2,475 research outputs found

    Classification of high dimensional data using LASSO ensembles

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    Urda, D., Franco, L. and Jerez, J.M. (2017). Classification of high dimensional data using LASSO ensembles. Proceedings IEEE SSCI'17, Symposium Series on Computational Intelligence, Honolulu, Hawaii, U.S.A. (2017). ISBN: 978-1-5386-2726-6The estimation of multivariable predictors with good performance in high dimensional settings is a crucial task in biomedical contexts. Usually, solutions based on the application of a single machine learning model are provided while the use of ensemble methods is often overlooked within this area despite the well-known benefits that these methods provide in terms of predictive performance. In this paper, four ensemble approaches are described using LASSO base learners to predict the vital status of a patient from RNA-Seq gene expression data. The results of the analysis carried out in a public breast invasive cancer (BRCA) dataset shows that the ensemble approaches outperform statistically significant the standard LASSO model considered as baseline case. We also perform an analysis of the computational costs involved for each of the approaches, providing different usage recommendations according to the available computational power.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tec

    Cognitive models for the concept of angle

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    Tese de doutoramento em FilosofiaThe instructional models taught in class were similar to the students' models. The teachers addressed angle as a basic-level category, discussed its submodels, clarified the boundaries, and established cognitive reference points. They gradually increased the use of complex metaphors and of several models. The study enriched the characterization of the first two levels of van Hiele theory and demonstrated the value of categorization theory in understanding how our comprehension of mathematics is rooted in basic human attributes pertaining to the material and social conditions of human life. The embodiment of mathematical ideas by the material world, including our bodies, needs greater emphasis in all facets of mathematics education

    Solving Scheduling Problems with Genetic Algorithms using a Priority Encoding Scheme

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    Scheduling problems are very hard computational tasks with several applications in multitude of domains. In this work we solve a practical problem motivated by a real industry situation, in which we apply a genetic algorithm for finding an acceptable solution in a very short time interval. The main novelty introduced in this work is the use of a priority based chromosome codification that determines the precedence of a task with respect to other ones, permitting to introduce in a very simple way all problem constraints, including setup costs and workforce availability. Results show the suitability of the approach, obtaining real time solutions for tasks with up to 50 products.Universidad de Málaga.Campus de Excelencia Internacional Andalucía Tech

    Seguimiento de la calidad de un embalse de abastecimiento de agua potable según las directrices de la Directiva Marco (embalse del Añarbe. Cuenca Norte)

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    The Añarbe reservoir is located in the Iberic-Macaronesian region and is a water body provisionally identified as heavily modified, comparable to 'lake', that according to the "A" classification system of the WFD is "siliceous, lowlands, big and very deep", and according to the "B" system is ¨lowlands, northern, warm monomictic and of acidic waters". Two annual cycles of studies have been completed (from May of 2004 to January of 2006) looking to the main biological, physicochemical and hydromorphological parameters. The trophic state is oligotrophic for most of the parameters, except for the total phosphorus, that classifies it as mesotrophic. It does not present algal blooms and the average oxygen concentration in the hypolimnion in the zone of the dam during the stratification is 4.5 mg O2/l. The percentage of variation of the water volume of the reservoir respective to the maximum volume varies between 40 and 33% for the years 2004 and 2005, respectively. It shows a good ecological potential and could be considered as a reference within its group.El embalse del Añarbe se encuentra en la Región ibérico-macaronésica y es una masa de agua identificada provisionalmente como muy modificada, asimilable a 'lago', que según el Sistema A de clasificación de la DMA es del tipo 'silíceo, tierras bajas, grande y muy profundo' y según el Sistema B; 'tierras bajas, septentrional, monomíctico cálido y de aguas 'acidas'. Se han completado dos ciclos anuales de estudio (desde mayo de 2004 hasta enero de 2006) con los principales parámetros biológicos, fisicoquímicos e hidromorfológicos. Su estado trófico es de oligotrofia para la mayoría de parámetros, excepto para el fósforo total, que lo clasifica como mesotrófico. No presenta blooms algales y la concentración media de oxígeno en el hipolimnion de la zona de la presa durante la estratificación es de 4.5 mg O2/l. El porcentaje de variación del volumen del embalse con respecto al volumen máximo varía entre el 40 y el 33 %, para los años 2004 y 2005, respectivamente. Presenta un buen potencial ecológico y podría ser considerado como de referencia para su tipología

