942 resultados para Optimização de “lead-time”e “set-up”


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Dissertação para obtenção do Grau de Mestre em Engenharia Biomédica

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BACKGROUND: Bioresorbable vascular scaffolds (BVS) were recently approved for percutaneous coronary intervention in Europe. The aim of this position statement is to review the information and studies on available BVS, to stimulate discussion on their use and to propose guidelines for this treatment option in Portugal. METHODS AND RESULTS: A working group was set up to reach a consensus based on current evidence, discussion of clinical case models and individual experience. The evidence suggests that currently available BVS can produce physiological and clinical improvements in selected patients. There are encouraging data on their durability and long-term safety. Initial indications were grouped into three categories: (a) consensual and appropriate - young patients, diabetic patients, left anterior descending artery, long lesions, diffuse disease, and hybrid strategy; (b) less consensual but possible - small collateral branches, stabilized acute coronary syndromes; and (c) inappropriate - left main disease, tortuosity, severe calcification. CONCLUSION: BVS are a viable treatment option based on the encouraging evidence of their applicability and physiological and clinical results. They should be used in appropriate indications and will require technical adaptations. Outcome monitoring and evaluation is essential to avoid inappropriate use. It is recommended that medical societies produce clinical guidelines based on high-quality registries as soon as possible.

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Dissertation presented to obtain the PhD degree in Biology

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Dissertation submitted in partial fulfillment of the requirements for the Degree of Master of Science in Geospatial Technologies.

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RESUMO - O presente trabalho pretende estudar a cultura de segurança de doente em alunos do ensino superior, na área das tecnologias de diagnóstico e terapêutica. Esta problemática não tem sido abordada pela comunidade científica, pelo que o seu estudo é relevante. Os alunos que finalizam a licenciatura estão legalmente autorizados para intervir perante o doente, contudo, a sensibilidade que têm para as questões da segurança do doente deve ser analisada com o intuito de melhorar a sua preparação como futuros profissionais de saúde. Neste estudo participaram 180 alunos estratificados consoante o curso e sexo de modo a obter uma amostra representativa da população alvo. Foi constituído um questionário com 31 itens numa escala dicotómica que avaliam a cultura de segurança do doente em 7 dimensões – liderança, trabalho de equipa, a prática baseada na evidência científica, a comunicação, a aprendizagem, a justiça, e a prática clínica centrada no doente. Pode igualmente compor-se uma medida global de cultura de segurança do doente através do somatório das 7 dimensões. Os resultados evidenciam a existência de uma correlação positiva moderada entre as dimensões – Trabalho em equipa (0,660); Liderança (0,610); Prática baseada na evidência científica (0,627); Ambiente justo (0,570); Comunicação (0,501) e o Total.

