CLUSTERING OF TERRITORIAL AREAS: A MULTI-CRITERIA DISTRICTING PROBLEM

Endogenous resources, economic profile and socio-economic issues are the criteria that define the development level and the identity features of a territorial unit. The territorial units that organize the country, in political and administrative terms – parishes and counties –, have a hierarquical structure, which initially reflected the organization of productive activities as well as the tradition State organization. The success of development policies addressed to territorial agglomerates depends on its homogeneity and of their territorial units. Facing to this the clustering of territorial areas can be stated as a districting multi-criteria problem. Thus, this paper aims to propose a framework for obtaining homogenous territorial clusters based on a Pareto frontier that includes multicriteria related to the territorial endogenous resources, economic profile and sociocultural features. This framework is developed in two phases. First, the criteria correlated with the development at the territory unit level are determined through statistical and econometric methods. Then, a multi-criteria approach is developed to allocate each territory unit to an agglomerate of territory according to the Pareto frontier established. The framework is applied to the context of a set of parishes and counties of the Alentejo Central region, southern Portugal. Results are presented and discussed in the scope of a regional strategy of development

Considering the inclusion of worth and values in the design of interactive artifacts

The development and design of computational artifacts and their current widespread use in diverse contexts (from work/task oriented to ludic applications) needs to take into account end-users needs, likes/dislikes and broader societal issues including human values. However, the fast pace of technological developments highlight the acknowledgment that the process of defining the computational artifacts not only needs to understand the user but also engineering and designers creativity. In order to take into account these issues, we have been exploring the utilization of a framework to guide our own development efforts. The Worth-Centred Design (WCD) can be seen as a conceptual framework that intends to facilitate the process of making explicit the connections between high level concepts related to desired ends/worth/values and simple/basic/atomic features composing an (or to be) artifact [1, 2]. In this paper, our insights as a heterogeneous design team regarding the use of the WCD framework are presented. More specifically, two on-going cases studies are considered: (a) one concerning the on-going development of situated digital public displays and (b) the development of games to assist therapists of children with emotional and cognitive impairments to conduct their daily therapeutic activities. The utilization of the framework definitely improved our understanding of the relationships between features and high-level interaction goals. The representational tools and the process of constructing them helped making explicit the design alternatives and the design team assumptions regarding artifact use. However, there are hurdles to conquer, in particular, the creation of common ground within the team in relation to the definition of the terms employed and assuring that the emergence of common ground does not hide fundamental differences regarding the meaning of the design elements uncovered. Furthermore, more research is needed in order to understand how to elicit values related to the artifact from the different stakeholders of a particular social context

Public Accountability and Sunshine Healthcare Regulation

The lack of economic sustainability of most healthcare systems and a higher demand for quality and safety has contributed to the development of regulation as a decisive factor for modernisation, innovation and competitiveness in the health sector. The aim of this paper is to determine the importance of the principle of public accountability in healthcare regulation, stressing the fact that sunshine regulation—as a direct and transparent control over health activities—is vital for an effective regulatory activity, for an appropriate supervision of the different agents, to avoid quality shading problems and for healthy competition in this sector. Methodologically, the authors depart from Kieran Walshe’s regulatory theory that foresees healthcare regulation as an instrument of performance improvement and they articulate this theory with the different regulatory strategies. The authors conclude that sunshine regulation takes on a special relevance as, by promoting publicity of the performance indicators, it contributes directly and indirectly to an overall improvement of the healthcare services, namely in countries were citizens are more critical with regard to the overall performance of the system. Indeed, sunshine regulation contributes to the achievement of high levels of transparency, which are fundamental to overcoming some of the market failures that are inevitable in the transformation of a vertical and integrated public system into a decentralised network where entrepreneurialism appears to be the predominant culture

Epicurean ethics - "Tetraphármakos" : some inquiries in Portuguese philosophical thought

Can we achieve a good life, endure pain and eliminate the fear of death? What is the role of philosophy and the philosopher in the face of practical and speculative concerns? The philosophy of Epicurus (341-270 BC) aims at "the health of the soul" through the rigorous knowledge of the Universe. This article aims at analysing the ethical proposal of the philosopher - his "tetraphármakos" (quadruple remedy to liberate the man). Below, two objections to his thinking are presented: on the one hand, Agostinho da Silva, criticizing Epicurean philosophy as a merely defensive method of pain; on the other hand, the characterization of the Epicurean legacy as unrealizable as a praxis ambition, as proposed by Fernando Pessoa's heteronym, Ricardo Reis.Poderemos alcançar uma vida boa, suportar a dor e eliminar o medo da morte? Qual o papel da filosofia e do filósofo ante inquietudes práticas e especulativas? A filosofia de Epicuro (341-270 a.C.) visa "a saúde da alma" através do rigoroso conhecimento do Universo. O presente artigo procura analisar a proposta ética do filósofo - o seu "tetraphármakos" (quádruplo remédio para libertar o homem). Apresentam-se, seguidamente, duas objeções ao seu pensamento: por um lado, Agostinho da Silva, criticando a filosofia epicurista enquanto método meramente defensivo da dor; e, por outro lado, a caracterização do legado epicureu como irrealizável enquanto ambição práxica, tal como propõe o heterónimo de Fernando Pessoa, Ricardo Reis

Analgesic interpatient variability of remifentanil assessed through pupillary dilation reflex

info:eu-repo/semantics/publishedVersio

The alcalar study: a quality of life comparative study on institutionalised elderly

