Avaliação geriátrica global integrada: perspetiva de atuação na prática clínica

O envelhecimento progressivo da população idosa, com aumento de prevalência de doenças crónicas, está associado a um aumento da prevalência de deterioração funcional, dependência, admissões hospitalares, e maior morbilidade e mortalidade. É nosso objetivo sinalizar a estrutura da avaliação geriátrica global integrada e a demonstração da sua eficiência na prática clinica. A avaliação geriátrica global integrada (AGGI) constitui desejavelmente uma prática multidimensional, sistemática, de caracterização do estado clínico, nutricional, funcional, qualidade de vida e aspectos sociais em pessoas idosas. A equipa de profissionais que a elaboram deverá ser multiprofissional de acordo com a diversidade de competências necessárias para uma avaliação que, a nível hospitalar, será efetuada na admissão e na alta do doente. Recomenda-se que seja protocolada em todas as instituições, que haja um registo único, onde todos os profissionais possam colocar as suas observações, constituindo uma forma eficiente de informação entre os intervenientes profissionais, os seus pares e os doentes e suas redes de apoio. A utilização de questionários de risco validados constitui uma mais valia na deteção de risco ou de situações já alteradas mas subnotificadas e no planeamento da sua intervenção. Após a realização da AGGI, deverá ser delineada e registada uma estratégia de intervenção, com o estabelecimento de objetivos a curto e a longo prazo, a serem monitorizados e ajustados, de acordo com a necessidade. A evidência científica tem demonstrado que a prática da AGGI constitui um método eficaz na redução da morbilidade e mortalidade em indivíduos idosos.

Análise psicométrica inicial da versão brasileira do DISABKIDS Atopic Dermatitis Module

OBJETIVO: Analisar as propriedades psicométricas iniciais da versão brasileira de instrumento de avaliação da qualidade de vida relacionada à saúde de crianças e adolescentes com dermatite atópica. MÉTODOS: Estudo transversal realizado com amostra de 52 crianças e adolescentes, com idades entre oito e 18 anos, diagnosticados com dermatite atópica, e seus responsáveis, recrutados em serviço de dermatologia de hospital universitário na cidade de São Paulo, SP, em 2009. Foram avaliadas a validade de construto, a confiabilidade de consistência interna e a correlação entre as respostas de crianças e adolescentes e seus responsáveis da versão brasileira do Atopic Dermatitis Module (DISABKIDS-ADM). RESULTADOS: A confiabilidade de consistência interna foi satisfatória, com coeficiente alfa de Cronbach aceitável para as dimensões constantes no instrumento (0,7024/0,8124 e 0,7239/0,8604). A análise multitraço-multimétodo para validade convergente mostrou valores maiores que 0,30 para todos os itens. Quanto à validade discriminante, a análise revelou resultados satisfatórios. A concordância entre as versões self e proxy foi avaliada pelo coeficiente de correlação intra-classe, com valores de 0,8173 para impacto e 0,7629 para estigma. CONCLUSÕES: Diante dos resultados encontrados, considera-se que o instrumento DISABKIDS-ADM pode ser utilizado por pesquisadores brasileiros depois de finalizado seu processo de validação, por seus resultados iniciais apontarem propriedades psicométricas satisfatórias, que permitem considerá-lo um instrumento válido e confiável.

