Validity of selected clinical signs and symptoms in diagnosis of Schistosoma mansoni infection

Sensitivity, specificity and positive predictive values of selected clinical signs and symptoms in the diagnosis of Schistosoma mansoni infection were evaluated in 403 individuals (69% of inhabitants over 1 year of age) in an endemic area in Brazil (Divino). Highest sensitivity (13%) was found for blood in stools. Specificity over 90% was found for blood in stools, palpable liver with normal consistency and palpable hardened liver at middle clavicular (MCL) or middle sternal lines (MSL). Hardened liver at MSL (83%) or MCL (75%), and blood in stools (78%) presented higher positive predictive values for S. mansoni infection, while palpable liver with normal consistency at MCL (45%) or MSL (48%) presented smaller values. Enlarged liver without specification of its consistency has been traditionally used as an indicator of the infection in areas where malaria or Kalazar are not endemic. Our results demonstrate that the probability that a person with blood in stools or hardened palpable liver is infected is higher than among those with palpable liver with normal consistency.

Reason Maintenance Systems: Tools for Foundations-based Belief Revision

Dynamic and distributed environments are hard to model since they suffer from unexpected changes, incomplete knowledge, and conflicting perspectives and, thus, call for appropriate knowledge representation and reasoning (KRR) systems. Such KRR systems must handle sets of dynamic beliefs, be sensitive to communicated and perceived changes in the environment and, consequently, may have to drop current beliefs in face of new findings or disregard any new data that conflicts with stronger convictions held by the system. Not only do they need to represent and reason with beliefs, but also they must perform belief revision to maintain the overall consistency of the knowledge base. One way of developing such systems is to use reason maintenance systems (RMS). In this paper we provide an overview of the most representative types of RMS, which are also known as truth maintenance systems (TMS), which are computational instances of the foundations-based theory of belief revision. An RMS module works together with a problem solver. The latter feeds the RMS with assumptions (core beliefs) and conclusions (derived beliefs), which are accompanied by their respective foundations. The role of the RMS module is to store the beliefs, associate with each belief (core or derived belief) the corresponding set of supporting foundations and maintain the consistency of the overall reasoning by keeping, for each represented belief, the current supporting justifications. Two major approaches are used to reason maintenance: single-and multiple-context reasoning systems. Although in the single-context systems, each belief is associated to the beliefs that directly generated it—the justification-based TMS (JTMS) or the logic-based TMS (LTMS), in the multiple context counterparts, each belief is associated with the minimal set of assumptions from which it can be inferred—the assumption-based TMS (ATMS) or the multiple belief reasoner (MBR).

Argumentation as Distributed Belief Revision: Conflict Resolution in Decentralised Multi-agent Systems

Decentralised co-operative multi-agent systems are computational systems where conflicts are frequent due to the nature of the represented knowledge. Negotiation methodologies, in this case argumentation based negotiation methodologies, were developed and applied to solve unforeseeable and, therefore, unavoidable conflicts. The supporting computational model is a distributed belief revision system where argumentation plays the decisive role of revision. The distributed belief revision system detects, isolates and solves, whenever possible, the identified conflicts. The detection and isolation of the conflicts is automatically performed by the distributed consistency mechanism and the resolution of the conflict, or belief revision, is achieved via argumentation. We propose and describe two argumentation protocols intended to solve different types of identified information conflicts: context dependent and context independent conflicts. While the protocol for context dependent conflicts generates new consensual alternatives, the latter chooses to adopt the soundest, strongest argument presented. The paper shows the suitability of using argumentation as a distributed decentralised belief revision protocol to solve unavoidable conflicts.

Environmental Decision Support: a Multi-Agent Approach

The environmental management domain is vast and encompasses many identifiable activities: impact assessment, planning, project evaluation, etc. In particular, this paper focusses on the modelling of the project evaluation activity. The environmental decision support system under development aims to provide assistance to project developers in the selection of adequate locations, guaranteeing the compliance with the applicable regulations and the existing development plans as well as satisfying the specified project requirements. The inherent multidisciplinarity features of this activity lead to the adoption of the Multi-Agent paradigm, and, in particular, to the modelling of the involved agencies as a community of cooperative autonomous agents, where each agency contributes with its share of problem solving to the final system’s recommendation. To achieve this behaviour the many conclusions of the individual agencies have to be justifiably accommodated: not only they may differ, but can be interdependent, complementary, irreconcilable, or simply, independent. We propose different solutions (involving both local and global consistency) to support the adequate merge of the distinct perspectives that inevitably arise during this type of decision making.

