Assessment of immediate conservative breast surgery reconstruction: A classification system of defects revisited and an algorithm for selecting the appropriate technique

Background: Although various techniques have been used for breast conservation surgery reconstruction, there are few studies describing a logical approach to reconstruction of these defects. The objectives of this study were to establish a classification system for partial breast defects and to develop a reconstructive algorithm. Methods: The authors reviewed a 7-year experience with 209 immediate breast conservation surgery reconstructions. Mean follow-up was 31 months. Type I defects include tissue resection in smaller breasts (bra size A/B), including type IA, which involves minimal defects that do not cause distortion; type III, which involves moderate defects that cause moderate distortion; and type IC, which involves large defects that cause significant deformities. Type II includes tissue resection in medium-sized breasts with or without ptosis (bra size C), and type III includes tissue resection in large breasts with ptosis (bra size D). Results: Eighteen percent of patients presented type I, where a lateral thoracodorsal flap and a latissimus dorsi flap were performed in 68 percent. Forty-five percent presented type II defects, where bilateral mastopexy was performed in 52 percent. Thirty-seven percent of patients presented type III distortion, where bilateral reduction mammaplasty was performed in 67 percent. Thirty-five percent of patients presented complications, and most were minor. Conclusions: An algorithm based on breast size in relation to tumor location and extension of resection can be followed to determine the best approach to reconstruction. The authors` results have demonstrated that the complications were similar to those in other clinical series. Success depends on patient selection, coordinated planning with the oncologic surgeon, and careful intraoperative management.

Assessment of synovitis with contrast-enhanced MRI using a whole-joint semiquantitative scoring system in people with, or at high risk of, knee osteoarthritis: the MOST study

Objectives To introduce a comprehensive and reliable scoring system for the assessment of whole-knee joint synovitis based on contrast-enhanced (CE) MRI. Methods Multicenter Osteoarthritis Study (MOST) is a cohort study of people with, or at high risk of, knee osteoarthritis (OA). Subjects are an unselected subset of MOST who volunteered for CE-MRI. Synovitis was assessed at 11 sites of the joint. Synovial thickness was scored semiquantitatively: grade 0 (< 2 mm), grade 1 (2-4 mm) and grade 2 (> 4 mm) at each site. Two musculoskeletal radiologists performed the readings and inter-and intrareader reliability was evaluated. Whole-knee synovitis was assessed by summing the scores from all sites. The association of Western Ontario and McMaster Osteoarthritis Index pain score with this summed score and with the maximum synovitis grade for each site was assessed. Results 400 subjects were included (mean age 58.8 +/- 7.0 years, body mass index 29.5 +/- 4.9 kg/m(2), 46% women). For individual sites, intrareader reliability (weighted kappa) was 0.67-1.00 for reader 1 and 0.60-1.00 for reader 2. Inter-reader agreement (kappa) was 0.67-0.92. For the summed synovitis scores, intrareader reliability (intraclass correlation coefficient (ICC)) was 0.98 and 0.96 for each reader and inter-reader agreement (ICC) was 0.94. Moderate to severe synovitis in the parapatellar subregion was associated with the higher maximum pain score (adjusted OR (95% CI), 2.8 (1.4 to 5.4) and 3.1 (1.2 to 7.9), respectively). Conclusions A comprehensive semiquantitative scoring system for the assessment of whole-knee synovitis is proposed. It is reliable and identifies knees with pain, and thus is a potentially powerful tool for synovitis assessment in epidemiological OA studies.

A-scan ultrasound system for real-time puncture safety assessment during percutaneous nephrolithotomy

Background: Kidney stone is a major universal health problem, affecting 10% of the population worldwide. Percutaneous nephrolithotomy is a first-line and established procedure for disintegration and removal of renal stones. Its surgical success depends on the precise needle puncture of renal calyces, which remains the most challenging task for surgeons. This work describes and tests a new ultrasound based system to alert the surgeon when undesirable anatomical structures are in between the puncture path defined through a tracked needle. Methods: Two circular ultrasound transducers were built with a single 3.3-MHz piezoelectric ceramic PZT SN8, 25.4 mm of radius and resin-epoxy matching and backing layers. One matching layer was designed with a concave curvature to work as an acoustic lens with long focusing. The A-scan signals were filtered and processed to automatically detect reflected echoes. Results: The transducers were mapped in water tank and tested in a study involving 45 phantoms. Each phantom mimics different needle insertion trajectories with a percutaneous path length between 80 and 150 mm. Results showed that the beam cross-sectional area oscillates around the ceramics radius and it was possible to automatically detect echo signals in phantoms with length higher than 80 mm. Conclusions: This new solution may alert the surgeon about anatomical tissues changes during needle insertion, which may decrease the need of X-Ray radiation exposure and ultrasound image evaluation during percutaneous puncture.

