The effects of sevoflurane and ketamine on intraocular pressure in children during examination under anesthesia

PURPOSE: We studied the effects on intraocular pressure (IOP) of anesthesia administered during examination under anesthesia (EUA) in children. DESIGN: Randomized clinical trial. METHODS: This randomized trial compared IOP after inhaled sevoflurane gas to that after intramuscular ketamine hydrochloride in children undergoing EUA. IOP was measured in 30 eyes with TonoPen XL (Mentor, Inc, Norwell, Massachusetts, USA) as soon as possible after anesthesia induction (T1) and two, four, six, and eight minutes thereafter. At the same times, we recorded systolic and diastolic blood pressure (SBP, DBP) and heart rate (HR). RESULTS: Compared with the mean IOP at T1, IOP in the sevoflurane group was significantly lower for all measurements from two to eight minutes thereafter (mean decrease in IOP: two minutes = 12%, four minutes = 19%; six minutes = 19%; eight minutes = 17%, all P < or = .01). In the ketamine group, mean IOP was not significantly changed from T1 through six minutes, whereas at eight minutes, it was 7% lower (P = .03). SBP and DBP were significantly lower for sevoflurane than for ketamine at all measurements from two minutes onward, and HR was lower for sevoflurane than for ketamine at two, four, and six minutes. CONCLUSIONS: IOP measured after ketamine sedation is more likely to represent the awake IOP than that after sevoflurane anesthesia. Changes in SBP, DBP, and HR caused by sevoflurane suggest that hemodynamic alterations may underlie its effects on IOP.

A comparison between accelerated hypofractionation and stereotactic ablative radiotherapy (SABR) for early-stage non-small cell lung cancer (NSCLC): Results of a propensity score-matched analysis

BACKGROUND AND PURPOSE: Stereotactic ablative radiotherapy (SABR) has become standard for inoperable early-stage non-small cell lung cancer (NSCLC). However, there is no randomized evidence demonstrating benefit over more fractionated radiotherapy. We compared accelerated hypofractionation (AH) and SABR using a propensity score-matched analysis.

MATERIALS AND METHODS: From 1997-2007, 119 patients (T1-3N0M0 NSCLC) were treated with AH (48-60Gy, 12-15 fractions). Prior to SABR, this represented our institutional standard. From 2008-2012, 192 patients (T1-3N0M0 NSCLC) were treated with SABR (48-52Gy, 4-5 fractions). A total of 114 patients (57 per cohort) were matched (1:1 ratio, caliper: 0.10) using propensity scores.

RESULTS: Median follow-up (range) for the AH cohort was 36.3 (2.5-109.1) months, while that for the SABR group was 32.5 (0.3-62.6)months. Three-year overall survival (OS) and local control (LC) rates were 49.5% vs. 72.4% [p=0.024; hazard ratio (HR): 2.33 (1.28, 4.23), p=0.006] and 71.9% vs. 89.3% [p=0.077; HR: 5.56 (1.53, 20.2), p=0.009], respectively. On multivariable analysis, tumour diameter and PET staging were predictive for OS, while the only predictive factor for LC was treatment cohort.

CONCLUSIONS: OS and LC were improved with SABR, although OS is more closely related to non-treatment factors. This represents one of the few studies comparing AH to SABR for early-stage lung cancer.

Root caries development in older adults- a prospective cohort study

Objectives: To identify factors associated with root caries development during a two year period in a population of independently living older adults. Methods: A prospective cohort study was carried out with 334 independently living volunteers aged 65 and older. At baseline (t0), each participant completed a questionnaire which recorded age, gender, medical history, fluoride exposure, oral and denture hygiene practices, smoking and alcohol consumption, diet information, and socio economic information. Clinical examinations were performed and stimulated saliva samples were collected. Patients were reviewed 12(t1) and 24(t2) months later to determine the root caries increment. Results: 307 adults were assessed at t1 and 280 were assessed at t2 with 83.8% of participants examined at 24 months. Incidence of root caries in this cohort was 17.4% at t1 and 21.6% at t2. The mean root caries increment was 0.43 (SD 1.45) surfaces at t1 and 0.70 (SD 1.86) surfaces at t2. Age >70 years, completing education at primary level, poor oral hygiene, xerostomia, coronal decay at baseline, higher root caries index at baseline and number of exposed root surfaces showed a statistically significant association (P < 0.05) with root caries development. Conclusion: Root caries is a substantive dental health problem for our older population. Root caries prevention strategies should be targeted at older adults who have poor plaque control and high levels of caries experience. In particular patients with xerostomia should be targeted with preventive measures.

