Prospective Estimation of Radiation Dose and Image Quality for Optimized CT Performance

X-ray computed tomography (CT) is a non-invasive medical imaging technique that generates cross-sectional images by acquiring attenuation-based projection measurements at multiple angles. Since its first introduction in the 1970s, substantial technical improvements have led to the expanding use of CT in clinical examinations. CT has become an indispensable imaging modality for the diagnosis of a wide array of diseases in both pediatric and adult populations [1, 2]. Currently, approximately 272 million CT examinations are performed annually worldwide, with nearly 85 million of these in the United States alone [3]. Although this trend has decelerated in recent years, CT usage is still expected to increase mainly due to advanced technologies such as multi-energy [4], photon counting [5], and cone-beam CT [6].

Despite the significant clinical benefits, concerns have been raised regarding the population-based radiation dose associated with CT examinations [7]. From 1980 to 2006, the effective dose from medical diagnostic procedures rose six-fold, with CT contributing to almost half of the total dose from medical exposure [8]. For each patient, the risk associated with a single CT examination is likely to be minimal. However, the relatively large population-based radiation level has led to enormous efforts among the community to manage and optimize the CT dose.

As promoted by the international campaigns Image Gently and Image Wisely, exposure to CT radiation should be appropriate and safe [9, 10]. It is thus a responsibility to optimize the amount of radiation dose for CT examinations. The key for dose optimization is to determine the minimum amount of radiation dose that achieves the targeted image quality [11]. Based on such principle, dose optimization would significantly benefit from effective metrics to characterize radiation dose and image quality for a CT exam. Moreover, if accurate predictions of the radiation dose and image quality were possible before the initiation of the exam, it would be feasible to personalize it by adjusting the scanning parameters to achieve a desired level of image quality. The purpose of this thesis is to design and validate models to quantify patient-specific radiation dose prospectively and task-based image quality. The dual aim of the study is to implement the theoretical models into clinical practice by developing an organ-based dose monitoring system and an image-based noise addition software for protocol optimization.

More specifically, Chapter 3 aims to develop an organ dose-prediction method for CT examinations of the body under constant tube current condition. The study effectively modeled the anatomical diversity and complexity using a large number of patient models with representative age, size, and gender distribution. The dependence of organ dose coefficients on patient size and scanner models was further evaluated. Distinct from prior work, these studies use the largest number of patient models to date with representative age, weight percentile, and body mass index (BMI) range.

With effective quantification of organ dose under constant tube current condition, Chapter 4 aims to extend the organ dose prediction system to tube current modulated (TCM) CT examinations. The prediction, applied to chest and abdominopelvic exams, was achieved by combining a convolution-based estimation technique that quantifies the radiation field, a TCM scheme that emulates modulation profiles from major CT vendors, and a library of computational phantoms with representative sizes, ages, and genders. The prospective quantification model is validated by comparing the predicted organ dose with the dose estimated based on Monte Carlo simulations with TCM function explicitly modeled.

Chapter 5 aims to implement the organ dose-estimation framework in clinical practice to develop an organ dose-monitoring program based on a commercial software (Dose Watch, GE Healthcare, Waukesha, WI). In the first phase of the study we focused on body CT examinations, and so the patient’s major body landmark information was extracted from the patient scout image in order to match clinical patients against a computational phantom in the library. The organ dose coefficients were estimated based on CT protocol and patient size as reported in Chapter 3. The exam CTDIvol, DLP, and TCM profiles were extracted and used to quantify the radiation field using the convolution technique proposed in Chapter 4.

With effective methods to predict and monitor organ dose, Chapters 6 aims to develop and validate improved measurement techniques for image quality assessment. Chapter 6 outlines the method that was developed to assess and predict quantum noise in clinical body CT images. Compared with previous phantom-based studies, this study accurately assessed the quantum noise in clinical images and further validated the correspondence between phantom-based measurements and the expected clinical image quality as a function of patient size and scanner attributes.

