Slipped Capital Femoral Epiphysis. A Report of 4 Cases Occurring in One Family

We describe slipped capital femoral epiphysis in 4 members of a black, obese family, who were all first-degree relatives. The aetiology of slipped capital femoral epiphysis is unknown, although it is thought to be multifactorial. Genetic predisposition and environmental factors have been associated with the condition. A familial incidence with at least two cases in the same family has been reported. In epidemiological studies, this incidence ranges from 3% to 35%. Our cases were investigated in an attempt to find a possible aetiological genetic factor. A genetic predisposition with an autosomal dominant pattern of transmission is suggested, although environmental variables must be considered as provocative factors.

Influence of Firms’ Environmental Management and Community Involvement Programs in their Employees and in the Community

To assure enduring success, firms need to generate economic value with respect for the environment and social value. They also need to be aware of the needs and expectations of relevant stakeholders and incorporate them in their business strategies and programs. These challenges imply that engineers should take into consideration societal, health and safety,environmental and commercial issues in their professional activity. This investigation accesses the influence of firms’ environmental management programs and community involvement programs on their own employees and in the community, with a focus on small and medium companies. Based on a quantitative research, the findings suggest that firms that invest both in environmental management programs and in community involvement programs have a higher involvement of their own employees with the community, while at the same time receiving more feedback (positive, but also negative) from the community, stressing the need to pay special attention to their communication policies.

A multi-objective model for scheduling of short-term incentive-based demand response programs offered by electricity retailers

In this paper, we formulate the electricity retailers’ short-term decision-making problem in a liberalized retail market as a multi-objective optimization model. Retailers with light physical assets, such as generation and storage units in the distribution network, are considered. Following advances in smart grid technologies, electricity retailers are becoming able to employ incentive-based demand response (DR) programs in addition to their physical assets to effectively manage the risks of market price and load variations. In this model, the DR scheduling is performed simultaneously with the dispatch of generation and storage units. The ultimate goal is to find the optimal values of the hourly financial incentives offered to the end-users. The proposed model considers the capacity obligations imposed on retailers by the grid operator. The profit seeking retailer also has the objective to minimize the peak demand to avoid the high capacity charges in form of grid tariffs or penalties. The non-dominated sorting genetic algorithm II (NSGA-II) is used to solve the multi-objective problem. It is a fast and elitist multi-objective evolutionary algorithm. A case study is solved to illustrate the efficient performance of the proposed methodology. Simulation results show the effectiveness of the model for designing the incentive-based DR programs and indicate the efficiency of NSGA-II in solving the retailers’ multi-objective problem.

Municipal solid waste management system: decision support through systems analysis

Thesis submitted to the Universidade Nova de Lisboa, Faculdade de Ciências e Tecnologia for the degree of Doctor of Philosophy in Environmental Engineering

Routine Transthoracic Echocardiography in a General Intensive Care Unit: an 18 Month Survey in 704 Patients

The authors analyzed 704 transthoracic echocardiographic (TTE) examinations, performed routinely to all admitted patients to a general 16-bed Intensive Care Unit (ICU) during an 18-month period. Data acquisition and prevalence of abnormalities of cardiac structures and function were assessed, as well as the new, previously unknown severe diagnoses. A TTE was performed within the first 24 h of admission on 704 consecutive patients, with a mean age of 61.5+/-17.5 years, ICU stay of 10.6+/-17.1 days, APACHE II 22.6+/-8.9, and SAPS II 52.7+/-20.4. In four patients, TTE could not be performed. Left ventricular (LV) dimensions were quantified in 689 (97.8%) patients, and LV function in 670 (95.2%) patients. Cardiac output (CO) was determined in 610 (86.7%), and mitral E/A in 399 (85.9% of patients in sinus rhythm). Echocardiographic abnormalities were detected in 234 (33%) patients, the most common being left atrial (LA) enlargement (n=163), and LV dysfunction (n=132). Patients with these alterations were older (66+/-16.5 vs 58.1+/-17.4, p<0.001), presented a higher APACHE II score (24.4+/-8.7 vs 21.1+/-8.9, p<0.001), and had a higher mortality rate (40.1% vs 25.4%, p<0.001). Severe, previously unknown echocardiographic diagnoses were detected in 53 (7.5%) patients; the most frequent condition was severe LV dysfunction. Through a multivariate logistic regression analysis, it was determined that mortality was affected by tricuspid regurgitation (p=0.016, CI 1.007-1.016) and ICU stay (p<0.001, CI 1-1.019). We conclude that TTE can detect most cardiac structures in a general ICU. One-third of the patients studied presented cardiac structural or functional alterations and 7.5% severe previously unknown diagnoses.