Comparative evaluation on Quality of Life (QoL) perception on different communitarian residential institutional environments for senior citizens. Method: Cross-sectional comparative study, using a deductive and a descriptive statistical method on a sample of 50 senior citizens inhabitants in the Retirement-village St. Joseph of Alcalar (Alcalar group), 56 senior residents in traditional retirement homes (RSS group) and on 52 senior attendees of day care institutions (DCI group). This research comprised on two self-applicable questioners for elderly citizens on WHOQOL-BREF e WHOQOL-Old PT. We evaluated 158 senior citizens selected from 22 Institutions. Results: QoL levels perceived by Alcalar Retirement-village inhabitants were predominantly higher than QoL levels perceived by residents in RSS and DCI attendees. The trend in QoL results obtained by the Alcalar Retirement-village inhabitants just wasn't absolute because they were overcome by DCI attendees results in some (few) areas assessed in both WHOQOL scales. Conclusion: The Alcalar Retirement-village group globally showed higher levels of Quality of Life perception by comparison with the other two group subjects' residents and attendees, respectively, from RSS and DCI.FCT- Foundation for Science and Technology [UID/SOC/04020/2013

Endovascular Treatment of Internal Iliac Artery Aneurysms: Single Center Experience

Objective: Internal iliac artery aneurysms (IIAA) are rare, representing only 0.3% of aortoiliac aneurysms. Its treatment with open surgery is complex and associated with high morbidity and mortality, which led to increasing application of endovascular solutions. In this study, we aimed to evaluate outcomes of endovascular aneurysm repair (EVAR) of IIAA in one institution. Methods: We retrospectively reviewed all cases of IIAA treated with endovascular techniques between 2003 and 2014. Endpoints were morbidity, mortality, freedom from pelvic ischemic symptoms (buttock claudication, ischemic colitis, and spinal cord injury), and need for reintervention. Results: There were 16 patients, 13 males and 3 females, with mean age of 75.1±7 years. A total of 20 IIAA (4 cases were bilateral), with mean diameter of 37.9 mm, were treated. EVAR was performed in 13 (81.3%) patients, with associated internal iliac artery's outflow occlusion in 2. Iliac branch device was used in one patient. Two patients underwent endovascular IIAA embolization alone. One patient underwent percutaneous, transgluteal, IIAA embolization. IIAA flow preservation in at least one internal iliac artery was possible in 9 (56.3%) patients. Early mortality was 7% (1 case). Early morbidity was 18.8%. Pelvic ischemic complications occurred in 1 (7%) patient with buttock claudication. Late reintervention was needed in 3 patients, none of them for IIAA related complications. Conclusion: Endovascular treatment of IIAA is technically feasible and durable. Although overall morbidity is relatively high, major complications are infrequent and perioperative mortality is low. internal iliac artery flow preservation is technically challenging and, in a significant number of cases, not possible at all.info:eu-repo/semantics/publishedVersio

Trazodone Addition to Paroxetine and Mirtazapine in a Patient with Treatment-Resistant Depression: The Pros and Cons of Combining Three Antidepressants

Dual antidepressant combination for treatment-resistant depression is a strategy well supported by literature and accepted in clinical practice. Rather, the usefulness of the combination of more than two antidepressants is controversial. This may be related to the possibility of higher side-effect burden and to doubts about its pharmacological effectiveness and therapeutic advantage compared to other standard treatment options. We report a relapse of moderate-to-severe depressive symptoms with insomnia that successfully remitted after the addition of trazodone to a dual combination of paroxetine and mirtazapine (in standard effective doses) in a patient with treatment-resistant depression. We also review the literature and discuss the utility of triple antidepressant combination in treatment-resistant depression. This clinical case highlights the utility of combining trazodone as a third antidepressant for the relapse of depressive symptoms after the failure of a dual antidepressant combination. Trazodone may be advantageous in patients presenting recurrence of moderate-to-severe depressive symptoms that include sleep problems and/or insomnia and may be particularly useful when benzodiazepines are not recommended. Although its use may be controversial and associated with higher risk of side-effects, more investigation is needed to determine the efficacy and safety for triple antidepressant combinations as reliable strategies for treatment-resistant depression in clinical practice

Pupillary pain index correlates with postoperative pain scores in neurosurgical patients

info:eu-repo/semantics/publishedVersio

ISOLATED ABDOMINAL AORTIC DISSECTION – A DIFFERENT ANIMAL? – CASE SERIES

Introduction: Isolated abdominal aortic dissection (IAAD) is a relatively rare event and precise indications for treatment aren't clearly defined. Its natural history is not fully understood due to the rarity of the disease and to the fact that most surgeons have a low threshold to intervene in these patients. Open surgery represents the classical treatment but endovascular intervention has gained wide acceptance in most centers and is now the most frequently adopted treatment option. The largest series of treated patients are from Asian centers with the largest of them comprising only 33 cases whereas in western surgical centers the largest series contains only 21 patients. Methods: Single center, retrospective, observational, study of patients with IAAD who were treated with open or endovascular surgery. Results: We describe eight patients with IAAD who underwent treatment in our institution (four males and four females). Median age at presentation was 78 years and all patients were asymptomatic. Median aortic diameter at presentation was 30mm (14-85mm). All but one patient underwent endovascular treatment. Three patients were treated with bifurcated aortic endografts, three patients had a single stent-graft (iliac limbs of aortic endografts) implanted and one patient underwent a CERAB procedure for coexistent stenotic disease of the aortic bifurcation. There were no perioperative deaths. Median follow-up was 6,2 years (2 months-13 years). Late reintervention was needed in one patient, 8 years after initial surgery, due to a type 1 endoleak. Conclusion: According to our experience, endovascular intervention represents a safe and durable treatment option in IAAD, however, long-term follow-up is mandatory. Larger studies with longer follow-ups are needed to understand this disease