Persistent asthma in adults: comparison of high resolution computed tomography of the lungs after one year of follow-up

OBJECTIVE: The aims of this study were to evaluate the role of high resolution computed tomography of the torax in detecting abnormalities in chronic asthmatic patients and to determine the behavior of these lesions after at least one year. METHOD: Fourteen persistent asthmatic patients with a mean forced expiratory volume in 1-second that was 63% of predicted and a mean forced expiratory volume in 1-second /forced vital capacity of 60% had two high resolution computed tomographys separated by an interval of at least one year. RESULTS: All 14 patients had abnormalities on both scans. The most common abnormality was bronchial wall thickening, which was present in all patients on both computed tomographys. Bronchiectasis was suggested on the first computed tomography in 5 of the 14 (36%) patients, but on follow-up, the bronchial dilatation had disappeared in 2 and diminished in a third. Only one patient had any emphysematous changes; a minimal persistent area of paraseptal emphysema was present on both scans. In 3 patients, a "mosaic" appearance was observed on the first scan, and this persisted on the follow-up computed tomography. Two patients had persistent areas of mucoid impaction. In a third patient, mucus plugging was detected only on the second computed tomography. CONCLUSIONS: We conclude that there are many abnormalities on the high resolution computed tomography of patients with persistent asthma. Changes suggestive of bronchiectasis, namely bronchial dilatation, frequently resolve spontaneously. Therefore, the diagnosis of bronchiectasis by high resolution computed tomography in asthmatic patients must be made with caution, since bronchial dilatation can be reversible or can represent false dilatation. Nonsmoking chronic asthmatic subjects in this study had no evidence of centrilobular or panacinar emphysema.

Optimization of wastewater quality in the Sines refinery

In order to address and resolve the wastewater contamination problem of the Sines refinery with the main objective of optimizing the quality of this stream and reducing the costs charged to the refinery, a dynamic mass balance was developed nd implemented for ammonia and polar oil and grease (O&G) contamination in the wastewater circuit. The inadequate routing of sour gas from the sour water stripping unit and the kerosene caustic washing unit, were identified respectively as the major source of ammonia and polar substances present in the industrial wastewater effluent. For the O&G content, a predictive model was developed for the kerosene caustic washing unit, following the Projection to Latent Structures (PLS) approach. Comparison between analytical data for ammonia and polar O&G concentrations in refinery wastewater originating from the Dissolved Air Flotation (DAF) effluent and the model predictions of the dynamic mass balance calculations are in a very good agreement and highlights the dominant impact of the identified streams for the wastewater contamination levels. The ammonia contamination problem was solved by rerouting the sour gas through an existing clogged line with ammonia salts due to a non-insulated line section, while for the O&G a dynamic mass balance was implemented as an online tool, which allows for prevision of possible contamination situations and taking the required preventive actions, and can also serve as a basis for establishing relationships between the O&G contamination in the refinery wastewater with the properties of the refined crude oils and the process operating conditions. The PLS model developed could be of great asset in both optimizing the existing and designing new refinery wastewater treatment units or reuse schemes. In order to find a possible treatment solution for the spent caustic problem, an on-site pilot plant experiments for NaOH recovery from the refinery kerosene caustic washing unit effluent using an alkaline-resistant nanofiltration (NF) polymeric membrane were performed in order to evaluate its applicability for treating these highly alkaline and contaminated streams. For a constant operating pressure and temperature and adequate operating conditions, 99.9% of oil and grease rejection and 97.7% of chemical oxygen demand (COD) rejection were observed. No noticeable membrane fouling or flux decrease were registered until a volume concentration factor of 3. These results allow for NF permeate reuse instead of fresh caustic and for significant reduction of the wastewater contamination, which can result in savings of 1.5 M€ per year at the current prices for the largest Portuguese oil refinery. The capital investments needed for implementation of the required NF membrane system are less than 10% of those associated with the traditional wet air oxidation solution of the spent caustic problem. The operating costs are very similar, but can be less than half if reusing the NF concentrate in refinery pH control applications. The payback period was estimated to be 1.1 years. Overall, the pilot plant experimental results obtained and the process economic evaluation data indicate a very competitive solution through the proposed NF treatment process, which represents a highly promising alternative to conventional and existing spent caustic treatment units.

