Força Muscular Isocinética após Reconstrução do Ligamento Cruzado Anterior – Influência do Tipo de Enxerto (Osso-Tendão-Osso/Isquio-Tibiais)

Introdução: É reconhecida a importância do ligamento cruzado anterior (LCA) no funcionamento normal do joelho. Em caso de rotura ligamentar, nomeadamente em desportos com marcada solicitação dos movimentos de rotação do joelho, é justificada a necessidade de reconstrução do LCA na maioria dos casos. Objetivo (s): Avaliar a influência do tipo de enxerto na reconstrução do ligamento cruzado anterior na força muscular isocinética, assim como na funcionalidade e sintomas após 6 meses. Métodos: Estudo transversal analítico, constituído por 20 indivíduos voluntários do sexo masculino, que haviam sido submetidos a uma ligamentoplastia do cruzado anterior, pelo mesmo cirurgião, seguido de uma intervenção individualizada por um fisioterapeuta. Em 10 indivíduos, o procedimento cirúrgico foi realizado com enxerto do tendão rotuliano (grupo OTO), e nos restantes 10 com enxerto do semitendinoso e gracilis (grupo STG). Como forma de avaliar a Força Muscular Isocinética (Peak Torque, Trabalho Total Muscular, ratio Isquiotibiais/Quadricipite), foi utilizado o Dinamómetro Isocinético Biodex. A avaliação foi efectuada apenas aos 6 meses após o procedimento cirúrgico. Para observação da funcionalidade, amplitude de movimento e sintomas, utilizou-se o questionário International Knee Documentation Committee (IKDC). Resultados: Foi possível observar que entre os grupos apenas se observaram diferenças significativas no peak torque de extensão a 180º no membro não lesado (p=0,019). Contudo, foi observada uma tendência para o grupo OTO apresentar um maior défice no peak torque e trabalho total muscular em extensão. Comparativamente ao membro contra-lateral, o membro lesado apresentou valores significativamente inferiores na maioria das variáveis ( p < 0,05). Conclusão: Após 6 meses de pós-cirúrgico com reabilitação de fisioterapia, não foi possível apontar qual o enxerto que garante uma melhor recuperação da força muscular. Aos 6 meses, ambos os grupos ainda apresentaram limitações musculares, quando comparados com o lado contra-lateral. Relativamente ao rácio isquiotibiais/quadricípite, assim como no IKDC, não se observaram diferenças entre os dois tipos de enxertos.Background: The importance of the anterior cruciate ligament (ACL) in the normal function of the knee is well recognized overall. In case of ligament rupture, as in sports with high marked request of knee rotation movements, the necessity of the ACL reconstruction is justified in most of the cases. Aim(s): Evaluate the influence of the type of graft in the ACL reconstruction, on the isokinetic muscular strength. Methods: This study was an analytic transversal, composed by 20 voluntary male subjects that were submitted to a ligamentoplasty of the ACL, by the same surgeon and followed by an individualized intervention by the physical therapist. In 10 subjects the surgical procedure was performed with a graft from the patellar tendon (OTO group), and the other 10 with a graft from the gracile and semitendinosus (STG group). As a mean to evaluate the Isokinetic muscular strength (Peak Torque, Total Muscular Work, Hamstring/Quadricipitis ratio), the Biodex Isokinetic Dynamometer was used. The evaluation took place only after 6 months past the surgical procedure. Results: Between the two groups there were significant statistical differences only on the 180º extension peak torque in the non-injured side (p=0,019). A tendency for the OTO group was observed, as it represents a bigger deficit in the extension (peak torque and total muscular work) in comparison to the other side. Conclusion: Six months after the surgery, with physical therapy rehabilitation, it was not possible to determine which of the grafts guaranties a be tter muscular strength recuperation. On the 6 months mark, both the groups still presented muscular limitations, when compared to the other side

The cost of Public-Private Partnerships for the public partner : the road sector in Portugal

