Health expenditures in the OECD: A political economy analysis using structural breaks

A Masters Thesis, presented as part of the requirements for the award of a Research Masters Degree in Economics from NOVA – School of Business and Economics

Dynamic adaptation of interaction models for stateful web services

Dissertação para obtenção do Grau de Mestre em Engenharia Informática

From a project to an organisation: a Strategic Communication’s approach

Relatório de Estágio apresentado para cumprimento dos requisitos necessários à obtenção do grau de Mestre em Ciências da Comunicação, área de especialização em Comunicação Estratégica

Development of a satellite based PM10 concentration product for urban areas

Dissertação para obtenção do Grau de Doutor em Engenharia do Ambiente

Developing clinical trials in the portuguese family medicine : challenges and opportunities in the European context

RESUMO: Introdução: A hipótese colocada nesta tese é a de que poderia haver um número bastante mais elevado de ensaios clínicos na medicina familiar portuguesa se os obstáculos fossem removidos e as oportunidades exploradas de modo adequado. Contexto: Em Portugal existe uma nova geração de Médicos de Família que está a assumir postos de trabalho um pouco por todo o país e que é aceite como sendo a mais bem preparada geração de sempre. Métodos: Busca na MEDLINE. Leitura de artigos na única publicação científica dedicada à Medicina Geral e Familiar – RPMGF. Consulta em livros portugueses de política da saúde e acerca do Plano Nacional de Saúde. O INFARMED foi contactado e relatórios seus sobre ensaios clínicos foram analisados. Os Médicos de Família portugueses foram contactados e convidados a responder a questionários. Além disso, quinze personalidades da Medicina Portuguesa foram chamadas a sugerir soluções. Resultados: De acordo com dados do INFARMED, de 2006 a 2011 houve apenas quatro centros de saúde envolvidos em ensaios clínicos. Em Portugal: Existe um número pouco significativo de ensaios académicos; Praticamente não há infraestruturas de suporte ou treino; Os registos clínicos eletrónicos são usados de forma ineficiente; a investigação é fracamente ligada às carreiras médicas; há isolamento interno e externo; a já complexa regulamentação da União Europeia é complicada ainda mais; há um subfinanciamento da Investigação Clínica. Os Médicos de Família portugueses estão disponíveis para participar ativamente numa mudança. Discussão: Com os presentes resultados o diagnóstico para a presente situação é claramente negativo. Felizmente existem muito boas oportunidades para melhorar. Conclusão/Recomendações: Tempo, dinheiro e apoio têm de ser fornecidos aos Médicos de Família portugueses. É nesse sentido que são fornecidas vinte recomendações para obter uma verdadeira mudança no panorama dos Ensaios Clínicos na Medicina Familiar portuguesa.-------------ABSTRACT: Introduction: The hypothesis of this thesis is that there could be a much greater number of Clinical Trials in Portuguese Family Medicine if obstacles were removed and opportunities explored properly. Background: In Portugal there is a new generation of Family Doctors that is assuming permanent positions all over the country and is accepted to be the most well prepared generation ever. Methods: Search on MEDLINE. Relevant articles were also identified in the only jornal dedicated to Portuguese Family Medicine, RPMGF. A search was made on Portuguese health policy textbooks and national health plan policy. INFARMED was also contacted and their reports about Clinical Trials were analysed. Portuguese Family Doctors themselves were contacted and invited to answer questionnaires. Besides that, fifteen key opinion leaders related to Portuguese Medicine were approached for solutions. Results: According to INFARMED data, from 2006 to 2011 there were only four health centres involved in clinical trials. In Portugal there is: A negligible number of academic trials; almost no support infrastructures or training; inefficiently used electronic health records; a research weakly linked to medical careers; an uninformed isolation internally and externally; an already complex European Union regulation that is compounded even more; Scarce funding for clinical research. Portuguese Family Doctors are keen to actively participate in a change. Discussion: With the present results the diagnosis for the current situation is clearly negative. Fortunately there are very good opportunities to improve. Conclusion/Recommendations: Time, money and support must be given to Portuguese Family Doctors. In this context, twenty recommendations are provided intending to promote a true change in Portuguese Family Medicine Clinical Trials panorama.