Assessment of guanylin peptides system in type 2 diabetes

Os doentes com diabetes mellitus tipo 2 apresentam predisposição para a retenção de sódio e são frequentemente hipertensos. No entanto, os mecanismos implicados na dificuldade do rim diabético em mobilizar o sódio são, ainda, pouco compreendidos. Os peptídeos da família das guanilinas estão envolvidos na regulação do transporte de electrólitos e água nos epitélios intestinal e renal, através da activação do receptor guanilato ciclase-C (GC-C) e subsequente libertação intracelular de GMPc. O objectivo do presente estudo foi a avaliação da actividade do sistema dos peptídeos das guanilinas (SPG) e do seu papel na regulação do balanço de sódio num modelo animal de diabetes tipo 2. Ratinhos machos C57BL/6 foram submetidos a uma dieta com alto teor de gordura e rica em hidratos de carbono simples (ratinhos diabéticos) ou a uma dieta normal (ratinhos controlo). A expressão renal e intestinal da guanilina (GN), uroguanilina (UGN) e do receptor GC-C assim como os níveis de GMPc na urina e plasma foram avaliados nos ratinhos controlo e diabéticos, durante a ingestão de dietas normo (NS) e hiper-salina (HS). Nos ratinhos diabéticos, durante a dieta NS verificou-se um aumento significativo da pressão arterial que foi acompanhado de redução da expressão do ARNm da GN, UGN e do GC-C no intestino e de aumento da expressão de ARNm da UGN no rim. A dieta HS induziu um aumento da expressão do ARNm da UGN no jejuno dos ratinhos controlo mas não nos diabéticos. Os ratinhos diabéticos apresentaram níveis urinários de GMPc inferiores aos controlos, em condições de dieta NS. Em conclusão, os nossos resultados sugerem que na diabetes tipo 2 ocorre uma redução da actividade intestinal do SPG que é acompanhada por um aumento compensatório da actividade renal do SPG. A diminuição da actividade do SPG intestinal na diabetes tipo 2 deve-se não só a uma redução da expressão dos peptídeos GN e UGN, mas também a uma redução da expressão do seu receptor, GC-C. Estes resultados sugerem que o SPG pode contribuir para a sensibilidade ao sódio na diabetes.

FIA potentiometric system based on periodate polymeric membrane sensors for the assessment of ascorbic acid in commercial drinks

Ascorbic acid is found in many food samples. Its clinical and technological importance demands an easyto- use, rapid, robust and inexpensive method of analysis. For this purpose, this work proposes a new flow procedure based on the oxidation of ascorbic acid by periodate. A new potentiometric periodate sensor was constructed to monitor this reaction. The selective membranes were of PVC with porphyrin-based sensing systems and a lipophilic cation as additive. The sensor displayed a near-Nernstian response for periodate over 1.0x10-2–6.0x10-6 M, with an anionic slope of 73.9 ± 0.9 mV decade-1. It was pH independent in acidic media and presented good selectivity features towards several inorganic anions. The flow set-up operated in double-channel, carrying a 5.0x10-4 M IO- 4 solution and a suitable buffer; these were mixed in a 50-cm reaction coil. The overall flow rate was 7 ml min-1 and the injection volume 70 µl. Under these conditions, a linear behaviour against concentration was observed for 17.7–194.0 µg ml-1, presenting slopes of 0.169 mV (mg/l)-1, a reproducibility of ±1.1 mV (n = 5), and a sampling rate of ~96 samples h-1. The proposed method was applied to the analysis of beverages and pharmaceuticals.

Health self-assessment by hemodialysis patients in the Brazilian Unified Health System

