animals worldwide. The disease is caused by pathogenic species of the genus Leptospira. These organisms are maintained in nature via chronic renal infection of carrier animals, which excrete the organisms in their urine. Humans become infected through direct or indirect exposure to infected animals and their urine or through contact with contaminated water and soil. This study was conducted to investigate Leptospira infections as a re-emerging zoonosis that has been neglected in Egypt. METHODS: Samples from 1,250 animals (270 rats, 168 dogs, 625 cows, 26 buffaloes, 99 sheep, 14 horses, 26 donkeys and 22 camels), 175 human contacts and 45 water sources were collected from different governorates in Egypt. The samples were collected from different body sites and prepared for culture, PCR and the microscopic agglutination test (MAT). RESULTS: The isolation rates of Leptospira serovars were 6.9%, 11.3% and 1.1% for rats, dogs and cows, respectively, whereas the PCR results revealed respective detection rates of 24%, 11.3% and 1.1% for rats, dogs and cows. Neither the other examined animal species nor humans yielded positive results via these two techniques. Only six Leptospira serovars (Icterohaemorrhagiae, Pomona, Canicola, Grippotyphosa, Celledoni and Pyrogenes) could be isolated from rats, dogs and cows. Moreover, the seroprevalence of leptospiral antibodies among the examined humans determined using MAT was 49.7%. CONCLUSIONS: The obtained results revealed that rats, dogs and cows were the most important animal reservoirs for leptospirosis in Egypt, and the high seroprevalence among human contacts highlights the public health implications of this neglected zoonosis.

History of insecticide resistance of Triatominae vectors

AbstractIn the last 15 years, different types of Triatominae resistance to different insecticides have been reported; thus, resistance may be more widespread than known, requiring better characterization and delimitation, which was the aim of this review. This review was structured on a literature search of all articles from 1970 to 2015 in the PubMed database that contained the keywords Insecticide resistance and Triatominae . Out of 295 articles screened by title, 33 texts were selected for detailed analysis. Insecticide resistance of Triatomines is a complex phenomenon that has been primarily reported in Argentina and Bolivia, and is caused by different factors (associated or isolated). Insecticide resistance of Triatominae is a characteristic inherited in an autosomal and semi-dominant manner, and is polygenic, being present in both domestic and sylvatic populations. The toxicological profile observed in eggs cannot be transposed to different stages of evolution. Different toxicological profiles exist at macro- and microgeographical levels. The insecticide phenotype has both reproductive and developmental costs. Different physiological mechanisms are involved in resistance. Studies of Triatomine resistance to insecticides highlight three deficiencies in interpreting the obtained results: I) the vast diversity of methodologies, despite the existence of a single guiding protocol; II) the lack of information on the actual impact of resistance ratios in the field; and III) the concept of the susceptibility reference lineage. Research on the biological and behavioral characteristics of each Triatominae species that has evolved resistance is required in relation to the environmental conditions of each region.

Suplementos alimentares: percepção dos profissionais dos cuidados de saúde primários quanto à segurança

