A importância da Telessaúde no âmbito da medicina propagou-se de forma exponencial, demonstrando capacidade de maximizar resultados, sendo utilizada rapidamente na área de Fonoaudiologia, podendo ser denominada de Telefonoaudiologia. Os resultados nesta área tornaram-se produtivos, possibilitando educação continuada mediada por tecnologia aos profissionais e disponibilizando atendimentos aos usuários que se encontram distantes dos centros médicos, tanto para realização de diagnósticos quanto para tratamento. O presente trabalho tem por objetivo desenvolver um instrumento para criar linhas de orientação das pesquisas dos projetos elaborados pelos docentes do Departamento de Fonoaudiologia da Faculdade de Odontologia de Bauru na área de Telessaúde, para identificar os pontos fortes e fracos destes projetos, como também as possíveis causas. Para isso, inicialmente foi aplicado um questionário específico, abordando quatro competências distintas: administrativa, tecnológica, financeira e de sustentabilidade. A pesquisa identificou que 11 docentes do Departamento de Fonoaudiologia desenvolviam projetos na área de Telessaúde. Dessa forma, os mesmos foram entrevistados para a aplicação do questionário, cujos resultados foram inseridos em planilha específica, analisados por meio de estatística descritiva e interpretados com a aplicação da Matriz SWOT, que possibilitou identificar os pontos fortes e pontos fracos dos projetos. Além disso, foi utilizado o Diagrama de Ishikawa para identificar os efeitos observados e posteriormente a identificação das causas. A interpretação dos resultados obtidos por meio da análise de trinta e dois projetos possibilitou verificar que o desempenho produtivo está concentrado na competência administrativa, também denominada de pontos fortes, obtidos a partir da pontuação máxima de 1034 pontos (87,33%) em relação ao total de pontos. Foram constatados como pontos fortes a missão do projeto, a qualidade das informações, os canais de comunicação e os benefícios proporcionados aos usuários, tendo como principais causas a utilização de multimeios específicos, a educação continuada, a quantidade de informações disponibilizadas e o comprometimento do capital humano. Em relação aos pontos fracos dos projetos de Telessaúde, constatou-se que a competência de sustentabilidade apresentou uma pontuação de 250 pontos (65,10%), indicando como fatores negativos a ausência de especialização da mão de obra em determinadas etapas do projeto, a falta de atualização de hardware e software, a exclusão digital dos usuários e a obsolescência do projeto. As principais causas desses pontos fracos estão concentradas na dificuldade de suporte técnico, profissionais para divulgação e treinamento, estratégias de marketing e a manutenção dos projetos desenvolvidos. Conclui-se que os pontos fortes estão concentrados na competência administrativa, sendo que o domínio desta competência proporciona a elaboração de planejamentos estratégicos, criando ações para tornar as instituições mais produtivas e competitivas. Os pontos fracos dos projetos estão identificados na competência de sustentabilidade, necessitando de ações específicas para diminuir os efeitos negativos durante a execução destes projetos pelos seus responsáveis. A pesquisa mostrou que o domínio dos pontos fortes e pontos fracos dos projetos, associados a especialização do capital humano, a maximização do tempo e a atualização dos recursos digitais são insumos importantes para ampliar os benefícios dos projetos de Telessaúde, rumo a vantagem competitiva organizacional. / Telehealth is a most important subject in medicine department because it shows how to maximize results and how to be used by Speech Therapy, being called Telepractice in Speech. Results in this area have become productive. It allows to professionals continued education mediated by technology and treatment or diagnostic by distance to users of medical centers. This work aim to develop a tool that would be able to create project research sides elaborated by teachers relationed to Fonoaudiologia da Faculdade de Odontologia de Bauru in Telehealth field. Thus, strengths and weak points and their causes and effects would be identified. First of all, a specific questionary was applied which addressed four topics: administrative, technological, financial and sustainability. The research identified that 11 teachers have been a project in Telehealth area. These teachers were interviewed to questionary application and its results were inserted in a specific spreadsheet. They were analyzed through descriptive statistics and interpreted by SWOT analysis that allows identify strengths and weak points present in projects. Besides, Ishikawa diagram was used to identify effects and, after that, causes. There were 32 projects. After analysis, it was verified that productive performance is focused in administrative skill, also called strengths which effect was acquired through maxim punctuation of 1034 points (87.33 per cent). It was checked many strengths such as project mission, information quality, communication channels and their benefits to users, being their causes using specific technologies, continued education, quantities of disponibilized information and human capital commitment. In relation to weak points, it was verified that sustainability skill presented 250 points (65.10 per cent), showing negative facts such as missing specialization work force in some phases of projects, missing actualized hardware and software, user digital exclusion and project obsolescence. These weak points are focused by difficulties to get technical support, professionals for releasing and training, marketing strategies and manutention of developed projects. In conclusion, it is known that strengths are focused in administrative skills because they provide strategic planning elaboration, creating actions to organization become more productive and competitive. Weak points are identified in sustainability skill, needing specific actions to decrease negative effects during project execution by responsible professionals. This research showed that weak points and strengths and human capital, time increasing and actualized digital resources are important inputs to extend Telehealth project benefits, intending to organization advantage competitive.