Chapter 7 aims to develop a practical strategy to generate hybrid CT images and assess the impact of dose reduction on diagnostic confidence for the diagnosis of acute pancreatitis. The general strategy is (1) to simulate synthetic CT images at multiple reduced-dose levels from clinical datasets using an image-based noise addition technique; (2) to develop quantitative and observer-based methods to validate the realism of simulated low-dose images; (3) to perform multi-reader observer studies on the low-dose image series to assess the impact of dose reduction on the diagnostic confidence for multiple diagnostic tasks; and (4) to determine the dose operating point for clinical CT examinations based on the minimum diagnostic performance to achieve protocol optimization.

Chapter 8 concludes the thesis with a summary of accomplished work and a discussion about future research.

3D Navigation with Six Degrees-of-Freedom using a Multi-Touch Display

With the introduction of new input devices, such as multi-touch surface displays, the Nintendo WiiMote, the Microsoft Kinect, and the Leap Motion sensor, among others, the field of Human-Computer Interaction (HCI) finds itself at an important crossroads that requires solving new challenges. Given the amount of three-dimensional (3D) data available today, 3D navigation plays an important role in 3D User Interfaces (3DUI). This dissertation deals with multi-touch, 3D navigation, and how users can explore 3D virtual worlds using a multi-touch, non-stereo, desktop display. The contributions of this dissertation include a feature-extraction algorithm for multi-touch displays (FETOUCH), a multi-touch and gyroscope interaction technique (GyroTouch), a theoretical model for multi-touch interaction using high-level Petri Nets (PeNTa), an algorithm to resolve ambiguities in the multi-touch gesture classification process (Yield), a proposed technique for navigational experiments (FaNS), a proposed gesture (Hold-and-Roll), and an experiment prototype for 3D navigation (3DNav). The verification experiment for 3DNav was conducted with 30 human-subjects of both genders. The experiment used the 3DNav prototype to present a pseudo-universe, where each user was required to find five objects using the multi-touch display and five objects using a game controller (GamePad). For the multi-touch display, 3DNav used a commercial library called GestureWorks in conjunction with Yield to resolve the ambiguity posed by the multiplicity of gestures reported by the initial classification. The experiment compared both devices. The task completion time with multi-touch was slightly shorter, but the difference was not statistically significant. The design of experiment also included an equation that determined the level of video game console expertise of the subjects, which was used to break down users into two groups: casual users and experienced users. The study found that experienced gamers performed significantly faster with the GamePad than casual users. When looking at the groups separately, casual gamers performed significantly better using the multi-touch display, compared to the GamePad. Additional results are found in this dissertation.

Considering Efficacy of an Outdoor Environmental Education Program: Facilitating Elementary Students’ Environmental Knowledge, Attitudes, and Behaviours

Various sources have sought to consider the educational interventions that foster changes in perception of and attitudes toward nature, with the ultimate intent of understanding how education can be used to encourage environmentally responsible behaviours. With these in mind, the current study identified an outdoor environmental education program incorporating these empirically supported interventions, and assessed its ability to influence environmental knowledge, attitudes, and behaviours. Specifically, this study considered the following research questions: 1) To what degree can participation in this outdoor education program foster environmental knowledge and encourage pro-environmental attitudes and self-reported pro-environmental behaviours? 2) How is this effect different among students of different genders, and those who have different prior experiences in nature? Two motivational frameworks guided inquiry in the current study: the Value-Belief-Norm Model of Environmentalism (VBN) and the Theory of Planned Behaviour (TPB). The study employed a quantitative survey methodology, combining contemporary data measuring knowledge, attitudes, and behaviours with archived data collected by program staff, reflecting frequency of environmentally responsible behaviour. Further, a single qualitative item was included for which students provided “the first three words that [came] to mind when [they] think of the word nature.” Terms provided before and after the program were compared for differences in theme to detect subtle or underlying changes. Quantitative results indicated no significant change in student knowledge or attitudes through the outdoor environmental education program. However, a significant change in self-reported behaviour was identified from both the contemporary and archived data. This agreement in positive findings across the two data sets, collected using different measures and different participants, lends evidence of the program’s ability to encourage self-reported pro-environmental behaviour. Further, qualitative results showed some change in students’ perceptions of nature through the program, providing direction for future research. These findings suggest that this particular outdoor education program was successful in encouraging students’ self-reported environmentally responsible behaviour. This change was achieved without significant change in knowledge or environmental attitudes, suggesting that external factors not measured in this study might have played a role in affecting behaviour.