Tradução com adaptação cultural para portugês e determinação da reprodutibilidade do questionnaire on respiratory symptoms in preschool children

RESUMO: Introdução: A asma brônquica é uma entidade frequente em idade pediátrica, apresentando uma grande heterogeneidade clínica e significativa morbilidade quando não controlada. A identificação de crianças sintomáticas pode atrasar ou até mesmo diminuir a ocorrência de algumas alterações estruturais. Reconhece-se a necessidade de questionários sobre sintomas respiratórios em língua portuguesa, devidamente validados, que tenham como população-alvo os grupos etários inferiores a 3 anos. Deste modo, será possível não só um conhecimento mais rigoroso da asma e da sibilância infantil mas também a uniformização de metodologias para o desenvolvimento de estratégias a nível nacional. Objetivos: Tradução com adaptação cultural para português e determinação da reprodutibilidade do Questionnaire on respiratory symptoms in preschool children de Strippoli e colaboradores. Material e métodos: A escolha do questionário obedeceu a vários critérios, entre os quais o grupo etário, o tipo e número de perguntas. O Questionnaire on respiratory symptoms in preschool children de Strippoli e colaboradores é um questionário de autopreenchimento, dirigido a crianças entre os 12 e os 24 meses de idade e destinado a estudos epidemiológicos ao nível da comunidade. Aborda aspetos referentes a sintomas respiratórios (sibilância, tosse crónica, sintomas das vias aéreas superiores), cuidados médicos, terapêutica, características ambientais, história familiar e situação social. Procedemos à sua tradução, com especial atenção para a adaptação do ponto de vista cultural e linguístico, utilizando o método da tradução / retroversão, amplamente utilizado e descrito na literatura internacional. Seguidamente determinámos a reprodutibilidade da versão final em língua portuguesa – Questionário de sintomas respiratórios em idade pré-escolar – utilizando o teste-reteste. Para tal, incluíram-se crianças entre os 12 e os 36 meses de idade recrutadas num Centro de Saúde e em creches de Lisboa. A distribuição dos questionários decorreu em duas fases: na primeira fase foram entregues pessoalmente nos locais de recrutamento e na segunda fase foram enviados por correio para os domicílios das crianças, respeitando-se um intervalo mínimo de 2 semanas entre ambos. Resultados: Na primeira fase foram distribuídos 180 questionários, com uma taxa de reposta de 41% (n=74). Na segunda fase enviaram-se para os respetivos domicílios 70 questionários,obtendo-se uma taxa de resposta de 66% (n=46). Para a análise de reprodutibilidade foram incluídos apenas os questionários preenchidos em ambos os momentos pelo mesmo indivíduo (mãe, pai ou representante legal) (n=41). A idade média das crianças foi, na primeira fase, de 22,5 meses e, na segunda fase, de 23,7 meses, com um predomínio do sexo feminino (F:M =1:0,6). A mediana do tempo decorrido entre os dois momentos de preenchimento dos questionários foi de 26 dias. Obtivemos valores de concordância globalmente bons a muito bons, à semelhança do sucedido no trabalho original. Conclusões: Procedemos à tradução e avaliação da reprodutibilidade do Questionnaire on respiratory symptoms in preschool children. Pretende-se que venha a ser uma ferramenta útil para estudos epidemiológicos e programas de rastreio na comunidade, contribuindo deste modo para uma otimização da abordagem da asma / sibilância infantil a nível nacional. -------------ABSTRACT: Background: Asthma is a very common feature in childhood, with important clinical heterogeneity and morbidity if not properly controlled. Identifying symptomatic children may delay or even reduce several structural changes. The development of questionnaires on respiratory symptoms in Portuguese for children under 3 years old will allow not only a more accurate knowledge of infantile asthma and recurrent wheezing but also the standardization of methodologies to develop nationwide strategies. Objectives: The aim of this study was to translate and adapt to the Portuguese culture and to determine the repeatability of the Questionnaire on respiratory symptoms in preschool children by Strippoli et al. Material and methods: The choice of the questionnaire took in consideration several criteria, among which the target age, the type and the number of questions. The Questionnaire on respiratory symptoms in preschool children by Strippoli et al is a parent-completed questionnaire for assessment of respiratory symptoms in 1 to 2-year-old children, developed for cross-sectional and longitudinal studies. It contains sections on respiratory symptoms (wheezing, chronic cough and upper airways symptoms), healthcare utilization, treatment, environmental exposure, family history and social situation. For the process of translation we used the method of translation and back-translation, with particular concern to cultural and linguistic adaptation. To assess the repeatability of the final Portuguese version - Questionário de sintomas respiratórios em idade pré-escolar - we used the test–retest analyses. The questionnaires were distributed to parents of children between 12 and 36 months old attending nurseries and a Primary Care Center of Lisbon. The distribution took place in two phases: the first questionnaires were delivered in person (phase one) and an identical questionnaire was posted to the families that participated in the first phase, 2 weeks after the first one was returned (phase two). Results: The response rates were 41% (180/74) in the first phase and 66% (70/46) in the second phase. For test–retest analyses, we included the 41 children with the same respondent (mother, father or legal representative) in both occasions. The median age of the children was 22,5 months at the first phase and 23,7 months at the second phase, with a predominance of girls (F:M = 1:0,6). The median time between the fillings of both questionnaires was 26 days. Globally, agreement values were good to excellent, similarly to the original work. Conclusion: In the present study we translated the Questionnaire on respiratory symptoms in preschool children and assessed its repeatability. Overall, we expect it to be a valuable tool for epidemiological studies and community-based screening programs, thus contributing to improve the management of infantile asthma / recurrent wheezing nationwide.