Devolução de doses unitárias: análise de uma prática diária

A Distribuição Individual Diária em Dose Unitária deve assegurar o maior rigor no Processo de Distribuição de Medicamentos, o que nem sempre se verificou no Hospital Pedro Hispano, dado que as Doses Unitárias devolvidas pelos Serviços de Internamento, nem sempre seguiam os Parâmetros de Qualidade. Assim, desenvolveu-se um estudo quasi-experimental, longitudinal, prospetivo e analítico, entre 1 de Março a 30 de Junho de 2012, no qual se analisaram as Doses Unitárias, devolvidas pelos Serviços de Internamento da Unidade Local de Saúde de Matosinhos a funcionam com Distribuição Individual Diária em Dose Unitária, tendo-se recolhido as não conformes relativamente aos Parâmetros de Qualidade instituídos. Na 1.ª fase do estudo (Recolha de amostras), foram contabilizadas 337 amostras, correspondentes a uma perda de 471 €. Na 2.ª fase do estudo (Implementação de acções correctivas às amostras previamente recolhidas), foram rejeitadas definitivamente 129 amostras, correspondentes a uma perda de 198 €. Na 4.ª fase do estudo (Segunda recolha de amostras), foram contabilizadas 228 amostras, correspondentes a uma perda de 199 €. A 3.ª fase do estudo incluiu a divulgação dos resultados às enfermeiras chefes dos serviços envolvidos no estudo e a 5.ª fase a comparação dos resultados obtidos na 1.ª, 2.ª e 4.ª fase do estudo. As amostras foram recolhidas em 16 serviços de internamento, sendo os valores monetários mais relevantes associados ao Espessante para alimentos líquidos e ao Imipeno + Cilastatina. A prática observada e sujeita a estudo aumenta os riscos associados ao consumo do medicamento e os custos relativos ao Processo, sendo de eliminar. A sua monitorização deve constituir uma rotina, uma vez que houve mudança de comportamentos. A redução/eliminação desta prática não conforme conduz à integração de novas tarefas com valor acrescentado, com aumento da fiabilidade do Processo.

Nutritional value and influence of the thermal processing on a traditional Portuguese fermented sausage (alheira)

Alheiras are a traditional, smoked, fermented meat sausage, produced in Portugal, with an undeniable cultural and gastronomic legacy. In this study, we assessed the nutritional value of this product, as well as the influence of different types of thermal processing. Alheiras from Mirandela were submitted to six different procedures: microwave, skillet, oven, charcoal grill, electric fryer and electric grill. Protein, fat, carbohydrate, minerals, NaCl, and cholesterol contents, as well as fatty acid profile were evaluated. The results show that alheiras are not hypercaloric but an unbalanced foodstuff (high levels of proteins and lipids) and the type of processing has a major impact on their nutritional value. Charcoal grill is the healthiest option: less fat (12.5 g/100 g) and cholesterol (29.3 mg/100 g), corresponding to a lower caloric intake (231.8 kcal, less 13% than the raw ones). Inversely, fried alheiras presented the worst nutritional profile, with the highest levels of fat (18.1 g/100 g) and cholesterol (76.0 g/100 g).

O contributo do Value For Money na análise da atividade do transporte não urgente de doentes

Mestrado em Auditoria

An integrated recycling approach for GFRP pultrusion wastes: recycling and reuse assessment into new composite materials using Fuzzy Boolean Nets

In this study, efforts were made in order to put forward an integrated recycling approach for the thermoset based glass fibre reinforced polymer (GPRP) rejects derived from the pultrusion manufacturing industry. Both the recycling process and the development of a new cost-effective end-use application for the recyclates were considered. For this purpose, i) among the several available recycling techniques for thermoset based composite materials, the most suitable one for the envisaged application was selected (mechanical recycling); and ii) an experimental work was carried out in order to assess the added-value of the obtained recyclates as aggregates and reinforcement replacements into concrete-polymer composite materials. Potential recycling solution was assessed by mechanical behaviour of resultant GFRP waste modified concrete-polymer composites with regard to unmodified materials. In the mix design process of the new GFRP waste based composite material, the recyclate content and size grade, and the effect of the incorporation of an adhesion promoter were considered as material factors and systematically tested between reasonable ranges. The optimization process of the modified formulations was supported by the Fuzzy Boolean Nets methodology, which allowed finding the best balance between material parameters that maximizes both flexural and compressive strengths of final composite. Comparing to related end-use applications of GFRP wastes in cementitious based concrete materials, the proposed solution overcome some of the problems found, namely the possible incompatibilities arisen from alkalis-silica reaction and the decrease in the mechanical properties due to high water-cement ratio required to achieve the desirable workability. Obtained results were very promising towards a global cost-effective waste management solution for GFRP industrial wastes and end-of-life products that will lead to a more sustainable composite materials industry.