Los números cuentan. Sub-representación de la obra artística de mujeres creadoras en museos y centros de arte contemporáneos

Este artículo cuantifica la presencia de obra artística de mujeres artistas en 21 museos y centros de arte contemporáneo españoles. Los resultados constatan una nítida sub-representación de la obra exhibida, por debajo del 20 por ciento. ¿Por qué sucede esto?, ¿diferencial potencial artístico de mujeres y hombres?, ¿superioridad masculina?, ¿discriminación? o ¿un sistema de arte con sesgo androcéntrico? En estas páginas se discute sobre la presencia de varios factores para explicar la brecha de género y se reclama, de las administraciones públicas y las instituciones de gestión cultural, el cumplimiento de la Ley para la Igualdad para garantizar la paridad.

Estereotipos masculinos y femeninos en los zoologismos fraseológicos españoles y checos

El trabajo pretende mostrar los estereotipos de hombre y mujer en la sociedad occidental según los estudios de género para, más tarde, comprobar si dichos estereotipos se reflejan en la fraseología checa y española relativa a animales, es decir, en los zoologismos. El análisis se sustenta en las teorías de la lingüística cognitiva acerca de la metáfora conceptual y del lenguaje figurado convencional. Las conclusiones muestran una clara discriminación de ambos géneros en el lenguaje, siendo el femenino más afectado que el masculino.

Work-to-family spillover: Gender differences in Hungary

It is crucial to understand the role that labor market positions might play in creating gender differences in work–life balance. One theoretical approach to understanding this relationship is the spillover theory. The spillover theory argues that an individual’s life domains are integrated; meaning that well-being can be transmitted between life domains. Based on data collected in Hungary in 2014, this paper shows that work-to-family spillover does not affect both genders the same way. The effect of work on family life tends to be more negative for women than for men. Two explanations have been formulated in order to understand this gender inequality. According to the findings of the analysis, gender is conditionally independent of spillover if financial status and flexibility of work are also incorporated into the analysis. This means that the relative disadvantage for women in terms of spillover can be attributed to their lower financial status and their relatively low access to flexible jobs. In other words, the gender inequalities in work-to-family spillover are deeply affected by individual labor market positions. The observation of the labor market’s effect on work–life balance is especially important in Hungary since Hungary has one of the least flexible labor arrangements in Europe. A marginal log-linear model, which is a method for categorical multivariate analysis, has been applied in this analysis.

Le pilocentrisme de la France d’Ancien Régime : évolution des représentations de la pilosité de François 1er à Louis XVI

Thèse réalisée en cotutelle avec la direction de Jean-Jacques Courtine à l'Université de Paris III Sorbonne Nouvelle sous la discipline anthropologie et avec la direction de Dominique Deslandres à l'Université de Montréal sous la discipline histoire

