Desvio de posicionamento em radioterapia para patologias de cabeça e pescoço e próstata: revisão de literatura

Introdução – Numa era em que os tratamentos de Radioterapia Externa (RTE) exigem cada vez mais precisão, a utilização de imagem médica permitirá medir, quantificar e avaliar o impacto do erro provocado pela execução do tratamento ou pelos movimentos dos órgãos. Objetivo – Analisar os dados existentes na literatura acerca de desvios de posicionamento (DP) em patologias de cabeça e pescoço (CP) e próstata, medidos com Cone Beam Computed Tomography (CBCT) ou Electronic Portal Image Device (EPID). Metodologia – Para esta revisão da literatura foram pesquisados artigos recorrendo às bases de dados MEDLINE/PubMed e b-on. Foram incluídos artigos que reportassem DP em patologias CP e próstata medidos através de CBCT e EPID. Seguidamente foram aplicados critérios de validação, que permitiram a seleção dos estudos. Resultados – Após a análise de 35 artigos foram incluídos 13 estudos e validados 9 estudos. Para tumores CP, a média (μ) dos DP encontra-se entre 0,0 e 1,2mm, com um desvio padrão (σ) máximo de 1,3mm. Para patologias de próstata observa-se μDP compreendido entre 0,0 e 7,1mm, com σ máximo de 7,5mm. Discussão/Conclusão – Os DP em patologias CP são atribuídos, maioritariamente, aos efeitos secundários da RTE, como mucosite e dor, que afetam a deglutição e conduzem ao emagrecimento, contribuindo para a instabilidade da posição do doente durante o tratamento, aumentando as incertezas de posicionamento. Os movimentos da próstata devem-se principalmente às variações de preenchimento vesical, retal e gás intestinal. O desconhecimento dos DP afeta negativamente a precisão da RTE. É importante detetá-los e quantificá-los para calcular margens adequadas e a magnitude dos erros, aumentando a precisão da administração de RTE, incluindo o aumento da segurança do doente. - ABSTRACT - Background and Purpose – In an era where precision is an increasing necessity in external radiotherapy (RT), modern medical imaging techniques provide means for measuring, quantifying and evaluating the impact of treatment execution and movement error. The aim of this paper is to review the current literature on the quantification of setup deviations (SD) in patients with head and neck (H&N) or prostate tumors, using Cone Beam Computed Tomography (CBCT) or Electronic Portal Image Device (EPID). Methods – According to the study protocol, MEDLINE/PubMed and b-on databases were searched for trials, which were analyzed using selection criteria based on the quality of the articles. Results – After assessment of 35 papers, 13 studies were included in this analysis and nine were authenticated (6 for prostate and 3 for H&N tumors). The SD in the treatment of H&N cancer patients is in the interval of 0.1 to 1.2mm, whereas in prostate cancer this interval is 0.0 to 7.1mm. Discussion – The reproducibility of patient positioning is the biggest barrier for higher precision in RT, which is affected by geometrical uncertainty, positioning errors and inter or intra-fraction organ movement. There are random and systematic errors associated to patient positioning, introduced since the treatment planning phase or through physiological organ movement. Conclusion – The H&N SD are mostly assigned to the Radiotherapy adverse effects, like mucositis and pain, which affect swallowing and decrease secretions, contributing for the instability of patient positioning during RT treatment and increasing positioning uncertainties. Prostate motion is mainly related to the variation in bladder and rectal filling. Ignoring SD affects negatively the accuracy of RT. Therefore, detection and quantification of SD is crucial in order to calculate appropriate margins, the magnitude of error and to improve accuracy in RTE and patient safety.