Sustainable waste recycling solution for the glass fibre reinforced polymer composite materials industry

In this paper the adequacy and the benefit of incorporating glass fibre reinforced polymer (GFRP) waste materials into polyester based mortars, as sand aggregates and filler replacements, are assessed. Different weight contents of mechanically recycled GFRP wastes with two particle size grades are included in the formulation of new materials. In all formulations, a polyester resin matrix was modified with a silane coupling agent in order to improve binder-aggregates interfaces. The added value of the recycling solution was assessed by means of both flexural and compressive strengths of GFRP admixed mortars with regard to those of the unmodified polymer mortars. Planning of experiments and data treatment were performed by means of full factorial design and through appropriate statistical tools based on analyses of variance (ANOVA). Results show that the partial replacement of sand aggregates by either type of GFRP recyclates improves the mechanical performance of resultant polymer mortars. In the case of trial formulations modified with the coarser waste mix, the best results are achieved with 8% waste weight content, while for fine waste based polymer mortars, 4% in weight of waste content leads to the higher increases on mechanical strengths. This study clearly identifies a promising waste management solution for GFRP waste materials by developing a cost-effective end-use application for the recyclates, thus contributing to a more sustainable fibre-reinforced polymer composites industry.

Avaliação da implementação de programa de fiabilidade de aeronaves na Força Aérea Portuguesa

Trabalho Final de Mestrado para obtenção do grau de Mestre em Engenharia Mecânica

Taxonomy of fundamental concepts of localization in cyber-physical and sensor networks

Localization is a fundamental task in Cyber-Physical Systems (CPS), where data is tightly coupled with the environment and the location where it is generated. The research literature on localization has reached a critical mass, and several surveys have also emerged. This review paper contributes on the state-of-the-art with the proposal of a new and holistic taxonomy of the fundamental concepts of localization in CPS, based on a comprehensive analysis of previous research works and surveys. The main objective is to pave the way towards a deep understanding of the main localization techniques, and unify their descriptions. Furthermore, this review paper provides a complete overview on the most relevant localization and geolocation techniques. Also, we present the most important metrics for measuring the accuracy of localization approaches, which is meant to be the gap between the real location and its estimate. Finally, we present open issues and research challenges pertaining to localization. We believe that this review paper will represent an important and complete reference of localization techniques in CPS for researchers and practitioners and will provide them with an added value as compared to previous surveys.

Biodegradação enzimática de aminas aromáticas tóxicas

Trabalho Final de Mestrado para obtenção do grau de Mestre em Engenharia Química e Biológica

Avaliação e a Qualidade das Práticas de Inclusão para Alunos com PEA: Escala LAQI (Louisiana Autism Quality Indicators)

Dissertação apresentada à Escola Superior de Educação de Lisboa para obtenção de grau de mestre em Educação Especial, domínio Cognição e Multideficiência

Short-term Value for the Water Stored in Headsensitivity Power System Reservoirs

As it is well known, competitive electricity markets require new computing tools for generation companies to enhance the management of its resources. The economic value of the water stored in a power system reservoir is crucial information for enhancing the management of the reservoirs. This paper proposes a practical deterministic approach for computing the short-term economic value of the water stored in a power system reservoir, emphasizing the need to considerer water stored as a scarce resource with a short-term economic value. The paper addresses a problem concerning reservoirs with small storage capacities, i.e., the reservoirs considered as head-sensitivity. More precisely, the respective hydro plant is head-dependent and a pure linear approach is unable to capture such consideration. The paper presents a case study supported by the proposed practical deterministic approach and applied on a real multi-reservoir power system with three cascaded reservoirs, considering as input data forecasts for the electric energy price and for the natural inflow into the reservoirs over the schedule time horizon. The paper presents various water schedules due to different final stored water volume conditions on the reservoirs. Also, it presents the respective economic value of the water for the reservoirs at different stored water volume conditions.