Improving Assumption based Distributed Belief Revision

Belief revision is a critical issue in real world DAI applications. A Multi-Agent System not only has to cope with the intrinsic incompleteness and the constant change of the available knowledge (as in the case of its stand alone counterparts), but also has to deal with possible conflicts between the agents’ perspectives. Each semi-autonomous agent, designed as a combination of a problem solver – assumption based truth maintenance system (ATMS), was enriched with improved capabilities: a distributed context management facility allowing the user to dynamically focus on the more pertinent contexts, and a distributed belief revision algorithm with two levels of consistency. This work contributions include: (i) a concise representation of the shared external facts; (ii) a simple and innovative methodology to achieve distributed context management; and (iii) a reduced inter-agent data exchange format. The different levels of consistency adopted were based on the relevance of the data under consideration: higher relevance data (detected inconsistencies) was granted global consistency while less relevant data (system facts) was assigned local consistency. These abilities are fully supported by the ATMS standard functionalities.

Portuguese version of the Tilburg Frailty Indicator: Transcultural adaptation and psychometric validation

Artigo científico disponível actualmente em Early View (Online Version of Record published before inclusion in an issue)

Comportamentos de sexo seguro em individuos infectados por VIH

A investigação científica que se seguiu à descoberta da infecção pelo vírus da imunodeficiência humana (VIH) representou um marco histórico importante, permitindo a instituição de terapêutica e alterando a história natural da infecção, melhorando as expectativas dos indivíduos infectados.Se, por um lado, a terapêutica antirretroviral de alta eficácia (do inglês, Highly Active Antiretroviral Theraphy: HAART), nos países desenvolvidos, teve um enorme impacto na melhoria da qualidade de vida e esperança média de vida dos indivíduos infectados, permitindo-lhes encarar a infecção como uma doença crónica, por outro lado, introduziu-se uma nova dinâmica epidemiológica na transmissão de VIH e um novo desafio para a sua prevenção.Os comportamentos sexuais são o factor-alvo através do qual se pode, de uma forma mais eficaz, prevenir a possibilidade de infectar um qualquer indivíduo na comunidade. Parece, pois, importante haver necessidade de um olhar atento da Saúde Pública sobre a vida sexual dos indivíduos infectados, não só na tentativa de, promover a sua qualidade de vida, como também, de prevenir a disseminação da doença, e, ainda mais importante, prevenir a disseminação do vírus nas suas formas resistentes.O objectivo deste estudo foi analisar a consistência do uso de preservativo/práticas de sexo seguro, em indivíduos infectados por VIH, seguidos em Consulta de Imunodepressão, do Serviço de Doenças Infecciosas, do Hospital de Santa Maria. Pretende-se avaliar, no âmbito da “Educação para a Saúde”, a necessidade de aconselhamento aos indivíduos infectados, relativamente aos seus comportamentos sexuais.Para o efeito, realizou-se um estudo descritivo e transversal. A população envolvida compreendeu todos os indivíduos infectados seguidos na Consulta de Imunodepressão. A amostra foi seleccionada através de aleatorização simples e constituída por 98 elementos. A colheita de dados foi efectuada através do método de entrevista, a qual só teve início após a assinatura do consentimento informado. O estudo decorreu entre 14 de Março e 27 de Junho de 2008.Foram analisados os dados relativamente às variáveis: sócio-demográficas, estado serológico da infecção, história sexual, consumo de substâncias, comportamento sexual e percepção de risco da transmissão da infecção por VIH.Os comportamentos de sexo não seguro foram associados ao número de parceiros sexuais/ano (p=0,007), ter parceiro sexual habitual (p=0,010), ter múltiplos parceiros sexuais ocasionais (p=0,000) e à prática de sexo oral (sexo oral receptivo, p=0,001; sexo oral activo, p=0,006).Os resultados demonstraram a importância da prevenção secundária nos indivíduos infectados por VIH. A necessidade dos centros de atendimento estarem providos de mensagem de prevenção, ensinos e aconselhamento a todas as pessoas infectadas e, também, aos seus parceiros sexuais, aumentando-lhes a qualidade de vida e reduzindo o risco de transmissão da infecção por HIV. ABSTRACT: The scientific research that followed the finding of human immunodeficiency virus (HIV) infection represented an important historical mark, allowing therapeutic institution and changing the natural history of the infection, thus improving the expectations of infected individuals. If by one side the Highly Active Antiretroviral Therapy (HAART) had an enormous impact on the improvement of life quality and life expectancy of the infected individuals on the developed countries, allowing them to face the infection as a chronic disease, on the other side it was introduced a epidemiologic dynamic on the HIV transmission and a new challenge for its prevention. Sexual behaviour is the main factor through which is possible to prevent more efficiently the possibility of infection of a community’s individual. Thus it appears important the need of Public Health to have a careful look into the sexual life of infected individuals, not only to try to promote their life quality but as well to prevent the dissemination of the disease and more importantly prevent the dissemination of the virus in its resistant forms. The objective of this study was to analyse the consistency of the use of condoms/safe sex by individuals infected by HIV that are followed by the Infectious Disease Service of the Santa Maria Hospital through Immune-depression Appointments. The goal was to evaluate the need of advisement to the infected individuals relatively to their sexual behaviours. For that it was done a descriptive and transversal study. The involved population included all infected individuals followed in the Immune-depression Appointments. The sample was selected by simple randomisation and was composed by 98 elements. The data was obtained by interview method, which was initiated after signing the informed consent. The study was took place between 14 March and 27 June 2008. It was analysed the data relative to the variables: socio-demographics, serologic state of the infection, sexual history, substances consumption, sexual behaviour and risk perception on the transmission of HIV infection. The unsafe sexual behaviours were associated to the number of sexual partners/year (p=0,007), having steady partner (p= 0,010), having occasional sexual partners (p=0,000) and oral sex practice (receptive oral sex, p=0,001; active oral sex, p= 0,006).The results demonstrated the importance of the secondary prevention on individuals infected by HIV. It also demonstrated the need of providing the attendance centres with a prevention message, teachings and advises to all infected persons as well as to their sexual partners, increasing their life quality and reducing the transmission risk of HIV infection.

