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Purpose: The aim of this study was to design an aluminiumbased fi lter to reduce the anode heel eff ect in lumbar spine radiographs. Methods: Initially, lumbar spine examinations were observed in a public imaging department to determine standard exposure parameters. Then, the characterization of the anode heel eff ect was made using the Unfors Xi R/F detector and, based on the data collected, aluminium fi lters were designed with a wedge shape and thicknesses ranging from 0.1 to 4.0 mm. The assessment of the entrance skin dose (ESD) reduction was performed on the anthropomorphic phantom with and without fi lters, using the universal dosimeter UNIDOS E equipped with an ionization chamber. Finally, the image quality assessment was performed with the Pehamed Phantom Digrad A+K and image quality surveys were applied to radiographers and radiologists. Results and Discussion: Uniformity of the beam was achieved, especially with fi lter number 2, which presents a signifi cant variation of 9% between the cathodic and anodic side. This fi lter contributes to ESD reduction of 35% and 36% for AP and lateral projection, respectively. Also, according to radiographers and radiologists, it improves the image quality of lumbar spine radiography. Conclusion: The use of aluminium fi lters can be advantageous in the clinical practice of radiographers when performing lumbar spine radiographs since it allows the standardization of the anode heel eff ect, reduces the radiation dose to the patient and does not compromise image quality. info:eu-repo/semantics/publishedVersion

This article reflects on possible and necessary transformations, based on the experiences lived by teachers, students, and educational institutions throughout the year 2020, as they survived, learned and adapted to the COVID-19 pandemic. Teaching should be based on pedagogical evidence, collaborative practices, educational technology, supported by computer infrastructure and evaluative practices that foster learning, through feedback and a closer interaction between learner and teacher. The direction pointed in the future includes and is based on blended education to help students to achieve competence for professional practice. The development of interpersonal skills will be fundamental, especially in the training of health professionals. Offering opportunities for faculty development and creating communities of practice for collaborative learning will also be essential. The greater flexibility of curricula and the technological mediation of the teaching and learning process should favor exchanges and the internationalization of institutions. In this way, both undergraduate, graduate and stricto-sensu education tends to expand its scope and will no longer be limited to its original niches, expanding to national and international agreements. University spaces and face-to-face moments will be adapted to a new reality, which allows the student to acquire essential clinical and relational skills, and which require activities in the professional practice settings. In the HPE, ensuring these training moments will continue to be a fundamental requirement. Thus, classrooms, laboratories and internship fields must be safe, allowing direct guidance and supervision by teachers and preceptors. It is possible and probable that, for a long time, it will still be necessary to maintain some social distance, use of personal protective equipment, hand and environment hygiene so that students are not deprived of these experiences during their training. In the health area, it will be necessary to reaffirm that there is no dilemma between the training of health professionals and patient safety, as we experienced with the interruption of most practical activities in the HPE undergraduate courses in Brazil, during the first semester of 2020. Training health professionals, in a context of a health & sanitary emergency, is equivalent to caring for people in any context or setting. It is the same if we are talking about access to personal protective equipment or access to vaccines. The challenges are launched and the possibilities for advancement emerge and need to be taken advantage of from a cohesive work between university managers, faculty, administrative staff and students.

Groundwater recharge is an important hydrological parameter for the quantification of water budgets in order to better achieve a sustainable groundwater management. Such management is paramount in the southern region of Portugal because groundwater represents more than 75% of the public water supply, the water demand for irrigated agriculture and tourism industries is rapidly growing, and the region is severely threatened by droughts and extreme dryness. Nevertheless, the estimation of recharge to carbonate aquifers in semi-arid regions remains challenging. Uncertainty analyses are still scarce and the natural variability of recharge is unknown in most cases. The present work aims at estimating the recharge rate in carbonate aquifers of southern Portugal based on the Kessler method, identifying the confidence interval with known variability and reduced uncertainty. The outcome is a cost-free graphical tool that calculates an annual recharge rate per year, proving to be a reliable tool for annual recharge estimation and allowing to overcome the limitations of the chronological variability and data acquisition associated with other current methods. Acknowledging the confidence intervals of the annual recharge estimations can improve greatly the decision making process for the regional sustainable groundwater resources management.

The purpose of this chapter is to give a perspective of patient safety culture by users of public health units through a qualitative analysis of open questions asked. The sample consists of 241 patients from the health region of Algarve. The open questions were the object of content analysis in thematic and categorical form, followed by lexical treatment using the Iramuteq software. From the patients' point of view, the evolution of patient safety is the result of an understanding of the meaning of the highlighted terms (safety, health, meaning), as well as of the intervention and improvement in these categories. It is known with these associations that for the patient, patient safety involves the existence of professionals for each individual (personal) and the existence of a receptive and empathic nature on the part of the professionals (human), as well as the need to demystify care for the understanding of patients (technician/knowledge) and the provision of care completely focused on the patient (attention).

Osteoporosis is a major cause of morbidity and mortality around the world and is a silent disease characterized by low bone strength that results in an increased risk of fracture. The benefits of being physically active in advanced ages to reduce the loss of bone mineral density (BMD) and improve functional capacities are well known. Quantitative ultrasound (QUS) is a peripheral bone densitometry technique that is rapidly gaining in popularity for the assessment of skeletal status, along with fall risk assessment. This chapter consists of a brief review of the literature on osteoporosis and describes ongoing activities on bone density and fall risk prevention in Algarve, Portugal as part of EIP AHA´s action group on fall prevention with the presentation of a preliminary study. This study aimed to demonstrate that the postmenopausal female seniors who adhere to the recommendations for the regular program of physical activity after osteoporosis screening one year later show a slower decrease in BMD. info:eu-repo/semantics/publishedVersion