HIV Voluntary Testing among Portuguese Women Attending Family Planning Clinics: Implications for HIV Prevention Education and Testing

Objectives: The aim of this article is to analyze the factors associated with HIV testing among 767 sexually active women. Methods: Participants were administered several self-report questionnaires that assessed behavioral and psychosocial measures. Results: Overall, 59.8% of the participants reported ever having tested for HIV. Results show that higher levels of education, being pregnant or having been pregnant, concern about AIDS, AIDS knowledge, self-efficacy in condom negotiation and perception of no risk in partner significantly predicted the likelihood of testing among women. Attending the mass was negatively associated with HIV testing. Conclusions: These findings provide information that can be used in the development of a focused gender sensitive HIV prevention program to increase HIV testing.

Predictors of consistent condom use among Portuguese women attending family planning clinics

Women account for 30% of all AIDS cases reported to the Health Ministry in Portugal and most infections are acquired through unprotected heterosexual sex with infected partners. This study analyzed socio-demographic and psychosocial predictors of consistent condom use and the role of education as a moderator variable among Portuguese women attending family planning clinics. A cross-sectional study using interviewer-administered fully structured questionnaires was conducted among 767 sexually active women (ages 18–65). Logistic regression analyses were used to explore the association between consistent condom use and the predictor variables. Overall, 78.7% of the women were inconsistent condom users. The results showed that consistent condom use was predicted by marital status (being not married), having greater perceptions of condom negotiation self-efficacy, having preparatory safer sexual behaviors, and not using condoms only when practicing abstinence. Living with a partner and having lack of risk perception significantly predicted inconsistent condom use. Less educated women were less likely to use condoms even when they perceive being at risk. The full model explained 53% of the variance in consistent condom use. This study emphasizes the need for implementing effective prevention interventions in this population showing the importance of taking education into consideration.

Protective and risk factors for toxocariasis in children from two different social classes of Brazil

The aim of this study was to analyze the prevalence of Toxocara spp. antibodies in children from two different socioeconomic classes in the Presidente Prudente municipality, São Paulo State, Brazil, and the protective and risk factors associated with toxocariasis. One hundred and twenty-six middle-class (MC) and 126 disadvantaged children (DC) were included in this study. Anti-Toxocara ELISA test was performed in order to evaluate seroprevalence. A survey was applied to the children's guardians/parents in order to analyze the protective and risk factors. The overall prevalence was 11.1%, and of 9.5% (12/126) and 12.7% (16/126) for MC and DC subgroups, respectively. Toxocara seropositivity was inversely proportional to the family income. A high household income was considered a protective factor for toxocariasis in the total population and in both MC and DC subgroups. Being a girl was considered a protective factor for the total population and for both subgroups. Whilst being an owner of cat was a risk factor for children belonging to the total and for both MC and DC subgroups, having dog was considered as a risk factor for only the MC. Epidemiologic protective/factor risks can be distinct depending on the strata of the same population. Thus, it is relevant to evaluate these factors independently for different socioeconomic classes in order to design future investigations and programs for preventing the infection of human beings by Toxocara spp. and other geohelminths.

