Effectiveness of see-and-treat for approaching pre-invasive lesions of uterine cervix

OBJECTIVE: To compare the effectiveness between the see-and-treat (S&T) approach and the conventional one (with prior biopsy) for squamous intraepithelial lesions of uterine cervix. METHODS: A cross-sectional study was conducted with 900 nonpregnant women with cytology suggestive of high grade squamous intraepithelial lesions in the city of Rio de Janeiro, Southeastern Brazil, between 1998 and 2004. The S&T approach consists of a large loop excision of the transformation zone procedure and is recommended when cytology is suggestive of high grade squamous intraepithelial lesion, satisfactory colposcopy with abnormalities compatible with the suspected cytological results, and the lesion is limited to the ectocervix or extends up to one centimeter of the endocervical canal. A subgroup of 336 patients whose colposcopy was considered satisfactory was analyzed, and they were divided into two groups for comparison: patients treated without prior biopsy (n = 288) and patients treated after a biopsy showing high grade squamous intraepithelial lesions (n = 48). Patients who were not treated or only treated more than a year later after recruitment at the colposcopy unit were considered dropouts. RESULTS: Of patients recruited during the study period, 71 were not treated or were only treated for at least a year. The overall dropout rate was 7.9% (95% CI: 6.1;9.7). Mean time elapsed between patient recruitment and treatment was 17.5 days in the S&T group and 102.5 days in the prior biopsy group. Dropout rates were 1.4% (95% CI: 0.04;2.7) and 5.% (95% CI: 0;12.3), respectively (p=0.07). The proportion of overtreated cases (negative histology) in the S&T group was 2.0% (95% CI: 0.4;3.6). CONCLUSIONS: The difference in the mean time elapsed between patient recruitment and treatment indicates that S&T is a time-saving approach The proportion of negative cases from using the S&T approach can be regarded as low.

10 kVp rule – An anthropomorphic pelvis phantom imaging study using a CR system: impact on image quality and effective dose using AEC and manual mode

Purpose - This study aims to investigate the influence of tube potential (kVp) variation in relation to perceptual image quality and effective dose (E) for pelvis using automatic exposure control (AEC) and non-AEC in a Computed Radiography (CR) system. Methods and materials - To determine the effects of using AEC and non-AEC by applying the 10 kVp rule in two experiments using an anthropomorphic pelvis phantom. Images were acquired using 10 kVp increments (60–120 kVp) for both experiments. The first experiment, based on seven AEC combinations, produced 49 images. The mean mAs from each kVp increment were used as a baseline for the second experiment producing 35 images. A total of 84 images were produced and a panel of 5 experienced observers participated for the image scoring using the two alternative forced choice (2AFC) visual grading software. PCXMC software was used to estimate E. Results - A decrease in perceptual image quality as the kVp increases was observed both in non-AEC and AEC experiments, however no significant statistical differences (p > 0.05) were found. Image quality scores from all observers at 10 kVp increments for all mAs values using non-AEC mode demonstrates a better score up to 90 kVp. E results show a statistically significant decrease (p = 0.000) on the 75th quartile from 0.37 mSv at 60 kVp to 0.13 mSv at 120 kVp when applying the 10 kVp rule in non-AEC mode. Conclusion - Using the 10 kVp rule, no significant reduction in perceptual image quality is observed when increasing kVp whilst a marked and significant E reduction is observed.

O Dilema de clio: uma leitura paratextual do romance histórico Herculaniano

Pretende-se, neste estudo, analisar o pensamento historiográfico de Alexandre Herculano, a partir dos paratextos com que o escritor enriqueceu a sua obra de ficção. Com esta análise pretende-se mostrar como o historiador Alexandre Herculano pensava a história, como sentia as limitações impostas pelo paradigma científico que, na sua época, dominava ou pretendia dominar todas as áreas do saber, e como se viu forçado a recorrer ao romance histórico para, juntando-o à história, produzir a síntese do homem global que perseguia.