Background Lewis-Sumner Syndrome (LSS) is considered an asymmetric sensory-motor variant of Chronic Inflammatory Demyelinating Polyneuropathy (CIDP), mostly affecting the limbs distally, with electrophysiological evidence of multifocal motor conduction blocks. Cranial nerve involvement is present in a minority. Various well-known infectious agents, directly or via the host’s immune responses, may trigger or exacerbate acute and chronic peripheral neuropathies, which may manifest clinically through a multitude of signs and symptoms. Case presentation We present the case of a 57-year-old male with Lewis-Sumner Syndrome, whose clinical course was quite stable over many years. He developed severe hyperacute relapse of his neuropathic disease in the context of active pneumonia due to influenza A (H1N1) virus infection. During this exacerbation, besides the obvious worsening of the previous asymmetric limb involvement, the patient also manifested left peripheral facial palsy and dysphagia that rapidly evolved over minutes, mimicking a stroke. The patient also showed rapid recovery, with marked improvement of the acute neuropathic dysfunction, immediately after initiation of treatment with oseltamivir. Our hypothesis is that the direct modulation of Na + ion channel activity in the host’s peripheral nerve cell by H1N1 viral proteins could cause acute and potentially reversible dysfunction in the conduction of nerve action potentials. Direct viral neuritis could also have been the cause. Immunomodulatory agents, namely IVIg, were not administered due to the swift clinical improvement noticed in the following days. Conclusions We aim to raise awareness of the possibility of atypical neurological presentations of viral infections, especially relevant in the context of the pandemic the world is now facing.

We present the case of a 62-year-old woman that reported right hemibody excessive sweating, which slowly progressed over 15 years, and which caused great social embarrassment. On examination, right hemibody hyperhidrosis was observed. A very slight anisocoria was also present (ambient light: right 3

Highlights • Unusual side effect of a widely used medication • Iatrogenic induced neurological states • Multifocal myoclonus. Voice tremor

This paper presents a Context-Based Blockchain Platform Definition and Analysis Methodology (MetaBlockX) to analyse and identify the best blockchain platform to specific context. Nowadays the number of existing platforms is enormous, in this way, assessing and identifying which best suits to context and service needs is a great challenge. In addition, each use case has its specifics, which can vary from prophecy in a certain programming language or need to keep data private, or even response time and delay to process the data. In this way a holistic and well-documented analysis is required to identify such a blockchain development platform that is proposed at this paper.

A 79-year-old man presented with an enlarging thoracic aneurysm on the background of superficial bladder cancer treated with intravesical bacillus Calmette-Guérin (BCG) injections. Following the injections, he developed deranged liver function tests and hepatomegaly. Liver biopsy revealed granulomatous hepatitis compatible with disseminated mycobacterial infection (BCG-osis) and was treated with anti-tuberculosis agents for 12 months. A surveillance CT scan performed as a follow-up for his bladder cancer in 2018 revealed a saccular thoracic aneurysm at the ligamentum arteriosum, which was metabolically active on positron emission tomography (PET) scan. Given the timeframe from intravesical instillation of BCG and the metabolic activity on PET scan, the lesion was consistent with a mycotic aneurysm secondary to disseminated mycobacterial infection. Following multidisciplinary team discussion, a thoracic endovascular aneurysm repair was performed. The stent grafts were placed distal to the left subclavian artery with good angiographic results and no immediate postoperative complications. He was initiated on long-term antibiotics to cover potential bacterial pathogens including mycobacterium.

This paper presents the application of the blockchain technology to the traceability problem in the production chain of Brazilian livestock. First, the context is introduced and the socio-environmental challenges are presented. A new methodology, Context-Based Blockchain Platform Definition and Analysis Methodology (MetaBlockX), is explained, showing how it was applied to the problem and the result obtained, which indicates the platform for the development of blockchain applications that has more adherences to the Positive Livestock Project's context. Then, the solution is presented, followed by the scenario description, the conclusions and further work.

The Guayas region in Ecuador is economically very important, producing 68% of the national crops. The main agricultural activities threaten the groundwater therein with nitrate contamination given the large fertiliser and water needs. The present work tests the applicability of the susceptibility index assessment method in evaluating the impact of agricultural activities on groundwater quality, using as a case study an aquifer of the Guayas river basin in Ecuador. The index adapts four parameters of the DRASTIC method and incorporated a new land use parameter. Results show that the areas highly vulnerable to contamination are located in irrigation perimeters of dominant paddy fields associated with the high recharge rates in the alluvial deposits. Respectively, moderately vulnerable and low-vulnerability areas correspond to aquatic environments and forests, semi-natural zones and water bodies. One of the main contributions of the Daule aquifer vulnerability is likely its wide, flat topography. A great part of the aquifer is at high risk of contamination by nitrates if a code of good agricultural practices is not applied. Therefore the implementation of a monitoring network to control the nitrates concentrations is the first step to assure groundwater quality for drinking purposes.

This paper presents an access control modelling that integrates risk assessment elements in the attribute-based model to organize the identification, authentication and authorization rules. Access control is complex in integrated systems, which have different actors accessing different information in multiple levels. In addition, systems are composed by different components, much of them from different developers. This requires a complete supply chain trust to protect the many existent actors, their privacy and the entire ecosystem. The incorporation of the risk assessment element introduces additional variables like the current environment of the subjects and objects, time of the day and other variables to help produce more efficient and effective decisions in terms of granting access to specific objects. The risk-based attributed access control modelling was applied in a health platform, Project CityZen.

This paper presents the implementation of a users' privacy protection approach in a health Internet of Things (IoT) system. It is composed of a set of security layers based on cryptography, pseudonymization and anonymization techniques applied to processed (Data-In-Use, DIU), stored (Data-At-Rest, DAR) and transmitted (Data-In-Motion, DIM) data. Regarding security and privacy in IoT systems, especially in digital health systems, it is necessary to guarantee that the user rights are respected. This requires a security-in-depth strategy established based on risk-based results, every interconnecting actors, their security and privacy requirements and the specific aspects of the entire ecosystem, including the applications and platform. The presented privacy protection approach was developed and applied in a digital health platform, OCARIoT.

This paper presents a risk assessment in a health IoT system by applying a methodology focused on privacy, security, safety, resilience and reliability. OCARIoT is an IoT system under development that comprehends a variety of components from the project partners. The system integration, the digital-physical-human fusion and the use of personal data represent a set of risks that needs to be properly managed. The results show that (i) the attack surface is considerable, (ii) there are regulatory issues related to GDPR and (iii) trust is important when dealing with health and children.