    A numerical study of the effect of nozzle diameter on diesel combustion ignition and flame stabilization

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    This is the author's version of a work that was accepted for publication in International Journal of Engine Research. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published as https://doi.org/10.1177/1468087419864203.[EN] The role of nozzle diameter on diesel combustion is studied by performing computational fluid dynamics calculations of Spray A and Spray D from the Engine Combustion Network. These are well-characterized single-hole sprays in a quiescent environment chamber with thermodynamic conditions representative of modern diesel engines. First, the inert spray evolution is described with the inclusion of the concept of mixing trajectories and local residence time into the analysis. Such concepts enable the quantification of the mixing rate, showing that it decreases with the increase in nozzle diameter. In a second step, the reacting spray evolution is studied focusing on the local heat release rate distribution during the auto-ignition sequence and the quasi-steady state. The capability of a well-mixed-based and a flamelet-based combustion model to predict diesel combustion is also assessed. On one hand, results show that turbulence-chemistry interaction has a profound effect on the description of the reacting spray evolution. On the other hand, the mixing rate, characterized in terms of the local residence time, drives the main changes introduced by the increase of the nozzle diameter when comparing Spray A and Spray D.The author(s) disclosed receipt of the following financial support for the research, authorship and/or publication of this article: The work was partially funded by the Government of Spain through the CHEST Project (TRA2017-89139-C2-1-R) and by Universitat Politecnica de Valencia through the Programa de Ayudas de Investigaciony Desarrollo (PAID-01-16).Desantes Fernández, JM.; García-Oliver, JM.; Novella Rosa, R.; Pachano-Prieto, LM. (2020). A numerical study of the effect of nozzle diameter on diesel combustion ignition and flame stabilization. International Journal of Engine Research. 21(1):101-121. https://doi.org/10.1177/1468087419864203S101121211Pickett, L. M., & Siebers, D. L. (2002). An investigation of diesel soot formation processes using micro-orifices. Proceedings of the Combustion Institute, 29(1), 655-662. doi:10.1016/s1540-7489(02)80084-0Pickett, L. M., & Siebers, D. L. (2005). Orifice Diameter Effects on Diesel Fuel Jet Flame Structure. Journal of Engineering for Gas Turbines and Power, 127(1), 187-196. doi:10.1115/1.1760525Du, C., Andersson, S., & Andersson, M. (2018). Two-dimensional measurements of soot in a turbulent diffusion diesel flame: the effects of injection pressure, nozzle orifice diameter, and gas density. Combustion Science and Technology, 190(9), 1659-1688. doi:10.1080/00102202.2018.1461850Ishibashi, R., & Tsuru, D. (2016). An optical investigation of combustion process of a direct high-pressure injection of natural gas. Journal of Marine Science and Technology, 22(3), 447-458. doi:10.1007/s00773-016-0422-xPang, K. M., Jangi, M., Bai, X.-S., Schramm, J., & Walther, J. H. (2017). Effects of Nozzle Diameter on Diesel Spray Flames: A numerical study using an Eulerian Stochastic Field Method. Energy Procedia, 142, 1028-1033. doi:10.1016/j.egypro.2017.12.350Pickett, L. M., Manin, J., Genzale, C. L., Siebers, D. L., Musculus, M. P. B., & Idicheria, C. A. (2011). Relationship Between Diesel Fuel Spray Vapor Penetration/Dispersion and Local Fuel Mixture Fraction. SAE International Journal of Engines, 4(1), 764-799. doi:10.4271/2011-01-0686García-Oliver, J. M., Malbec, L.-M., Toda, H. B., & Bruneaux, G. (2017). A study on the interaction between local flow and flame structure for mixing-controlled Diesel sprays. Combustion and Flame, 179, 157-171. doi:10.1016/j.combustflame.2017.01.023Dahms, R. N., Paczko, G. A., Skeen, S. A., & Pickett, L. M. (2017). Understanding the ignition mechanism of high-pressure spray flames. Proceedings of the Combustion Institute, 36(2), 2615-2623. doi:10.1016/j.proci.2016.08.023Gimeno, J., Martí-Aldaraví, P., Carreres, M., & Peraza, J. E. (2018). Effect of the nozzle holder on injected fuel temperature for experimental test rigs and its influence on diesel sprays. International Journal of Engine Research, 19(3), 374-389. doi:10.1177/1468087417751531Matusik, K. E., Duke, D. J., Kastengren, A. L., Sovis, N., Swantek, A. B., & Powell, C. F. (2017). High-resolution X-ray tomography of Engine Combustion Network diesel injectors. International Journal of Engine Research, 19(9), 963-976. doi:10.1177/1468087417736985Pandurangi, S. S., Bolla, M., Wright, Y. M., Boulouchos, K., Skeen, S. A., Manin, J., & Pickett, L. M. (2016). Onset and progression of soot in high-pressure n-dodecane sprays under diesel engine conditions. International Journal of Engine Research, 18(5-6), 436-452. doi:10.1177/1468087416661041Aubagnac-Karkar, D., Michel, J.