(PPPs) are often in the headlines of Portuguese newspapers. In this context, the purpose of this dissertation is to analyze the estimated costs with Public-Private Partnerships projects for the public partner in the road sector. Actually, over the last years, the National State Budgets presented different estimations for these costs. Therefore, I have the objective of assessing if there are explanations for these differences and which factors can affect the estimations. To accomplish this objective I analyzed each project and each State Budget, in order to identify potential reasons for the differences. After identifying the potential factors, that, based on the literature review, are likely to be responsible for the differences in the costs of PPPs, I computed an econometric model. This has as dependent variable the Net Present Value of the estimated costs for each project in each State Budget. Through the data and econometric analysis, one of the conclusions is that the estimated costs depend on the renegotiations verified in recent years. Other results are that a project has higher costs for the public partner if more risks are allocated to it, and that the economic situation of the country affects the estimations. Another reason is that during the period that was analyzed (from the State Budget of 2005 to 2014), new projects with expected costs for the public partner were launched. With this dissertation I identified some challenges for the public partner with the PPP model. As a conclusion, one of the main aspects that it has to improve is the transparency. The State Budgets should disclose more information and mainly explain significant deviations from the previous ones.Nos dias de hoje, os elevados custos suportados pelo Estado com Parcerias Público-Privadas (PPPs) são muitas vezes manchetes dos jornais portugueses. Neste contexto, o objetivo desta dissertação é analisar os custos estimados com Parcerias Público-Privadas do sector rodoviário para o parceiro público. Na verdade, ao longo dos últimos anos, os Orçamentos de Estado apresentaram diferentes estimativas para esses custos. Deste modo, pretendo avaliar se existem explicações para essas diferenças e quais os fatores que podem afetar as estimativas. Para atingir esse objetivo eu analisei cada projeto e cada Orçamento do Estado (OE), a fim de identificar possíveis razões para essas diferenças. Depois de identificar os potenciais fatores, que, com base na revisão de literatura, são mais susceptíveis de ser responsáveis pelas diferenças nos custos com PPPs, desenvolvi um modelo econométrico. Este tem como variável dependente o Valor Atualizado Líquido dos custos estimados para cada projeto em cada OE. Através dos dados e da análise econométrica, uma das conclusões retiradas é que os custos estimados dependem das renegociações verificadas nos últimos anos. Outros dos resultados foram que quanto mais riscos são alocados ao parceiro publico, mais elevados são os seus custos, e que a situação económica do país afeta as estimativas. Além disso, outra razão é que, durante o período analisado (os Orçamentos do Estado de 2005 a 2014), foram lançados novos projectos com custos para o parceiro público. Com esta dissertação identifiquei alguns desafios para o parceiro público com o modelo de PPP. Para concluir, um dos principais aspectos a melhorar é a transparência. Os Orçamentos de Estado devem divulgar mais informação e, principalmente, explicar os desvios mais significativos relativamente a estimativas anteriores

Equity valuation : Rolls-Royce PLC

The purpose of this thesis is to evaluate Rolls-Royce PLC. In order to do so, two valuation methodologies will be presented. The first one regards the Discount Cash Flow – WACC methodology, where each sector of the company is valued. By doing so, it is possible to reach a price per share of 1369 pence. Therefore, when using this methodology, the company is presented as a buying opportunity (the market yields a price of 1112 pence.) The second valuation presented and which is introduced as a second stage valuation is the multiples one. By using the price to earnings ratio, it is possible to value RR at 988 pence. With this methodology, the company is presented as a selling opportunity. Finally, when comparing the valuation introduced in this thesis to the one performed by J.P.Morgan, it is possible to conclude that this valuation is more conservative than the one presented by the investment bank (J.P.Morgan presents a price of 1420 pence). The differences in the assumptions will be further analyzed in this report

Mapping CMMI process areas to agile best practices

Dissertation presented as the partial requirement for obtaining a Master's degree in Information Management, specialization in Information Systems and Technologies ManagementTo maintain competitiveness, software development companies are pressured to deliver products in less time, without compromising on quality and budget. To meet this demand, companies often adopt Agile software development techniques that enable shorter delivery times through constant smaller deliveries and shorter interactive cycles in software development processes. Although the innovation and the decrease of development time provided by these techniques, companies have perceived that quality is a differentiated factor and feel the urge to maintain the quality of their software to stand out from the competitors. At this point CMMI is presented as a reference model that contains a set of practices which lead to the maturity of organizations with focus on the improvement of organization processes and reduction of processes risk of failure increasing quality. In contrast with Agile, that puts individuals and their interactions in higher importance than processes and tools and where being adaptable to changes is more important than following strictly what was planned, CMMI it is a strict traditional approach that implies extensive formalism and focus on the processes. Derived of those apparent opposite beliefs, Agile development methods and CMMI best practices are frequently perceived to be at odds with each other. There is a great discussion about CMMI ability to be Agile and Agile methods to adapt to CMMI requirements without losing agility. This study aims to map CMMI for development process areas to Agile best practices to help in the understanding of the compatibilities and incompatibilities regarding the integration of CMMI and Agile. That will guide companies into the successful integration of Agile and maturity models together taking full advantage of their capabilities leading to enhanced software development. With the integration of those two approaches it is expected that Agile practices can help mature organizations to become more flexible, and CMMI could help Agile organizations to increase processes quality, fulfilling their goals and having their competitiveness sustained

Associação entre alterações da composição corporal e o perfil cardiometabólico após cirurgia metabólica e bariátrica