Regarding security and privacy in Internet of Things (IoT), especially in a digital health system, is necessary to guarantee that user rights are respected. This requires an approach that considers security-in-depth strategy established on risk-based results, actors, their privacy and the entire ecosystem, including the applications and platform. This paper presents an approach to strengthen the security and privacy aspects, using different security layers based on cryptographic, pseudonymization and anonymization technics to protect the processed, stored and transmitted data. The approach present at this paper was developed and applied in a digital health platform in the Project OCARIoT.

This aim of this paper is the acquisition of geographic data from the Foursquare application, using data mining to perform exploratory and spatial analyses of the distribution of tourist attraction and their density distribution in Rio de Janeiro city. Thus, in accordance with the Extraction, Transformation, and Load methodology, three research algorithms were developed using a tree hierarchical structure to collect information for the categories of Museums, Monuments and Landmarks, Historic Sites, Scenic Lookouts, and Trails, in the foursquare database. Quantitative analysis was performed of check-ins per neighborhood of Rio de Janeiro city, and kernel density (hot spot) maps were generated The results presented in this paper show the need for the data filtering process - less than 50% of the mined data were used, and a large part of the density of the Museums, Historic Sites, and Monuments and Landmarks categories is in the center of the city; while the Scenic Lookouts and Trails categories predominate in the south zone. This kind of analysis was shown to be a tool to support the city's tourist management in relation to the spatial localization of these categories, the tourists’ evaluations of the places, and the frequency of the target public. Resumo Este trabalho tem por objetivo a aquisição de dados geográficos do aplicativo Foursquare, empregando mineração de dados para efetuar análises exploratórias e espaciais da distribuição de pontos turísticos e de sua distribuição de densidade no município do Rio de Janeiro. Desta forma, seguindo a metodologia de Extração, Transformação e Carga, foram desenvolvidos três algoritmos de pesquisa usando a estrutura hierárquica de árvore para coletar na base de dados do Foursquare informações das categorias de Museu, Monumento e Marco, Patrimônio Histórico, Vista Panorâmica e Trilha e efetuada análise quantitativa de check-ins por bairros do município do Rio de Janeiro e gerados mapas de densidade Kernel (mapas de calor). Os resultados apresentados nesse trabalho mostram a necessidade do processo de filtragem de dados, sendo que menos de 50% total dos dados minerados foram utilizados e que grande parte da densidade de Museu, Patrimônio Histórico e Monumento e Marco encontram-se no Centro da cidade e Vista Panorâmica e Trilha predominam na Zona Sul. Este tipo de análise mostrou-se uma ferramenta de apoio a gestão turística do município quanto à localização espacial dessas categorias, as avaliações do turista sobre os locais e sobre a frequência do público alvo.

Stroke-like migraine attacks after radiation (SMART) syndrome is a rare and late complication of cerebral radiotherapy of unknown pathophysiology. It is characterised by hemicranial headache associated with persistent unilateral focal neurological signs and, occasionally, epileptic seizures. An increase in the frequency of SMART syndrome can be attributed to an increase in the survival rate of patients undergoing radiation therapy This study details the case of a 60-year-old woman with a history of small-cell lung carcinoma, who, in her late forties, was treated with prophylactic cranial irradiation. She presented at the emergency room with acute onset of global aphasia, lethargy and headache that started a few days before.

Horticulture crops play an important commercial and economic role, providing employment and food security. A sustainable horticulture production requires updated and accurate statistics in terms of area and production. High temporal resolution remote sensing can be used to identify horticulture crops, especially vegetables that have shorter production cycles. Normalized Difference Vegetation Index (NDVI) bands generated from Sentinel-2A data are used to define the growth cycle of different vegetable types. NDVI time series allow the identification of several parameters, such as planting and maturation dates and crop cycle duration, that enable the characterization of each crop. A curve-matching algorithm, based on a set of NDVI curve parameters, were used to identify horticulture parcels. Two approaches were considered, one considering the total overlapping area and other considering a minimum of 1 pixel of overlap with the ancillary parcels delimitation. Results show that the latter approach allows the identification of possible horticulture crops with an accuracy higher than 80% while the former returns a lower accuracy of around 50%.

This paper presents an IIoT systems risk assessment methodology focused on privacy, security, safety, resilience and reliability. The methodology is composed of ten phases that comprehends the risks elements to calculate the probability of a threat agent to explore one or more vulnerabilities in an IIoT asset that turns a threat into an incident that causes impacts on different actors: manufacturers, developers, customers, integrators, service providers and users.

Today, more than ever, there is a need to implement robust statistical methods to ensure the proper evaluation of water resources data to support decision makers in water resources planning and management. Graphing or mapping data for visualization is the easiest way to communicate trends, especially to a non-technical audience. This paper describes the use of an approach that combines the Mann-Kendall test, Sen slope test and principal component analysis to detect and map the monthly trends of piezometric time series and their magnitude in the period 1979–2008. The data were obtained in 23 shallow wells in the alluvial aquifers of the Elqui River basin in central Chile, an area characterized by scarce water resources and intense agricultural and mining activities. The results show significant downward trends at the majority of the wells. Because groundwater in these shallow wells is highly dependent on the water in the river and its tributaries, the reasons for these downward trends are mainly re...