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RESUMO: Os vírus respiratórios continuam a ocupar um papel relevante na morbilidade e mortalidade infantil, tendo na última década sido alargado o espectro de vírus potencialmente causadores das infeções respiratórias. O diagnóstico destas infeções pode ser efetuado por várias metodologias, sendo as técnicas de biologia molecular consideradas as mais sensíveis para este fim. No âmbito do Projeto Ambiente e Saúde em Creches e Infantários (ENVIRH) foi efetuada uma comparação da prevalência dos principais vírus respiratórios em crianças em idade pré-escolar, com critérios de infeção respiratória, recorrendo a técnicas de biologia molecular, em duas populações: crianças que se encontravam na escola/domicilio e crianças que recorreram a uma urgência hospitalar. O estudo decorreu em dois períodos, de Fevereiro a Maio de 2011 e de Outubro de 2011 a Abril de 2012. Foram efetuadas duas colheitas de zaragatoas, uma nasal e outra orofaríngea. A metodologia utilizada para a identificação viral nas amostras foi a PCR e RT-PCR multiplex em tempo real. Os vírus pesquisados foram: Influenza A e B, Parainfluenza 1-4, Metapneumovirus humano, Vírus Sincicial respiratório (VSR), Rinovírus, Enterovírus, Coronavírus e Bocavirus. Foram realizadas 100 colheitas em crianças com idades compreendidas entre os 5 meses e os 5 anos. Foram obtidas 64 amostras dos infantários/domicílios, das quais 47 foram positivas. Da urgência Hospitalar obtiveram-se 36 amostras, em que 32 foram positivas. O vírus da gripe A (H3) foi o mais frequentemente detetado nas duas populações, mas apenas durante o surto de 2012. O VSR e os adenovírus foram mais frequentes nas crianças que recorreram ao hospital, ao contrário dos enterovirus e dos coronavírus, que não foram detetados nesta população. Os bocavirus nunca foram detetados isoladamente. Este estudo reforça a importância de se utilizarem técnicas de biologia molecular para o diagnóstico etiológico das infeções respiratórias, devido à elevada sensibilidade das mesmas, o que se reflete na elevada percentagem de amostras positivas. O facto de se utilizarem técnicas “multiplex”, que permitem a pesquisa simultânea de vários vírus, facilita a deteção de um maior espectro destes agentes. A elevada prevalência de Influenza A H3N2 deveu-se ao facto de grande parte do estudo ter coincidido com um período de surto por este vírus. O sistema de alerta montado durante o projeto ENVIRH pareceu promissor para uma eventual utilização futura em períodos de atividade gripal.--------------ABSTRACT: In the last decade, as respiratory viruses keep representing a relevant factor in child morbidity and mortality, the spectrum of viruses that may potentially cause respiratory infections has been widened. Within the several methodologies that may be applied in the diagnosis of these types of infections, the ones that use molecular biology are considered to be the most sensitive. The Environment and Health in Daycares and Nurseries Project (ENVIRH) arranged for a study, by means of molecular biology techniques, on the main respiratory viruses' influence in pre-school aged children with respiratory infection symptoms. This study compared children in two different populations: children at school or at home and children that were taken to a hospital emergency service. The study was conducted in two different time periods, one from February to May 2011 and the other from October 2011 to April 2012. During this time, two swab collections were held, one nasal and one oropharyngeal. PCR and RT-PCR multiplex in real time techniques were used for viral identification of the samples, searching for the viruses Influenza A and B, Parainfluenza 1-4, human Metapneumovirus, Respiratory Sincytial Virus (RSV), Rhinovirus, Enterovirus, Coronavirus and Bocavirus. One hundred (100) collections were held in children between the ages of 5 months and 5 years, sixty-four (64) at home/school and thirty-six (36) at the hospital's emergency service. From a total of seventy-nine (79) positive samples, forty-seven (47) were obtained at home/school and thirty-two (32) at the hospital. The virus detected the most in both populations was the Influenza A (H3), but only during the outbreak of 2012. Unlike the enteroviruses and coronaviruses, that were not detected within this population, the RSV and the adenoviruses were most common within the children at the hospital. Bocaviruses were never detected isolated from other viruses. The high percentage of positive samples reinforces the significance of using molecular biology techniques for the etiological diagnosis of respiratory infections. The use of multiplex techniques, that make the simultaneous search for multiple viruses possible, enhances the detection of a larger spectrum of such agents. Most of the study coincided with an outbreak of the Influenza A H3N2 virus, thus explaining the high number of its cases identified. The alert system set up during the ENVIRH project looked promising enough for eventual periods of flu activity in the future.

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Dissertation for the Master degree in Biotechnology

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Dissertação para obtenção do Grau de Mestre em Biotecnologia

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A population-based cross-sectional study was set up in Sabará country, Southeastern Brazil, to identify asymptomatic human visceral leishmaniasis in an urban area of low disease prevalence. Blood was collected on filter paper (n=1,604 inhabitants) and examined by indirect immunofluorescent test, enzyme-linked immunosorbent assay and immunochromatographic strip test. The prevalence rates of infection ranged from 2.4 to 5.6% depending on the test used. One year later, venous blood was collected in a subset of 226 participants (102 seropositive and 124 seronegative). The tests performed were IFAT, ELISA, rk39-ELISA, polymerase chain reaction and hybridization with Leishmania donovani complex probe. No clinical signs or symptoms of leishmaniasis were observed. Using hybridization as a reference test, the sensitivity and specificity of serology were respectively: 24.8 and 71% (ELISA); 26.3 and 76.3% (rk-39); 30.1 and 63.4% (IFAT). Due to disagreements, different criteria were tested to define the infection and hybridization should be considered in epidemiological studies.

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Cell-to-cell communication is required for many biological processes in development and adult life. One of the most common systems utilized by a wide range of eukaryotes is the Notch signalling pathway. Four Notch receptors and five ligands have been identified in mammals that interact via their extracellular domains leading to transcription activation. Studies have shown that the Notch ligands expression is undetectable in normal breast tissues, but moderate to high expression has been detected in breast cancer. Thus, any of the Notch1 ligands can be studied as possible therapeutic targets for breast cancer. To study Notch pathway proteins there is the need to obtain stable protein solutions. E. coli is the host of excellence for recombinant proteins for the ease of use, fast growth and high cell densities. However, the expression of mammalian proteins in such systems may overwhelm the bacterial cellular machinery, which does not possess the ability for post-translational modifications, or dedicated compartments for protein synthesis. Mammalian cells are therefore preferred, despite their technical and financial increased demands. We aim to determine the best expression and purification conditions for the different ligand protein constructs, to develop specific function-blocking antibodies using the Phage Display technology. Moreover, we propose to crystallize the Notch1 ligands alone and in complex with the phage display selected antibodies, unveiling molecular details. hJag2DE3 and hDll1DE6 proteins were purified from refolded inclusion bodies or mammalian cell culture supernatants, respectively, and purity was confirmed by SDS-PAGE (>95%). Protein produced in mammalian cells showed to be more stable, apparently with the physiological disulfide pattern, contrary to what was observed in the refolded protein. Several nano-scale crystallization experiments were set up in 96-well plates, but no positive result was obtained. We will continue to pursue for the best expression for the Notch ligand constructs in both expression systems.