Image quality and dose analysis for a PA chest X-ray: comparison between AEC mode acquisition and manual mode using the 10 kVp ‘rule’

Purpose - To compare the image quality and effective dose applying the 10 kVp rule with manual mode acquisition and AEC mode in PA chest X-ray. Method - 68 images (with and without lesions) were acquired using an anthropomorphic chest phantom using a Wolverson Arcoma X-ray unit. These images were compared against a reference image using the 2 alternative forced choice (2AFC) method. The effective dose (E) was calculated using PCXMC software using the exposure parameters and the DAP. The exposure index (lgM provided by Agfa systems) was recorded. Results - Exposure time decreases more when applying the 10 kVp rule with manual mode (50%–28%) when compared with automatic mode (36%–23%). Statistical differences for E between several ionization chambers' combinations for AEC mode were found (p = 0.002). E is lower when using only the right AEC ionization chamber. Considering the image quality there are no statistical differences (p = 0.348) between the different ionization chambers' combinations for AEC mode for images with no lesions. Considering lgM values, it was demonstrated that they were higher when the AEC mode was used compared to the manual mode. It was also observed that lgM values obtained with AEC mode increased as kVp value went up. The image quality scores did not demonstrate statistical significant differences (p = 0.343) for the images with lesions comparing manual with AEC mode. Conclusion - In general the E is lower when manual mode is used. By using the right AEC ionising chamber under the lung the E will be the lowest in comparison to other ionising chambers. The use of the 10 kVp rule did not affect the visibility of the lesions or image quality.

Increasing source to image distance for AP pelvis imaging: impact on radiation dose and image quality

Aim - A quantative primary study to determine whether increasing source to image distance (SID), with and without the use of automatic exposure control (AEC) for antero-posterior (AP) pelvis imaging, reduces dose whilst still producing an image of diagnostic quality. Methods - Using a computed radiography (CR) system, an anthropomorphic pelvic phantom was positioned for an AP examination using the table bucky. SID was initially set at 110 cm, with tube potential set at a constant 75 kVp, with two outer chambers selected and a fine focal spot of 0.6 mm. SID was then varied from 90 cm to 140 cm with two exposures made at each 5 cm interval, one using the AEC and another with a constant 16 mAs derived from the initial exposure. Effective dose (E) and entrance surface dose (ESD) were calculated for each acquisition. Seven experienced observers blindly graded image quality using a 5-point Likert scale and 2 Alternative Forced Choice software. Signal-to-Noise Ratio (SNR) was calculated for comparison. For each acquisition, femoral head diameter was also measured for magnification indication. Results - Results demonstrated that when increasing SID from 110 cm to 140 cm, both E and ESD reduced by 3.7% and 17.3% respectively when using AEC and 50.13% and 41.79% respectively, when the constant mAs was used. No significant statistical (T-test) difference (p = 0.967) between image quality was detected when increasing SID, with an intra-observer correlation of 0.77 (95% confidence level). SNR reduced slightly for both AEC (38%) and no AEC (36%) with increasing SID. Conclusion - For CR, increasing SID significantly reduces both E and ESD for AP pelvis imaging without adversely affecting image quality.

Exposure to volatile organic compounds, particulate matter and fungi in a composting plant

Composting is an important process of solid waste management and it can be used for treatment of a variety of different wastes (green waste, household waste, sewage sludge and more). This process aims to: 1. Reduce the volumes of waste and; 2. Create a valuable product which can be recycled as a soil amendment in agriculture and gardening. A natural self-heating process involving the biological degradation of organic matter under aerobic conditions. The handling of waste and compost is responsible for the release of airborne microorganisms and their compounds in the air. Possible contaminants: a) Dust; b) Mesophilic and thermophilic microorganisms; c) Volatile organic compounds; d) Endotoxins and mycotoxins…. Aim: assess exposure/contamination to: a) Volatile organic compounds (VOCs); b) Particulate matter (PM); c) Fungi. In a composting plant located in Lisbon. An additional goal was to identify the workplace with higher level of contamination. In a totally indoor composting plant. The composting operations consisted: 1º Waste already sorted is unloaded in a reception area; 2º Pretreatment - remove undesirable materials from the process (glass, rocks, plastics, metals…); 3º Anaerobic digestion; 4º Dehydration; 5º Open composting with forced aeration. All the process takes thirteen weeks.