Purpose Verify if the use of thyroid shield was effective in reducing the radiation dose received by the thyroid in mammography Materials and methods Using a General Electric Senograph DMR mammographer with two bucky s thermoluminescent dosimeters and two phantoms one of body and the other of breast were made measurements in cranio caudal and medio lateral oblique views The variation was made with and without thyroid shield and in the breast without shield on both views Results After collecting and analyzing data it was verified a reduction of the entrance skin doses on thyroid with protection Conclusion Given the significant reduction of the dose and the principle ALARA we can conclude that the shield should be used by the Radiology service However the use of the shield may provide artifacts making difficult the analysis of the breast tissue and leading to the examination repetition increasing the radiation from the mammary gland as well as the other organs

The World Health Organization recommends that TB treatment be administered using combination therapy. The methodologies for quantifying simultaneously associated drugs are highly complex, being costly, extremely time consuming and producing chemical residues harmful to the environment. The need to seek alternative techniques that minimize these drawbacks is widely discussed in the pharmaceutical industry. Therefore, the objective of this study was to develop and validate a multivariate calibration model in association with the near infrared spectroscopy technique (NIR) for the simultaneous determination of rifampicin, isoniazid, pyrazinamide and ethambutol. These models allow the quality control of these medicines to be optimized using simple, fast, low-cost techniques that produce no chemical waste. In the NIR - PLS method, spectra readings were acquired in the 10,000-4000cm-1 range using an infrared spectrophotometer (IRPrestige - 21 - Shimadzu) with a resolution of 4cm-1, 20 sweeps, under controlled temperature and humidity. For construction of the model, the central composite experimental design was employed on the program Statistica 13 (StatSoft Inc.). All spectra were treated by computational tools for multivariate analysis using partial least squares regression (PLS) on the software program Pirouette 3.11 (Infometrix, Inc.). Variable selections were performed by the QSAR modeling program. The models developed by NIR in association with multivariate analysis provided good prediction of the APIs for the external samples and were therefore validated. For the tablets, however, the slightly different quantitative compositions of excipients compared to the mixtures prepared for building the models led to results that were not statistically similar, despite having prediction errors considered acceptable in the literature.

The Portuguese National Ecological Reserve (NER) was created in 1983, with the aim of preserving, in certain areas, the biophysical structure necessary to maintain exploitation of natural resources and land use without jeopardizing their sustainability. For the first time, issues related to groundwater resources were addressed. Since then, this legal tool has been revised for a better integration of the new national and European legislation and new scientific and technical knowledge. In the latest NER, the concept of “strategic areas of protection and aquifer recharge (SAPAR)” was created, being now necessary to define which are the methodologies and criteria to be applied for its delimitation. This paper summarizes the strategic guidelines that were established from debates held in several meetings with land-use planners, water resources managers, specialists and other stakeholders concerning the development of harmonized definitions and criteria of NER. As a result of those contributions a report was elaborated where guidelines and criteria for the NER delimitation were defined at national level, in accordance with national legislation and other relevant sector plans. In this work, the articulation and integration of SAPAR-protected areas in Portuguese Water Act and the expected difficulties of its application at operative level are evaluated since the SAPAR are important for the control of urban sprawl and therefore to preserve groundwater resources and dependent ecosystems. A brief explanation about the Portuguese main hydrogeological features is given for a better understanding of the groundwater resources and dependent ecosystems. Finally, the key guidelines for a good NER delimitation are compiled.

Objective To compare the capacity of mammography, sonoelastography, B-mode ultrasonography and histological analysis to differentiate benign from malignant breast lesions. Materials and Methods A total of 12 histopathologically confirmed breast lesions were documented. The lesions were assessed by means of mammography, B-mode ultrasonography and sonoelastography, and histopathological analysis was utilized as a gold standard. Sensitivity and specificity were calculated. A receiver operating characteristic (ROC) curve was constructed to evaluate the diagnostic performance of the mentioned techniques. Results Sensitivity and specificity in the differentiation between benign and malignant lesions were respectively 100% and 50% for mammography, 100% and 71% for B-mode ultrasonography, and 67% and 83% for sonoelastography. The area under the ROC curve was calculated for the three imaging modalities and corresponded to 0.792 for mammography, 0.847 for B-mode ultrasonography, and 0.806 for sonoelastography. Conclusion Sonoelastography demonstrated higher specificity and lower sensitivity as compared with mammography and B-mode ultrasonography. On the other hand, B-mode ultrasonography had the largest area under the ROC curve. Sonoelastography has demonstrated to be a promising technique to detect and evaluate breast lesions, and could potentially reduce the number of unnecessary biopsies. Objetivo Comparar a capacidade de diferenciação de lesões benignas versus malignas por parte da mamografia, ultrassonografia modo-B e elastografia. Materiais e Métodos Um total de 12 lesões mamárias confirmadas histologicamente foi documentado. A avaliação das lesões foi realizada por meio da mamografia, ultrassonografia modo-B e elastografia. Os resultados histopatológicos foram utilizados como técnica padrão ouro. As sensibilidades e as especificidades foram calculadas. A curva receiver operating characteristic (ROC) foi realizada para avaliar o desempenho diagnóstico das técnicas utilizadas. Resultados A sensibilidade e a especificidade na diferenciação entre lesões mamárias benignas e malignas foram 100% e 50%, respectivamente, para a mamografia, e 100% e 71% para a ultrassonografia modo-B. A elastografia obteve sensibilidade de 67% e especificidade de 83%. A área abaixo da curva ROC foi calculada para as três técnicas imaginológicas, sendo 0,792 para a mamografia, 0,847 para a ultrassonografia modo-B e 0,806 para a elastografia. Conclusão A elastografia mostrou ter maior especificidade e menor sensibilidade comparativamente à mamografia e à ultrassonografia modo-B. A ultrassonografia modo-B foi a técnica que demonstrou maior área abaixo da curva ROC. A elastografia mostra-se uma técnica promissora na detecção de doença mamária e, potencialmente, poderá reduzir biópsias desnecessárias.

High-sucrose and high-fat diets induce deregulation in the metabolism of lipids and carbohydrates. This study aimed to detect the initial consequences on lipogenesis, gluconeogenesis and insulin signaling in the livers of rodents fed high-fat and/or high-sucrose diets for a short period of time. Male mice received a standard chow (SC), high-fat (HF), high-sucrose (HSu) or high-fat, high-sucrose (HFHSu) diet for 4 weeks. At euthanasia, blood was collected and the liver was removed for histomorphometrical and molecular analysis. The HF, HSu and HFHSu groups presented glucose intolerance, hepatomegaly, liver steatosis and lipid profile alteration when compared to the SC group (p < 0.0005). Additionally, there was an elevation in protein levels involved in lipogenesis (SREBP-1c), gluconeogenesis (PEPCK and G6Pase) and insulin signaling (IRS-1 and Akt) in the livers from the experimental groups compared to the SC group (p < 0.0005). Thus, we conclude that a short-term HF and/or HSu diet promotes glucose intolerance and liver damage in adult male mice. Surprisingly, the short exposure to excess sucrose in the diet promoted glucose intolerance and liver damage even in the absence of an increase in body mass or changes in serum insulin, cholesterol and triacylglycerol levels.

