The use of Log-file analysis within VMAT audits

OBJECTIVE: This work investigates the delivery accuracy of different Varian linear accelerator models using log-file derived MLC RMS values.

METHODS: Seven centres independently created a plan on the same virtual phantom using their own planning system and the log files were analysed following delivery of the plan in each centre to assess MLC positioning accuracy. A single standard plan was also delivered by seven centres to remove variations in complexity and the log files were analysed for Varian TrueBeams and Clinacs (2300IX or 2100CD models).

RESULTS: Varian TrueBeam accelerators had better MLC positioning accuracy (<1.0mm) than the 2300IX (<2.5mm) following delivery of the plans created by each centre and also the standard plan. In one case log files provided evidence that reduced delivery accuracy was not associated with the linear accelerator model but was due to planning issues.

CONCLUSIONS: Log files are useful in identifying differences between linear accelerator models, and isolate errors during end-to-end testing in VMAT audits. Log file analysis can rapidly eliminate the machine delivery from the process and divert attention with confidence to other aspects. Advances in Knowledge: Log file evaluation was shown to be an effective method to rapidly verify satisfactory treatment delivery when a dosimetric evaluation fails during end-to-end dosimetry audits. MLC RMS values for Varian TrueBeams were shown to be much smaller than Varian Clinacs for VMAT deliveries.

U-TRACER® - the use of communication technology in higher education - an information visualization tool for the context of Portuguese public higher education

Information Visualization is gradually emerging to assist the representation and comprehension of large datasets about Higher Education Institutions, making the data more easily understood. The importance of gaining insights and knowledge regarding higher education institutions is little disputed. Within this knowledge, the emerging and urging area in need of a systematic understanding is the use of communication technologies, area that is having a transformative impact on educational practices worldwide. This study focused on the need to visually represent a dataset about how Portuguese Public Higher Education Institutions are using Communication Technologies as a support to teaching and learning processes. Project TRACER identified this need, regarding the Portuguese public higher education context, and carried out a national data collection. This study was developed within project TRACER, and worked with the dataset collected in order to conceptualize an information visualization tool U-TRACER®. The main goals of this study related to: conceptualization of the information visualization tool U-TRACER®, to represent the data collected by project TRACER; understand higher education decision makers perception of usefulness regarding the tool. The goals allowed us to contextualize the phenomenon of information visualization tools regarding higher education data, realizing the existing trends. The research undertaken was of qualitative nature, and followed the method of case study with four moments of data collection.The first moment regarded the conceptualization of the U-TRACER®, with two focus group sessions with Higher Education professionals, with the aim of defining the interaction features the U-TRACER® should offer. The second data collection moment involved the proposal of the graphical displays that would represent the dataset, which reading effectiveness was tested by end-users. The third moment involved the development of a usability test to the UTRACER ® performed by higher education professionals and which resulted in the proposal of improvements to the final prototype of the tool. The fourth moment of data collection involved conducting exploratory, semi-structured interviews, to the institutional decision makers regarding their perceived usefulness of the U-TRACER®. We consider that the results of this study contribute towards two moments of reflection. The challenges of involving end-users in the conceptualization of an information visualization tool; the relevance of effective visual displays for an effective communication of the data and information. The second relates to the reflection about how the higher education decision makers, stakeholders of the U-TRACER® tool, perceive usefulness of the tool, both for communicating their institutions data and for benchmarking exercises, as well as a support for decision processes. Also to reflect on the main concerns about opening up data about higher education institutions in a global market.

Competências profissionais dos professores dos cursos de educação e formação : a construção de uma nova identidade docente

Tese de mestrado, Ciências da Educação (Formação de Professores), Universidade de Lisboa, Instituto de Educação, 2010

Four years on: a longitudinal study assessing the impact of a virtual community of practice

This paper explores the long term impact of a virtual learning community (VLC) from the perspective of community members and their employing organization. It argues that membership potentially has a significant impact on individual identities and careers, and that managed communities provide an important means for strategic workforce development. The study evaluates the impact of membership of a VLC over a four year period within the context of the theoretical frameworks of communities of practice and identity theory. The concept of boundary crossing is also explored in relation to VLCs. The paper considers the benefits to host organisations in supporting structured VLCs as a means of enabling workforce development and supporting change and innovation.