Relações de Vinculação dos Jovens Institucionalizados com os Cuidadores Formais

No quadro da teoria da vinculação, é possível estabelecer relações de vinculação ao longo de toda a vida, sendo que, apesar dos jovens institucionalizados rejeitarem estabelecer novas relações de vinculação numa fase inicial, acabam por procurá-las, desde que essa figura desempenhe funções de cuidador responsivo, de modo estável e apoiante. Este estudo tem como objetivo principal perceber se as crianças e jovens acolhidos em Lares de Infância e Juventude (LIJ) estabelecem relações de vinculação com os cuidadores formais e compreender como essa relação foi construída. Foram utilizados os questionários Important People Interview (IPI; Kobak e Rosenthal, 2010) e Hierarquização das Figuras Significativas por Campos de Vida (HFSCV), criado para incluir os jovens que consideram não terem desenvolvido relações de vinculação com os cuidadores formais do LIJ. Foi, ainda, realizada uma entrevista semiestruturada. Apesar de usarmos uma metodologia quantitativa para análise dos resultados dos dois primeiros questionários, esta investigação prima sobretudo pela abordagem qualitativa, através do recurso à técnica de análise conteúdo das entrevistas. O estudo foi realizado no LIJ “Comunidade Juvenil de São Francisco de Assis”, localizado em Coimbra, contando com a participação de 16 jovens de ambos os géneros, com idades entre os 13 e os 19 anos (M=16; DP=1,8), com tempo de permanência no LIJ igual ou superior a 2 anos contínuos. Estes 16 jovens constituem a amostra total da investigação, sobre a qual incidiu a primeira parte do estudo (abordagem quantitativa), ao que se seguiu a segunda parte do estudo (abordagem qualitativa), que contou com a participação de uma subamostra de 11 jovens, pertencentes à amostra total. Os resultados sugerem que a maioria dos jovens estabeleceu relações de vinculação com os cuidadores formais do LIJ, sendo que a maioria das hierarquias das figuras de vinculação foram constituídas com base nos laços de familiaridade e na ligação afetiva com os seus cuidadores formais. Os jovens destacaram a compreensibilidade, confiabilidade e disponibilidade para o auxílio como sendo as características que determinaram a sua preferência em relação aos cuidadores formais do LIJ. Refira-se, ainda, que as situações que ativam a procura destas figuras estão relacionadas com a necessidade de apoio e proteção. O presente estudo sugere que é possível um LIJ promover relações semelhantes às desenvolvidas em meio familiar e atuar de forma reparadora ao nível das relações de vinculação. / In the attachment theory framework, one can establish attachment relationships throughout one's life. In the case of institutionalized youngsters, even though at first they seem to refuse new attachment relationships, these adolescents end up looking for them, if the person is perceived as a responsive, stable and supportive caregiver. The main goal of this study is to understand whether children and young people taken into Child and Youth Residential Care establish attachment relationships with formal caregivers and, if so, understand how that relationship is built. We have used the questionnaires Important People Interview (IPI; Kobak & Rosenthal, 2010) and Hierarquização das Figuras Significativas por Campos de Vida (HFSCV) (Hierarchization of Significant Figures by Life Fields), created to include the youngsters who consider not have developed attachment relations with Residential Care's formal caregivers. We have also conducted a semi-structured interview. Even though we used a quantitative methodology to process the results of the two inquiries, this research nevertheless privileges a qualitative approach, thorough the technique of analysis of interview content. The study was conducted at the “Comunidade Juvenil de São Francisco de Assis” residential care institution, in Coimbra, Portugal. It had the participation of 16 youngsters of both genders, with ages between 13 and 19 (M=16; DP=1,8), who had been staying at the home for two or more years, non-interrupted. These 16 adolescents are therefore the total sample for this study, and all of them were submitted to the first part (the quantitative approach) of the research. For the second part (the qualitative approach) we worked with a subsample of 11 youngsters, chosen from the initial sample of 16. Results suggest that most young people have indeed developed attachment relationships with residential care's formal caregivers, and most hierarchies of attachment figures were built based on familiarity and affection bonds with their formal caregivers. The subjects have highlighted understanding, trustworthiness and helpfulness as the features that best determine their preference regarding formal caregivers. We must note that the need for protection and support is what enables young people to look out for attachment figures the most. The current study suggests that it is possible for Child and Youth Residential Care to promote relationships similar to those developed in family environment and acts as repairing in what concerns attachment relationships.