The purpose of this study was to analyze the relationship between martial arts practice (judo, karate and kung-fu) and bone mineral density in adolescents.METHODS: The study was composed of 138 (48 martial arts practitioners and 90 non-practitioners) adolescents of both sexes, with an average age of 12.6 years. Bone mineral density was measured using Dual-Energy X-ray Absorptiometry in arms, legs, spine, trunk, pelvis and total. Weekly training load and previous time of engagement in the sport modality were reported by the coach. Partial correlation tested the association between weekly training load and bone mineral density, controlled by sex, chronological age, previous practice and somatic maturation. Analysis of covariance was used to compare bone mineral density values according to control and martial arts groups, controlled by sex, chronological age, previous practice and somatic maturation. Significant relationships between bone mineral density and muscle mass were inserted into a multivariate model and the slopes of the models were compared using the Student t test (control versus martial art).RESULTS: Adolescents engaged in judo practice presented higher values of bone mineral density than the control individuals (p-value=0.042; Medium Effect size [Eta-squared=0.063]), while the relationship between quantity of weekly training and bone mineral density was significant among adolescents engaged in judo (arms [r=0.308] and legs [r=0.223]) and kung-fu (arms [r=0.248] and spine [r=0.228]).CONCLUSIONS: Different modalities of martial arts are related to higher bone mineral density in different body regions among adolescents. O objetivo desse estudo foi analisar a relac¸ão entre a prática de artes marciais (judô, karatê e kung-fu) e a densidade mineral óssea em adolescentes. Métodos: O estudo foi composto por 138 adolescentes (48 praticantes de artes marciais e 90 não praticantes) de ambos os sexos, com idade média de 12,6 anos. A densidade mineral óssea foi medida usando absortometria radiológica de dupla energia em brac¸os, pernas, coluna, tronco, pelve e total. A carga de treinamento semanal e o tempo anterior de envolvimento na modalidade esportiva foram relatados pelo treinador. A correlac¸ão parcial testou a associac¸ão entre a carga semanal de treinamento e a densidade mineral óssea, controlada para sexo, idade cronológica, prática anterior e maturac¸ão somática. A análise de covariância foi utilizada para comparar os valores de densidade mineral óssea de acordo com os grupos controle e de artes marciais, controlados para sexo, idade cronológica, prática anterior e maturac¸ão somática. Associac¸ões significativas entre a densidade mineral óssea e a massa muscular foram inseridas em um modelo multivariado e as inclinac¸ões dos modelos foram comparadas usando o teste t de Student (controle versus arte marcial). Resultados: Os adolescentes envolvidos na prática de judô apresentaram valores maiores de densidade mineral óssea do que os indivíduos do grupo controle (p=0,042; tamanho de efeito médio [eta-quadrado=0,063]), enquanto a relac¸ão entre a quantidade de treinos semanais e a densidade mineral óssea foi significativa entre os adolescentes praticantes de judô (brac¸os [r=0,308] e pernas [r=0,223]) e kung-fu (brac¸os [r=0,248] e coluna [r=0,228]). Conclusões: Diferentes modalidades de artes marciais estão relacionadas com maior densidade mineral óssea em diferentes regiões do corpo em adolescentes.

BACKGROUND Research on relationships between lifestyle behaviors and adiposity in school youth is potentially important for identifying subgroups at risk. This study evaluates the associations between waist circumference (WC) and objective measures of sedentary behavior (SB) in a sample of rural school adolescents. METHODS The sample included 254 students (114 boys, 140 girls), 13-16 years of age, from rural regions of the Portuguese midlands. Height, weight, and WC were measured. Cardiorespiratory fitness (CRF) was assessed with the 20-m shuttle-run test. An uniaxial GT1M accelerometer was used to obtain 5 consecutive days of physically activity (PA) and SB. Multiple linear regression was used to test associations between WC and SB, adjusted for several potential confounders (age, sex, PA, CRF, parental education). RESULTS SB was not significantly associated with the WC, neither in the unadjusted model nor after adjustment for all potential confounders. In the final model, the unique significant predictor of the WC was cardiorespiratory fitness (β = −0.82; 95% confidence interval [CI], −1.02 to −0.62). CONCLUSION WC was not independently associated with SB time in rural school adolescents. Future research is claimed among rural adolescents in different geographic contexts to try to clarify recent findings of less studied communities.

We describe a girl with Alagille syndrome and a moyamoya angiographic pattern on magnetic resonance angiography. She was referred for genetic consultation because of posterior embryotoxon and peripheral pulmonary stenosis. Her facial appearance was typical, but she had no cholestasis or vertebral involvement. A heterozygous duplication of one nucleotide (a c.715dupA mutation) not previously described was identified in exon 5 of the JAG1 gene. We review similar cases in the literature and possible pathophysiologic mechanisms (e.g., the Jagged 1 and Notch signaling pathway) of this association.