ABSTRACT OBJECTIVE To examine whether the level of complexity of the services structure and sociodemographic and clinical characteristics of patients in hemodialysis are associated with the prevalence of poor health self-assessment. METHODS In this cross-sectional study, we evaluated 1,621 patients with chronic terminal kidney disease on hemodialysis accompanied in 81 dialysis services in the Brazilian Unified Health System in 2007. Sampling was performed by conglomerate in two stages and a structured questionnaire was applied to participants. Multilevel multiple logistic regression was used for data analysis. RESULTS The prevalence of poor health self-assessment was of 54.5%, and in multivariable analysis it was associated with the following variables: increasing age (OR = 1.02; 95%CI 1.01–1.02), separated or divorced marital status (OR = 0.62; 95%CI 0.34–0.88), having 12 years or more of study (OR = 0.51; 95%CI 0.37–0.71), spending more than 60 minutes in commuting between home and the dialysis service (OR = 1.80; 95%CI 1.29–2.51), having three or more self-referred diseases (OR = 2.20; 95%CI 1.33–3.62), and reporting some (OR = 2.17; 95%CI 1.66–2.84) or a lot of (OR = 2.74; 95%CI 2.04–3.68) trouble falling asleep. Individuals in treatment in dialysis services with the highest level of complexity in the structure presented less chance of performing a self-assessment of their health as bad (OR = 0.59; 95%CI 0.42–0.84). CONCLUSIONS We showed poor health self-assessment is associated with age, years of formal education, marital status, home commuting time to the dialysis service, number of self-referred diseases, report of trouble sleeping, and also with the level of complexity of the structure of health services. Acknowledging these factors can contribute to the development of strategies to improve the health of patients in hemodialysis in the Brazilian Unified Health System.

Assessment and optimization of wind energy integration into the power systems: application to the portuguese system

The increasing integration of wind energy in power systems can be responsible for the occurrence of over-generation, especially during the off-peak periods. This paper presents a dedicated methodology to identify and quantify the occurrence of this over-generation and to evaluate some of the solutions that can be adopted to mitigate this problem. The methodology is applied to the Portuguese power system, in which the wind energy is expected to represent more than 25% of the installed capacity in a near future. The results show that the pumped-hydro units will not provide enough energy storage capacity and, therefore, wind curtailments are expected to occur in the Portuguese system. Additional energy storage devices can be implemented to offset the wind energy curtailments. However, the investment analysis performed show that they are not economically viable, due to the present high capital costs involved.

Generic life cycle assessment of the Jatropha biodiesel system

Dissertação apresentada na Faculdade de Ciências e Tecnologia da Universidade Nova de Lisboa para obtenção do Grau de Mestre em Energia e Bioenergia

Performance assessment of a wind energy conversion system using a hierarchical controller structure

This paper deals with a hierarchical structure composed by an event-based supervisor in a higher level and two distinct proportional integral (PI) controllers in a lower level. The controllers are applied to a variable speed wind energy conversion system with doubly-fed induction generator, namely, the fuzzy PI control and the fractional-order PI control. The event-based supervisor analyses the operation state of the wind energy conversion system among four possible operational states: park, start-up, generating or brake and sends the operation state to the controllers in the lower level. In start-up state, the controllers only act on electric torque while pitch angle is equal to zero. In generating state, the controllers must act on the pitch angle of the blades in order to maintain the electric power around the nominal value, thus ensuring that the safety conditions required for integration in the electric grid are met. Comparisons between fuzzy PI and fractional-order PI pitch controllers applied to a wind turbine benchmark model are given and simulation results by Matlab/Simulink are shown. From the results regarding the closed loop point of view, fuzzy PI controller allows a smoother response at the expense of larger number of variations of the pitch angle, implying frequent switches between operational states. On the other hand fractional-order PI controller allows an oscillatory response with less control effort, reducing switches between operational states. (C) 2015 Elsevier Ltd. All rights reserved.

Synthesis about a collaborative project on “Technology Assessment of Autonomous System

The project started in 2009 with the support of DAAD in Germany and CRUP in Portugal under the “Collaborative German-Portuguese University Actions” programme. One central goal is the further development of a theory of technology assessment applied to robotics and autonomous systems in general that reflects in its methodology the changing conditions of knowledge production in modern societies and the emergence of new robotic technologies and of associated disruptive changes. Relevant topics here are handling broadened future horizons and new clusters of science and technology (medicine, engineering, interfaces, industrial automation, micro-devices, security and safety), as well as new governance structures in policy decision making concerning research and development (R

Application of geographic information system and modelling in health impact assessment for urban road mobility in Vietnam