Prova de Consciência Morfológica (PCM): contributos para a sua validação

A relação entre consciência fonológica e consciência morfológica e a contribuição independente de cada uma para a aprendizagem da leitura não reúnem ainda consenso na literatura. Alguns autores argumentam que a consciência morfológica não contribui de forma independente da consciência fonológica para a aprendizagem da leitura. No entanto, outros encontraram dados que indicam que a consciência morfológica tem um papel específi co na progressão da aprendizagem da leitura. Todavia, para além da variedade de tarefas usadas não permitir a comparação de resultados, a ausência de estudos prévios sobre a validade e a fi delidade das mesmas conduz a resultados cuja confi abilidade pode ser posta em causa. Este estudo tem como objetivo apresentar uma análise das qualidades psicométricas da PCM - Prova de Consciência Morfológica. A amostra é constituída por 243 crianças do 2.º (n = 79), 3.º (n = 83) e 4.º (n = 81) anos frequentando escolas públicas, urbanas, do distrito do Porto (norte de Portugal). Os resultados revelaram que a PCM possui uma elevada consistência interna (α = .95). Na análise em componentes principais, foi extraído um único fator, com valor próprio igual a 10.88, que explica 54.42% da variância total dos resultados. Os itens são todos saturados no fator, variando as saturações fatoriais entre um mínimo de .42 e o máximo de .91

Efficient schedulability tests for real-time embedded systems with urgent routines

Task scheduling is one of the key mechanisms to ensure timeliness in embedded real-time systems. Such systems have often the need to execute not only application tasks but also some urgent routines (e.g. error-detection actions, consistency checkers, interrupt handlers) with minimum latency. Although fixed-priority schedulers such as Rate-Monotonic (RM) are in line with this need, they usually make a low processor utilization available to the system. Moreover, this availability usually decreases with the number of considered tasks. If dynamic-priority schedulers such as Earliest Deadline First (EDF) are applied instead, high system utilization can be guaranteed but the minimum latency for executing urgent routines may not be ensured. In this paper we describe a scheduling model according to which urgent routines are executed at the highest priority level and all other system tasks are scheduled by EDF. We show that the guaranteed processor utilization for the assumed scheduling model is at least as high as the one provided by RM for two tasks, namely 2(2√−1). Seven polynomial time tests for checking the system timeliness are derived and proved correct. The proposed tests are compared against each other and to an exact but exponential running time test.

How to link organizational competences in public organizations?

Comunicação apresentada na 17ª Conferência Anual da Network of Intitutes and Schools of Public Administration (NISPA) em Birdua, Montenegro de 14 a 16 dem Maio de 2009.