Development of a novel immersive interactive virtual reality cricket simulator for cricket batting

Research in the field of sports performance is constantly developing new technology to help extract meaningful data to aid in understanding in a multitude of areas such as improving technical or motor performance. Video playback has previously been extensively used for exploring anticipatory behaviour. However, when using such systems, perception is not active. This loses key information that only emerges from the dynamics of the action unfolding over time and the active perception of the observer. Virtual reality (VR) may be used to overcome such issues. This paper presents the architecture and initial implementation of a novel VR cricket simulator, utilising state of the art motion capture technology (21 Vicon cameras capturing kinematic profile of elite bowlers) and emerging VR technology (Intersense IS-900 tracking combined with Qualisys Motion capture cameras with visual display via Sony Head Mounted Display HMZ-T1), applied in a cricket scenario to examine varying components of decision and action for cricket batters. This provided an experience with a high level of presence allowing for a real-time egocentric view-point to be presented to participants. Cyclical user-testing was carried out, utilisng both qualitative and quantitative approaches, with users reporting a positive experience in use of the system.

Projecto de receptores integrados de banda larga

O presente trabalho tem como objectivo o estudo e projecto de receptores optimizados para sistemas de comunicações por fibra óptica de muito alto débito (10Gb/s e 40Gb/s), com a capacidade integrada de compensação adaptativa pós-detecção da distorção originada pela característica de dispersão cromática e de polarização do canal óptico. O capítulo 1 detalha o âmbito de aplicabilidade destes receptores em sistemas de comunicações ópticas com multiplexagem no comprimento de onda (WDM) actuais. O capítulo apresenta ainda os objectivos e principais contribuições desta tese. O capítulo 2 detalha o projecto de um amplificador pós-detecção adequado para sistemas de comunicação ópticos com taxa de transmissão de 10Gb/s. São discutidas as topologias mais adequadas para amplificadores pós detecção e apresentados os critérios que ditaram a escolha da topologia de transimpedância bem como as condições que permitem optimizar o seu desempenho em termos de largura de banda, ganho e ruído. Para além disso são abordados aspectos relacionados com a implementação física em tecnologia monolítica de microondas (MMIC), focando em particular o impacto destes no desempenho do circuito, como é o caso do efeito dos componentes extrínsecos ao circuito monolítico, em particular as ligações por fio condutor do monólito ao circuito externo. Este amplificador foi projectado e produzido em tecnologia pHEMT de Arsenieto de Gálio e implementado em tecnologia MMIC. O protótipo produzido foi caracterizado na fábrica, ainda na bolacha em que foi produzido (on-wafer) tendo sido obtidos dados de caracterização de 80 circuitos protótipo. Estes foram comparados com resultados de simulação e com desempenho do protótipo montado num veículo de teste. O capítulo 3 apresenta o projecto de dois compensadores eléctricos ajustáveis com a capacidade de mitigar os efeitos da dispersão cromática e da dispersão de polarização em sistemas ópticos com débito binário de 10Gb/s e 40Gb/s, com modulação em banda lateral dupla e banda lateral única. Duas topologias possíveis para este tipo de compensadores (a topologia Feed-Forward Equalizer e a topologia Decision Feedback Equaliser) são apresentadas e comparadas. A topologia Feed-Forward Equaliser que serviu de base para a implementação dos compensadores apresentados é analisada com mais detalhe sendo propostas alterações que permitem a sua implementação prática. O capítulo apresenta em detalhe a forma como estes compensadores foram implementados como circuitos distribuídos em tecnologia MMIC sendo propostas duas formas de implementar as células de ganho variável: com recurso à configuração cascode ou com recurso à configuração célula de Gilbert. São ainda apresentados resultados de simulação e experimentais (dos protótipos produzidos) que permitem tirar algumas conclusões sobre o desempenho das células de ganho com as duas configurações distintas. Por fim, o capítulo inclui ainda resultados de desempenho dos compensadores testados como compensadores de um sinal eléctrico afectado de distorção. No capítulo 4 é feita uma análise do impacto da modulação em banda lateral dupla (BLD) em comparação com a modulação em banda lateral única (BLU) num sistema óptico afectado de dispersão cromática e de polarização. Mostra-se que com modulação em BLU, como não há batimento entre portadoras das duas bandas laterais em consequência do processo quadrático de detecção e há preservação da informação da distorção cromática do canal (na fase do sinal), o uso deste tipo de modulação em sistemas de comunicação óptica permite maior tolerância à dispersão cromática e os compensadores eléctricos são muito mais eficientes. O capítulo apresenta ainda resultados de teste dos compensadores desenvolvidos em cenários experimentais de laboratório representativos de sistemas ópticos a 10Gb/s e 40Gb/s. Os resultados permitem comparar o desempenho destes cenários sem e com compensação eléctrica optimizada, para os casos de modulação em BLU e em BLD, e considerando ainda os efeitos da dispersão na velocidade de grupo e do atraso de grupo diferencial. Mostra-se que a modulação BLU em conjunto com compensação adaptativa eléctrica permite um desempenho muito superior á modulação em BLD largamente utilizada nos sistemas de comunicações actuais. Por fim o capítulo 5 sintetiza e apresenta as principais conclusões deste trabalho.