-B., Colin, O., & Darabiha, N. (2017). Combustion and soot modelling of a high-pressure and high-temperature Dodecane spray. International Journal of Engine Research, 19(4), 434-448. doi:10.1177/1468087417714351Ihme, M., Ma, P. C., & Bravo, L. (2018). Large eddy simulations of diesel-fuel injection and auto-ignition at transcritical conditions. International Journal of Engine Research, 20(1), 58-68. doi:10.1177/1468087418819546Yue, Z., & Reitz, R. D. (2017). An equilibrium phase spray model for high-pressure fuel injection and engine combustion simulations. International Journal of Engine Research, 20(2), 203-215. doi:10.1177/1468087417744144Bhattacharjee, S., & Haworth, D. C. (2013). Simulations of transient n-heptane and n-dodecane spray flames under engine-relevant conditions using a transported PDF method. Combustion and Flame, 160(10), 2083-2102. doi:10.1016/j.combustflame.2013.05.003Pei, Y., Hawkes, E. R., & Kook, S. (2013). Transported probability density function modelling of the vapour phase of an n-heptane jet at diesel engine conditions. Proceedings of the Combustion Institute, 34(2), 3039-3047. doi:10.1016/j.proci.2012.07.033Pang, K. M., Jangi, M., Bai, X.-S., Schramm, J., & Walther, J. H. (2018). Modelling of diesel spray flames under engine-like conditions using an accelerated Eulerian Stochastic Field method. Combustion and Flame, 193, 363-383. doi:10.1016/j.combustflame.2018.03.030D’Errico, G., Lucchini, T., Contino, F., Jangi, M., & Bai, X.-S. (2014). Comparison of well-mixed and multiple representative interactive flamelet approaches for diesel spray combustion modelling. Combustion Theory and Modelling, 18(1), 65-88. doi:10.1080/13647830.2013.860238Kösters, A., Karlsson, A., Oevermann, M., D’Errico, G., & Lucchini, T. (2015). RANS predictions of turbulent diffusion flames: comparison of a reactor and a flamelet combustion model to the well stirred approach. Combustion Theory and Modelling, 19(1), 81-106. doi:10.1080/13647830.2014.982342Lucchini, T., D’Errico, G., Onorati, A., Frassoldati, A., Stagni, A., & Hardy, G. (2017). Modeling Non-Premixed Combustion Using Tabulated Kinetics and Different Fame Structure Assumptions. SAE International Journal of Engines, 10(2), 593-607. doi:10.4271/2017-01-0556Pal, P., Keum, S., & Im, H. G. (2015). Assessment of flamelet versus multi-zone combustion modeling approaches for stratified-charge compression ignition engines. International Journal of Engine Research, 17(3), 280-290. doi:10.1177/1468087415571006Pope, S. B. (1978). An explanation of the turbulent round-jet/plane-jet anomaly. AIAA Journal, 16(3), 279-281. doi:10.2514/3.7521Novella, R., García, A., Pastor, J. M., & Domenech, V. (2011). The role of detailed chemical kinetics on CFD diesel spray ignition and combustion modelling. Mathematical and Computer Modelling, 54(7-8), 1706-1719. doi:10.1016/j.mcm.2010.12.048CONVERGE manual. Madison, WI: Convergent Science, 2016.Yao, T., Pei, Y., Zhong, B.-J., Som, S., Lu, T., & Luo, K. H. (2017). A compact skeletal mechanism for n-dodecane with optimized semi-global low-temperature chemistry for diesel engine simulations. Fuel, 191, 339-349. doi:10.1016/j.fuel.2016.11.083Perez E. Application of a flamelet-based combustion model to diesel-like reacting sprays. Unpublished PhD Thesis, Universitat Politècnica de València, Valencia, 2019.Peters, N. (2000). Turbulent Combustion. doi:10.1017/cbo9780511612701Naud, B., Novella, R., Pastor, J. M., & Winklinger, J. F. (2015). RANS modelling of a lifted H2/N2 flame using an unsteady flamelet progress variable approach with presumed PDF. Combustion and Flame, 162(4), 893-906. doi:10.1016/j.combustflame.2014.09.014Payri, R., García-Oliver, J. M., Xuan, T., & Bardi, M. (2015). A study on diesel spray tip penetration and radial expansion under reacting conditions. Applied Thermal Engineering, 90, 619-629. doi:10.1016/j.applthermaleng.2015.07.042Narayanaswamy, K., Pepiot, P., & Pitsch, H. (2014). A chemical mechanism for low to high temperature oxidation of n-dodecane as a component of transportation fuel surrogates. Combustion and Flame, 161(4), 866-884. doi:10.1016/j.combustflame.2013.10.012Kahila, H., Wehrfritz, A., Kaario, O., Ghaderi Masouleh, M., Maes, N., Somers, B., & Vuorinen, V. (2018). Large-eddy simulation on the influence of injection pressure in reacting Spray A. Combustion and Flame, 191, 142-159. doi:10.1016/j.combustflame.2018.01.004Pang, K. M., Jangi, M., Bai, X.-S., Schramm, J., Walther, J. H., & Glarborg, P. (2019). Effects of ambient pressure on ignition and flame characteristics in diesel spray combustion. Fuel, 237, 676-685. doi:10.1016/j.fuel.2018.10.020Tagliante, F., Poinsot, T., Pickett, L. M., Pepiot, P., Malbec, L.-M., Bruneaux, G., & Angelberger, C. (2019). A conceptual model of the flame stabilization mechanisms for a lifted Diesel-type flame based on direct numerical simulation and experiments. Combustion and Flame, 201, 65-77. doi:10.1016/j.combustflame.2018.12.00

