Prognostic Value of a New Cardiopulmonary Exercise Testing Parameter in Chronic Heart Failure: Oxygen Uptake Efficiency at Peak Exercise - Comparison with Oxygen Uptake Efficiency Slope

INTRODUCTION: A growing body of evidence shows the prognostic value of oxygen uptake efficiency slope (OUES), a cardiopulmonary exercise test (CPET) parameter derived from the logarithmic relationship between O(2) consumption (VO(2)) and minute ventilation (VE) in patients with chronic heart failure (CHF). OBJECTIVE: To evaluate the prognostic value of a new CPET parameter - peak oxygen uptake efficiency (POUE) - and to compare it with OUES in patients with CHF. METHODS: We prospectively studied 206 consecutive patients with stable CHF due to dilated cardiomyopathy - 153 male, aged 53.3±13.0 years, 35.4% of ischemic etiology, left ventricular ejection fraction 27.7±8.0%, 81.1% in sinus rhythm, 97.1% receiving ACE-Is or ARBs, 78.2% beta-blockers and 60.2% spironolactone - who performed a first maximal symptom-limited treadmill CPET, using the modified Bruce protocol. In 33% of patients an cardioverter-defibrillator (ICD) or cardiac resynchronization therapy device (CRT-D) was implanted during follow-up. Peak VO(2), percentage of predicted peak VO(2), VE/VCO(2) slope, OUES and POUE were analyzed. OUES was calculated using the formula VO(2) (l/min) = OUES (log(10)VE) + b. POUE was calculated as pVO(2) (l/min) / log(10)peakVE (l/min). Correlation coefficients between the studied parameters were obtained. The prognosis of each variable adjusted for age was evaluated through Cox proportional hazard models and R2 percent (R2%) and V index (V6) were used as measures of the predictive accuracy of events of each of these variables. Receiver operating characteristic (ROC) curves from logistic regression models were used to determine the cut-offs for OUES and POUE. RESULTS: pVO(2): 20.5±5.9; percentage of predicted peak VO(2): 68.6±18.2; VE/VCO(2) slope: 30.6±8.3; OUES: 1.85±0.61; POUE: 0.88±0.27. During a mean follow-up of 33.1±14.8 months, 45 (21.8%) patients died, 10 (4.9%) underwent urgent heart transplantation and in three patients (1.5%) a left ventricular assist device was implanted. All variables proved to be independent predictors of this combined event; however, VE/VCO2 slope was most strongly associated with events (HR 11.14). In this population, POUE was associated with a higher risk of events than OUES (HR 9.61 vs. 7.01), and was also a better predictor of events (R2: 28.91 vs. 22.37). CONCLUSION: POUE was more strongly associated with death, urgent heart transplantation and implantation of a left ventricular assist device and proved to be a better predictor of events than OUES. These results suggest that this new parameter can increase the prognostic value of CPET in patients with CHF.

Comparison between E-test and CLSI broth microdilution method for antifungal susceptibility testing of Candida albicans oral isolates

Thirty Candida albicans isolated from oral candidosis patients and 30 C. albicans isolated from control individuals were studied. In vitro susceptibility tests were performed for amphotericin B, fluconazole, 5-flucytosine and itraconazole through the Clinical and Laboratorial Standards Institute (CLSI) reference method and E test system. The results obtained were analyzed and compared. MIC values were similar for the strains isolated from oral candidosis patients and control individuals. The agreement rate for the two methods was 66.67% for amphotericin B, 53.33% for fluconazole, 65% for flucytosine and 45% for itraconazole. According to our data, E test method could be an alternative to trial routine susceptibility testing due to its simplicity. However, it can not be considered a substitute for the CLSI reference method.