Dimensioning of multilayer optical networks

Este trabalho apresenta um estudo sobre o dimensionamento de redes ópticas, com vistas a obter um modelo de dimensionamento para redes de transporte sobreviventes. No estudo utilizou-se uma abordagem estatística em detrimento à determinística. Inicialmente, apresentam-se as principais tecnologias e diferentes arquitecturas utilizadas nas redes ópticas de transporte. Bem como os principais esquemas de sobrevivência e modos de transporte. São identificadas variáveis necessárias e apresenta-se um modelo dimensionamento para redes de transporte, tendo-se dado ênfase às redes com topologia em malha e considerando os modos de transporte opaco, transparente e translúcido. É feita uma análise rigorosa das características das topologias de redes de transporte reais, e desenvolve-se um gerador de topologias de redes de transporte, para testar a validade dos modelos desenvolvidos. Também é implementado um algoritmo genético para a obtenção de uma topologia optimizada para um dado tráfego. São propostas expressões para o cálculo de variáveis não determinísticas, nomeadamente, para o número médio de saltos de um pedido, coeficiente de protecção e coeficiente de restauro. Para as duas últimas, também é analisado o impacto do modelo de tráfego. Verifica-se que os resultados obtidos pelas expressões propostas são similares às obtidas por cálculo numérico, e que o modelo de tráfego não influencia significativamente os valores obtidos para os coeficientes. Finalmente, é demonstrado que o modelo proposto é útil para o dimensionamento e cálculo dos custos de capital de redes com informação incompleta.

Multifunctional nanoparticles for MR and fluorescence imaging

In the past few years a new generation of multifunctional nanoparticles (NPs) has been proposed for biomedical applications, whose structure is more complex than the structure of their predecessor monofunctional counterparts. The development of these novel NPs aims at enabling or improving the performance in imaging, diagnosis and therapeutic applications. The structure of such NPs comprises several components exhibiting various functionalities that enable the nanoparticles to perform multiple tasks simultaneously, such as active targeting of certain cells or compartmentalization, imaging and delivery of active drugs. This thesis presents two types of bimodal bio-imaging probes and describes their physical and chemical properties, namely their texture, structure, and 1H dynamics and relaxometry, in order to evaluate their potential as MRI contrast agents. The photoluminescence properties of these probes are studied, aiming at assessing their interest as optical contrast agents. These materials combine the properties of the trivalent lanthanide (Ln3+) complexes and nanoparticles, offering an excellent solution for bimodal imaging. The designed T1- type contrast agent are SiO2@APS/DTPA:Gd:Ln or SiO2@APS/PMN:Gd:Ln (Ln= Eu or Tb) systems, bearing the active magnetic center (Gd3+) and the optically-active ions (Eu3+ and Tb3+) on the surface of silica NPs. Concerning the relaxometry properties, moderate r1 increases and significant r2 increases are observed in the NPs presence, especially at high magnetic fields, due to susceptibility effects on r2. The Eu3+ ions reside in a single low-symmetry site, and the photoluminescence emission is not influenced by the simultaneous presence of Gd3+ and Eu3+. The presence of Tb3+, rather than Eu3+ ion, further increases r1 but decreases r2. The uptake of these NPs by living cells is fast and results in an intensity increase in the T1-weighted MRI images. The optical features of the NPs in cellular pellets are also studied and confirm the potential of these new nanoprobes as bimodal imaging agents. This thesis further reports on a T2 contrast agent consisting of core-shell NPs with a silica shell surrounding an iron oxide core. The thickness of this silica shell has a significant impact on the r2 and r2* relaxivities, and a tentative model is proposed to explain this finding. The cell viability and the mitochondrial dehydrogenase expression given by the microglial cells are also evaluated.