RESUMOO atraso pubertário representa uma causa frequente de referenciação à consulta de Endocrinologia Pediátrica. A sua etiologia é variada, classificando-se em hipogonadismo hipogonadotrófico ou hipergonadotrófico, consoante exista diminuição ou aumento das gonadotrofinas. A Síndrome de Kallmann é uma forma rara de hipogonadismo hipogonadotrófico e caracteriza-se pela sua associação a anosmia ou hiposmia. É causada por um defeito na migração dos neurónios que produzem a GnRH e dos que formam os nervos olfativos, cuja origem embriológica é comum. A doença afeta apenas a secreção de gonadotrofinas, sendo as restantes hormonas hipofisárias produzidas normalmente. Está frequentemente associada a outras malformações que podem ser um elemento fundamental para um diagnóstico precoce. Os autores apresentam três casos clínicos de Síndrome de Kallmann e malformações associadas.ABSTRACTDelayed puberty is a frequent cause of referral to pediatric endocrinologists. It may be due to a large number of causes divided in two major groups based on measurement of gonadotrophins: hypogonadotrophic or hypergonadotrophic hypogonadism. Kallmann syndrome is a rare form of hypogonadotrophic hypo­gonadism and is characteristically associated with anosmia or hyposmia. Its primary defect is an anomalous migration of the neurons responsible for the GnRH production and the neurons that compose the olfactory nerves. The syndrome only affects gonadotrophin production, while all other hypophyseal hormones are normally secreted. In this paper we report and discuss three cases of Kallmann's syndrome and associated anomalies.

Published online march 2012, Aim. The aim of this study was to evaluate how simple it is to build a homemade low-cost simulator using a simple 5-step scheme. Methods. A scheme explaining how to build an endoscopic surgery simulator in 5 easy steps was presented to 26 surgeons. The simulator required a pair of scissors and easy-to-find materials. Its total cost was less than €35. The participants assessed the simulator using common endoscopic training toys or ex vivo tissue and completed an anonymous query comparing it with other commercial simulators that they had experienced before. Results. In all, 84.6% found the simulator really easy to build. Every participant felt that he or she could do the same simulator themselves. Comparing with other commercial available box simulators, the majority of participants found the homemade simulator easier to (a) mount and dismount, (b) transport, (c) clean, and (d) use when practicing alone. Conclusions. Anyone can build its own simulator for a small amount of money., The author(s) received no financial support for the research, authorship, and/or publication of this article.

In open energy markets, the settlement process between distribution operators and traders is made on an hourly (or 15 min) basis, while LV consumers’ billing data continues to result from monthly energy bills. In order to reconcile these two different realities, load profiling is used as a means to redistribute the consumed energy of each trader's portfolio by hourly intervals, according to recorded consumption patterns. This paper presents a new clustering approach to derive typical load diagrams that can be used in the process. The algorithm uses real load diagrams obtained in measurement campaigns to define classes (in the billing information space) that maximize the compactness of the diagrams in each class. The methodology was developed in a project with EDP Distribution (the Portuguese distribution system operator) and the result was approved by the Regulatory Authority that adopted the proposed profiles for market use.

INTRODUÇÃO: A elevação do índice de massa corporaleapresençadesíndromemetabólica se associam com diminuição da função renal e o aparecimento de doença renal terminal. OBJETIVO: Avaliar o efeito da sobreposição de um modelo de obesidade experimental e hipertensão arterial sobre a pressão arterial, peso corporal e parâmetros metabólicos e renais de ratos. MÉTODOS: Foram estudados ratos machos das cepas Wistar e espontaneamente hipertensos (SHR). Os grupos MSG receberam glutamato monossódico no período neonatal (WST + MSG e SHR + MSG). Os animais controles receberam salina no período neonatal (WST e SHR). Após completarem três meses de vida, por 12 semanas foram pesados e tiveram a pressão arterial de cauda aferida semanalmente. A determinação de microalbuminúria foi realizada nas semanas 0, 4, 8 e 12. Ao final do período de acompanhamento, coletou-se sangue para glicemia de jejum, creatinina e perfil lipídico. Os rins foram retirados, corados e o índice de esclerose glomerular foi calculado. RESULTADOS: A administração de MSG produziu maior ganho percentual de peso corporal, elevação da glicemia de jejum e maior grau de lesão glomerular nos ratos WST -MSG e SHR -MSG quando comparados aos seus controles. Houve maior excreção urinária de albumina nos ratos do Grupo SHR + MSG quando comparados aos SHR. Não houve diferença estatística na pressão arterial de cauda, creatinina e parâmetros do metabolismo lipídico. CONCLUSÕES: A associação de obesidade neuroendócrina e a hipertensão arterial promoveram alterações morfológicas e funcionais no glomérulo mais severas do que aquelas observadas nos ratos somente hipertensos. INTRODUCTION: Increased body mass index and the metabolic syndrome are associated with decreased renal function and the development of end-stage kidney disease. OBJECTIVE: To evaluate the effect of the overlap between an experimental model of obesity and genetic hypertension on the blood pressure, body weight and metabolic and kidney parameters of rats. METHODS: We studied male rats of the Wistar (WST) and spontaneously hypertensive rats (SHR) strains. Monosodium glutamate (MSG) was administered in the neonatal period to both strains, to make up two groups: WST + MSG and SHR + MSG. Animals in the control groups (WST and SHR) received saline. After completing three months of life, a 12-week follow-up period ensued, during which bi-weekly measurements of body weight (BW) and tail-cuff blood pressure (TCBP) were obtained. Microalbuminuria was analyzed at weeks 0, 4, 8 and 12. At the end of the follow-up period, blood was obtained for fasting glucose, plasma creatinine, and lipid profile determinations. The kidneys were removed, stained, and the glomerular sclerosis index was calculated. RESULTS: The administration of MSG produced higher percentage body weight gain, higher fasting blood glucose and a higher degree of glomerular injury in WST-MSG and MSG-SHR rats, compared to their controls. Greater urinary albumin excretion was observed in SHR + MSG rats, when compared to SHR. There was no statistical difference in the TCBP, creatinine, and lipid profile. CONCLUSIONS: The association of neuroendocrine obesity and arterial hypertension promoted morphological and functional changes in the glomerulus. These changes were more severe than those observed in hypertensive-only rats.