Outermost european regions of the atlantic area network

This paper is part of the results from the project "Implementation Strategies and Development of an Open and Distance Education System for the University of the Azores" funded by the European Social Fund. http://hdl.handle.net/10400.3/2327

Funding sources and fostering of educational projects

This paper is part of the results from the project "Implementation Strategies and Development of an Open and Distance Education System for the University of the Azores" funded by the European Social Fund. http://hdl.handle.net/10400.3/2327

eHealth e a adoção da inovação em assisted living technologies : o caso das demências

RESUMO - Assistimos hoje a um contexto marcado (i) pelo progressivo envelhecimento das sociedades ocidentais, (ii) pelo aumento da prevalência das doenças crónicas, de que as demências são um exemplo, (iii) pelo significativo aumento dos custos associados a estas patologias, (iv) por orçamentos públicos fortemente pressionadas pelo controlo da despesa, (v) por uma vida moderna que dificulta o apoio intergeracional, tornando o suporte proporcionado pelos filhos particularmente difícil, (vi) por fortes expectativas relativamente à prestação de cuidados de saúde com qualidade. Teremos assim de ser capazes de conseguir melhorar os serviços de saúde, ao mesmo tempo que recorremos a menos recursos financeiros e humanos, pelo que a inovação parece ser crítica para a sustentabilidade do sistema. Contudo a difusão das Assistive Living Technologies, apesar do seu potencial, tem sido bastante baixa, nomeadamente em Portugal. Porquê? Hamer, Plochg e Moreira (2012), no editorial do International Journal of Healthcare Management, enquadram a Inovação como “podendo ser imprevisível e mesmo dolorosa, pelo que talvez possamos não ficar surpreendidos se surgirem resistências e que, inovações bastante necessárias, capazes de melhorar os indicadores de saúde, tenham sido de adoção lenta ou que tenham mesmo sido insustentáveis”. Em Portugal não há bibliografia que procure caracterizar o modelo de difusão da inovação em eHealth ou das tecnologias de vivência assistida. A bibliografia internacional é igualmente escassa. O presente projeto de investigação, de natureza exploratória, tem como objetivo principal, identificar barreiras e oportunidades para a implementação de tecnologias eHealth, aplicadas ao campo das demências. Como objetivos secundários pretendemse identificar as oportunidades e limitações em Portugal: mapa de competências nacionais, e propor medidas que possa acelerar a inovação em ALT, no contexto nacional. O projeto seguirá o modelo de um estudo qualitativo. Para o efeito foram conduzidas entrevistas em profundidade junto de experts em ALT, procurando obter a visão daqueles que participam do lado da Oferta- a Indústria; do lado da Procura- doentes, cuidadores e profissionais de saúde; bem como dos Reguladores. O instrumento utilizado para a recolha da informação pretendida foi o questionário não estruturado. A análise e interpretação da informação recolhida foram feitas através da técnica de Análise de Conteúdo. Os resultados da Análise de Conteúdo efetuada permitiram expressar a dicotomia barreira/oportunidade, nas seguintes categorias aqui descritas como contextos (i) Contexto Tecnológico, nas subcategorias de Acesso às Infraestruturas; Custo da Tecnologia; Interoperabilidade, (ii) Contexto do Valor Percecionado, nas subcategorias de Utilidade; Eficiência; Divulgação, (iii) Contexto Político, compreendendo a Liderança; Organização; Regulação; Recursos, (iv) Contexto Sociocultural, incluindo nomeadamente Idade; Literacia; Capacidade Económica, (v) Contexto Individual, incluindo como subcategorias, Capacidade de Adaptação a Novas tecnologias; Motivação; Acesso a equipamentos (vi) Contexto Específico da Doença, nomeadamente o Impacto Cognitivo; Tipologia Heterogénea e a Importância do Cuidador. Foi proposto um modelo exploratório, designado de Modelo de Contextos e Forças, que estudos subsequentes poderão validar. Neste modelo o Contexto Tecnológico é um Força Básica ou Fundamental; o Contexto do Valor Percecionado, constitui-se numa Força Crítica para a adoção de inovação, que assenta na sua capacidade para oferecer valor aos diversos stakeholders da cadeia de cuidados. Temos também o Contexto Político, com capacidade de modelar a adoção da inovação e nomeadamente com capacidade para o acelerar, se dele emitir um sinal de urgência para a mudança. O Contexto Sociocultural e Individual expressam uma Força Intrínseca, dado que elas são características internas, próprias e imutáveis no curto-prazo, das sociedade e das pessoas. Por fim há que considerar o Contexto Específico da Doença, nesta caso o das demências. Das conclusões do estudo parece evidente que as condições tecnológicas estão medianamente satisfeitas em Portugal, com evidentes progressos nos últimos anos (exceção para a interoperabilidade aonde há necessidade de maiores progressos), não constituindo portanto barreira à introdução de ALT. Aonde há necessidade de investir é nas áreas do valor percebido. Da análise feita, esta é uma área que constitui uma barreira à introdução e adoção das ALT em Portugal. A falta de perceção do valor que estas tecnologias trazem, por parte dos profissionais de saúde, doentes, cuidadores e decisores políticos, parece ser o principal entrave à sua adoção. São recomendadas estratégias de modelos colaborativos de Investigação e Desenvolvimento e de abordagens de cocriação com a contribuição de todos os intervenientes na cadeia de cuidados. Há também um papel que cabe ao estado no âmbito das prioridades e da mobilização de recursos, sendo-lhe requerida a expressão do sentido de urgência para que esta mudança aconteça. Foram também identificadas oportunidades em diversas áreas, como na prevenção, no diagnóstico, na compliance medicamentosa, na terapêutica, na monitorização, no apoio à vida diária e na integração social. O que é necessário é que as soluções encontradas constituam respostas àquilo que são as verdadeiras necessidades dos intervenientes e não uma imposição tecnológica que só por si nada resolve. Do estudo resultou também a perceção de que há que (i) continuar a trabalhar no sentido de aproximar a comunidade científica, da clínica e do doente, (ii) fomentar a colaboração entre centros, com vista à criação de escala a nível global. Essa colaboração já parece acontecer a nível empresarial, tendo sido identificadas empresas Portuguesas com vocação global. A qualidade individual das instituições de ensino, dos centros de investigação, das empresas, permite criar as condições para que Portugal possa ser país um piloto e um case-study internacional em ALT, desde que para tal pudéssemos contar com um trabalho colaborativo entre instituições e com decisões políticas arrojadas.