Rede Social Pessoal de Cuidadores Informais de Adultos com Necessidades Especiais

Objetivo. Devido ao aumento da esperança de vida, os adultos com necessidades especiais vivem mais tempo, sendo os seus principais cuidadores, geralmente familiares, também mais envelhecidos. Tal situação representa novas necessidades específicas de apoio, sendo inúmeros os desafios colocados ao Serviço Social no sentido de garantir o bem-estar da pessoa com incapacidade e dos seus cuidadores. Assim, este estudo tem como objetivo realizar um levantamento das necessidades de apoio e a caraterização da rede social pessoal de apoio do cuidador informal de adultos com necessidades especiais. Participantes. A amostra é constituída por 40 cuidadores informais de adultos com necessidades especiais, integrados na resposta social “Centro de Atividades Ocupacionais-CAO” da Associação de Paralisia Cerebral de Coimbra, de ambos os sexos com idade igual ou superior a 40 anos. Material e métodos. Foi utilizado o Instrumento de Avaliação da Rede Social Pessoal e um questionário para caracterização sociodemográfica e sociofamiliar dos cuidadores, assim como para avaliação de necessidades. Resultados. Aproximadamente um terço dos cuidadores relatou a experiência de níveis moderados de sobrecarga associada à prestação de cuidados, enquanto mais de metade relatou a experiência de níveis elevados e muito elevados dessa sobrecarga; o apoio financeiro foi referido como a forma de apoio mais necessária no presente, ainda que o apoio em residência tenha sido percecionado por cerca de um terço dos cuidadores como a forma de apoio mais necessária no futuro; enquanto mais de metade considerou o apoio domiciliário e de unidade residencial (institucional). Estes cuidadores familiares referiram a "incerteza" e a "esperança" como os sentimentos mais frequentemente experienciados em relação ao futuro das suas vidas. No que respeita às redes sociais, as relações familiares são centrais a nível estrutural; em termos de caraterísticas funcionais da rede, foram observados valores mais elevados para as dimensões de reciprocidade do apoio e satisfação com a rede social. Implicações. Este estudo sublinha a importância da avaliação das necessidades de apoio dos cuidadores familiares de adultos com necessidades especiais. A sua implementação sistemática pode auxiliar a tomada de decisão baseada na evidência empírica para as intervenções do Serviço Social, tais como na planificação e gestão de respostas e serviços sociais, a par do reconhecimento e ativação dos recursos das próprias famílias, de forma a promover a eficiência dos recursos e eficácia das intervenções, focadas no bem-estar do cidadão com deficiência e das suas famílias. / Aim. The general increase in human life expectancy has resulted in greater rates of survival for adults with special care needs, as well as for their ageing family caregivers. This situation poses different and specific support needs, which represent a major challenge in social work interventions aimed at ensuring the well-being of disabled persons and their caregivers. Therefore, this study was aimed to describe the needs for support and the perceived social support network of family caregivers of adults with special care needs. Participants. The sample for this study comprised 40 family caregivers of disabled adults with special care needs, of both genders and aged 40 years old at minimum, who attended a long-term care facility at Coimbra Cerebral Palsy Association. Material and methods. Participants were administered a self-report questionnaire on socio-economic, family and caregiving needs, along with the Instrument for Assessing Personal Social Networks. Results. Nearly one third a family caregivers experienced moderate caregiving burden, while more than half experienced high or very high levels of caregiving burden; financial support was perceived as the most needed form of support in the present, but residential home care was identified as the most needed form of support in the future; while more than a half considered home-based support and residential support viable options for their disabled family members with special care needs. These family caregivers reported "uncertainty" and "hope" as the most common feelings towards their family life in the future. On the topic of social networks, family relations were found to be crucial at the structural level; in terms of functional characteristics of the network, elevated scores were observed for reciprocity of support and satisfaction with the social network. Implications. This study highlights the importance of increasing the specificity of the assessments of needs for support in family caregivers of disabled adults with special care needs. The systematic conduction of these assessments may assist evidence-based decision making in social work interventions, such as for planning and managing social services, acknowledging and activating the families' own resources, and ultimately promote the efficacy and effectiveness 57 interventions aimed at improving the well-being of disabled citizens and their families.