With the advent of the Internet and the progressive development and consolidation of a wide range of web standards and technologies as well as the advances in distributed artificial intelligence (DAI), namely the multi agent system concept, new opportunities have emerged for conceiving, modelling and enhancing shop floor's performance and response. Modern IT-supported production paradigms denote a common concept where the shop floor is a lively entity composed by interacting intelligent modules whose individual and collective function adapts and evolves ensuring the fitness and adequacy of the organization, owning the system, in tackling profitable but volatile business opportunities. The self-organizing and peer to peer nature of these systems renders a collective behaviour and dynamics that are fundamentally new. Conventional diagnostic methods and tools have not been designed targeting the envisioned systems therefore lack the required support. In this paper the emerging IT-based production paradigms are surveyed as well as the existing diagnostic methods whose adequacy is analysed. The resulting requirements and characteristics are exposed to stress the need for rethinking current diagnostic practices in future automation systems.

This paper describes a simulation-optimization model aimed at helping water utilities determine the best way to operate large-scale multisource water-supply systems. The operation of water systems is optimized taking into account the principal planning objectives defined for interventions that include reducing operating costs, satisfying demand, delivering water of appropriate quality, and not prompting the use of emergency sources. The model allows that these planning objectives may not be completely fulfilled in critical circumstances (e.g., droughts) when goals have to be prioritized by the water utilities. The model is a highly nonlinear programming problem and is solved with the general algebraic modeling system (GAMS), using the MINOS algorithm (GAMS/MINOS). The application of the model to the multimunicipal urban water-supply system of the Algarve shows its capabilities for optimizing the operation considering economic and noneconomic goals included in the objective function and to cope with future...

Groundwater quality assessment is important to ensure sustainable safe use of water. In the region of Gabes, groundwaters represent the main source of water supply for drinking, agriculture and industry seeing the shortage in surface water. In the present paper, an attempt has been made, for the first time in this region, to study the spatial and temporal evolution of the hydrochemistry and to identify factors and phenomena governing the assessment parameters of Gabes-south groundwaters quality, based on (1) an integrated analysis of physical–chemical parameters (2) use of Geological Information System (GIS) and (3) statistical methods. To this purpose, water samples were collected during the period of 1995–2003 from nine boreholes to represent Gabes-south deep aquifer. The water samples were investigated with respect to salinity, concentrations of hydrogen (pH), calcium (Ca 2+ ), magnesium (Mg 2+ ), sodium (Na + ), potassium (K + ), chloride (Cl − ), sulphate, SO 4 2 - , bicarbonates HCO 3 - and fluoride (F − ). Spatial distribution maps of these parameters have been created using GIS contouring methods with Arcview 3.2. The analytical results obtained were interpreted using hydrochemical methods reinforced by statistical analysis (trend analysis, principal component analysis and correspondence analysis) which has been widely used to analyse large sets of variables in environmental studies. Chemical analysis show that during the considered period, salinity and major elements concentrations vary little with time, and decrease in the direction of the groundwater flow. The waters are mostly SO 4 , Cl, Na and Ca type. The chemical composition of these waters is related to the lithology of the aquifer, to their origin and to the exploitation conditions. Water quality analysis indicates that Gabes-south groundwaters are mainly composed of SO 4 , Cl, Na and Ca type. Results showed that fluoride concentrations exceed the World Health Organisation (WHO) maximum permissible limit of 1.5 mg/l. Therefore, the water of these boreholes must be defluorinated before use for drinking.

The use of the concept of greenway can be identified in Portugal throughout the 20th century as a planning and design tool. Several examples, such as the ‘Improvement Plans for Lisbon’ by Ressano Garcia (1901), the continuum naturale concept [Cabral, F.C., 1980. O Continuum Naturale e a Conservacao da Natureza. Conservacao da Natureza. Servico de Estudos do Ambiente, Lisbon; Andresen, T., 2001. Francisco Caldeira Cabral. Landscape Design Trust, Surrey, UK, 213 pp.], the Green Plan for Lisbon [Telles, G.R., et al., 1997. Plano Verde de Lisboa. Ed. Colibri, Lisboa, 197 pp.], deal with the subjects of implementing vegetation corridors, pedestrian networks and landscape quality. These examples establish Portuguese planning and design tradition within the international greenway movement first identified by Fabos [Fabos, J.Gy., 1991. From Park to Greenways into the 21st Century. In: Proceedings from Selected Educational Sessions, ASLA Annual Meeting, Kansas City, Missouri]. Though several projects have been developed at the planning level, there is a need to analyze the applicability of such a concept at the regional, municipal and local level. We must consider the characteristics of Portugal's cultural landscape, recognition by other professions dealing with planning and involvement by politicians. By analyzing five case studies, this paper shows the significance of the greenway as a planning and design strategy, which coincides, with the current objectives of political and planning authorities at the municipal level. It also proves that it is possible to reconcile political objectives and urban development while safeguarding landscape quality and providing new opportunities for public recreation and education. Greenway planning and design is now undoubtedly a subject of growing significance in Portugal.

The evolution of the concept of landscape to incorporate components like cultural and socio‐economic factors, in addition to the natural and aesthetic features, influenced the perception of landscape as a resource. On the other hand, the relationships between territorial features as well as the understanding of their temporal dynamics determine the significance of these features for the quality of a landscape and, consequently, for its conservation. This implies that all components – natural and physical, but also cultural and visual – upon which landscape quality is assessed, ought to be considered and studied globally. Natural resources and cultural heritage, however, are usually considered independently when developing protected areas management plans. Here, we present a methodology developed for the Monte da Guia management plan, which allows the interrelated analysis of landscape factors such as geology, geomorphology, pedology, flora and vegetation cover as well as the cultural and visual characters. Using the concepts of biophysical sensitivity and visual quality, we evaluated the relevance of these various factors for the determination of the state of equilibrium/degradation of a landscape, and hence for its conservation value. This methodology may contribute to the development of improved zoning maps and management guidelines determining land use and management strategies for the conservation of individual resources that, together, determine landscape quality.

Three optimization models are proposed to select the best subset of stations from a large groundwater monitoring network: ~1! one that maximizes spatial accuracy; ~2! one that minimizes temporal redundancy; and ~3! a model that both maximizes spatial accuracy and minimizes temporal redundancy. The proposed optimization models are solved with simulated annealing, along with an algorithm parametrization using statistical entropy. A synthetic case-study with 32 stations is used to compare results of the proposed models when a subset of 17 stations are to be chosen. The first model tends to distribute the stations evenly in space; the second model clusters stations in areas of higher temporal variability; and results of the third model provide a compromise between the first two, i.e., spatial distributions that are less regular in space, but also less clustered. The inclusion of both temporal and spatial information in the optimization model, as embodied in the third model, contributes to selection of the most relevant stations.