In vitro susceptibility testing of dermatophytes isolated in Goiania, Brazil, against five antifungal agents by broth microdilution method

The antifungal activities of fluconazole, itraconazole, ketoconazole, terbinafine and griseofulvin were tested by broth microdilution technique, against 60 dermatophytes isolated from nail or skin specimens from Goiania city patients, Brazil. In this study, the microtiter plates were incubated at 28 ºC allowing a reading of the minimal inhibitory concentration (MIC) after four days of incubation for Trichophyton mentagrophytes and five days for T. rubrum and Microsporum canis. Most of the dermatophytes had uniform patterns of susceptibility to the antifungal agents tested. Low MIC values as 0.03 µg/mL were found for 33.3%, 31.6% and 15% of isolates for itraconazole, ketoconazole and terbinafine, respectively.

Testing Nelder-Mead Based Repulsion Algorithms for Multiple Roots of Nonlinear Systems via a Two-Level Factorial Design of Experiments

This paper addresses the challenging task of computing multiple roots of a system of nonlinear equations. A repulsion algorithm that invokes the Nelder-Mead (N-M) local search method and uses a penalty-type merit function based on the error function, known as 'erf', is presented. In the N-M algorithm context, different strategies are proposed to enhance the quality of the solutions and improve the overall efficiency. The main goal of this paper is to use a two-level factorial design of experiments to analyze the statistical significance of the observed differences in selected performance criteria produced when testing different strategies in the N-M based repulsion algorithm. The main goal of this paper is to use a two-level factorial design of experiments to analyze the statistical significance of the observed differences in selected performance criteria produced when testing different strategies in the N-M based repulsion algorithm.

Process engineering of liver cells for drug testing applications

Dissertação para obtenção do Grau de Doutor em Bioengenharia

Inspeção e reabilitação de estruturas de betão armado

O setor da reabilitação em Portugal tem vindo a crescer consideravelmente ao longo dos últimos anos, demonstrando uma consciencialização da sociedade e das entidades competentes para definição de estratégias e planeamento, para uma manutenção das estruturas atempada de modo a prevenir patologias que provocam a sua degradação. O presente trabalho pretende fazer uma síntese das técnicas de proteção e reparação das estruturas de betão armado, efetuando também ensaios para determinação das causas das anomalias que levaram à sua reparação. O projeto de reabilitação deve seguir as recomendações indicadas nos Eurocódigos e norma EN1504 sobre produtos e sistemas para a proteção e reparação das estruturas de betão. Segundo esta norma explicam – se as principais causas de deterioração das estruturas de betão armado e os sintomas que estão na base dessa deterioração. Desta forma são descritos os métodos de intervenção, explicando o seu funcionamento e modo mais adequado de utilização com indicação dos produtos adequados para cada intervenção. Para aplicação do referido nos parágrafos anteriores desenvolveu-se uma proposta de fichas de inspeção, através de levantamento fotográfico e registo das anomalias e suas causas e ensaios não destrutivos de modo a perceber o estado atual da estrutura para uma melhor compreensão da metodologia de reparação a seguir

HIV Voluntary Testing among Portuguese Women Attending Family Planning Clinics: Implications for HIV Prevention Education and Testing

Objectives: The aim of this article is to analyze the factors associated with HIV testing among 767 sexually active women. Methods: Participants were administered several self-report questionnaires that assessed behavioral and psychosocial measures. Results: Overall, 59.8% of the participants reported ever having tested for HIV. Results show that higher levels of education, being pregnant or having been pregnant, concern about AIDS, AIDS knowledge, self-efficacy in condom negotiation and perception of no risk in partner significantly predicted the likelihood of testing among women. Attending the mass was negatively associated with HIV testing. Conclusions: These findings provide information that can be used in the development of a focused gender sensitive HIV prevention program to increase HIV testing.

Isolation and antifungal susceptibility testing of Trichosporon asahii in Ceará, Brazil

Trichosporon spp. are yeasts capable of causing invasive disease, which mainly affect immunocompromised patients. A clinical strain of T. asahii was isolated from the blood cultures of patients admitted to the General Hospital of Fortaleza. Susceptibility tests were conducted by disk diffusion and broth microdilution. The isolated strain of T. asahii was resistant to fluconazole. The patient used amphotericin B and caspofungin in order to facilitate the microbiological cure. It was the first isolation and identification of T. asahii in blood culture in Ceará, Brazil.