Effect of technical parameters on dose and image quality in a computed radiography system

The discovery of X-rays was undoubtedly one of the greatest stimulus for improving the efficiency in the provision of healthcare services. The ability to view, non-invasively, inside the human body has greatly facilitated the work of professionals in diagnosis of diseases. The exclusive focus on image quality (IQ), without understanding how they are obtained, affect negatively the efficiency in diagnostic radiology. The equilibrium between the benefits and the risks are often forgotten. It is necessary to adopt optimization strategies to maximize the benefits (image quality) and minimize risk (dose to the patient) in radiological facilities. In radiology, the implementation of optimization strategies involves an understanding of images acquisition process. When a radiographer adopts a certain value of a parameter (tube potential [kVp], tube current-exposure time product [mAs] or additional filtration), it is essential to know its meaning and impact of their variation in dose and image quality. Without this, any optimization strategy will be a failure. Worldwide, data show that use of x-rays has been increasingly frequent. In Cabo Verde, we note an effort by healthcare institutions (e.g. Ministry of Health) in equipping radiological facilities and the recent installation of a telemedicine system requires purchase of new radiological equipment. In addition, the transition from screen-films to digital systems is characterized by a raise in patient exposure. Given that this transition is slower in less developed countries, as is the case of Cabo Verde, the need to adopt optimization strategies becomes increasingly necessary. This study was conducted as an attempt to answer that need. Although this work is about objective evaluation of image quality, and in medical practice the evaluation is usually subjective (visual evaluation of images by radiographer / radiologist), studies reported a correlation between these two types of evaluation (objective and subjective) [5-7] which accredits for conducting such studies. The purpose of this study is to evaluate the effect of exposure parameters (kVp and mAs) when using additional Cooper (Cu) filtration in dose and image quality in a Computed Radiography system.

Value of a lower limb immobilization device for SPECT/CT image fusion optimization

The foot and the ankle are small structures commonly affected by disorders, and their complex anatomy represent significant diagnostic challenges. SPECT/CT Image fusion can provide missing anatomical and bone structure information to functional imaging, which is particularly useful to increase diagnosis certainty of bone pathology. However, due to SPECT acquisition duration, patient’s involuntary movements may lead to misalignment between SPECT and CT images. Patient motion can be reduced using a dedicated patient support. We aimed at designing an ankle and foot immobilizing device and measuring its efficacy at improving image fusion. Methods: We enrolled 20 patients undergoing distal lower-limb SPECT/CT of the ankle and the foot with and without a foot holder. The misalignment between SPECT and CT images was computed by manually measuring 14 fiducial markers chosen among anatomical landmarks also visible on bone scintigraphy. Analysis of variance was performed for statistical analysis. Results: The obtained absolute average difference without and with support was 5.1±5.2 mm (mean±SD) and 3.1±2.7 mm, respectively, which is significant (p<0.001). Conclusion: The introduction of the foot holder significantly decreases misalignment between SPECT and CT images, which may have clinical influence in the precise localization of foot and ankle pathology.

A web-based tool to evaluate the iterative processes of direct search methods

Constrained and unconstrained Nonlinear Optimization Problems often appear in many engineering areas. In some of these cases it is not possible to use derivative based optimization methods because the objective function is not known or it is too complex or the objective function is non-smooth. In these cases derivative based methods cannot be used and Direct Search Methods might be the most suitable optimization methods. An Application Programming Interface (API) including some of these methods was implemented using Java Technology. This API can be accessed either by applications running in the same computer where it is installed or, it can be remotely accessed through a LAN or the Internet, using webservices. From the engineering point of view, the information needed from the API is the solution for the provided problem. On the other hand, from the optimization methods researchers’ point of view, not only the solution for the problem is needed. Also additional information about the iterative process is useful, such as: the number of iterations; the value of the solution at each iteration; the stopping criteria, etc. In this paper are presented the features added to the API to allow users to access to the iterative process data.