Context-based wireless mesh networks

In the modern society, new devices, applications and technologies, with sophisticated capabilities, are converging in the same network infrastructure. Users are also increasingly demanding in personal preferences and expectations, desiring Internet connectivity anytime and everywhere. These aspects have triggered many research efforts, since the current Internet is reaching a breaking point trying to provide enough flexibility for users and profits for operators, while dealing with the complex requirements raised by the recent evolution. Fully aligned with the future Internet research, many solutions have been proposed to enhance the current Internet-based architectures and protocols, in order to become context-aware, that is, to be dynamically adapted to the change of the information characterizing any network entity. In this sense, the presented Thesis proposes a new architecture that allows to create several networks with different characteristics according to their context, on the top of a single Wireless Mesh Network (WMN), which infrastructure and protocols are very flexible and self-adaptable. More specifically, this Thesis models the context of users, which can span from their security, cost and mobility preferences, devices’ capabilities or services’ quality requirements, in order to turn a WMN into a set of logical networks. Each logical network is configured to meet a set of user context needs (for instance, support of high mobility and low security). To implement this user-centric architecture, this Thesis uses the network virtualization, which has often been advocated as a mean to deploy independent network architectures and services towards the future Internet, while allowing a dynamic resource management. This way, network virtualization can allow a flexible and programmable configuration of a WMN, in order to be shared by multiple logical networks (or virtual networks - VNs). Moreover, the high level of isolation introduced by network virtualization can be used to differentiate the protocols and mechanisms of each context-aware VN. This architecture raises several challenges to control and manage the VNs on-demand, in response to user and WMN dynamics. In this context, we target the mechanisms to: (i) discover and select the VN to assign to an user; (ii) create, adapt and remove the VN topologies and routes. We also explore how the rate of variation of the user context requirements can be considered to improve the performance and reduce the complexity of the VN control and management. Finally, due to the scalability limitations of centralized control solutions, we propose a mechanism to distribute the control functionalities along the architectural entities, which can cooperate to control and manage the VNs in a distributed way.

Affections dermatologiques et troubles dépressifs : leur association chez les personnes âgées du Québec

Résumé : Les liens entre les maladies dermatologiques et les troubles de santé mentale, dont la dépression, sont reconnus depuis longtemps. Cependant, peu d’études de population ont examiné cette problématique et aucune n’a été faite auprès des aînés. Le but de ce mémoire est d’explorer l’association entre les affections dermatologiques et les troubles dépressifs chez les personnes âgées vivant à domicile. Pour ce faire, deux études ont été réalisées. La première visait à décrire les caractéristiques dermatologiques de la population à l’étude et la deuxième avait pour but de tester l’hypothèse d’une association bidirectionnelle entre les problèmes mentionnés. Il s’agit d’une analyse secondaire des données de l’Enquête sur la Santé des Aînés (ESA) qui a été menée auprès d’un échantillon représentatif de la population âgée (≥ 65 ans) vivant à domicile au Québec. Des mesures répétées à un an d’intervalle (T1 et T2) ont été obtenues auprès de 2 cohortes successives fixes. Les données de l’enquête ESA ont été appariées à celles des registres de la Régie de l’assurance maladie du Québec (RAMQ). Les troubles dépressifs ont été définis en se basant sur les critères du DSM-IV et les affections dermatologiques ont été mesurées à partir de deux sources de données (enquête et registres administratifs de la RAMQ). Des modèles autorégressifs bivariés ont été utilisés pour tester l’hypothèse d’association bidirectionnelle entre les affections dermatologiques et les troubles dépressifs. Nos résultats ont montré que près de 13% et 21% des répondants ont rapporté des affections dermatologiques auto-rapportées ou avaient été diagnostiqués selon les registres de la RAMQ. En plus, près de 6% des participants rapportaient un trouble dépressif probable au T1 et au T2. Nos résultats suggèrent la présence d’une association synchronique (transversale) entre les affections dermatologiques et les troubles dépressifs. Ce projet souligne l’importance d’évaluer et d’explorer la cooccurrence de ces deux pathologies afin d’améliorer la prise en charge des individus atteints simultanément par ces deux problèmes. Nous suggérons l'inclusion des affections dermatologiques dans les futures études épidémiologiques visant à explorer les liens entre les troubles de santé mentale et de santé physique chez les personnes âgées.//Abstract : The relationship between skin conditions and mental health disorders, which includes depression, has long been recognized. However, few population - based studies have examined this issue and none were carried out in older - adults. The aim of this project was to explore the associations between skin conditions and depressive disorders affecting the elderly living at home. To do this, two studies were conducted; the first aimed to describe the dermatological features of the study population. The second was designed to test the hypothesis of a bidirectional association between the conditions mentioned above. We carried out secondary data analyses from data collected in the Study on the Health of Seniors (ESA ) survey, which consisted of a representative sample of the elderly population (≥ 65 years) living at home in Quebec. Two repeated measurements one year apart (T1 and T2) were obtained from two fixed successive cohorts. Participants in both phases of the investigation and with available health service information from Quebec’s health insurance plan agency (Régie de l'assurance maladie du Québec - RAMQ) were selected for this project. Depressive disorders were defined based on DSM - IV criteria and dermatological conditions were measured from two data sources (survey and administrative records). Cross - lagged panel models were used to test the hypothesis of association between the two mentioned conditions. Our results showed that nearly 13% and 21% of respondents have self - reported and diagnosed skin conditions, respectively. In addition, about 6% of participants reported symptoms that were consistent with a probable depressive disorder on T1 and T2. Our results suggested the presence of synchronous (cross - sectional) associations between skin conditions and depressive disorders in the elderly. This research highlights the importance of assessing and exploring the co - occurrence of these two conditions to improve the management of individuals who are affected. We suggest the inclusion of dermatological conditions in future/further studies exploring the comorbidity between mental and physical health in the older adults.