Trypanocide treatment among adults with chronic Chagas disease living in Santa Fe city (Argentina), over a mean follow-up of 21 years: parasitological, serological and clinical evolution

The efficacy of treatment with nifurtimox and/or benznidazole among adults with chronic Chagas disease with no previous electrocardiographic disturbances was evaluated over a mean follow-up of 21 years, by means of conventional serology, xenodiagnosis, clinical examination, electrocardiograms and chest X-ray. One hundred and eleven patients, between 17 and 46 years old, were studied: 54 underwent treatment (nifurtimox 27, benznidazole 27) and 57 remained untreated (control group). Xenodiagnosis was performed on 65% of them: 36/38 of the treated and 9/34 of the untreated patients had previous positive xenodiagnosis. Post-treatment, 133 xenodiagnoses were performed on 41 patients, all resulting negative. In the control group, 29 xenodiagnoses were performed on 14 patients; 2 resulted positive. Sera stored during the follow-up were simultaneously analyzed through conventional serology tests (IHA; DA-2ME; IIF). The serological evolution in the treated group was: a) 37% underwent negative seroconversion (nifurtimox 11, benznidazole 9); b) 27.8% decreased titers (nifurtimox 9, benznidazole 6), 9 showed inconclusive final serology (nifurtimox 7, benznidazole 2); c) 35.2% remained positive with constant titers (nifurtimox 7; benznidazole 12). The control group conserved the initial antibody levels during the follow-up. In the clinical evolution, 2/54 (3.7%) of the treated and 9/57 (15.8%) of the untreated patients showed electrocardiographic disturbances attributable to Chagas myocardiopathy, with a statistically relevant difference (p<0.05). Treatment caused deparasitation in at least 37% of the chronically infected adults and a protective effect on their clinical evolution.

Schottky principal G-bundles over compact Riemann surfaces

Fundação para a Ciência e a Tecnologia (FCT)- PhD grant SFRH/BD/37151/2007; projects PTDC/MAT/099275/2008; PTDC/MAT/119689/2010; PTDC/MAT/120411/2010; PTDC/MAT-GEO/0675/2012

Hole cleaning performance monitoring during the drilling of directional wells

During drilling operation, cuttings are produced downhole and must be removed to avoid issues which can lead to Non Productive Time (NPT). Most of stuck pipe and then Bottom-Hole Assembly (BHA) lost events are hole cleaned related. There are many parameters which help determine hole cleaning conditions, but a proper selection of the key parameters will facilitate monitoring hole cleaning conditions and interventions. The aim of Hole Cleaning Monitoring is to keep track of borehole conditions including hole cleaning efficiency and wellbore stability issues during drilling operations. Adequate hole cleaning is the one of the main concerns in the underbalanced drilling operations especially for directional and horizontal wells. This dissertation addresses some hole cleaning fundamentals which will act as the basis for recommendation practice during drilling operations. Understand how parameters such as Flowrate, Rotation per Minute (RPM), Rate of Penetration (ROP) and Mud Weight are useful to improve the hole cleaning performance and how Equivalent Circulate Density (ECD), Torque & Drag (T&D) and Cuttings Volumes coming from downhole help to indicate how clean and stable the well is. For case study, hole cleaning performance or cuttings volume removal monitoring, will be based on real-time measurements of the cuttings volume removal from downhole at certain time, taking into account Flowrate, RPM, ROP and Drilling fluid or Mud properties, and then will be plotted and compared to the volume being drilled expected. ECD monitoring will dictate hole stability conditions and T&D and Cuttings Volume coming from downhole monitoring will dictate how clean the well is. T&D Modeling Software provide theoretical calculated T&D trends which will be plotted and compared to the real-time measurements. It will use the measured hookloads to perform a back-calculation of friction factors along the wellbore.

Evaluation of motor neuron excitability by CMAP scanning with modulated current

It is important to have better evaluation and understanding of the motor neuron physiology, with the goal to early and objectively diagnose and treat patients with neurodegenerative pathologies. The Compound Muscle Action Potential (CMAP) scan is a non-invasive diagnosis technique for neurodegenerative pathologies, such as ALS, and enables a quick analysis of the muscle action potentials in response to motor nerve stimulation. This work aims to study the influence of different pulse modulated waveforms in peripheral nerve excitability by CMAP scan technique on healthy subjects. A total of 13 healthy subjects were submitted to the same test. The stimuli were applied in the medium nerve on the right wrist and electromyography signal collected on the Abductor Pollicis Brevis (APB) muscle surface on the right thumb. Stimulation was performed with an increasing intensities range from 4 to 30 mA, with varying steps, 3 stimuli per step. The procedure was repeated 4 times per subject, each repetition using a different single pulse stimulation waveform: monophasic square, monophasic triangular, monophasic quadratic and biphasic square. Results were retrieved from the averaging of the stimuli on each current intensity step. The square pulse needs less current intensity to generate the same response amplitude regarding the other waves and presents a more steep curve slope and this effect is gradually decreasing for the triangular and quadratic pulse,respectively, being the difference even more evident regarding the biphasic pulse. The control of the waveform stimulation pulse allows varying the stimulusresponse curve slope.