Hormone replacement therapy and the risk of breast cancer: assessment of therapy acceptance in a cohort of previously treated breast cancer patients

INTRODUCTION: In the postmenopausal period, an average of 25% of women will present symptomatic ovarian failure requiring hormonal replacement therapy. Estrogen can relieve vasomotor symptoms. Hormonal replacement therapy is generally not recommended for breast cancer patients due to the potential risk of tumor recurrence. To answer the questions about the safety of hormonal replacement therapy in this subgroup of women, it is necessary to establish the acceptance of treatment. METHODS: Between September 1998 and February 2001, a cohort of 216 breast cancer patients were asked to complete a questionnaire. All patients had completed their treatment and were informed about survival rates after breast cancer and hormonal replacement therapy. RESULTS: Among the 216 patients, 134 (62%) would refuse hormonal replacement therapy. A hundred patients were afraid of relapse (74.6%). Adjuvant tamoxifen therapy was the only statistically significant variable (70.3% versus 29.7% p=0.003). Understanding clinical stage (p= 0.045) and type of medical assistance (private versus public , p=0.033) also seemed to influence the decision. Early stage disease (p= 0.22), type of surgical procedure (radical versus conservative, p=0.67), adjuvant chemotherapy (p=0.082) or marital status (p=0.98 ) were not statistically significant in decision making. Several patients submitted to adjuvant chemotherapy (41.6%) would accept hormonal replacement therapy under medical supervision, as did most of advanced clinical stage patients (58.3%; p=0.022). CONCLUSION: There is a high level of rejection for hormonal replacement therapy among breast cancer patients when current data on tumor cure rates, and potential risks of estrogen use is available. Adverse effects of tamoxifen in the adjuvant setting may be the reason for refusal of hormonal replacement therapy .

Avaliação do risco de LMEMSLT : aplicação dos métodos RULA e SI / Florentino , António de Sousa Uva

RESUMO - A frequente insuficiência de informação e até, eventualmente, a presença de elementos cientificamente pouco robustos (ou mesmo hipotéticos) no procedimento de obtenção dos resultados finais (scores) com os diversos métodos de avaliação do risco, julga-se determinar a obtenção de distintos resultados no mesmo posto de trabalho e que interessam analisar. O presente estudo foi efectuado numa empresa da indústria automóvel e pretendeu contribuir para a efectividade do processo de avaliação do risco destas lesões em meio industrial. Utilizaram-se como ponto de partida as classificações de risco em postos de trabalho onde a aplicação do método OCRA — base do projecto de norma Europeu prEN 1005-5 para a estimativa do risco de LMEMSLT (Lesões Musculoesqueléticas do Membro Superior Ligadas ao Trabalho) — identificou níveis de risco moderados e/ou elevados (score OCRA ≥ 16,5). Assim nos postos de trabalho (n = 71) registou-se em vídeo a actividade de trabalho. Analisaram-se os principais factores de risco (postura, força, repetitividade e exposição a vibrações) com uma amostragem de segundo em segundo e aplicaram-se dois métodos: 1) RULA (McAtamney; Corlett, 1993); 2) SI (Moore; Garg, 1995). Dos resultados globais da aplicação dos métodos identificam- se discrepâncias evidentes: o método SI classificou 41 postos de risco elevado e o método RULA classificou apenas 26 postos de risco. Destaque para as divergências entre os postos classificados de risco elevado como, por exemplo: de entre os 41 postos com scores de risco da aplicação do método SI apenas se encontram 12 postos classificados de risco pelo método RULA. Os resultados permitem evidenciar validades preditivas diversas para os factores de risco analisados: 1) situações de aplicação de força (SI = 0,80; RULA = 0,66); 2) presença de posturas extremas (SI = 0,68; RULA = 0,48); 3) repetitividade (SI = 0,35; RULA = 0,43). Conclui-se pela divergência de resultados dos métodos SI e RULA aplicados nos mesmos postos de trabalho que tal situação alerta para a pertinência da utilização de um filtro que permita a identificação dos factores de risco presentes em cada posto de trabalho e que, por consequência, oriente a selecção do método mais indicado ou ainda, em oposição, do método contra-indicado. Este trabalho, como um contributo para uma efectiva identificação e avaliação do risco de LMEMSLT, conduz, no limite, à necessidade de elaboração de uma «grelha» das «grelhas» e de informação mais precisa sobre os métodos e sua aplicação, permitindo, desse modo, uma mais efectiva gestão do risco destas lesões.