Epidemiologic transition in northern Angola: discussion of cumulative results from CISA (Health Research Centre of Angola)

The 41 years of armed conflict (1961 to 2002) resulted in a poor development of the health care and education infrastructures, and forced the relocation of people to safer places, namely major urban cities like Luanda. This phase was characterized by typical demographic, nutritional and epidemiological profiles. With the end of this period Angola has been repeatedly ranked as one of the three fastest growing economies in the world, and along with the social stabilization and globalization, the country is facing the introduction of new medical technologies, improvement of health sys-tems and services, better access to them, and overall better quality of life. These changes could also be translating into socio-cultural, demographic and nutritional changes which in turn may leading to changes in the epidemiological profile of the country. Thus, the emergence of non-communicable diseases are likely to become an increasingly im-portant public health problem in Angola. Also, considering that several infectious diseases persist, our weakened health system will have to face a double burden. Thus, disease surveillance data on non-communicable diseases to determine their prevalence and impact, along with the major behavioural risk factors like consumption of tobacco, alcohol, diets and physical inactivity are urgently needed.

Leitura à primeira vista ao piano: relatório de estágio

A frequência de um Estágio de Ensino Especializado proporciona uma oportunidade de proximidade entre futuro docente e aluno. A observação de metodologias e o envolvimento com a música e contexto musical das escolas e alunos é algo fundamental para a formação correcta de docentes. Devido ao carácter prático do ensino de um instrumento, esta interacção demonstra-se fundamental para a experiência pedagógica. Neste estágio pretendeu-se aumentar o grau de qualidade de ensino e o número de ferramentas pedagógicas, comparando-as com ferramentas aprendidas e articuladas por experiência pré-adquirida como docente. A pedagogia de ensino de piano tem vindo a sofrer várias modificações e adaptações, como reflexo do meio e dos recursos disponíveis. A existência de conservatórios onde os alunos podem frequentar um grande número de disciplinas trouxe vantagens significativas para a sua cultura musical. Embora o estudo do instrumento continue a ser a prática principal, a diminuição nos horários de estudo obriga a uma selecção criteriosa dos conteúdos programáticos deste instrumento, de modo a não por em causa o desenvolvimento técnico dos alunos. Uma área raramente encontrada nestes conteúdos é a leitura à primeira vista. A investigação aqui apresentada pretendeu compreender como se realiza a leitura à primeira vista de uma partitura ao piano e como se pode desenvolver esta competência. Recorrendo a fontes bibliográficas consultadas e à análise de métodos de ensino representativos, foram alvo de investigação a forma como um leitor lê à primeira vista uma partitura, qual a importância do tacto e da visão, e até que ponto esta competência pode ser estudada e desenvolvida. Quais são os factores-chave da leitura à primeira vista? Até que ponto a prática ao instrumento pode influenciar esta capacidade? Embora a leitura à primeira vista tenha sido retirada como disciplina e forma de avaliação em vários estabelecimentos de ensino, a realização de alguns inquéritos pretendeu avaliar a importância dada a esta disciplina, entre professores e alunos.