A new MDA-SOA based framework for intercloud interoperability

Cloud computing has been one of the most important topics in Information Technology which aims to assure scalable and reliable on-demand services over the Internet. The expansion of the application scope of cloud services would require cooperation between clouds from different providers that have heterogeneous functionalities. This collaboration between different cloud vendors can provide better Quality of Services (QoS) at the lower price. However, current cloud systems have been developed without concerns of seamless cloud interconnection, and actually they do not support intercloud interoperability to enable collaboration between cloud service providers. Hence, the PhD work is motivated to address interoperability issue between cloud providers as a challenging research objective. This thesis proposes a new framework which supports inter-cloud interoperability in a heterogeneous computing resource cloud environment with the goal of dispatching the workload to the most effective clouds available at runtime. Analysing different methodologies that have been applied to resolve various problem scenarios related to interoperability lead us to exploit Model Driven Architecture (MDA) and Service Oriented Architecture (SOA) methods as appropriate approaches for our inter-cloud framework. Moreover, since distributing the operations in a cloud-based environment is a nondeterministic polynomial time (NP-complete) problem, a Genetic Algorithm (GA) based job scheduler proposed as a part of interoperability framework, offering workload migration with the best performance at the least cost. A new Agent Based Simulation (ABS) approach is proposed to model the inter-cloud environment with three types of agents: Cloud Subscriber agent, Cloud Provider agent, and Job agent. The ABS model is proposed to evaluate the proposed framework.

A domain specific language for domotic systems

To cope with modernity, the interesting of having a fully automated house has been increasing over the years, as technology evolves and as our lives become more stressful and overloaded. An automation system provides a way to simplify some daily tasks, allowing us to have more spare time to perform activities where we are really needed. There are some systems in this domain that try to implement these characteristics, but this kind of technology is at its early stages of evolution being that it is still far away of empowering the user with the desired control over a habitation. The reason is that the mentioned systems miss some important features such as adaptability, extension and evolution. These systems, developed from a bottom-up approach, are often tailored for programmers and domain experts, discarding most of the times the end users that remain with unfinished interfaces or products that they have difficulty to control. Moreover, complex behaviors are avoided, since they are extremely difficult to implement mostly due to the necessity of handling priorities, conflicts and device calibration. Besides, these solutions are only reachable at very high costs, yet they still have the limitation of being difficult to configure by non-technical people once in runtime operation. As a result, it is necessary to create a tool that allows the execution of several automated actions, with an interface that is easy to use but at the same time supports all the main features of this domain. It is also desirable that this tool is independent of the hardware so it can be reused, thus a Model Driven Development approach (MDD) is the ideal option, as it is a method that follows those principles. Since the automation domain has some very specific concepts, the use of models should be combined with a Domain Specific Language (DSL). With these two methods, it is possible to create a solution that is adapted to the end users, but also to domain experts and programmers due to the several levels of abstraction that can be added to diminish the complexity of use. The aim of this thesis is to design a Domain Specific Language (DSL) that uses the Model Driven Development approach (MDD), with the purpose of supporting Home Automation (HA) concepts. In this implementation, the development of simple and complex scenarios should be supported and will be one of the most important concerns. This DSL should also support other significant features in this domain, such as the ability to schedule tasks, which is something that is limited in the current existing solutions.