    Antibiotic prophylaxis to prevent local infection in Oral Surgery : use or abuse?

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    Antibiotics have a well-documented efficacy in the treatment of established infections and as prophylactic agents in medically compromised patients. However, the systematic administration of antibiotics to prevent local infections in fit patients is much more controversial. The aim of this paper is to reflect on the justification for prophylactic usage of antibiotics to prevent wound infection and to reason out the most appropriate antibiotic guidelines taking into account available scientific data and studies by other authors. Numerous clinical trials question the efficacy of antibiotics in preventing wound infection. While some studies establish that antibiotics reduce the incidence of postoperative infections, others compare their efficacy to that of placebo. Thus, scientific literature suggests that every oral surgical intervention is not tributary of systematic antibiotic prophylaxis to prevent local infections. Intrinsic surgical risk factors and the patient?s individual circumstances must be taken into account. Even though the efficacy of other antibiotics cannot be ruled out due to our limited comprehension of the bacteriologic interrelations intervening in the pathogenesis of postextraction local infection, the amoxicillin-clavulanic acid combination theoretically covers the complete odontogenic bacterial spectrum in Spain. When the prophylactic use of antibiotics is indicated, this should be performed preoperatively, at high doses, and its extent should not exceed 24 hours. Special attention should be paid to antiinfectious local measures that can minimize infection risk during the wound?s healing period

    Papillary cystoadenoma lymphomatosum (Warthin-like) of minor salivary glands

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    Papillary cystadenoma lymphomatosum is a benign salivary gland tumor most frequently located in the parotid gland (Warthin?s tumor). Its presentation in other major, or in minor, salivary glands is rare. Clinically, it manifests as a slow growing tumor, fluctuant on palpation due to its cystic morphology. The treatment of choice is complete excision with wide tumor-free margins. We present a 73-year-old female patient with an asymptomatic tumor of 8 years evolution in the right posterior area of the hard palate. We performed surgical excision and a biopsy, which was reported as papillary cystadenoma lymphomatosum. During the post-operative examination carried out after 3 weeks, it was observed that the lesion had recurred. The lesion was re-operated, performing the excision with CO2 laser and including the periosteum to ensure complete resection of the tumor. At 10 months follow-up, there was no recurrence of the lesion. This article includes a review of this condition and discusses its most important clinical and pathologic features and therapeutic approaches