Probabilistic linkage in household survey on hospital care usage

OBJECTIVE: To evaluate the potential advantages and limitations of the use of the Brazilian hospital admission authorization forms database and the probabilistic record linkage methodology for the validation of reported utilization of hospital care services in household surveys. METHODS: A total of 2,288 households interviews were conducted in the county of Duque de Caxias, Brazil. Information on the occurrence of at least one hospital admission in the year preceding the interview was obtained from a total of 10,733 household members. The 130 records of household members who reported at least one hospital admission in a public hospital were linked to a hospital database with 801,587 records, using an automatic probabilistic approach combined with an extensive clerical review. RESULTS: Seventy-four (57%) of the 130 household members were identified in the hospital database. Yet only 60 subjects (46%) showed a record of hospitalization in the hospital database in the study period. Hospital admissions due to a surgery procedure were significantly more likely to have been identified in the hospital database. The low level of concordance seen in the study can be explained by the following factors: errors in the linkage process; a telescoping effect; and an incomplete record in the hospital database. CONCLUSIONS: The use of hospital administrative databases and probabilistic linkage methodology may represent a methodological alternative for the validation of reported utilization of health care services, but some strategies should be employed in order to minimize the problems related to the use of this methodology in non-ideal conditions. Ideally, a single identifier, such as a personal health insurance number, and the universal coverage of the database would be desirable.

O empreendedorismo como fator dinamizador da competitividade regional: o papel do financiamento

Dissertação de Mestrado em Finanças Empresariais

Adaptive tool for automatic data collection of real electricity markets

The study of electricity markets operation has been gaining an increasing importance in last years, as result of the new challenges that the electricity markets restructuring produced. This restructuring increased the competitiveness of the market, but with it its complexity. The growing complexity and unpredictability of the market’s evolution consequently increases the decision making difficulty. Therefore, the intervenient entities are forced to rethink their behaviour and market strategies. Currently, lots of information concerning electricity markets is available. These data, concerning innumerous regards of electricity markets operation, is accessible free of charge, and it is essential for understanding and suitably modelling electricity markets. This paper proposes a tool which is able to handle, store and dynamically update data. The development of the proposed tool is expected to be of great importance to improve the comprehension of electricity markets and the interactions among the involved entities.

Avaliação do desempenho docente : o papel da supervisão e as competências dos professores avaliadores

Dissertação apresentada à Escola Superior de Educação de Lisboa para obtenção do grau de Mestre em Ciências da Educação - Especialização em Supervisão em Educação

As formas animadas e a criatividade

Projeto de Intervenção apresentado à Escola Superior de Educação de Lisboa para obtenção de grau de mestre em Educação Artística - Especialidade Teatro na Educação

A data-mining based methodology for wind forecasting

In many countries the use of renewable energy is increasing due to the introduction of new energy and environmental policies. Thus, the focus on the efficient integration of renewable energy into electric power systems is becoming extremely important. Several European countries have already achieved high penetration of wind based electricity generation and are gradually evolving towards intensive use of this generation technology. The introduction of wind based generation in power systems poses new challenges for the power system operators. This is mainly due to the variability and uncertainty in weather conditions and, consequently, in the wind based generation. In order to deal with this uncertainty and to improve the power system efficiency, adequate wind forecasting tools must be used. This paper proposes a data-mining-based methodology for very short-term wind forecasting, which is suitable to deal with large real databases. The paper includes a case study based on a real database regarding the last three years of wind speed, and results for wind speed forecasting at 5 minutes intervals.

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.

Quase-verdade e pragmatismo

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Towards the wide implementation of standards IEC 61968/70 (CIM) and IEC 61850 in the distribution system (CIGRÉ C6-105_2010)

Currently, power systems (PS) already accommodate a substantial penetration of distributed generation (DG) and operate in competitive environments. In the future, as the result of the liberalisation and political regulations, PS will have to deal with large-scale integration of DG and other distributed energy resources (DER), such as storage and provide market agents to ensure a flexible and secure operation. This cannot be done with the traditional PS operational tools used today like the quite restricted information systems Supervisory Control and Data Acquisition (SCADA) [1]. The trend to use the local generation in the active operation of the power system requires new solutions for data management system. The relevant standards have been developed separately in the last few years so there is a need to unify them in order to receive a common and interoperable solution. For the distribution operation the CIM models described in the IEC 61968/70 are especially relevant. In Europe dispersed and renewable energy resources (D&RER) are mostly operated without remote control mechanisms and feed the maximal amount of available power into the grid. To improve the network operation performance the idea of virtual power plants (VPP) will become a reality. In the future power generation of D&RER will be scheduled with a high accuracy. In order to realize VPP decentralized energy management, communication facilities are needed that have standardized interfaces and protocols. IEC 61850 is suitable to serve as a general standard for all communication tasks in power systems [2]. The paper deals with international activities and experiences in the implementation of a new data management and communication concept in the distribution system. The difficulties in the coordination of the inconsistent developed in parallel communication and data management standards - are first addressed in the paper. The upcoming unification work taking into account the growing role of D&RER in the PS is shown. It is possible to overcome the lag in current practical experiences using new tools for creating and maintenance the CIM data and simulation of the IEC 61850 protocol – the prototype of which is presented in the paper –. The origin and the accuracy of the data requirements depend on the data use (e.g. operation or planning) so some remarks concerning the definition of the digital interface incorporated in the merging unit idea from the power utility point of view are presented in the paper too. To summarize some required future work has been identified.

