Estudo da qualidade organizacional da unidade de rastreio da retinopatia diabética do Alentejo central: projecto de intervenção comunitária em saúde

Mestrado em Intervenção Sócio-Organizacional na Saúde - Área de especialização: Políticas de Gestão e Administração dos Serviços de Saúde.

Reorganização dos componentes neuro-motores com influência na marcha em indivíduos com lesão do sistema nervoso central - impacto funcional

Objectivo: Avaliar o impacto qualitativo de um programa de intervenção em fisioterapia, segundo o Conceito de Bobath, nas actividades e participação de dois indivíduos com lesão do Sistema Nervoso Central. Avaliar as modificações no comportamento da actividade muscular ao longo da fase de apoio do ciclo da marcha, na força de reacção ao solo e respectiva contribuição muscular. Metodologia: A avaliação realizou-se antes e após um programa de intervenção, segundo a abordagem do Conceito de Bobath, através da Classificação Internacional de Funcionalidade, Incapacidade e Saúde, electromiografia, plataforma de forças e máquina fotográfica. Resultados: Obteve-se melhorias na restrição da participação e na limitação da actividade. Verifica-se uma tendência de modificação do comportamento muscular ao longo da fase de apoio e na componente antero-posterior (Fy), mais evidente no mecanismo de aceleração. A mudança na contribuição muscular para a este mecanismo é mais evidente. Conclusão: O programa de intervenção, segundo o Conceito de Bobath, induziu mudanças positivas quanto à funcionalidade dos indivíduos, reflectindo-se na possibilidade de reorganização dos componentes neuro-motores em indivíduos com lesão do Sistema Nervoso Central.

O Planeamento estratégico nos hospitais portugueses num contexto de austeridade: o caso particular dos Hospitais E.P.E.

Dissertação apresentada para obtenção do grau de Mestre em Contabilidade e Finanças Orientador: Professor Doutor José Freitas Santos

Advances in smart grids - benefits on sharing background experiences from Portugal, Central Europe and Brazil

This paper presents ELECON - Electricity Consumption Analysis to Promote Energy Efficiency Considering Demand Response and Non-technical Losses, an international research project that involves European and Brazilian partners. ELECON focuses on energy efficiency increasing through consumer´s active participation which is a key area for Europe and Brazil cooperation. The project aims at significantly contributing towards the successful implementation of smart grids, focussing on the use of new methods that allow the efficient use of distributed energy resources, namely distributed generation, storage and demand response. ELECON puts together researchers from seven European and Brazilian partners, with consolidated research background and evidencing complementary competences. ELECON involves institutions of 3 European countries (Portugal, Germany, and France) and 4 Brazilian institutions. The complementary background and experience of the European and Brazilian partners is of main relevance to ensure the capacities required to achieve the proposed goals. In fact, the European Union (EU) and Brazil have very different resources and approaches in what concerns this area. Having huge hydro and fossil resources, Brazil has not been putting emphasis on distributed renewable based electricity generation. On the contrary, EU has been doing huge investments in this area, taking into account environmental concerns and also the economic EU external dependence dictated by huge requirements of energy related products imports. Sharing these different backgrounds allows the project team to propose new methodologies able to efficiently address the new challenges of smart grids.

A data-mining-based methodology for transmission expansion planning

In recent decades, all over the world, competition in the electric power sector has deeply changed the way this sector’s agents play their roles. In most countries, electric process deregulation was conducted in stages, beginning with the clients of higher voltage levels and with larger electricity consumption, and later extended to all electrical consumers. The sector liberalization and the operation of competitive electricity markets were expected to lower prices and improve quality of service, leading to greater consumer satisfaction. Transmission and distribution remain noncompetitive business areas, due to the large infrastructure investments required. However, the industry has yet to clearly establish the best business model for transmission in a competitive environment. After generation, the electricity needs to be delivered to the electrical system nodes where demand requires it, taking into consideration transmission constraints and electrical losses. If the amount of power flowing through a certain line is close to or surpasses the safety limits, then cheap but distant generation might have to be replaced by more expensive closer generation to reduce the exceeded power flows. In a congested area, the optimal price of electricity rises to the marginal cost of the local generation or to the level needed to ration demand to the amount of available electricity. Even without congestion, some power will be lost in the transmission system through heat dissipation, so prices reflect that it is more expensive to supply electricity at the far end of a heavily loaded line than close to an electric power generation. Locational marginal pricing (LMP), resulting from bidding competition, represents electrical and economical values at nodes or in areas that may provide economical indicator signals to the market agents. This article proposes a data-mining-based methodology that helps characterize zonal prices in real power transmission networks. To test our methodology, we used an LMP database from the California Independent System Operator for 2009 to identify economical zones. (CAISO is a nonprofit public benefit corporation charged with operating the majority of California’s high-voltage wholesale power grid.) To group the buses into typical classes that represent a set of buses with the approximate LMP value, we used two-step and k-means clustering algorithms. By analyzing the various LMP components, our goal was to extract knowledge to support the ISO in investment and network-expansion planning.