    Study of Air Flow Interaction with Pilot Injections in a Diesel Engine by Means of PIV Measurements

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    [EN] With ever-demanding emission legislations in Compression Ignition (CI) engines, new premixed combustion strategies have been developed in recent years seeking both, emissions and performance improvements. Since it has been shown that in-cylinder air flow affects the combustion process, and hence the overall engine performance, the study of swirling structures and its interaction with fuel injection are of great interest. In this regard, possible Turbulent Kinetic Energy (TKE) distribution changes after fuel injection may be a key parameter for achieving performance improvements by reducing in-cylinder heat transfer. Consequently, this paper aims to gain an insight into spray-swirl interaction through the analysis of in-cylinder velocity fields measured by Particle Image Velocimetry (PIV) when PCCI conditions are proposed. Experiments are carried out in a single cylinder optical Diesel engine with bowl-in-piston geometry. A standard 2D PIV system is used for measuring instantaneous velocity fields in a cross section (swirl-plane) inside the combustion chamber. The test matrix is based on an advanced single pilot injection with energizing time and injection pressure sweeps at different crank-angles. Results show that swirl ratio decreases with the increase of injected fuel mass. The decrease in swirl ratio also comes with a homogenization of the flow field. This homogenization along with lower swirl ratios might decrease heat transfer to cylinder walls.The support of the Spanish Ministry of Economy and Competitiveness (TRA2014-58870-R,) is greatly acknowledged through HiReCo project.García-Oliver, JM.; García Martínez, A.; Gil, A.; Pachano-Prieto, LM. (2017). Study of Air Flow Interaction with Pilot Injections in a Diesel Engine by Means of PIV Measurements. SAE International Journal of Engines. 10(3):740-751. doi:10.4271/2017-01-0617S74075110

    Estudo da Liderança enquanto factor antecedente do Comprometimento Organizacional

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    O estudo do comprometimento organizacional e da liderança têm, desde há algumas décadas, suscitado um grande interesse entre os investigadores, tendo sido produzido um grande número de trabalhos sobre estes temas. Apesar da falta de consenso quanto a estes conceitos, designadamente a sua definição, formas de os medir e modos de actuação dos mesmos, o modelo de liderança transaccional e transformacional de Burns e Bass (sistematizando a liderança em dois grandes tipos que integram 5 factores) e o modelo de comprometimento organizacional de Meyer e Allen (que considera o empenhamento organizacional constituído por três componentes) tem vindo a ter uma crescente aceitação por parte dos investigadores que se dedicam aos comportamentos organizacionais. O trabalho empírico realizado ao longo do presente estudo procurou caracterizar a liderança enquanto factor antecedente do comprometimento organizacional e confirmar as hipóteses colocadas acerca das correlações existentes entre os factores que constituem ambos os conceitos, e analisar de que forma os níveis do comprometimento estão associados a alguns factores demográficos. Para o efeito aplicou-se um inquérito por questionário a 568 agentes e chefes do CI e da 3ª e 4ª Divisões do COMETLIS. Para a análise dos resultados foi efectuada análise em componentes principais e análise factorial confirmatória. Encontraram-se algumas diferenças nos níveis de comprometimento já observados em outros estudos com amostras policiais e não policiais, mas não se confirmaram as hipóteses de trabalho, apontando para a possibilidade de os modelos acima referidos, pelo menos na população inquirida, não se aplicarem, devendo ser procuradas outras formas de análise destes conceitos nas forças policiais e, eventualmente, desenvolver uma teoria específica para este tipo de funções. Contribuiu-se para o preenchimento de uma lacuna na literatura relativa à relação de antecedência da liderança relativamente ao comprometimento organizacional numa amostra policial. Contribuiu-se ainda para um melhor conhecimento destes conceitos associados às forças policiais.N/