Creation of a web application for smart park system and parking prediction study for system integration

In the last few years, we have observed an exponential increasing of the information systems, and parking information is one more example of them. The needs of obtaining reliable and updated information of parking slots availability are very important in the goal of traffic reduction. Also parking slot prediction is a new topic that has already started to be applied. San Francisco in America and Santander in Spain are examples of such projects carried out to obtain this kind of information. The aim of this thesis is the study and evaluation of methodologies for parking slot prediction and the integration in a web application, where all kind of users will be able to know the current parking status and also future status according to parking model predictions. The source of the data is ancillary in this work but it needs to be understood anyway to understand the parking behaviour. Actually, there are many modelling techniques used for this purpose such as time series analysis, decision trees, neural networks and clustering. In this work, the author explains the best techniques at this work, analyzes the result and points out the advantages and disadvantages of each one. The model will learn the periodic and seasonal patterns of the parking status behaviour, and with this knowledge it can predict future status values given a date. The data used comes from the Smart Park Ontinyent and it is about parking occupancy status together with timestamps and it is stored in a database. After data acquisition, data analysis and pre-processing was needed for model implementations. The first test done was with the boosting ensemble classifier, employed over a set of decision trees, created with C5.0 algorithm from a set of training samples, to assign a prediction value to each object. In addition to the predictions, this work has got measurements error that indicates the reliability of the outcome predictions being correct. The second test was done using the function fitting seasonal exponential smoothing tbats model. Finally as the last test, it has been tried a model that is actually a combination of the previous two models, just to see the result of this combination. The results were quite good for all of them, having error averages of 6.2, 6.6 and 5.4 in vacancies predictions for the three models respectively. This means from a parking of 47 places a 10% average error in parking slot predictions. This result could be even better with longer data available. In order to make this kind of information visible and reachable from everyone having a device with internet connection, a web application was made for this purpose. Beside the data displaying, this application also offers different functions to improve the task of searching for parking. The new functions, apart from parking prediction, were: - Park distances from user location. It provides all the distances to user current location to the different parks in the city. - Geocoding. The service for matching a literal description or an address to a concrete location. - Geolocation. The service for positioning the user. - Parking list panel. This is not a service neither a function, is just a better visualization and better handling of the information.

Transactions in dynamic reactive environments

Most of today’s systems, especially when related to the Web or to multi-agent systems, are not standalone or independent, but are part of a greater ecosystem, where they need to interact with other entities, react to complex changes in the environment, and act both over its own knowledge base and on the external environment itself. Moreover, these systems are clearly not static, but are constantly evolving due to the execution of self updates or external actions. Whenever actions and updates are possible, the need to ensure properties regarding the outcome of performing such actions emerges. Originally purposed in the context of databases, transactions solve this problem by guaranteeing atomicity, consistency, isolation and durability of a special set of actions. However, current transaction solutions fail to guarantee such properties in dynamic environments, since they cannot combine transaction execution with reactive features, or with the execution of actions over domains that the system does not completely control (thus making rolling back a non-viable proposition). In this thesis, we investigate what and how transaction properties can be ensured over these dynamic environments. To achieve this goal, we provide logic-based solutions, based on Transaction Logic, to precisely model and execute transactions in such environments, and where knowledge bases can be defined by arbitrary logic theories.

Species distribution and in vitro fluconazole susceptibility of clinical Candida isolates in a Brazilian tertiary-care hospital over a 3-year period

INTRODUCTION: In this study, we aimed at identifying Candida isolates obtained from blood, urine, tracheal secretion, and nail/skin lesions from cases attended at the Hospital Universitário de Londrina over a 3-year period and at evaluating fluconazole susceptibilities of the isolates. METHODS: Candida isolates were identified by polymerase chain reaction (PCR) using species-specific forward primers. The in vitro fluconazole susceptibility test was performed according to EUCAST-AFST reference procedure. RESULTS: Isolates were obtained from urine (53.4%), blood cultures (19.2%), tracheal secretion (17.8%), and nail/skin lesions (9.6%). When urine samples were considered, prevalence was similar in women (45.5%) and in men (54.5%) and was high in the age group >61 years than that in younger ones. For blood samples, prevalence was high in neonates (35%) and advanced ages (22.5%). For nail and skin samples, prevalence was higher in women (71.4%) than in men (28.6%). Candida albicans was the most frequently isolated in the hospital, but Candida species other than C. albicans accounted for 64% of isolates, including predominantly Candida tropicalis (33.2%) and Candida parapsilosis (19.2%). The trend for non-albicans Candida as the predominant species was noted from all clinical specimens, except from urine samples. All Candida isolates were considered susceptible in vitro to fluconazole with the exception of isolates belonging to the intrinsically less-susceptible species C. glabrata. CONCLUSIONS: Non-albicans Candida species were more frequently isolated in the hospital. Fluconazole resistance was a rare finding in our study.

FPC current marketing strategy

Direct Research Internship Course