A marcha: a influência do Gerador de Padrão Central

A marcha é influenciada por um conjunto de factores que resultam da interacção e organização própria de sistemas neurais e mecânicos, entre os quais, da dinâmica músculo-esquelética, da modulação pelos centros nervosos superiores, pela modulação aferente e é, também, assumida como sendo controlada pelo Gerador de Padrão Central (GPC), que se define como um programa central baseado num circuito espinal geneticamente determinado, capaz de produzir um ritmo associado a cada marcha. Apresenta-se como objectivo deste trabalho abordar quais os modelos explicativos para o funcionamento do GPC e qual a evidência científica, que continua a ter muitas divergências.

Optimization techniques for power distribution planning with uncertainties: a comparative study

Important research effort has been devoted to the topic of optimal planning of distribution systems. The non linear nature of the system, the need to consider a large number of scenarios and the increasing necessity to deal with uncertainties make optimal planning in distribution systems a difficult task. Heuristic techniques approaches have been proposed to deal with these issues, overcoming some of the inherent difficulties of classic methodologies. This paper considers several methodologies used to address planning problems of electrical power distribution networks, namely mixedinteger linear programming (MILP), ant colony algorithms (AC), genetic algorithms (GA), tabu search (TS), branch exchange (BE), simulated annealing (SA) and the Bender´s decomposition deterministic non-linear optimization technique (BD). Adequacy of theses techniques to deal with uncertainties is discussed. The behaviour of each optimization technique is compared from the point of view of the obtained solution and of the methodology performance. The paper presents results of the application of these optimization techniques to a real case of a 10-kV electrical distribution system with 201 nodes that feeds an urban area.

Cancer incidence projections for Lisbon and Santarém districts: an aid to radiotherapy services planning

Will the existing means in Radiotherapy respond to the needs of the potential user population in 2014 for Lisbon and Santarém districts? Number of treatment units? Number of Radiotherapy Technologists? Temporal variations of the dimension and age structure of the populations: Coastal areas/Interior areas, Urban areas/Rural areas. Temporal variations in the incidence of several types of cancer. Overall objectives: evaluate of the necessities of Radiotherapy for Lisbon and Santarém districts in 2014 and elaboration of proposals that aim the access/use for the potential user population.

Reposição do sistema semi-automático Pyxis® num Hospital Central Universitário: avaliação do número de unidades repostas

Introdução: No Centro Hospitalar de São João, EPE a partir de 2008, foi implementado o sistema semi-automático de reposição de stocks nivelados de medicamentos, Pyxis®, atualmente implementado em 16 serviços clínicos. Atendendo ao crescimento verificado na implementação deste sistema automatizado na instituição, este trabalho pretende dar a conhecer a realidade de preparação da medicação para reposição no sistema semi-automático Pyxis®, por avaliação do número de unidades de medicamentos repostos diariamente e por dia da semana. Material e Métodos: Desenvolveu-se um estudo longitudinal retrospetivo onde se analisou a totalidade de serviços com implementação Pyxis® através do registo diário de reposição dos diferentes Serviços Clínicos num período de 41 dias consecutivos. Numa segunda fase, os dados foram sintetizados sob a forma de tabelas em Microsoft Office Excel®, tendo posteriormente sido construídos os respetivos gráficos para análise. Resultados: Os resultados, representados graficamente, mostram que a segunda-feira é o dia da semana com maior número de reposições de medicamentos, sendo os serviços com maior número de reposições totais UCI Geral, UCI Neurocríticos, Cirurgia Cardiotorácica e UCIPU. Discussão / Conclusões: Os resultados obtidos permitiram verificar uma sobrecarga de referências de medicamentos e unidades repostas às segundas-feiras, atingindo, em muitos serviços, valores de unidades repostas duas vezes superior à média de reposições do serviço (por ex. UCI Neurocíticos). Contudo, apesar do reduzido período de análise, os dados parecem evidenciar que o facto de haver reposições ao domingo agiliza o processo de reposição dos Pyxis® às segundas-feiras.

Recommendation and planning through mobile devices in tourism context

In this paper we present a mobile recommendation and planning system, named PSiS Mobile. It is designed to provide effective support during a tourist visit through context-aware information and recommendations about points of interest, exploiting tourist preferences and context. Designing a tool like this brings several challenges that must be addressed. We discuss how these challenges have been overcame, present the overall system architecture, since this mobile application extends the PSiS project website, and the mobile application architecture.