In offset disc harrows, the angle between gangs may be changed to meet the field conditions. Tractor drivers usually use an angle close to maximum, increasing power requirements and therefore limiting the forward speed and, consequently, the work rate. The objective of this work was to study, in the specific soil conditions present in Southern Portuguese agriculture, the effect of working with a disc harrow at a reduced gang angle and at a higher forward speed, in terms of work rate, fuel consumption per hectare and distribution of dry soil aggregates. A trailed-type medium-weight offset disc harrow (20 discs of 610 mm diameter) was used, pulled by a four-wheel drive tractor. A portable computer-based record system was used to collect engine speed, actual forward speed, slip, fuel consumption and draught force. Higher work rates and lower values of fuel consumption per hectare were attained, with no visible difference in soil tilth, by operating the disc harrow at a lower angle between disc gangs and shifting up to a higher gear ratio whilst maintaining engine speed. Tractor drivers, particularly those with tractors equipped with performance monitors should consider setting, by preliminary tests prior to the main field work, the right combination of gang angle and forward speed within the limits of quality of the work and the safety of the operation.

An inclusive society leads all citizens to participate in community life, without any discrimination, but often citizens with reduced or conditioned mobility face barriers of a different nature. The condition of person with disability is arduous and unequal, even protected by legislation, but it is essential effectiveness in its application, which also involves the Rehabilitation Nurse. Objectives: Reflect on the rights of persons with disabilities and on the role of professionals in the overall rehabilitation action, particularly the rehabilitation nurses; Mobilize strategies for the promotion of accessibility. Methodology: Descriptive study using specific legislation, official websites and sources on rehabilitation, nursing and rehabilitation nursing. Results: The legislation is oriented towards the protection of the citizen with reduced or conditioned mobility. But barriers exist and changes are needed in people and society, and the professional has a relevant role in its implementation. Nurses in general and rehabilitation specialists in particular should advocate for the conditions necessary for the enjoyment of accessibility by developing specific strategies. Conclusions: Continuous monitoring is required for equal opportunities and accessibility, which involves the attitude of people, responsible entities and professionals. Rehabilitation nurses must assert themselves as an integral part of this mission. Keywords: Rehabilitation nursing; human rights; legislation; architectural accessibility; disabled persons.

Introducao: Ainda e controverso se ocorre sinergismo entre as diferentes medidas nao farmacologicas utilizadas no tratamento da hipertensao arterial. Objetivo: Avaliar o efeito do exercicio fisico aerobico, da sobrecarga oral de potassio e da sua associacao sobre a pressao arterial, metabolismo glicidico, excrecao urinaria de albumina e morfologia glomerular de ratos espontaneamente hipertensos (SHR). Metodos: SHRs foram divididos em: Grupo Controle (SHR; dieta padrao e sedentario, n = 10); Grupo Exercicio (SHR + E; treinado em esteira rolante, dieta padrao, n = 10), Grupo Potassio (SHR + K; sedentario, dieta rica em potassio, n = 10) e Grupo Exercicio + Potassio (SHR + E + K; exercitado, dieta rica em potassio, n = 10). Semanalmente, foi aferido o peso corporal (PC) e a pressao arterial de cauda (PAC). Ao final de 16 semanas, foi realizado o Teste de Tolerância oral a Glicose. A albuminuria foi determinada nos periodos basal, na 8a e 16a semana. Apos o sacrificio, foi realizada a analise do indice de esclerose glomerular e a pesagem da gordura visceral. Resultados: A PAC e o PC nao variaram significativamente. Houve melhora da sensibilidade a insulina no Grupo Exercicio e Grupo Potassio, mas nao no Grupo Exercicio + Potassio. Na 16a semana, a albuminuria de todos os grupos foi significativamente menor que o grupo SHR Controle. O indice de esclerose glomerular e o peso da gordura visceral tambem foram significativamente menores em todos os grupos tratados quando comparados ao controle. Conclusao: A dieta rica em potassio e o exercicio fisico determinaram melhora no metabolismo glicidico, na albuminuria e na morfologia glomerular, porem, a sobreposicao dos tratamentos nao apresentou sinergismo.

With the emergence of new modern manufacturing paradigms new concepts, originally from the complexity sciences started to be introduced in the manufacturing systems, rendering traditional control approaches insufficient. Therefore, new approaches were developed, supported by the modern manufacturing paradigms bio-inspired background. However, somehow along the way the physical and logical nature of the system was partially lost, leading to the convergence of approaches towards more traditional systems, 'neglecting' their bio-inspired principles. With the present work the authors aim to introduce and analyse two new different self-organising approaches that try to bring the focus of manufacturing systems, again to the bio-inspired principles. For this purpose, in the context of this work, manufacturing systems are approached from a bottom-up perspective, in an attempt to reduce the specification of the production processes to the minimum and foster the production emergence. A test case is considered, to draw initial conclusions.

There is a substantial difference between traditional industrial systems and systems resultant from emerging production paradigms in terms of both conceptualization and implementation. Backwards compatibility is fundamental in assessing the potential transitional period whereby legacy technology will operate under the conceptual framework of modern approaches. However, before this point can be reached it is necessary to further investigate, assess and quantify the behavior of modern approaches that increasingly rely in self-organization. This article's goal is to give an overview of the behavioral assessment problematic, in the context of self-organizing mechatronic systems, and provide a discussion on opportunities to explore rule-extraction techniques to better understand the influence of design and configuration on the overall system behavior. Although the discussion widely applies to almost all emerging production paradigms the Evolvable Production System paradigm is used as case to bring context and clarity to the discussion.

In recent years a set of production paradigms has emerged to circumvent pressing production challenges. In particular the ability of composing lower order components to form higher order entities w ...