Visuoperceptual deficits and participation in older adults after stroke

Introduction: Visuoperceptual deficits frequently occur after a stroke but little is known about how they evolve over time. These deficits may have an impact on participation in daily activities and social roles. Objectives: The aims were to 1) track changes over six months in the visual perception of older adults with persistent visuoperceptual deficits after a stroke; 2) examine if these changes differed between participants who had and had not received rehabilitation services; and 3) verify if participation differed between participants with and without visuoperceptual deficits. Methods: Visual perception as well as participation of 189 older adults who had had a stroke were evaluated in the first month (T1) after being discharged home from an acute care hospital (NO REHAB group) or rehabilitation unit (REHAB group). For visual perception, only participants presenting deficits at T1 were re-evaluated at 3 months (T2; n=93), and those with deficits at T2 were re-evaluated at 6 months (T3; n=61). Results: A total of 57 people (30.2%) had visuoperceptual deficits six months after discharge home. Despite persistent deficits, approximately 45% of the participants in the two groups improved while 50% of the NO REHAB group and 24.3% of the REHAB group deteriorated. Changes in the mean scores on the MVPT-V were similar in the two groups. Participation, and especially participation in social roles, was more restricted in participants with visuoperceptual deficits (p<0.001), whatever the severity of the stroke. Conclusion: Visuoperceptual deficits are common post-stroke. However, they evolve differently in different people and are associated with a reduction in participation.

Brain-derived neurotrophic factor and adenosine signalling on amyloid-β peptide induced toxicity : impact on hippocampal function

Tese de doutoramento, Ciências Biomédicas (Neurociências), Universidade de Lisboa, Faculdade de Medicina, 2014

Molecular features of glycine-mediated neurotransmission in rat brain

Tese de doutoramento, Ciências Biomédicas (Neurociências), Universidade de Lisboa, Faculdade de Medicina, 2015

Methods for the transfer function design of multiple narrow-band bandpass sigma-delta modulators

This paper presents the design analysis of novel tunable narrow-band bandpass sigma-delta modulators, which can achieve concurrent multiple noise-shaping for multi-tone input signals. Four different design methodologies based on the noise transfer functions of comb filters, slink filters, multi-notch filters and fractional delay comb filters are applied for the design of these multiple-band sigma-delta modulators. The latter approach utilises conventional comb filters in conjunction with FIR, or allpass IIR fractional delay filters, to deliver the desired nulls for the quantisation noise transfer function. Detailed simulation results show that FIR fractional delay comb filter-based sigma-delta modulators tune accurately to most centre frequencies, but suffer from degraded resolution at frequencies close to Nyquist. However, superior accuracies are obtained from their allpass IIR fractional delay counterpart at the expense of a slight shift in noise-shaping bands at very high frequencies. The merits and drawbacks of each technique for the various sigma-delta topologies are assessed in terms of in-band signal-to-noise ratios, accuracy of tunability and coefficient complexity for ease of implementation.

Utilidade dos exames de ressonância magnética no diagnóstico da doença de Parkinson : revisão sistemática e meta análise

Tese de mestrado, Neurociências, Faculdade de Medicina, Universidade de Lisboa, 2014

Characterization of adenosinergic system in Rett syndrome

Tese de mestrado, Neurociências, Faculdade de Medicina, Universidade de Lisboa, 2015