A Qualidade da Vinculação e o Comportamento Social em Jovens Institucionalizados

A qualidade da vinculação é fundamental para o desenvolvimento das crianças e adolescentes e tem uma enorme importância tanto a nível social como a nível emocional O presente estudo teve como objetivo averiguar a associação entre a qualidade da vinculação e os comportamentos sociais entre adolescentes institucionalizados que constituíram a sua amostra (34 jovens, de ambos os sexos e com idades compreendidas entre os 11 e os 18 anos). O protocolo de investigação incluiu um questionário sociodemográfico e a versão portuguesa do Inventory of parent and peer attachment (IPPA, Armsden & Greenberg, 1987). Os resultados dão conta da perceção normativa dos comportamentos sociais, a despeito de se tratar de uma população de adolescentes institucionalizados. Relativamente à qualidade da vinculação, este estudo dá conta que, apesar da aparente instabilidade da retaguarda familiar, uma parte destes adolescentes tem, ainda assim, a perceção de uma vinculação segura aos pais. / The quality of attachment is essential for the healthy development of children and adolescents, both socially and emotionally. The goal of this study was to analyze the eventual association between the quality of attachment and social behaviors among the institutionalized adolescents in study (34 adolescents from both genders aged 11 to 18 years-old). The research protocol included a social-demographic questionnaire and the Portuguese language version of "Inventory of parent and peer attachment (IPPA, Armsden & Greenberg, 1987). The results show that the perception of social behavior among these adolescents is normative, despite their institutionalization. In what relates to attachment data shows that, regardless of the apparent disorganization of the familial background, these adolescents have the perception of a secure attachment to their parents.

Satisfação com a Vida e Redes Sociais Pessoais de Idosos

Objetivos: A investigação tem como objetivo geral analisar a associação entre a satisfação com a vida nos idosos e as características estruturais, funcionais e relacionais-contextuais das suas redes sociais pessoais. Metodologia: A recolha dos dados foi feita através de um questionário sociodemográfico, da Satisfaction With Life Scale – SWLS (Diener, 1985) que permite avaliar o grau de satisfação com a vida e também do Instrumento de Avaliação da Rede Social Pessoal – IARSP – Idosos (Guadalupe, 2009; Guadalupe & Vicente, 2012) que possibilita a análise das características das redes sociais pessoais dos idosos. Participantes: A amostra é constituída por 416 idosos com idades compreendidas entre os 65 anos e os 98 anos (M = 76,15; DP = 7,584). Os participantes são de ambos os sexos, mas na sua maioria do sexo feminino (63,7%; n = 265). A maioria dos sujeitos da amostra é casada (51,2%; n = 213) e tem escolaridade (64,2%; n = 267). Resultados: Verifica-se que são as mulheres idosas, os casados e com escolaridade que percebem uma maior satisfação com a vida. Constata-se que existe uma maior proporção de idosos satisfeitos com a vida (53,8%; n = 83) em comparação com os medianamente satisfeitos (26,2%; n = 109) e com os insatisfeitos (20%; n = 83). Os idosos que apresentam uma maior satisfação percebida têm uma média mais elevada na proporção das relações familiares nas redes (M = 80,67), no apoio emocional, material e instrumental, informativo, companhia social, e no acesso a novos vínculos, e consideram estar muito satisfeitos tanto com a rede (M = 2,92) como com o apoio que esta disponibiliza (M = 2,77). Conclusão: Verificaram-se associações estatisticamente significativas nas características estruturais da rede, no entanto são as características funcionais que atestam os principais resultados que nos permitem afirmar uma associação entre satisfação com a vida nos idosos e as relações interpessoais, pelo conteúdo das relações e pelo apoio que percecionam. Concluímos que os idosos que se consideram satisfeitos com a vida apresentavam, na generalidade, características de rede social mais positivas quando comparados com os que percebiam menor satisfação com a vida. / Objectives: The research has as main objective to analyze the association between life satisfaction in the elderly and the structural, functional and relational-contextual characteristics of their personal social networks. Methodology: The data collection was done through a sociodemographic questionnaire, the Satisfaction With Life Scale – SWLS (Diener, 1985) that evaluates the degree of satisfaction with life and also the Personal Social Network Analysis Tool – IARSP – Elderly (Guadalupe, 2009; Guadalupe & Vicente, 2012) for the analysis of personal social networks’ characteristics. Participants: The sample consisted of 416 elderly aged between 65 and 98 years (M = 76,15; SD = 7,584). Participants are both genders, but mostly female (63,7%; n =265). Most of the participants are married (51,2%; n = 213) and have education (64,2%; n = 267). Results: It is found that are the older women, married and with education that perceive a greater satisfaction with life. There is a greater proportion of elderly satisfied with the lives (53,8%; n = 83) compared to the moderately satisfied (26,2%; n = 109) and the unsatisfied (20%; n = 83). Seniors who have a higher satisfaction have a higher average in the proportion of family relationships in their networks (M = 80,67), emotional support, material and instrumental, informational, social companionship, and access to new bonds, and consider to be very satisfied with their social network (M = 2,92) and with the social support that it provides (M = 2,77). Conclusion: There were statistically significant associations in the structural characteristics of the network, however are the functional characteristics that allow us to state an association between life satisfaction in the elderly through interpersonal relationships, the content of relations and the support they perceive. We conclude that elderly people who consider themselves satisfied with life showed, in general, have more positive characteristics of social personal network when compared to those who perceive less satisfaction with life.