Diversity and equity: dealing with biological and social differences

In the context of the design of working hours inequities in health associated with biological, psychological, social, and socioeconomic diversities can be observed. The paper first tries to set up a frame of reference for a discussion of this topic, relating to the Universal Declaration of Human Rights and some recent discussions on equity in health and then goes into some factors that produce inequities in health in the context of the design of working hours, dealing with sex or gender, age and job age, personality traits, marital status, social support, diversities in values, and socio-economic differences; the discussion deals with approaches on how to deal with these differences and inequities.

Os desafios da inclusão de alunos com síndrome de down

Dissertação apresentada à Escola Superior de Educação de Lisboa para a obtenção do Grau de Mestre em Ciências da Educação - Especialidade Educação especial

A responsabilidade social e ética nas organizações: estudo de caso na indústria farmacêutica

Mestrado em Contabilidade

Ontologies for reusing data cleaning knowledge

The emergence of new business models, namely, the establishment of partnerships between organizations, the chance that companies have of adding existing data on the web, especially in the semantic web, to their information, led to the emphasis on some problems existing in databases, particularly related to data quality. Poor data can result in loss of competitiveness of the organizations holding these data, and may even lead to their disappearance, since many of their decision-making processes are based on these data. For this reason, data cleaning is essential. Current approaches to solve these problems are closely linked to database schemas and specific domains. In order that data cleaning can be used in different repositories, it is necessary for computer systems to understand these data, i.e., an associated semantic is needed. The solution presented in this paper includes the use of ontologies: (i) for the specification of data cleaning operations and, (ii) as a way of solving the semantic heterogeneity problems of data stored in different sources. With data cleaning operations defined at a conceptual level and existing mappings between domain ontologies and an ontology that results from a database, they may be instantiated and proposed to the expert/specialist to be executed over that database, thus enabling their interoperability.

Context-aware emotion-based model for group decision making

Involving groups in important management processes such as decision making has several advantages. By discussing and combining ideas, counter ideas, critical opinions, identified constraints, and alternatives, a group of individuals can test potentially better solutions, sometimes in the form of new products, services, and plans. In the past few decades, operations research, AI, and computer science have had tremendous success creating software systems that can achieve optimal solutions, even for complex problems. The only drawback is that people don’t always agree with these solutions. Sometimes this dissatisfaction is due to an incorrect parameterization of the problem. Nevertheless, the reasons people don’t like a solution might not be quantifiable, because those reasons are often based on aspects such as emotion, mood, and personality. At the same time, monolithic individual decisionsupport systems centered on optimizing solutions are being replaced by collaborative systems and group decision-support systems (GDSSs) that focus more on establishing connections between people in organizations. These systems follow a kind of social paradigm. Combining both optimization- and socialcentered approaches is a topic of current research. However, even if such a hybrid approach can be developed, it will still miss an essential point: the emotional nature of group participants in decision-making tasks. We’ve developed a context-aware emotion based model to design intelligent agents for group decision-making processes. To evaluate this model, we’ve incorporated it in an agent-based simulator called ABS4GD (Agent-Based Simulation for Group Decision), which we developed. This multiagent simulator considers emotion- and argument based factors while supporting group decision-making processes. Experiments show that agents endowed with emotional awareness achieve agreements more quickly than those without such awareness. Hence, participant agents that integrate emotional factors in their judgments can be more successful because, in exchanging arguments with other agents, they consider the emotional nature of group decision making.