RESUMO - Enquadramento: À semelhança do que tem acontecido com o risco de reacções adversas a medicamentos (RAM), também o risco de reacções adversas a suplementos alimentares tem aumentado gradualmente, com o aumento do consumo destes produtos definidos como géneros alimentícios comuns. Existem vários estudos publicados na área das RAM e alguns na área dos suplementos alimentares, mas a maior parte da investigação decorre em contexto hospitalar, sendo raros os estudos realizados nos cuidados de saúde primários (CSP). Assim, o presente estudo, ao avaliar a percepção dos profissionais de saúde dos CSP face à segurança dos suplementos alimentares, pretende contribuir para o aumento do conhecimento nesta área, o que permitirá o desenvolvimento de estratégias adequadas, que reduzam a ocorrência de eventos adversos e protejam a população. Métodos: Trata-se de um estudo observacional, transversal e analítico, com recurso a inquérito por questionário desenvolvido para o efeito. O presente estudo incluiu todos os profissionais de saúde dos Agrupamentos de Centros de Saúde (ACeS) Lisboa Central e Pinhal Litoral que aceitaram participar. Globalmente, a amostra do estudo (n=190) corresponde a 28% da população de profissionais de saúde dos dois ACeS. Resultados: O presente estudo permitiu concluir que muitos dos profissionais de saúde (64 a 93%) considera que a toma de suplementos alimentares pode representar algum risco para a saúde dos consumidores. Referem inclusivamente conhecer algumas reacções adversas associadas ao consumo destas substâncias, embora a maioria (85%) admita desconhecer a forma adequada de proceder à sua notificação. Contudo, esse conhecimento dos riscos para a saúde, ou mesmo das reacções adversas associadas, não parece condicionar os hábitos de prescrição ou aconselhamento aos utentes nem os hábitos de consumo pessoal de suplementos alimentares. Conclusões: Os resultados obtidos reforçam a necessidade de realização de mais estudos nesta área. Parece igualmente necessário o envolvimento dos Conselhos Clínicos e de Saúde dos ACeS na promoção da notificação de eventos adversos e a aposta na formação dos profissionais de saúde na área dos suplementos alimentares.

Determinação da protoporfirina-zinco por hematofluorímetro portátil : investigação sobre validade dos dados

RESUMO - A determinação da protoporfirina-zinco (PPZ) por meio de um hematofluorímetro portátil vem sendo descrita como apreciável contributo no contexto da vigilância de saúde de trabalhadores expostos a chumbo. Num estudo abrangendo 178 indivíduos (cerca de 60% dos quais referenciados como profissionalmente expostos àquele metal) foi testado o método e a técnica propostos e estudada a validade dos resultados assim obtidos. Concluiu-se que a determinação da PPZ em sangue colhido por punção capilar, por meio de hematofluorímetro portátil, oferece resultados fiáveis, permitindo, deste modo, o recurso a esta técnica de fácil execução e baixo custo.

Carry and trend-following strategies

Recent research has shown that carry and trend strategies when combined lead to significant risk-adjusted returns that can be very attractive to investors, at a low cost with small and positive skewness. This study proposes to combine both carry and trend-following, considering a data set of ten years (09/2005-09/2015), within a portfolio composed by three major asset classes: currencies, commodities and equity indices. Following a futures-based methodology, the obtained results show that, indeed, the strategy results inevitably in higher returns and greater sharpe ratios for every asset class in study. This outcome results from the fact that trend proved to provide a significant hedge to the downside risk that carry is exposed to.

Prevalência da C.trachomatis entre homens que fazem sexo com homens (HSH) que frequentam um centro clínico comunitário alternativo em Barcelona

RESUMO - Enquadramento: A infeção por Chlamydia trachomatis (CT) é considerada um grave problema de Saúde Pública. É causa de infeções sintomáticas tanto no homem como na mulher, bem como, de infeções assintomáticas que podem ter consequências muito graves a longo prazo. A presença de CT sem tratamento aumenta o risco de transmissão do vírus da imunodeficiência humana. Existem vários estudos publicados de prevalência da CT por todo o mundo, no entanto, estudos de prevalência da CT em populações assintomáticas, envolvendo homens que fazem sexo com homens (HSH) são raros na Europa. Assim, o presente estudo, ao estimar a prevalência e ao descrever as caraterísticas epidemiológicas e de conduta dos HSH, pretende contribuir para o plano de ação contra as IST´s e VIH na Catalunha, através de estratégias concretas para deteção e prevenção da CT. Métodos: Trata-se de um estudo observacional, transversal de prevalência da CT em HSH utentes de um serviço comunitário em Barcelona, com recurso a técnicas de diagnóstico de biologia molecular e a um questionário. Durante Março e Junho de 2015, foram recrutados 200 voluntários de um serviço comunitário em Barcelona que foram testados para CT e NG em três locais anatómicos através de uma PCR em tempo real utilizando o ensaio Anyplex™ CT/NG Real-time Detection. Resultados: O presente estudo permitiu uma caraterização da situação atual quanto á prevalência e aos fatores de risco associados á infeção por CT em HSH. A prevalência nesta população específica foi de 12,6% e os fatores risco associados foram o facto de serem VIH e praticarem sexo anal insertivo/recetivo com parceiro estável. Conclusões: Os resultados obtidos reforçam a necessidade do desenvolvimento de estratégias adequadas de controlo e prevenção da CT nesta população de risco, tais como: rastreios frequentes e tratamento dos casos positivos para quebrar a cadeia de transmissão, promoção da saúde, educação e notificação dos parceiros sexuais. Também demonstram a importância destes rastreios nos três locais anatómicos: uretra, reto e faringe.