    Qualidade de vida de pacientes usuários do cateterismo urinário intermitente

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    Objetivos: mensurar e comparar a qualidade de vida de pacientes com bexiga neurogênica em uso do cateterismo urinário intermitente em processo de reabilitação, no Brasil e em Portugal. Método: estudo multicêntrico, Brasil e Portugal, quantitativo, transversal, observacional-analítico e correlacional. Foram utilizados dois instrumentos de coleta, um questionário de dados sociodemográficos e clínicos e World Health Organization Quality Life-bref. Foram inclusos pacientes maiores de 18 anos, com bexiga urinária neurogênica, e usuários do cateterismo urinário intermitente. Resultados: na amostra de pacientes brasileiros (n = 170) e portugueses (n = 52), respectivamente, a maioria era solteira (87-51,2%; 25-48,1%), com ensino fundamental (47-45,3%; 31-59,6%), aposentada (70-41,2%; 21-40,4%). A lesão medular foi a principal causa do uso do cateter urinário nos dois países. Os pacientes brasileiros apresentaram média de escores mais elevados de qualidade de vida no domínio psicológico (68,9) e menos elevados no domínio físico (58,9). Os pacientes portugueses apresentaram escores mais elevados no domínio psicológico (68,4) e menos no domínio ambiente (59,4). A realização do autocateterismo urinário intermitente foi significativa para os dois países. Conclusões: nos dois países, a qualidade de vida desses pacientes pode ser determinada pela melhora dos sintomas urinários, da independência, autoconfiança, relações sociais e acesso a atividades laborais.Objetivos: mensurar y comparar la calidad de vida de pacientes con vejiga neurogénica en uso de cateterismo vesical intermitente durante el proceso de rehabilitación en Brasil y en Portugal. Método: estudio multicéntrico, Brasil y Portugal, cuantitativo, trasversal, observacional-analítico y correlacional. Fueron utilizados dos instrumentos de recolecta, un cuestionario de datos sociodemográficos y clínicos y el World Health Organization Quality Life-bref. Fueron inclusos pacientes mayores de 18 años, con vejiga urinaria neurogénica, y usuarios de cateterismo vesical intermitente. Resultados: en la muestra de pacientes brasileños (n = 170) y portugueses (n = 52), respectivamente, la mayoría era soltera (87-51,2%; 25-48,1%), con educación fundamental (47-45,3%; 31-59,6%), jubilada (70-41,2%; 21-40,4%). La lesión medular fue la principal causa del uso del catéter urinario en los dos países. En promedio, los pacientes brasileños presentaron scores de calidad de vida superiores en el dominio psicológico (68,9) e inferiores en el dominio físico (58,9). Los pacientes portugueses presentaron scores superiores en el dominio psicológico (68,4) y inferiores en el dominio ambiente (59,4). La ejecución del autocateterismo vesical intermitente fue significativa para los dos países. Conclusiones: en los dos países, la calidad de vida de esos pacientes puede ser determinada por la mejora de los síntomas urinarios, de la independencia, autoconfianza, relaciones sociales y acceso a actividades laborales.Objectives: measure and compare the quality of life of neurogenic bladder patients using intermittent urinary catheterization who were going through rehabilitation in Brazil and Portugal. Method: multicenter, quantitative, cross-sectional, observational-analytic and correlational study executed in Brazil and Portugal. Two data collection tools were used, being one questionnaire with sociodemographic and clinical data and the World Health Organization Quality of Life-bref. Patients were included who were over 18 years of age, suffering from neurogenic urinary bladder and using intermittent urinary catheterization. Results: in the sample of Brazilian (n = 170) and Portuguese (n = 52) patients, respectively, most patients were single (87-51.2%; 25-48.1%), had finished primary education (47-45.3%; 31-59.6%) and were retired (70-41.2%; 21-40.4%). Spinal cord injury was the main cause of using the urinary catheter in both countries. The Brazilian patients presented higher mean quality of life scores in the psychological domain (68.9) and lower scores in the physical domain (58.9). The Portuguese patients presented higher scores in the psychological domain (68.4) and lower scores in the environment domain (59.4). The execution of intermittent urinary self-catheterization was significant for both countries. Conclusions: in the two countries, these patients’ quality of life can be determined by the improvement in the urinary symptoms, independence, self-confidence, social relationships and access to work activities
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