As peculiaridades da democratização da região do Cáucaso do Sul no contexto da Política Europeia de Vizinhança

O período após o colapso da União Soviética foi o tempo da procura de novas identidades na nova realidade e de escolha de novos parceiros e aliados, o tempo da construção de novos estados e de formulação das regras e normas nacionais. Após o desmoronamento da ideologia soviética - um facto reconhecido oficialmente durante o período da Perestroika –, as pessoas sentiram uma necessidade de preencher o vácuo ideológico e desenvolver uma nova identidade. Foi proclamada a rejeição da estrutura política administrativa herdada da União Soviética e do sistema de economia planificada, e desenvolvida a tendência para a construção do estado democrático fundado numa economia de mercado. As expectativas relativas às transformações no período pós-soviético estavam relacionadas com o Ocidente (EUA e UE), e a construção do estado soberano foi fundada em modelos ocidentais de estado de direito, ‘boa governança’ e a economia de mercado. A UE desempenhou um papel importante na democratização dos estados da região do Sul do Cáucaso através de vários projetos e programas bilaterais e multilaterais no âmbito da Política Europeia de Vizinhança e da Parceria Oriental. Embora as reformas democráticas tenham sido realizadas com vista ao estabelecimento de uma Constituição democrática, à implementação de eleições democráticas e ao desenvolvimento da sociedade civil, fortaleceram, também, ainda mais, a natureza autoritária do poder, impediram a criação de um estado de direito, reforçaram violação dos direitos e das liberdades humanas. (NODIYA, 2003: 30; BAKHMAN, 2003: 17; BADALOV, 2003: 20). Deste modo, o processo da promoção da democracia através das reformas nos três estados do Sul do Cáucaso conduziu à criação de estados de “conteúdo autocrático misto, mas de forma democrática” (CHETERYAN, 2003: 41). Embora seja possível identificar as semelhanças entre os três estados da região do Sul do Cáucaso nas reformas do processo de desenvolvimento, os métodos e meios de implementação de reformas nas realidades dos estados regionais pela administração nacional foram bastante diferentes, por razões associadas às especificidades de cada um (DELCOUR e WOLCZUK, 2013: 3). Cada país é caracterizado pelas suas peculiaridades ao nível da situação geopolítica e diversidade do potencial económico – fatores que definem a trajetória política e económica do estado no período pós-soviético e, em certa medida, influenciam o modo como se desenvolvem as relações com a UE e, portanto, o processo de adoção das reformas e a sua introdução a nível nacional.

Da falsa integração do espectador na TV informativa

As actuais potencialidades tecnológicas abrem, perante o (tele)spectador, a promessa de um ilusório empowered user que se vai construindo alicerçado na narrativa mítica da omnipotência, tornada modo verbal e complemento directo da promessa moderna da omnividência. No entanto, os plateaux informativos da televisão portuguesa do século XXI ainda não vêem no telespectador um elemento estruturante do seu trabalho. São escassos os programas que abrem o alinhamento à participação do público e aqueles que o fazem atiram-no para margens que pouco ou nada interferem no desenvolvimento das emissões. Neste artigo, analisamos a integração dos telespectadores em 1673 emissões informativas, distribuídas por seis canais de televisão (RTP1, SIC, TVI, SICN, RTPN, TVI 24). Trata-se de uma investigação que desenvolvemos no âmbito do projecto “Jornalismo televisivo e cidadania”.

Caught between changing tides: Gender and kinship in Cape Verde

Gender ideologies in Cape Verde are shifting. Individuals find themselves caught between changing tides, pushed and pulled in opposite directions by divergent gendered expectations. The article examines the different ways in which young women and men take recourse to tactics in response to the tensions that arise as they deal with changing gender ascriptions in the midst of their relations with community and kin. Women, in particular, are unevenly affected by traditional demands and expectations whilst they cross the boundaries of traditional gender roles in their pursuit of enhanced education and more sexual freedom. Yet, their actions are not characterized by an outright rejection of traditional gender ideologies, but rather by piecemeal tactical manoeuvres to plot a route through the centrifugal forces at play. keywords

Da 'portugalidade' à lusofonia

Tese de Doutoramento em Ciências da Comunicação (Especialidade em Teoria da Cultura)

Escolhas sequenciais e simultâneas em humanos: processamento independente ou por competição?

Dissertação de mestrado integrado em Psicologia

Attachment orientation and caretaking memories in fathers during the transition to parenthood

Dissertação de mestrado em Psicologia Aplicada

Modification of microfiltration membranes by hydrogel impregnation for pDNA purification

The huge efforts for the achievement of highly purified biomolecules are growing every day. A great number of efficient techniques, such as chromatography, are already available in laboratory for separation processes. However, membrane-based technologies are the best match to assure simplicity, efficiency and easy scale-up procedures. Herein we report the modification of a commercial microfiltration membrane for plasmid DNA purification by agarose gel impregnation. The membrane was characterized by SEM, ATR-FTIR, EDS, contact angle, and porosity measurements. Additionally, the membrane pore radius was estimated from observed rejections of different proteins and with that information the rejection of a 6050 bp plasmid DNA (pDNA) molecule was estimated for different values of flux using a theoretical model of large flexible molecules in membranes with parallel cylindrical pores, which is applicable to pDNA ultrafiltration in conventional membranes, as recently shown in the literature. The experimental results show that the modified membrane has higher pDNA rejections than the predicted by the model, suggesting that the different type of porous structure that a hydrogel has, may have a positive effect on pDNA rejections as compared to other biomolecules with more rigid structures, making this type of modified membranes potential better candidates to be used for the selective recovery of pDNA in this type of bioprocesses.