Transport is an essential sector in modern societies. It connects economic sectors and industries. Next to its contribution to economic development and social interconnection, it also causes adverse impacts on the environment and results in health hazards. Transport is a major source of ground air pollution, especially in urban areas, and therefore contributing to the health problems, such as cardiovascular and respiratory diseases, cancer, and physical injuries. This thesis presents the results of a health risk assessment that quantifies the mortality and the diseases associated with particulate matter pollution resulting from urban road transport in Hai Phong City, Vietnam. The focus is on the integration of modelling and GIS approaches in the exposure analysis to increase the accuracy of the assessment and to produce timely and consistent assessment results. The modelling was done to estimate traffic conditions and concentrations of particulate matters based on geo-references data. A simplified health risk assessment was also done for Ha Noi based on monitoring data that allows a comparison of the results between the two cases. The results of the case studies show that health risk assessment based on modelling data can provide a much more detail results and allows assessing health impacts of different mobility development options at micro level. The use of modeling and GIS as a common platform for the integration of different assessments (environmental, health, socio-economic, etc.) provides various strengths, especially in capitalising on the available data stored in different units and forms and allows handling large amount of data. The use of models and GIS in a health risk assessment, from a decision making point of view, can reduce the processing/waiting time while providing a view at different scales: from micro scale (sections of a city) to a macro scale. It also helps visualising the links between air quality and health outcomes which is useful discussing different development options. However, a number of improvements can be made to further advance the integration. An improved integration programme of the data will facilitate the application of integrated models in policy-making. Data on mobility survey, environmental monitoring and measuring must be standardised and legalised. Various traffic models, together with emission and dispersion models, should be tested and more attention should be given to their uncertainty and sensitivity

Prospective system analysis of stationary battery systems under the frame of Constructive Technology Assessment

Based on the report for the unit “Project IV” of the PhD programme on Technology Assessment under the supervision of Dr.-Ing. Marcel Weil and Prof. Dr. António Brandão Moniz. The report was presented and discussed at the Doctorate Conference on Technologogy Assessment in July 2013 at the University Nova Lisboa, Caparica campus.

Assessment of overlay masonry strengthening system under in-plane monotonic and cyclic loading using the diagonal tensile test

The development of novel strengthening techniques to address the seismic vulnerability of masonry elements is gradually leading to simpler, faster and more effective strengthening strategies. In particular, the use of fabric reinforced cementitious matrix systems is considered of great potential, given the increase of ductility achieved with simple and economic strengthening procedures. To assess the effectiveness of these strengthening systems, and considering that the seismic action is involved, one important component of the structural behaviour is the in-plane cyclic response. In this work is discussed the applicability of the diagonal tensile test for the assessment of the cyclic response of strengthened masonry. The results obtained allowed to assess the contribution of the strengthening system to the increase of the load carrying capacity of masonry elements, as well as to evaluate the damage evolution and the stiffness degradation mechanisms developing under cyclic loading.

Oral cancer treatments and adherence: medication event monitoring system assessment for capecitabine

Background: Oncological treatments are traditionally administered via intravenous injection by qualified personnel. Oral formulas which are developing rapidly are preferred by patients and facilitate administration however they may increase non-adherence. In this study 4 common oral chemotherapeutics are given to 50 patients, who are still in the process of inclusion, divided into 4 groups. The aim is to evaluate adherence and offer these patients interdisciplinary support with the joint help of doctors and pharmacists. We present here the results for capecitabine. Materials and Methods: The final goal is to evaluate adhesion in 50 patients split into 4 groups according to oral treatments (letrozole/exemestane, imatinib/sunitinib, capecitabine and temozolomide) using persistence and quality of execution as parameters. These parameters are evaluated using a medication event monitoring system (MEMS®) in addition to routine oncological visits and semi-structured interviews. Patients were monitored for the entire duration of treatment up to a maximum of 1 year. Patient satisfaction was assessed at the end of the monitoring period using a standardized questionary. Results: Capecitabine group included 2 women and 8 men with a median age of 55 years (range: 36−77 years) monitored for an average duration of 100 days (range: 5-210 days). Persistence was 98% and quality of execution 95%. 5 patients underwent cyclic treatment (2 out of 3 weeks) and 5 patients continuous treatment. Toxicities higher than grade 1 were grade 2−3 hand-foot syndrome in 1 patient and grade 3 acute coronary syndrome in 1 patient both without impact on adherence. Patients were satisfied with the interviews undergone during the study (57% useful, 28% very useful, 15% useless) and successfully integrated the MEMS® in their daily lives (57% very easily, 43% easily) according to the results obtained by questionary at the end of the monitoring period. Conclusion: Persistence and quality of execution observed in our Capecitabine group of patients were excellent and better than expected compared to previously published studies. The interdisciplinary approach allowed us to better identify and help patients with toxicities to maintain adherence. Overall patients were satisfied with the global interdisciplinary follow-up. With longer follow up better evaluation of our method and its impact will be possible. Interpretation of the results of patients in the other groups of this ongoing trial will provide us information for a more detailed analysis.