Two years survival rate of Class II ART restorations in primary molars using two ways to avoid saliva contamination

AIM To compare the survival rates of Class II Atraumatic Restorative Treatment (ART) restorations placed in primary molars using cotton rolls or rubber dam as isolation methods. METHODS A total of 232 children, 6-7 years old, both genders, were selected having one primary molar with proximal dentine lesion. The children were randomly assigned into two groups: control group with Class II ART restoration made using cotton rolls and experimental group using rubber dam. The restorations were evaluated by eight calibrated evaluators (Kappa > 0.8) after 6, 12, 18 and 24 months. RESULTS A total of 48 (20.7%) children were considered dropout, after 24 months. The cumulative survival rate after 6, 12, 18 and 24 months was 61.4%, 39.0%, 29.1% and 18.0%, respectively for the control group, and 64.1%, 55.1%, 40.1% and 32.1%, respectively for the rubber dam group. The log rank test for censored data showed no statistical significant difference between the groups (P = 0.07). The univariate Cox Regression showed no statistical significant difference after adjusting for independent variables (P > 0.05). CONCLUSION Both groups had similar survival rates, and after 2 years, the use of rubber dam does not increase the success of Class II ART restorations significantly.

Measuring function and mobility among clients with diabetes in Samoa

The aim of the thesis was to collect baseline data and to investigating suitable physical tests and a self-rapport questionnaire. Collected data was used to find a routine measurement when investigating foot health, function and mobility among clients suffering from diabetes in Samoa. Twenty-one participants suffering from diabetes were included in the study. Clients answered the Foot function index (FFI) questionnaire and performed physical tests, consisting of Bergs balance scale (BBS) and Time up and go (TUG). Results from the physical tests revealed a great balance disturbance and mobility limitations among the majority of the clients. General high weight and BMI was measured among both genders. Subjects with the highest BMI performed lowest time during TUG test. The statistic analyze revealed a strong correlation between the two physical tests, indicating that one of the tests could be applied as a routine measurement in the future, when evaluating function and mobility in Samoa. The compilation of self-report questionnaires indicated a general good foot health with a low amount of pain, disabilities and activity limitations.