Caracterização do transporte intermodal de cargas na zona norte de Portugal

Dissertação apresentada ao Instituto Politécnico do Porto para obtenção do Grau de Mestre em Logística Orientado pela professora Doutora Maria Teresa Ribeiro Pereira Esta dissertação não inclui as críticas e sugestões feitas pelo Júri.

Fisioterapia : influência na qualidade de vida da mulher com cancro da mama : contributo para a qualidade do serviço em oncologia

RESUMO - O cancro da mama é uma preocupação da saúde pública a nível mundial, pela sua incidência, mortalidade e custos económicos associados. As terapias utilizadas no seu tratamento, embora eficazes, conduzem a alterações de todas as dimensões da Qualidade de Vida (QdV) da mulher com cancro da mama. A garantia de uma qualidade de serviço prestado deve ser uma prioridade das organizações de saúde, sendo a QdV uma medida de resultado. Partindo do pressuposto que em Portugal existe uma diferença potencial na forma como as mulheres com cancro da mama recebem o apoio por parte da fisioterapia, importa saber se a fisioterapia tem ou não influência na QdV da mulher com cancro da mama, o que, no caso de ser afirmativo, poderá constituir uma mais-valia para a qualidade do serviço prestado em oncologia. O Objectivo deste trabalho é construir um modelo de análise no sentido de responder à questão inicial de investigação: “Será que a fisioterapia contribui para a melhoria da Qualidade de Vida das mulheres com cancro da mama submetidas a cirurgia e outras terapias oncológicas?”. Neste sentido o trabalho de projecto dividiu-se por etapas. Inicialmente foi realizado um enquadramento teórico, através de uma revisão de literatura e da realização de entrevistas exploratórias, permitindo desta forma ter um conhecimento actual das temáticas que definem as variáveis e o objecto de estudo. Na etapa seguinte, foi feita uma análise crítica sobre o conhecimento actual do tema em estudo, que permitiu definir as variáveis a estudar, escolher o instrumento de medida a utilizar, ter conhecimento dos procedimentos a seguir. Após a definição do objectivo geral (avaliar se a fisioterapia tem influência na QdV das mulheres submetidas a cirurgia e outras terapias oncológicas) e dos objectivos específicos, iniciou-se o delineamento da metodologia tida como adequada para responder às questões de investigação levantadas (tipo de estudo, as variáveis, a unidade de análise, os métodos e técnicas de recolha de dados, os procedimentos e a metodologia de tratamento de dados). No âmbito do trabalho de projecto está definida a colocação em campo de um caso de estudo efectivo que permita dar um contributo real no delineamento da metodologia. Neste trabalho optou-se pela realização de um estudo piloto, que se enquadra nos procedimentos da metodologia e que teve por objectivo retirar algumas conclusões sobre: a aplicabilidade do instrumento de medida; os tempos definidos para a recolha de dados; as características sociodemográficas e clínicas da amostra; as questões de investigação levantadas. O estudo piloto consistiu num estudo pré-experimental, com uma amostra de 35 indivíduos, submetidos a cirurgia a cancro da mama e a outras terapias oncológicas. Foram avaliadas as dimensões do bem-estar físico e actividades quotidianas, bem-estar psicológico, relações sociais, sintomas e características sociodemográficas/clínicas, no início do tratamento individual de fisioterapia e no momento de alta. Utilizou-se como instrumento de medida o questionário EORTC QLQ–30 e o seu questionário complementar EORTC QLQ–23. Tendo sido construída uma ficha para recolha de dados sociodemográficos e clínicos. A significância estatística foi aceite para valores de p<0,05. Para comparação entre grupos e evolução dentro de cada grupo aplicou-se o teste t-student e o teste de Mann-Whitney. A análise dos resultados do estudo piloto permitiu verificar que: - O instrumento de medida proposto (questionário EORTC QLQ30 e BR23) mostrou ser de fácil aplicação, não tendo existido dificuldade por parte das doentes no seu preenchimento. Não houve problemas no cálculo dos scores e na sua interpretação; - Parte considerável das mulheres com cancro da mama será submetida a protocolos que se poderão prolongar por vários meses após a cirurgia (ex: QT+RT+HT). Esta realidade leva-nos a propor que sejam realizados vários momentos de avaliação, para que possam ser avaliadas as dimensões da QdV ao longo dos diferentes protocolos de tratamentos. Pensamos que o ideal seria a realização de 4 momentos de avaliação (3 a 4 semanas após a cirurgia, 3 meses, 6 meses e 9 meses após cirurgia). Sugerimos também que o estudo proposto seja realizado com uma amostra de maior dimensão; - O estudo piloto como recorreu a uma metodologia pré-experimental (ausência de grupo de controlo e apenas dois momentos de avaliação), não permite a consistência dos resultados; no entanto os resultados obtidos podem constituir um indicador de que a fisioterapia tem influência nas diferentes dimensões da QdV da mulher com cancro da mama submetida a cirurgia e a outras terapias oncológicas, podendo constituir uma mais-valia para a qualidade do serviço prestado em oncologia. Os resultados do estudo piloto permitiram redefinir a metodologia tida como adequada para responder à questão de investigação inicial. Apresentamos de seguida a mesma: Estudo quase-experimental, sendo a amostra constituída por dois grupos de 60 mulheres cada, submetidas a cirurgia a cancro da mama e a outras terapias oncológicas. O grupo experimental será submetido a tratamentos individuais de fisioterapia. Serão avaliadas as dimensões do bem-estar físico e actividades quotidianas, bem-estar psicológico, relações sociais e sintomas. A recolha de dados será realizada 3 semanas, 3 meses, 6 meses e 9 meses após a cirurgia. Como instrumento de medida será utilizado o questionário EORTC QLQ–30 e o seu questionário complementar EORTC QLQ–23, serão também recolhidos dados sociodemográficos e clínicos. A significância estatística será aceite para valores de p<0,05. Para comparação entre grupos e evolução dentro de cada grupo serão utilizados testes paramétricos e não paramétricos. A realização de um estudo que seguisse a metodologia acima referida permitiria uma maior consistência dos resultados, podendo eventualmente existir a confirmação de que a fisioterapia pode ter influência na QdV da mulher submetida a cirurgia a cancro da mama e a outras terapias oncológicas. A evidência de que a