Frequency-domain receiver design for doubly-selective channels

This work is devoted to the broadband wireless transmission techniques, which are serious candidates to be implemented in future broadband wireless and cellular systems, aiming at providing high and reliable data transmission and concomitantly high mobility. In order to cope with doubly-selective channels, receiver structures based on OFDM and SC-FDE block transmission techniques, are proposed, which allow cost-effective implementations, using FFT-based signal processing. The first subject to be addressed is the impact of the number of multipath components, and the diversity order, on the asymptotic performance of OFDM and SC-FDE, in uncoded and for different channel coding schemes. The obtained results show that the number of relevant separable multipath components is a key element that influences the performance of OFDM and SC-FDE schemes. Then, the improved estimation and detection performance of OFDM-based broadcasting systems, is introduced employing SFN (Single Frequency Network) operation. An initial coarse channel is obtained with resort to low-power training sequences estimation, and an iterative receiver with joint detection and channel estimation is presented. The achieved results have shown very good performance, close to that with perfect channel estimation. The next topic is related to SFN systems, devoting special attention to time-distortion effects inherent to these networks. Typically, the SFN broadcast wireless systems employ OFDM schemes to cope with severely time-dispersive channels. However, frequency errors, due to CFO, compromises the orthogonality between subcarriers. As an alternative approach, the possibility of using SC-FDE schemes (characterized by reduced envelope fluctuations and higher robustness to carrier frequency errors) is evaluated, and a technique, employing joint CFO estimation and compensation over the severe time-distortion effects, is proposed. Finally, broadband mobile wireless systems, in which the relative motion between the transmitter and receiver induces Doppler shift which is different or each propagation path, is considered, depending on the angle of incidence of that path in relation to the direction of travel. This represents a severe impairment in wireless digital communications systems, since that multipath propagation combined with the Doppler effects, lead to drastic and unpredictable fluctuations of the envelope of the received signal, severely affecting the detection performance. The channel variations due this effect are very difficult to estimate and compensate. In this work we propose a set of SC-FDE iterative receivers implementing efficient estimation and tracking techniques. The performance results show that the proposed receivers have very good performance, even in the presence of significant Doppler spread between the different groups of multipath components.

Cryopreservation of Cell Sheets of Adipose Stem Cells: Limitations and Successes

Cell Sheets of hASCs (hASCs-CS) have been previously proposed for wound healing applications(1, 2) and despite the concern for production time reduction, the possibility of having these hASCs-CS off-the-shelf is appealing. The goal of this work was to define a cryopreservation methodology allowing to preserve cells viability and the properties CS matrix. hASCs-CS obtained from three different donors were created in UP-cell thermoresponsive dishes(Nunc, Germany) as previously reported(1,2). Different cryopreservation conditions were considered: i)FBS plus DMSO(5% and10%); ii)0.4M of Trehalose plus DMSO (5% and 10%); iii)cryosolution PLL (Akron Biotech, USA); and iv)vitrification. The cryopreservation effect was first assessed for cellular viability by flow cytometry using 7-AAD, and after dissociating the hASCs-CS with collagenase and trypsin-EDTA 0.25%. The expression (RT-PCR) and deposition (western blot and immunocytochemistry) of collagen type I, laminin and fibronectin, and the organization (TEM) of the extracellular matrix was further assessed before and after hASCs-CS cryopreservation to determine a potential effect of the method over matrix composition and integrity. The obtained results confirmed that cell viability is affected by the cryopreservation methodology, as shown before for different CS(3). Interestingly, the matrix properties were not significantly altered and the typical cell sheetâ s easiness of manipulation for transplantation was not lost.