Neonatal mortality in intensive care units of Central Brazil

OBJECTIVE: To identify potential prognostic factors for neonatal mortality among newborns referred to intensive care units. METHODS: A live-birth cohort study was carried out in Goiânia, Central Brazil, from November 1999 to October 2000. Linked birth and infant death certificates were used to ascertain the cohort of live born infants. An additional active surveillance system of neonatal-based mortality was implemented. Exposure variables were collected from birth and death certificates. The outcome was survivors (n=713) and deaths (n=162) in all intensive care units in the study period. Cox's proportional hazards model was applied and a Receiver Operating Characteristic curve was used to compare the performance of statistically significant variables in the multivariable model. Adjusted mortality rates by birth weight and 5-min Apgar score were calculated for each intensive care unit. RESULTS: Low birth weight and 5-min Apgar score remained independently associated to death. Birth weight equal to 2,500g had 0.71 accuracy (95% CI: 0.65-0.77) for predicting neonatal death (sensitivity =72.2%). A wide variation in the mortality rates was found among intensive care units (9.5-48.1%) and two of them remained with significant high mortality rates even after adjusting for birth weight and 5-min Apgar score. CONCLUSIONS: This study corroborates birth weight as a sensitive screening variable in surveillance programs for neonatal death and also to target intensive care units with high mortality rates for implementing preventive actions and interventions during the delivery period.

A marcha: a influência do Gerador de Padrão Central

A marcha é influenciada por um conjunto de factores que resultam da interacção e organização própria de sistemas neurais e mecânicos, entre os quais, da dinâmica músculo-esquelética, da modulação pelos centros nervosos superiores, pela modulação aferente e é, também, assumida como sendo controlada pelo Gerador de Padrão Central (GPC), que se define como um programa central baseado num circuito espinal geneticamente determinado, capaz de produzir um ritmo associado a cada marcha. Apresenta-se como objectivo deste trabalho abordar quais os modelos explicativos para o funcionamento do GPC e qual a evidência científica, que continua a ter muitas divergências.

Planning, Cooperation and Competition: A case study in industry and construction in a Portuguese Region

In the present paper we analyzed the behavior of firms in the construction and manufacturing sectors, located in the region of Vale do Sousa, in the north of Portugal. From the literature, even existing some disagreements, it is possible to conclude that planning is crucial for firms survival and growth. Cooperation is another aspect that the literature presents as an important factor for firms sustainability. It also plays a major role in competition, since firms are adopting coopetition strategies. By studying a sample of 251 firms, it was possible to realize, that the majority started their business without a formal planning, and they keep going without using it. In cooperation aspects, there is a lack of cooperation. It was possible to verify, that existing cooperation has some evidence but at a vertical level. These vertical relations were also identified in stakeholder’s involvement.

Central obesity and dietary intake in HIV/AIDS patients

OBJECTIVE: To assess the association between dietary intake and central obesity among people living with HIV/AIDS and receiving highly active antiretroviral therapy. METHODS: A cross-sectional study was conducted involving 223 adult individuals in the city of São Paulo city in 2002. The study population was classified according to central obesity, defined as waist-to-hip ratio >0.95 for men and >0.85 for women. The dietary variables studied were energy consumption (in calories and calories/kilo of body weight), macronutrients (in grams and % of energy intake), total fiber (grams) and fruit and vegetables intake (grams). The potential confounders examined were sex, skin color, age, schooling, income, body mass index, physical activity, smoking habits, peripheral CD4+ T lymphocyte count and length of protease inhibitor use. The multiple logistic regression model was performed in order to evaluate the association between central obesity and dietary intake. RESULTS: The prevalence of central obesity was 45.7% and it was associated with greater consumption of lipids: for every increase of 10g of lipid intake the odds of central obesity increased 1.28 times. Carbohydrate consumption showed negative association (OR=0.93) with central obesity after adjustment for control variables. CONCLUSIONS: The results suggest that the amount of carbohydrates and lipids in the diet, regardless of total energy intake, may modify the chance of developing central obesity in the studied population. Nutritional interventions may be beneficial for preventing central obesity among HIV/AIDS patients.

Towards systematic conservation planning in the Azores

Several field methodologies, analytical measures and theoretical patterns have been explored for conservation planning for arthropods in native forests of the Azores archipelago. Here, the outcomes are assembled to make recommendations on practical strategies to assess arthropod diversity and to select and manage protected native forests in the Azores. Suggestions are made on how to apply similar plans for conservation of other plant and animal groups in these forests. Potential threats to the Azorean native forest are described and measures to minimize them are proposed. Future studies are also suggested that would improve the present knowledge of arthropod diversity and distribution in Azorean native forests and could assist in the identification of suitable conservation strategies.