Comparison of five methods for oxacillin susceptibility testing of Staphylococcus aureus isolates from cystic fibrosis patients

Methicillin-resistant Staphylococcus aureus (MRSA) are now a worldwide problem. Cystic fibrosis (CF) patients are commonly colonized and infected by MRSA. Accurate oxacillin susceptibility testing is mandatory for the adequate management of these patients. We performed a comparison of the accuracy of different tests in CF isolates, including methicillin-susceptible S. aureus and MRSA with different SCCmec types, and using the mecA gene as the gold-standard. The sensitivity and specificity of oxacillin disc, Etest, and oxacillin agar screening plate were 100%. Sensitivity of the cefoxitin disc was 85% and specificity was 100%. For clinically relevant isolates, laboratories may consider the use of a combination of two phenotypic methods.

TESTING A SUBTYPE-SPECIFIC GP41 AMPLIFICATION METHOD FOR GENOTYPING INDIVIDUALS INFECTED BY HUMAN IMMUNODEFICIENCY VIRUS TYPE-1 IN THE BRAZILIAN POPULATION OF ITAJAÍ, SOUTH BRAZIL

The method used by YAGYU et al. for the subtype-specific polymerase chain reaction (PCR) amplification of the gp41 transmembrane region of the human immunodeficiency virus type-1 (HIV-1) env gene, was tested. HIV-1 proviral DNA from 100 infected individuals in Itajaí, South Brazil was used to analyze this method. Seventy individuals were determined according to this method as having PCR products at the expected size for subtypes B, C, D and F. Of these individuals, 26 (37.1%) were observed as having the expected amplification for subtype C, and 42 (60%) were observed as having the expected products for subtypes B and D. Of the subtype B and D amplicons, 16 (22.9%) were classified as subtype D, and 26 (37.1%) were classified as subtype B. Two individuals (2.9%) had amplicons that were observed after subtype F-specific amplification was performed. Sequencing and comparing the patient sequences to reference sequences confirmed the classification of sequences of subtypes C and B. However, sequences that were falsely determined as being D and F in the PCR assay were determined as being subtypes C and B, respectively, by sequence analysis. For those individuals from whom no amplified products were obtained, a low viral load that was indicated in their patient history may explain the difficulty in subtyping by PCR methods. This issue was demonstrated by the results of ANOVA when testing the effect of viral load on the success of PCR amplification. The alignment of the obtained sequences with HIV-1 reference sequences demonstrated that there is high intra-subtype diversity. This indicates that the subtype-specific primer binding sites were not conserved or representative of the subtypes that are observed in the Brazilian populations, and that they did not allow the correct classification of HIV-1 subtypes. Therefore, the proposed method by YAGYU et al. is not applicable for the classification of Brazilian HIV-1 subtypes.

Viva@Matemática project: a different way to see math

Viva@Mat is a project developed by four Math teachers from the School of Industrial Studies and Management (ESEIG) that was born with the fundamental objective of engaging ESEIG students with different math backgrounds in Math challenging activities. Some of these activities were transformed into real palpable materials and others into small interactive ones, being the great majority of them proposed by ESEIG’ students themselves. This small project rapidly grew into something we didn’t expect – it did flow over the walls of our institution to the general involving community – specifically to pre-university schools through the Viva@Math Exhibits – Orange, Blue and Green (the fourth, the Purple one is still in development). Nowadays, Viva@Math Exhibits – the public face of the Project – are itinerant and have been travelling between several, and different institutions (pre-university schools, preparatory schools, libraries, among others), around ESEIG and IPP area of influence and having registered visitors/participants of all ages. In this article we will describe the Viva@Math Project, its different activities that are categorized in some “great groups” like Numerical Trivia, Logic Activities and Mental Calculation, Puzzles, Geometric Curiosities, Magic Tricks, among others, designed to challenge students to use the underlying logical-mathematical reasoning to any ordinary and everyday activity. We will give specific and concrete examples of some of the activities developed and, also, reproduce of the general stimulating feedback the Project receives from the enrolled “actors” (teachers, students and their relatives, institutions, among others). We feel that this Project has become a small “bridge” between the pre-university schools and Higher Education Institutions (HEI), in trying to shorten the “gap” between the institutions of different levels of education and bring them to work together.