Field oriented control of an axial flux permanent magnet synchronous motor for traction solutions

Electric Vehicles (EVs) are increasingly used nowadays, and different powertrain solutions can be adopted. This paper describes the control system of an axial flux Permanent Magnet Synchronous Motor (PMSM) for EVs powertrain. It is described the implemented Field Oriented Control (FOC) algorithm and the Space Vector Modulation (SVM) technique. Also, the mathematical model of the PMSM is presented. Both, simulation and experimental, results with different types of mechanical load are presented. The experimental results were obtained using a laboratory test bench. The obtained results are discussed.

Monitoring the early stiffness development in epoxy adhesives for structural strengthening

The present work aimed to assess the early-age evolution of E-modulus of epoxy adhesives used for Fibre-Reinforced Polymer (FRP) strengthening applications. The study involved adapting an existing technique devised for continuous monitoring of concrete stiffness since casting, called EMM-ARM (Elasticity Modulus Measurement through Ambient Response Method) for evaluation of epoxy stiffness. Furthermore, monotonic tensile tests according to ISO standards and cyclic tensile tests were carried out at several ages. A comparison between the obtained results was performed in order to better understand the performance of the several techniques in the assessment of stiffness of epoxy resins. When compared to the other methodologies, the method for calculation of E-modulus recommended by ISO standard led to lower values, since in the considered strain interval, the adhesive had a non-linear stress–strain relationship. The EMM-ARM technique revealed its capability in clearly identifying the hardening kinetics of epoxy adhesives, measuring the material stiffness growth during the entire curing period. At very early ages the values of Young׳s modulus obtained with quasi-static tests were lower than the values collected by EMM-ARM, due to the fact that epoxy resin exhibited a significant visco-elastic behaviour.

A autonomia no processo de aquisição da competência plurilingue e intercultural no âmbito da aprendizagem do Espanhol

Relatório de estágio de mestrado em Ensino de Português no 3.º ciclo do Ensino Básico Secundário e do Ensino do Espanhol no Ensino Básico e Secundário

Prestress losses in reinforced concrete beams strengthened with NSM-CFRP laminates

Using prestressed near surface mounted fibre reinforced polymers (NSM-FRP) is nowadays regaining the attention from the scientific community for the strengthening of existing reinforced concrete (RC) structures. The application of prestressed internal FRP bars and externally bonded prestressed FRPs has already been deeply investigated and revealed considerable benefits when compared to the corresponding passive solutions. A certain amount of prestress provides benefits mainly associated to structural integrity and material durability. Immediately after prestress transference, it is possible to close some of the existing cracks, decreasing the susceptibility of the element to corrosion and, a certain amount of deflection can be recovered due to the creation of a negative curvature. However, very few studies have been carried out to properly assess the preservation of prestress over time. In this context, several reinforced concrete beams strengthened with prestressed NSM carbon FRP (CFRP) laminates were prestressed and monitored for about 40 days. The data obtained from these experimental programs is in this paper presented and analysed. The observed prestress losses were later modelled using finite elements analysis and, although this topic is not addressed in this paper, the obtained results revealed considerable precision. The largest strain losses in the CFRP laminate were found to be mainly located in the extremities of the bonded length, while in the central zone most of the applied pre-strain was retained over time. The highest CFRP strain losses were observed in the first 6 to 12 days after prestress transfer, suggesting that the application of prestressed NSM-FRP will be very effective over time.