Background: Some evidence suggests that different changes in body composition after Metabolic and Bariatric Surgery (MBS) may be distinctly associated with specific cardiometabolic outcomes. However, evidence is scarce and longitudinal studies describing body composition changes and their association with cardiometabolic markers are warranted. Objective: To evaluate the association of weight and body composition changes with the cardiometabolic profile, after MBS, considering a possible heterogeneity between Roux-en-Y Gastric Bypass (Bypass) and Sleeve Gastrectomy (Sleeve). Methodology: Longitudinal retrospective study in patients undergoing MBS at CUF Tejo Hospital, between September 2018 and March 2021.Anthropometric and body composition assessment data [weight, BMI, Fat Mass (FM) and Skeletal Muscle Mass (SMM)],as well as cardiometabolic markers [Total Cholesterol (TC), LDL, HDL and VLDL, Triacylglycerols, Fasting Glucose (FG) and Glycated Haemoglobin A1c], were collected in the electronic medical record from the preoperative evaluation until the follow-up of 6 months post-surgery, at four time points (pre surgery, 1, 3, and 6 months after surgery). Associations of anthropometric and body composition changes with cardiometabolic outcomes were estimated by regression coefficients (ẞ) and respective 95% confidence intervals (95%CI) by separate linear regression models for each marker. Results: No significant heterogeneity was observed between Bypass and Sleeve on the association with cardiometabolic markers. One month after surgery, we observed that decreased weight and BMI were significantly associated with lower HDL cholesterol levels at 3 months (ß=- 2,118 mg/dL; 95%CI: -2,970; -1,267; ß=-7,192 mg/dL; 95%CI: -9,485 ; -4,900, respectively).A decreased in SMM at 3 months after MBS, was associated with lower HDL cholesterol and TC at 6 months (ß=-9,612 mg/dL; 95%CI: -13,583; -5,640; ß=-16;296 mg/dL; 95%CI: -29,243; -3,349, respectively). After adjustment for sociodemographic characteristics, no significant associations were observed with the remaining cardiometabolic markers. Conclusion: Weight loss and the corresponding decrease in BMI are associated with a decrease in HDL cholesterol at 3 and 6 months of follow-up, with loss of SMM being the factor most strongly associated with this decrease

Carbon prices. Dynamic analysis of European and Californian markets

Dissertação para obtenção do Grau de Doutor em Alterações Climáticas e Políticas de Desenvolvimento SustentávelCarbon markets’ goal is to promote the reduction of emissions of greenhouse gases where it is most cost-efficient. This makes the price of the tradable good – carbon dioxide equivalent (CO2e) - a key variable in management and risk decisions, in markets related to activities connected with the burning of fossil fuels, such as power generation. This work aims to improve the analysis of carbon prices’ dynamics, considering the possibility of multidirectional effects between prices of CO2e, energy (primary and final), offsets licenses and the economy performance, in various frequencies. The two main research questions are: (i) what drives carbon price variations? (ii) what variations do carbon prices drive? We used two comple-mentary methodologies: (a) a vector autoregression model (of common use in macroeconomics and financial markets but not in carbon-energy relations), which allows the analysis of causality and of impulse-response functions of daily prices; and (b) an innovative multivariate wavelet analysis, which allows us to understand the relationship and causal link between the variables in the time and frequency dimensions, particularly in longer cycles (4~8 and 8~20 months), not perceived in previous studies. As case studies we considered the European (EU ETS) and Califor-nia (AB32) carbon markets. This is the first research to present the analysis of the referred US market. The analysis covers the 2008-2013 period, intentionally excluding the EU ETS phase I, for greater consistency of results. Results suggest that the economy and electricity drive the price of European carbon, while gas and oil have a greater role in California. So, there is a greater influence of final energy prices in the most mature market. We also observe that the price of CERs does not affect the European carbon price. On the other hand, this study shows for the first time that carbon prices have impacts on electricity prices over longer cycles (8~20 months) and in coal over short cycles (lim-ited to the first days). It is suggested that the carbon market has more significant effects in longer cycles. The price of European carbon also has impact in CERs prices. The results are statistically significant and relevant, and will improve the quality of decision making of all parties involved in the energy and carbon markets - polluters and regulators included

Prevalence of COVID-19 in health professionals and occupational psychosocial risks

Introduction: Health professionals who provide clinical care are exposed to patients potentially infected by the severe acute respiratory syndrome coronavirus 2 SARS-CoV-2), namely physicians and nurses; consequently, these professionals face higher risks of infection. Objectives: This study aimed to describe the prevalence of coronavirus disease 19 (COVID-19) cases among health professionals and the frequencies of risk factors and psychosocial risk. Methods: This is a cross-sectional study targeted at health professionals working in Portugal during the current COVID-19 pandemic. Data were obtained through a self-administered questionnaire available online at the websites of medical and nursing boards, among other sources. We performed a univariate analysis, calculating absolute and relative frequencies, and a bivariate analysis with a Pearson's chi-squared test. Results: We studied 4,212 health professionals, of which 36.7% (n = 1,514) worked in areas dedicated to the treatment of sick or suspected COVID-19 patients. Of these, 2.11% tested positive for SARS-CoV-2. Among all participants, 76.7% and 79.1% presented moderate to severe levels of fatigue and anxiety, respectively. Fatigue levels were significantly higher in professionals working in areas dedicated to the treatment of patients with COVID-19 (80.5% p = 0.01), but this difference was not observed regarding anxiety (79.5% p = 0.681). Conclusions: The percentage of health professionals who tested positive for SARS-CoV-2 was 2.11%. The reported high levels of fatigue and anxiety should determine a better protection of the health and safety of those who provide health care in the current pandemic.info:eu-repo/semantics/publishedVersio