Reconfiguração e desenvolvimento do sistema de controlo de um AGV

O veículo guiado automaticamente (AGV) adquirido pelo Departamento de Engenharia Mecânica (DEM) tem vindo a ficar obsoleto devido ao hardware, que nos dias de hoje começa a dar sinais de falhas bem como falta de peças de substituição, e ao software, sendo o PLC (Programmable Logic Controller) usado muito limitado quanto às suas funções de controlo, ficando as principais tarefas de controlo do AGV a cargo de placas eletrónicas de controlo. Para promover o controlo autónomo do AGV, foi decidido retirar toda a parte de hardware que detinha o controlo do mesmo e passou a ser um novo PLC, com maior capacidade de processamento, a executar todo o tipo de controlo necessário ao funcionamento do mesmo. O hardware considerado apenas incluí, de forma resumida, os motores responsáveis pelo movimento e direção, placa de controlo de potência dos motores, placa de interface entre as saídas digitais do PLC e as entradas da placa de controlo de potência dos motores e os demais sensores necessários à deteção de obstáculos, fins de curso da direção, sensores dos postos de trabalho e avisadores de emergência. Todo o controlo de movimento e direção bem como a seleção das ações a executar passou a ficar a cargo do software programado no PLC assim como a interação entre o sistema de supervisão instalado num posto de controlo e o PLC através de comunicação via rádio. O uso do PLC permitiu a flexibilidade de mudar facilmente a forma como as saídas digitais são usadas, ao contrário de um circuito eletrónico que necessita de uma completa remodelação, tempo de testes e implementação para efetuar a mesma função. O uso de um microcontrolador seria igualmente viável para a aplicação em causa, no entanto o uso do PLC tem a vantagem de ser robusto, mais rápido na velocidade de processamento, existência de software de interface de programação bastante intuitivo e de livre acesso, facilidade de alterar a programação localmente ou remotamente, via rádio, acesso a vários protocolos de comunicação robustos como Modbus, Canbus, Profinet, Modnet, etc., e acesso integrado de uma consola gráfica totalmente programável. iv É ainda possível a sua expansão com adição de módulos de entradas e saídas digitais e/ou analógicas permitindo expandir largamente o uso do AGV para outros fins. A solução está a ser amplamente testada e validada no Laboratório de Automação (LabA) do Departamento de Engenharia Mecânica do ISEP (Instituto Superior de Engenharia do Porto), permitindo a otimização dos sistemas de controlo de direção bem como a interatividade entre o PLC e o programa de interface/supervisão do posto de trabalho.

HEPATITIS B VACCINATION COVERAGE AND POSTVACCINATION SEROLOGIC TESTING AMONG MEDICAL STUDENTS AT A PUBLIC UNIVERSITY IN BRAZIL

The aim of this cross-sectional study was to determine the hepatitis B vaccination coverage among medical students at a public university in Rio de Janeiro, Brazil, and their compliance with the postvaccination serologic testing recommendations. Of the total of 858 students, 675 (78.7%) participated in the study. Among the participants, 48.9% (95% CI: 45.1% to 52.7%) were vaccinated against hepatitis B (received ≥ 3 doses of the vaccine), 31.6% were not (received 0, 1 or 2 doses), and 19.6% did not know their vaccination status. Hepatitis B vaccination coverage increased from 26.0% among first-year students to 70.6% among sixth-year students while the prevalence of unknown vaccination status decreased from 39.7% among first-year students to 2.4% among sixth-year students. The frequency of unvaccinated students ranged from 23.7% among fifth-year students to 34.4% among first-year students. Only 34.8% of the vaccinated students performed the anti-HBs testing after vaccination. Among these medical students, we found a low adherence to the hepatitis B vaccination and to the postvaccination serologic testing. A comprehensive hepatitis B immunization program should be offered to students at this medical school.