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Microelectromechanical systems (MEMS) technologies can be used to produce from the simplest structures to the most complex devices and systems. Due to their many applications in various fields, MEMS have turned into one of the most researched areas in microtechnology. In this context, this project was developed in an attempt to produce one of most used structures in MEMS sensing devices - microcantilevers. Several microfabrication techniques were combined to fabricate this type of structures on the top layer of silicon of a silicon-on-insulator (SOI) wafer. After the microcantilevers had been successfully created, an experiment was set up to verify the microcantilevers ability to bend. Here, a voltage was applied between the top and bottom layers of silicon of the SOI wafer. It was then observed that the microcantilevers were deflected all the way to the bottom silicon layer by the electrostatic force acting between them, given that a current was detected when a certain value of applied voltage was reached.

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INTRODUCTION: Chagas disease is caused by Trypanosoma cruzi. Wild and perianthropic mammals maintain the infection/transmission cycle, both in their natural habitat and in the peridomestic area. The aim of this paper was to present the results from a study on wild rodents in the central and northern regions of San Luis province, Argentina, in order to evaluate the prevalence of this infection. METHODS: Sherman traps were set up in capture areas located between latitudes 32º and 33º S, and longitudes 65º and 66º W. The captured rodents were taxonomically identified and hemoflagellates were isolated. Morphological, biometric and molecular studies and in vitro cultures were performed. Infection of laboratory animals and histological examination of the cardiac muscle and inoculation area were also carried out. Parasites were detected in circulating blood in Calomys musculinus, Graomys griseoflavus, Phyllotis darwini and Akodon molinae. The parasites were identified using biological criteria. Molecular PCR studies were performed on some isolates, which confirmed the characterization of these hemoflagellates as Trypanosoma cruzi. RESULTS AND CONCLUSIONS: Forty-four percent of the 25 isolates were identified as Trypanosoma cruzi, and the remaining 56% as Trypanosoma cruzi-like. These findings provide evidence that wild rats infected with Trypanosoma cruzi and Trypanosoma cruzi-like organisms are important in areas of low endemicity.

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Despite the growing relevance of co-creating customer communities only little scientific evidence is available on their impact on transactional behavior of participants. Previous research has mostly used self-reported data or distinguished only between during and pre-community phases obtaining mixed results. However, the author proposes that co-creating community activity takes place in five distinguishable phases and changes in transactional behavior are limited to certain phases. Using 33 months of transactional data of a Dutch online auction provider a study was conducted covering all five phases of the community co-creation process from community planning over community set-up, co-development and co-testing to post-launch. The overall results indicate mixed effects of community participation on the different transactional variables during the co-creation process. Community participation had positive effects on auctions listing behavior at the community set-up, co-development and post-launch phases, whereby the number of auctions listed peaked during the community set-up phase. These results suggest that the impact on transactional behavior differs between co-creation phases and different psychological mechanism limited to certain phases might trigger the respective changes.

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The underlying thesis examines the value drivers of direct investments in nursing home real estate in Germany. A survey among investors and operators is conducted in order to identify significant value drivers. Moreover, based on survey results, a framework for assessing German nursing home real estate is developed. This is applied in a case-study about the set-up of a nursing home value-add fund which will demonstrate the value creation process of redeveloping an existing nursing home real estate portfolio. Through a concluding analysis the sources of value creation, sensitivities and future prospects of direct investing into German nursing home real estate are concluded.

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The main purpose of the present dissertation is the simulation of the response of fibre grout strengthened RC panels when subjected to blast effects using the Applied Element Method, in order to validate and verify its applicability. Therefore, four experimental models, three of which were strengthened with a cement-based grout, each reinforced by one type of steel reinforcement, were tested against blast effects. After the calibration of the experimental set-up, it was possible to obtain and compare the response to the blast effects of the model without strengthening (reference model), and a fibre grout strengthened RC panel (strengthened model). Afterwards, a numerical model of the reference model was created in the commercial software Extreme Loading for Structures, which is based on the Applied Element Method, and calibrated to the obtained experimental results, namely to the residual displacement obtained by the experimental monitoring system. With the calibration verified, it is possible to assume that the numerical model correctly predicts the response of fibre grout RC panels when subjected to blast effects. In order to verify this assumption, the strengthened model was modelled and subjected to the blast effects of the corresponding experimental set-up. The comparison between the residual and maximum displacements and the bottom surface’s cracking obtained in the experimental and the numerical tests yields a difference of 4 % for the maximum displacements of the reference model, and a difference of 4 and 10 % for the residual and maximum displacements of the strengthened model, respectively. Additionally, the cracking on the bottom surface of the models was similar in both methods. Therefore, one can conclude that the Applied ElementMethod can correctly predict and simulate the response of fibre grout strengthened RC panels when subjected to blast effects.