Macrophages as biomarkers in BCG treatment response in bladder cancer

Bladder cancer is a common urologic cancer and the majority has origin in the urothelium. Patients with intermediate and high risk of recurrence/progression bladder cancer are treated with intravesical instillation with Bacillus Calmette-Guérin, however, approximately 30% of patients do not respond to treatment. At the moment, there are no accepted biomarkers do predict treatment outcome and an early identification of patients better served by alternative therapeutics. The treatment initiates a cascade of cytokines responsible by recruiting macrophages to the tumor site that have been shown to influence treatment outcome. Effective BCG therapy needs precise activation of the Th1 immune pathway associated with M1 polarized macrophages. However, tumor-associated macrophages (TAMs) often assume an immunoregulatory M2 phenotype, either immunosuppressive or angiogenic, that interfere in different ways with the BCG induced antitumor immune response. The M2 macrophage is influenced by different microenvironments in the stroma and the tumor. In particular, the degree of hypoxia in the tumors is responsible by the recruitment and differentiation of macrophages into the M2 angiogenic phenotype, suggested to be associated with the response to treatment. Nevertheless, neither the macrophage phenotypes present nor the influence of localization and hypoxia have been addressed in previous studies. Therefore, this work devoted to study the influence of TAMs, in particular of the M2 phenotype taking into account their localization (stroma or tumor) and the degree of hypoxia in the tumor (low or high) in BCG treatment outcome. The study included 99 bladder cancer patients treated with BCG. Tumors resected prior to treatment were evaluated using immunohistochemistry for CD68 and CD163 antigens, which identify a lineage macrophage marker and a M2-polarized specific cell surface receptor, respectively. Tumor hypoxia was evaluated based on HIF-1α expression. As a main finding it was observed that a high predominance of CD163+ macrophage counts in the stroma of tumors under low hypoxia was associated with BCG immunotherapy failure, possibly due to its immunosuppressive phenotype. This study further reinforces the importance the tumor microenvironment in the modulation of BCG responses.

As competências transversais e as práticas de gestão por competências: um estudo exploratório de diferentes realidades organizacionais

Ao profissional de hoje é exigido o domínio de competências que transcendem a sua própria função, área ou nível de qualificação, colocando-se assim às empresas o desafio de identificar e desenvolver as referidas competências, a partir de uma gestão de recursos humanos (GRH) que tenha por base as competências, seja ela uma gestão mais ou menos formalizada. A gestão por competências permite uma gestão estratégica, integrada e coerente dos processos de GRH, na medida em que poderá ser transversal a todos os seus subsistemas e acontece de forma articulada com os objetivos globais do negócio. Neste contexto, emerge a investigação que se segue, um estudo exploratório, de cariz qualitativo que tem como objetivos compreender em profundidade a realidade de diversas empresas em termos de competências transversais valorizadas e as suas práticas de gestão de recursos humanos baseadas em competências. Entrevistamos dez gestores de recursos humanos e administradores de empresas, com um número diferenciado de trabalhadores, representando assim as micro, peque- nas, médias e grandes empresas do norte de Portugal. Concluímos que as competências transversais mais valorizadas pelas empresas são a flexibilidade, relacionamento interpessoal, adaptação à mudança e trabalho em equipa. Esta investigação permitiu ainda compreender que a presença das competências na GRH é caracterizada por uma forte informalidade. Nesta informalidade, as competências transversais estão presentes na contratação, na retenção e nos planos de desenvolvimento, sendo menos frequente a sua utilização em práticas como a gestão e avaliação de desempenho, gestão de carreiras e gestão de benefícios e recompensas. Estes resultados representam vantagens para a produção científica e para as empre- sas, sistemas de ensino, profissionais e estudantes, não só pela importância que as competências e as competências transversais assumem no mercado de hoje e porque fornecem dados atualizados e pistas para investigações futuras.

Os serviços partilhados no âmbito dos grupos económicos e sua avaliação no contexto da qualidade da informação financeira

Mestrado em Contabilidade

Detecção de sectores cruzados e optimização de cobertura em redes LTE

Trabalho Final de Mestrado para obtenção do grau de Mestre em Engenharia de Electrónica e Telecomunicações

Desempenho energético no âmbito do aquecimento solar térmico para as condições de utilização recomendadas pelo RSECE/RCCTE

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