The importance of risk assessment in the context of investment project management: a case study

Risk management is an important component of project management. Nevertheless, such process begins with risk assessment and evaluation. In this research project, a detailed analysis of the methodologies used to treat risks in investment projects adopted by the Banco da Amazonia S.A. was made. Investment projects submitted to the FNO (Constitutional Fund for Financing the North) during 2011 and 2012 were considered for that purpose. It was found that the evaluators of this credit institution use multiple indicators for risk assessment which assume a central role in terms of decision-making and contribute for the approval or the rejection of the submitted projects; namely, the proven ability to pay, the financial records of project promotors, several financial restrictions, level of equity, level of financial indebtedness, evidence of the existence of a consumer market, the proven experience of the partners/owners in the business, environmental aspects, etc. Furthermore, the bank has technological systems to support the risk assessment process, an internal communication system and a unique system for the management of operational risk.

Nonparametric estimation of time-dependent ROC curves conditional on a continuous covariate

The receiver-operating characteristic (ROC) curve is the most widely used measure for evaluating the performance of a diagnostic biomarker when predicting a binary disease outcome. The ROC curve displays the true positive rate (or sensitivity) and the false positive rate (or 1-specificity) for different cut-off values used to classify an individual as healthy or diseased. In time-to-event studies, however, the disease status (e.g. death or alive) of an individual is not a fixed characteristic, and it varies along the study. In such cases, when evaluating the performance of the biomarker, several issues should be taken into account: first, the time-dependent nature of the disease status; and second, the presence of incomplete data (e.g. censored data typically present in survival studies). Accordingly, to assess the discrimination power of continuous biomarkers for time-dependent disease outcomes, time-dependent extensions of true positive rate, false positive rate, and ROC curve have been recently proposed. In this work, we present new nonparametric estimators of the cumulative/dynamic time-dependent ROC curve that allow accounting for the possible modifying effect of current or past covariate measures on the discriminatory power of the biomarker. The proposed estimators can accommodate right-censored data, as well as covariate-dependent censoring. The behavior of the estimators proposed in this study will be explored through simulations and illustrated using data from a cohort of patients who suffered from acute coronary syndrome.

The archaeogenetics of european ancestry

The archaeogenetics of Europe remains deeply controversial. Advances in ancient deoxyribonucleic acid (DNA) analysis have suggested gene flow between Neanderthals and modern humans, who arrived in Europe <50 000 years ago, but have so far failed to support evolution of Neanderthals from a population of Homo heidelbergensis represented by remains in northern Spain. The extent to which European Mesolithic forager populations versus Neolithic pioneers from the Near East contributed to the extant gene pool of Europeans also continues to be contested. Whilst analyses of extant mitochondrial lineages have emphasised late Palaeolithic and Mesolithic expansions, ancient DNA (aDNA) results suggest significant Neolithic dispersals from the southern ‘refugial’ zone into the northern ‘bio-tidal’ zone. However, whether these had a primarily Near Eastern or North Mediterranean source remains a matter for debate. Meanwhile, aDNA has also begun to highlight an important role for later dispersals, especially during the late Neolithic, in shaping the European gene pool.

Some notes on a historical perspective of panic disorder

This article aims to describe important points in the history of panic disorder concept, as well as to highlight the importance of its diagnosis for clinical and research developments. Panic disorder has been described in several literary reports and folklore. One of the oldest examples lies in Greek mythology - the god Pan, responsible for the term panic. The first half of the 19th century witnessed the culmination of medical approach. During the second half of the 19th century came the psychological approach of anxiety. The 20th century associated panic disorder to hereditary, organic and psychological factors, dividing anxiety into simple and phobic anxious states. Therapeutic development was also observed in psychopharmacological and psychotherapeutic fields. Official classifications began to include panic disorder as a category since the third edition of the American Classification Manual (1980). Some biological theories dealing with etiology were widely discussed during the last decades of the 20th century. They were based on laboratory studies of physiological, cognitive and biochemical tests, as the false suffocation alarm theory and the fear network. Such theories were important in creating new diagnostic paradigms to modern psychiatry. That suggests the need to consider a wide range of historical variables to understand how particular features for panic disorder diagnosis have been developed and how treatment has emerged.