fisioterapia tem influência na QdV da mulher com cancro da mama, e o facto de a QdV ser um indicador da qualidade do serviço prestado em oncologia, poderão constituir um agente facilitador para a mudança na gestão de recursos humanos em organizações de saúde com a valência de oncologia, levando a uma alteração dos padrões de prática na área da fisioterapia em oncologia em Portugal, que poderá conduzir a uma melhor qualidade de serviço prestado ao doente oncológico. ----- ABSTRACT - Breast Cancer is a worldwide public health concern due to the incidence, mortality and economic costs associated. Although effective, therapies used in its treatment lead to changes in all Quality of Life (QoL) dimensions of a woman suffering from Breast Cancer. QoL is an outcome measure, and the insurance of quality of care provided should be a priority to health organizations. Taking into consideration that in Portugal there is a potential difference in the way women with Breast Cancer are provided with physical therapy, it is important to know whether physical therapy does or does not influence the QoL of women with breast cancer. If it does, it will lead to a health care quality improvement to cancer patients. The goal of the following study is to build an analysis model in order to answer the initial investigation question: “Does Physical Therapy contribute to enhance the Quality of Life of women with breast cancer who underwent surgery and other oncology treatments?” The project was divided in different stages. Initially, a literature revision was elaborated and exploratory interviews were held, which allowed an actual knowledge of the themes that define the variables and the object of study. The next stage included a critical analysis of the theme, which allowed the definition of variables of study, the choice of instrument of measure and the acquisition of some knowledge on how to proceed. After the definition of the general goal (to evaluate the influence of physical therapy on the QoL of women with breast cancer who underwent surgery and other oncology treatments) and specific goals, the choice of a right methodology took place, in order to answer the investigation questions (type of study, variables, unit analysis, methods and techniques on data collection, procedures and data treatment). In the scope of the project, it is decided to put out on the field an effective case-study which assures a real contribution on the choice of te methodology. In this particular work, there was a pilot study, included in the methodology procedures, with the goal of obtaining conclusions on the applicability of the instrument of measure; the length of time to collect data, the socio-demographic and clinical characteristics of the sample; the investigation questions. The pilot study consisted on a one group pretest-postest design, with a sample of 35 individuals who underwent surgery and other oncology treatments. Dimensions such as physical well-being and everyday life activities, psychological well-being, social relationships, symptoms and socio-demographical/clinical characteristics were assessed at the beginning of physical therapy individual treatment and at the moment of release. The instrument of measure used was the EORTC QLQ–30 questionnaire and its complementary questionnaire EORTC QLQ–23. A chart was made in order to collect socio-demographic and clinical data. Statistic significance was accepted for values of p<0,05. To compare between groups and to detect the evolution within each group, the t-student test and the Mann-Whitney test were applied. The outcome analysis of the pilot study allowed to verify that: - The instrument of measure proposed (EORTC QLQ30 and BR23) was easy to apply, and the subjects did not show any difficulty in filling it up. There was also no problem on calculating the scores or interpreting them; - A considerable part of the women with breast cancer will be submitted to protocols that may occur throughout several months after surgery (e.g., QT+RT+HT). This reality leads us to suggest several moments of assessment of the QoL dimensions in various moments of the different protocol treatments. We consider that the ideal number of evaluations would be 4 (3/4 weeks, 3 months, 6 months and 9 months after surgery). We also suggest the use of a larger sample; - Since the pilot study resorted to a one group pretest-postest design (there is an absence of control group and only two moments of assessment), there is no consistency of outcome. However, the results obtained indicate that physical therapy influences the dimensions of QoL on women with breast cancer who underwent surgery and other oncology treatments, which may be an asset to the quality of care provided to cancer patients. The outcome of the pilot study allowed to redefine the methodology given as adequate to answer the initial investigation question. Our suggestion is as follows: quasi-experimental design, with a sample of 120 subjects (2 groups of 60 women) with breast cancer who underwent surgery and other oncology treatments. The experimental group will be submitted to individual treatments of physical therapy. Dimensions such as physical well-being and everyday life activities, psychological well-being, social relationships and symptoms will be assessed. The collection of data will occur at 3 weeks, 3 months, 6 months and 9 months after surgery. The instrument of measure is the EORTC QLQ–30 questionnaire and its complementary questionnaire EORTC QLQ–23, and social-demographic and clinical information will also be collected. The statistic significance will be accepted for values of p<0,05. Parametric and non-parametric tests will be used to compare between groups and to detect the evolution within each group. Carrying out a study that followed the methodology discussed above would allow a better consistency of results, possibly enabling the confirmation that physical therapy influences the QoL of women with breast cancer who underwent surgery and other oncology treatments. The evidence that physical therapy influences the QoL of women with breast cancer, and the fact that QoL is an indicator of quality of care provided to cancer patients, may work as a facilitating agent in the change of human resources management in health organizations associated to oncology, which will lead to a change in oncology physical therapy practice patterns in Portugal, guiding to a health care quality improvement to cancer patients.