Chirality in the new generation of antidepressants: stereoselective analysis of the enantiomers of mirtazapine, N-demethylmirtazapine, and 8-hydroxymirtazapine by LC-MS.

Mirtazapine is an antidepressant that acts specifically on noradrenergic and sertonergic receptors. A LC-MS method was developed that allows the simultaneous analysis of the R-(-)- and S-(+)-enantiomers of mirtazapine (MIR), demethylmirtazapine (DMIR), and 8-hydroxymirtazapine (8-OH-MIR) in plasma of MIR-treated patients. The method involves a 3-step liquid-liquid extraction, an HPLC separation on a Chirobiotic V column, and MS detection in electrospray mode. The limit of quantification (LOQ) for all enantiomers was 0.5 ng/mL, and the intra- and interday CVs were within 3.3% to 11.7% (concentration ranges 5-50 ng/mL). A method is also presented for the quantitative analysis of glucuroconjugated MIR and 8-OH-MIR. S-(+)-8-OH-MIR is present in plasma mainly as its glucuronide. Preliminary data suggest that in all patients, except in those comedicated with CYP2D6 inhibitors such as fluoxetine and thioridazine, R-(-)-MIR concentrations were higher than those of S-(+)MIR. Moreover, fluvoxamine seems also to inhibit the metabolism of MIR. Therefore, this method seems to be suitable for the stereoselective assay of MIR and its metabolites in plasma of patients comedicated with MIR and other drugs for routine and research purposes.

Family history of cancer: pooled analysis in the International Head and Neck Cancer Epidemiology Consortium.

Alcohol and tobacco consumption are well-recognized risk factors for head and neck cancer (HNC). Evidence suggests that genetic predisposition may also play a role. Only a few epidemiologic studies, however, have considered the relation between HNC risk and family history of HNC and other cancers. We pooled individual-level data across 12 case-control studies including 8,967 HNC cases and 13,627 controls. We obtained pooled odds ratios (OR) using fixed and random effect models and adjusting for potential confounding factors. All statistical tests were two-sided. A family history of HNC in first-degree relatives increased the risk of HNC (OR=1.7, 95% confidence interval, CI, 1.2-2.3). The risk was higher when the affected relative was a sibling (OR=2.2, 95% CI 1.6-3.1) rather than a parent (OR=1.5, 95% CI 1.1-1.8) and for more distal HNC anatomic sites (hypopharynx and larynx). The risk was also higher, or limited to, in subjects exposed to tobacco. The OR rose to 7.2 (95% CI 5.5-9.5) among subjects with family history, who were alcohol and tobacco users. A weak but significant association (OR=1.1, 95% CI 1.0-1.2) emerged for family history of other tobacco-related neoplasms, particularly with laryngeal cancer (OR=1.3, 95% CI 1.1-1.5). No association was observed for family history of nontobacco-related neoplasms and the risk of HNC (OR=1.0, 95% CI 0.9-1.1). Familial factors play a role in the etiology of HNC. In both subjects with and without family history of HNC, avoidance of tobacco and alcohol exposure may be the best way to avoid HNC.