Valores de referência de parâmetros acústicos para a voz normal no português europeu

O presente estudo tem como objetivo a caraterização acústica da voz normal para os falantes do Português Europeu, em termos de frequência fundamental, jitter, shimmer e relação sinal-ruído. São também analisadas as caraterísticas individuais que possam ter influência sobre a qualidade vocal, nomeadamente idade, género, índice de massa corporal, hábitos tabágicos e uso da voz no canto. Para tal, foram recolhidas amostras de fala de 363 indivíduos com uma voz avaliada como normal: 113 homens e 250 mulheres com idades compreendidas entre os 18 e os 91 anos. Amostras da produção sustentada da vogal /a/ foram analisadas acusticamente com o programa Praat, tendo sido extraídos os valores da média, mediana e desvio-padrão da frequência fundamental, jitter (ppq5), shimmer (apq11) e relação sinal-ruído. Os resultados obtidos apontam no sentido do género e a idade do indivíduo serem os fatores que maior influência exercem na voz, sendo que ambos os géneros apresentam um declínio da qualidade vocal ao longo da vida. As mulheres, globalmente, apresentam valores de frequência fundamental de 193,4±28,5 Hz (média ± desvio padrão da média), significativamente mais elevados que os homens, com valores de 120,7±22,3 Hz. Em termos de jitter, as mulheres obtiveram valores de 0,214±0,126 %, significativamente mais reduzidos que os 0,247±0,190 % obtidos para os homens. O shimmer não apresentou diferenças significativas entre géneros, sendo que os valores apresentados foram de 5,403±2,652 % para homens e 5,174±2,696 % para as mulheres. Relativamente à relação sinal-ruído, foram obtidos valores significativamente mais elevados nas mulheres, com 17,335±3,958 dB, tendo-se obtido para os homens 16,315±3,267 dB. Não foi encontrado um efeito significativo do índice de massa corporal, hábitos tabágicos e uso da voz no canto. Este trabalho disponibiliza novos dados para que a avaliação da voz em contexto clínico seja mais objetiva e eficaz.

Agentes etiológicos de infecções urinárias em ambulatório

As infeções do trato urinário (ITU), depois das infeções respiratórias, são as mais comuns na comunidade, sendo a Escherichia coli o principal agente etiológico. Afeta predominantemente o sexo feminino e, anualmente, estima-se que ocorram em todo o Mundo cerca de 150 milhões de episódios de ITU, sendo responsável por 15% dos antibióticos prescritos em ambulatório. Os objetivos deste estudo foram caracterizar os agentes etiológicos das ITU e determinar o seu padrão de resistência aos antimicrobianos na região litoral norte de Portugal, de modo a contribuir para o uso racional na terapêutica empírica. Foi realizado um estudo observacional, descritivo e transversal, sendo obtidos 80 967 resultados de uroculturas de um Laboratório de Análises Clínicas de prestação de serviços à comunidade, relativos ao período entre Abril de 2007 e Março de 2015. Registaram-se 13 541 bacteriúrias positivas (16,72%). Escherichia coli foi o microrganismo mais isolado (71,62%), seguida de Klebsiella pneumoniae (12,41%), Proteus mirabilis (7,84%), Enterococcus. faecalis (3,97%) e Pseudomonas aeruginosa (1,42%), tendo-se observado diferenças estatisticamente significativas entre sexos e idades. Verificou-se uma diminuição da resistência aos antimicrobianos a partir do ano de 2012. E. coli apresentou em 2015 a menor taxa de resistência respetivamente de 4,46% e 12,37% para a fosfomicina e nitrofurantoína. A combinação de amoxicilina+ácido clavulânico registou uma taxa de resistência superior a 20% (22,03%). O baixo nível de resistência à fosfomicina permite que este antibiótico se apresente como a opção terapêutica de primeira linha no tratamento empírico de ITU não complicada na mulher em ambulatório, pelo que, estes resultados permitem corroborar as indicações de 2011 da Direção Geral de Saúde sobre a substituição de fluoroquinolonas por fosfomicina.