Development Process and Cognitive Testing of CARATkids - Control of Allergic Rhinitis and Asthma Test for Children

Background: Allergic rhinitis and asthma (ARA) are chronic inflammatory diseases of the airways that often coexist in children. The only tool to assess the ARA control, the Control of Allergic Rhinitis and Asthma Test (CARAT) is to be used by adults. We aimed to develop the Pediatric version of Control of Allergic Rhinitis and Asthma Test (CARATkids) and to test its comprehensibility in children with 4 to 12 years of age. Methods: The questionnaire development included a literature review of pediatric questionnaires on asthma and/or rhinitis control and two consensus meetings of a multidisciplinary group. Cognitive testing was carried out in a cross-sectional qualitative study using cognitive interviews. Results: Four questionnaires to assess asthma and none to assess rhinitis control in children were identified. The multidisciplinary group produced a questionnaire version for children with 17 questions with illustrations and dichotomous (yes/no) response format. The version for caregivers had 4-points and dichotomous scales. Twenty-nine children, 4 to 12 years old, and their caregivers were interviewed. Only children over 6 years old could adequately answer the questionnaire. A few words/expressions were not fully understood by children of 6 to 8 years old. The drawings illustrating the questions were considered helpful by children and caregivers. Caregivers considered the questionnaire complete and clear and preferred dichotomous over the 4-points scales. The proportion of agreement between children and their caregivers was 61%. The words/expressions that were difficult to understand were amended. Conclusion: CARATkids, the first questionnaire to assess a child’s asthma and rhinitis control was developed and its content validity was assured. Cognitive testing showed that CARATKids is well-understood by children 6 to 12 years old. The questionnaire’s measurement properties can now be assessed in a validation study.

Caraterização das propriedades macânicas e de fratura de um adesivo estrutural de alta ductilidade

As juntas adesivas são uma alternativa viável para substituir ligações comuns como as mecânicas ou soldadas, devido a diversas vantagens como a possibilidade de união de materiais de natureza diferente, maior leveza, menores custos inerentes ao fabrico e ainda prevenção da corrosão galvânica que pode ocorrer nas ligações entre dois materiais metálicos diferentes. A resistência de uma junta depende, para um determinado tipo de solicitação imposta, da distribuição de tensões no interior da junta. Por outro lado, a geometria das juntas, as propriedades mecânicas dos adesivos e os componentes a ligar vão influenciar a distribuição de tensões. O carregamento nas camadas adesivas de uma junta poderá induzir tensões de tração, compressão, corte, arrancamento ou clivagem, ou ainda uma combinação de duas ou mais destas componentes. O objetivo da presente dissertação é a caraterização completa de um adesivo estrutural de alta ductilidade recentemente lançado no mercado (SikaPower® -4720), para facilitar o projeto e otimização de juntas adesivas ligadas com o mesmo. São quatro os ensaios a realizar: ensaios à tração de provetes maciços (também denominados de bulk), ensaios ao corte com a geometria Thick Adherend Shear Test, ensaios Double-Cantilever Beam e ainda ensaios End-Notched Flexure. Com a realização dos ensaios referidos, são determinadas as propriedades essenciais à caraterização mecânica e de fratura do adesivo. Os resultados obtidos para cada ensaio resultaram em propriedades medidas com elevada repetibilidade, da mesma maneira que se revelaram de acordo com os dados disponibilizados pelo fabricante, sempre que estes estavam disponíveis.