Problems of allometric scaling analysis: examples from mammalian reproductive biology.

Biological scaling analyses employing the widely used bivariate allometric model are beset by at least four interacting problems: (1) choice of an appropriate best-fit line with due attention to the influence of outliers; (2) objective recognition of divergent subsets in the data (allometric grades); (3) potential restrictions on statistical independence resulting from phylogenetic inertia; and (4) the need for extreme caution in inferring causation from correlation. A new non-parametric line-fitting technique has been developed that eliminates requirements for normality of distribution, greatly reduces the influence of outliers and permits objective recognition of grade shifts in substantial datasets. This technique is applied in scaling analyses of mammalian gestation periods and of neonatal body mass in primates. These analyses feed into a re-examination, conducted with partial correlation analysis, of the maternal energy hypothesis relating to mammalian brain evolution, which suggests links between body size and brain size in neonates and adults, gestation period and basal metabolic rate. Much has been made of the potential problem of phylogenetic inertia as a confounding factor in scaling analyses. However, this problem may be less severe than suspected earlier because nested analyses of variance conducted on residual variation (rather than on raw values) reveals that there is considerable variance at low taxonomic levels. In fact, limited divergence in body size between closely related species is one of the prime examples of phylogenetic inertia. One common approach to eliminating perceived problems of phylogenetic inertia in allometric analyses has been calculation of 'independent contrast values'. It is demonstrated that the reasoning behind this approach is flawed in several ways. Calculation of contrast values for closely related species of similar body size is, in fact, highly questionable, particularly when there are major deviations from the best-fit line for the scaling relationship under scrutiny.

The inadequate dominance of realism : an analysis of the U.S. war on terror /

There has been and will continue to be substantial debate over how the international system can best be characterized. The objective of this paper is to demonstrate that the international system can best be characterized by the essential features of realism, but the use of realist policy prescriptions are inadequate when applied independently to deal with the threat of terrorism as it exists today. In order to demonstrate this an examination of realism in the international system, U.S. foreign policy, and case analysis of Afghanistan and Iraq will be undertaken to demonstrate that although realist policy prescriptions do have a role in dealing with modem transnational security threats, these prescriptions on their own are inadequate when dealing with terrorism.

Youth's experiences of motivation in school physical education and sport

This study's objective was to examine how thirteen year-old females perceive and describe their lived experiences of being physically active in school PE (physical education) and organized youth sport settings through a self-determination theory (Deci & Ryan, 1985) lens. Motivational factors and links between both settings were discussed with five participants using in-depth interviews. Participants discussed factors that facilitated and disrupted their motivation to be active in PE and sport settings. The selfdetermination theory was used as a framework in this qualitative study and results are based on participants' own words and perspectives. Results indicate that participants' positive experiences in school PE and organized sport have the potential to meet their needs of autonomy, competence and relatedness. The autonomy supportive behaviours of social agents, feeling challenged and successful at activities and the strong relationships formed in both settings are all things that motivated young people in this study to continue being physically active throughout high-school and into adulthood.

Assessing the psychometric properties of dream content questionnaires

The present study was the first of its kind to systematically explore the psychometric properties of dream content questionnaires as measures of dream experience. One hundred and six University students filled out the Dream Content Questionnaire (DCQ) and kept a 14-day dream diary on two separate occasions, in addition to filling out the NEO-PI-R and Multidimensional Personality Questionnaire and measures of spatial ability and imaginativeness. The DCQ's reliability was acceptable, as was its discriminant and construct validity. Six of eight predicted relationships between trait personality and DCQ reported dream content were significant. In contrast, dream diaries showed instability over time and were unrelated to personality traits. The DCQ's concurrent validity could not be adequately appraised due to the inconsistency in dream diary content over time. The results suggest that questionnaires may be used to measure dream experience; however, the precise utility of dream questionnaires remains unclear. The findings raise important questions concerning measures of dream experience.