Expression of antibodies and retroviralVectors from defined chromosomal sites: strategies towards reliable production systems

Dissertation presented to obtain a Ph.D. degree in Sciences of Engineering and Technology, Cell Technology, at the Instituto de Tecnologia Química e Biológica, Universidade Nova de Lisboa

EXPERIENCE IN THE EVALUATION OF CHILDREN WITH HEPATOSPLENOMEGALY AT A TEACHING AMBULATORY, SÃO PAULO, BRAZIL

Objectives: Describe cases of children with hepatosplenomegaly (HS) attended at the General Pediatric Teaching Ambulatory (AGER) of Instituto da Criança, São Paulo, identifying the main causes, evolution, necessity for hospitalization and/or referral to specialists. Methodology: Retrospective analysis of the records of children presenting HS on admission at AGER from September 1, 1993 to August 31, 1996. Results: Of the 89 children included (age range, 1 to 148 months; median, 24 months), 64 (72%) were referred from other services for HS investigation. Most common presenting complaints were: fever - 39 (44%); pallor - 26 (29%); weight loss - 21 (24%) and jaundice - 14 (16%). Main alterations noticed on physical examination were: pallor - 47 (53%) and short stature - 17 (19%). Anemia was diagnosed in 70 children (79%); 35 children (39%) had infections; 7 (8%) metabolic disorders and 5 (6%) neoplastic disorders. The most frequent infections were of the urinary tract - 9 (10%) and hepatitis A - 6 (7%).Thirty six children (40%) were referred to specialists, 17 of which were already diagnosed. Conclusions: Most of the children with HS present deficiency anemia associated with infections which the general pediatrician is able to diagnose. Persistence of unexplained HS for more than 2 months, especially when there is substantial volume enlargement or alteration in the organs consistency, is an indication for referral to specialists.

Extremum estimators and stochastic optimization methods

Submitted in partial fulfillment for the Requirements for the Degree of PhD in Mathematics, in the Speciality of Statistics in the Faculdade de Ciências e Tecnologia