Mortality after Discharge from Intensive Care: the Impact of Organ System Failure and Nursing Workload Use at Discharge

OBJECTIVES: Mortality after ICU discharge accounts for approx. 20-30% of deaths. We examined whether post-ICU discharge mortality is associated with the presence and severity of organ dysfunction/failure just before ICU discharge. PATIENTS AND METHODS: The study used the database of the EURICUS-II study, with a total of 4,621 patients, including 2,958 discharged alive to the general wards (post-ICU mortality 8.6%). Over a 4-month period we collected clinical and demographic characteristics, including the Simplified Acute Physiology Score (SAPS II), Nine Equivalents of Nursing Manpower Use Score, and Sequential Organ Failure Assessment (SOFA) score. RESULTS: Those who died in the hospital after ICU discharge had a higher SAPS II score, were more frequently nonoperative, admitted from the ward, and had stayed longer in the ICU. Their degree of organ dysfunction/failure was higher (admission, maximum, and delta SOFA scores). They required more nursing workload resources while in the ICU. Both the amount of organ dysfunction/failure (especially cardiovascular, neurological, renal, and respiratory) and the amount of nursing workload that they required on the day before discharge were higher. The presence of residual CNS and renal dysfunction/failure were especially prognostic factors at ICU discharge. Multivariate analysis showed only predischarge organ dysfunction/failure to be important; thus the increased use of nursing workload resources before discharge probably reflects only the underlying organ dysfunction/failure. CONCLUSIONS: It is better to delay the discharge of a patient with organ dysfunction/failure from the ICU, unless adequate monitoring and therapeutic resources are available in the ward.

Constraint-based verification of imperative programs

work presented in the context of the European Master’s program in Computational Logic, as the partial requirement for obtaining Master of Science degree in Computational Logic

Modeling in-Hospital Patient Survival During the First 28 Days After Intensive Care Unit Admission: a Prognostic Model for Clinical Trials in General Critically Ill Patients

OBJECTIVE: The objective of the study was to develop a model for estimating patient 28-day in-hospital mortality using 2 different statistical approaches. DESIGN: The study was designed to develop an outcome prediction model for 28-day in-hospital mortality using (a) logistic regression with random effects and (b) a multilevel Cox proportional hazards model. SETTING: The study involved 305 intensive care units (ICUs) from the basic Simplified Acute Physiology Score (SAPS) 3 cohort. PATIENTS AND PARTICIPANTS: Patients (n = 17138) were from the SAPS 3 database with follow-up data pertaining to the first 28 days in hospital after ICU admission. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: The database was divided randomly into 5 roughly equal-sized parts (at the ICU level). It was thus possible to run the model-building procedure 5 times, each time taking four fifths of the sample as a development set and the remaining fifth as the validation set. At 28 days after ICU admission, 19.98% of the patients were still in the hospital. Because of the different sampling space and outcome variables, both models presented a better fit in this sample than did the SAPS 3 admission score calibrated to vital status at hospital discharge, both on the general population and in major subgroups. CONCLUSIONS: Both statistical methods can be used to model the 28-day in-hospital mortality better than the SAPS 3 admission model. However, because the logistic regression approach is specifically designed to forecast 28-day mortality, and given the high uncertainty associated with the assumption of the proportionality of risks in the Cox model, the logistic regression approach proved to be superior.

Characterizing the Risk Profiles of Intensive Care Units

OBJECTIVE: To develop a new method to evaluate the performance of individual ICUs through the calculation and visualisation of risk profiles. METHODS: The study included 102,561 patients consecutively admitted to 77 ICUs in Austria. We customized the function which predicts hospital mortality (using SAPS II) for each ICU. We then compared the risks of hospital mortality resulting from this function with the risks which would be obtained using the original function. The derived risk ratio was then plotted together with point-wise confidence intervals in order to visualise the individual risk profile of each ICU over the whole spectrum of expected hospital mortality. MAIN MEASUREMENTS AND RESULTS: We calculated risk profiles for all ICUs in the ASDI data set according to the proposed method. We show examples how the clinical performance of ICUs may depend on the severity of illness of their patients. Both the distribution of the Hosmer-Lemeshow goodness-of-fit test statistics and the histogram of the corresponding P values demonstrated a good fit of the individual risk models. CONCLUSIONS: Our risk profile model makes it possible to evaluate ICUs on the basis of the specific risk for patients to die compared to a reference sample over the whole spectrum of hospital mortality. Thus, ICUs at different levels of severity of illness can be directly compared, giving a clear advantage over the use of the conventional single point estimate of the overall observed-to-expected mortality ratio.