Mobile health (mHealth) can be defined as the practice of medicine and public health supported by mobile computing technologies, such as mobile phones, PDAs, tablets, sensors and other wireless devices. Particularly in the case of mobile phones, there has been a significant increase in the number of lines, equipment, and network infrastructure in Low- and Middle-Income Countries (LMIC), allowing the adoption of mHealth systems efficiently. There are now several cases of systems for data collection focused on primary care, health surveillance and epidemiological research, which were adopted in these countries. Such systems provide health care managers information with higher quality and in a shorter time, which in turn improves their ability to plan actions and respond to emergencies. However, security is not included among the main requirements of such systems. Aiming to address this issue, we developed a survey about mHealth applications and research initiatives in Brazil, which shows that a reasonable number of papers only briefly (13%) or simply do not mention (40%) their security requirements. This survey also provides a discussion about the current state-of-art of Brazilian mHealth researches, including the main types of applications, target users, devices employed and the research barriers identified. After that, we present the SecourHealth, a security framework for mHealth data collection applications. SecourHealth was designed to cope with six main security requirements: support user registration and authentication mechanisms; treat network disconnections and delays; provide a secure data storage - even in case of possible theft or loss of equipment; allow secure data exchange between the device and server; enabling device sharing between users (i.e., health workers); and allow trade-offs between security, performance and usability. This thesis also describes in detail the framework modeling and development steps showing how it was integrated into an application for the Android platform. Finally, we benchmarked the cryptographic algorithms implemented, when compared to the overhead of using HTTPS protocol. / Saúde Móvel (mHealth) pode ser definida como a prática médica e a saúde pública suportadas por tecnologias de computação móvel, como: telefones celulares, PDAs, tablets, sensores e outros dispositivos sem fio. Particularmente no caso dos celulares, há um aumento expressivo no número de linhas, aparelhos, e na infraestrutura de rede em países de média e baixa renda (Low- Middle- Income Countries, LMIC), permitindo a adoção de sistemas mHealth de maneira eficiente. Existem, hoje, vários casos de sistemas de coleta de dados voltadas à atenção primária, vigilância (em saúde) e pesquisas epidemiológicas adotados nesses países. Tais sistemas fornecem aos gestores de saúde uma informação de melhor qualidade em menor tempo, que por sua vez melhoram a capacidade de planejamento e resposta a emergências. Contudo, nota-se um relaxamento no cumprimento de requisitos de segurança nestes sistemas. Com base nisso, foi feito um levantamento de aplicações e iniciativas de pesquisa em mHealth no Brasil, no qual se constatou que um número razoável de trabalhos mencionam fracamente (13%) ou não menciona (40%) os requisitos de segurança. Este levantamento também discute sobre o estado atual das pesquisas de mHealth no Brasil, os principais tipos de aplicações, os grupos de usuários, os dispositivos utilizados e as barreiras de pesquisa identificadas. Em seguida, este trabalho apresenta o SecourHealth, um framework de segurança voltado ao desenvolvimento de aplicações de mhealth para coleta de dados. O SecourHealth foi projetado com base em seis requisitos principais de segurança: suportar o registro e a autenticação do usuário; tratar a desconexão e os atrasos na rede; prover o armazenamento seguro de dados prevendo possibilidades de furto ou perda dos aparelhos; fazer transmissão segura de dados entre o aparelho e o servidor; permitir o compartilhamento de dispositivos entre os usuários (e.g., agentes de saúde); e considerar opções de compromisso entre segurança, desempenho e usabilidade. O trabalho também descreve com detalhes as etapas de modelagem e desenvolvimento do framework - que foi integrado a uma aplicação para a plataforma Android. Finalmente, é feita uma análise do desempenho dos algoritmos criptográficos implementados, considerando o overhead pelo simples uso do protocolo HTTPS.

Avaliou-se a eficácia de um procedimento de teleconsulta baseado na internet para a verificação do aparelho de amplificação sonora individual (AASI) por meio da realização de medidas com microfone sonda em adultos deficientes auditivos. Foram comparados os valores da amplitude da resposta de ressonância da orelha externa (REUR), resposta de ressonância da orelha externa com uso da amplificação (REAR) e o ganho de inserção (REIG) realizados face a face (F) e à distância (D). O erro casual das medidas da REUR, REAR e REIG realizadas pelos dois métodos foi analisado. Participaram do estudo: grupo A: sessenta adultos (média de idade de 67 anos) com deficiência auditiva unilateral (n=15) ou bilateral (n=45), totalizando 105 orelhas; grupo B: 19 adultos (média de idade de 28 anos) sem queixas auditivas (19 orelhas). Os AASIs utilizados foram do tipo mini-retroauricular e não possuíam microfone direcional ou algoritmos de cancelamento de retroalimentação e/ou redução de ruído. Para o grupo B foi feito ajuste do AASI resultando na menor saída possível. Cinco fonoaudiólogos voluntários auxiliaram na coleta dos dados à distância. O procedimento face a face foi realizado pela pesquisadora em todos os participantes, utilizando-se o equipamento Unity PC Probe Mic (Siemens) conectado a um computador pessoal. Para realização das medidas à distância esse computador foi conectado à LAN (10 Mpbs). O participante e o fonoaudiólogo voluntário se posicionaram na sala junto ao equipamento (ambiente de teste). A pesquisadora posicionou-se em outra sala denominada ambiente remoto juntamente com um notebook também conectado à LAN. Webcams e headsets foram utilizados para a captura de audio e video, transmitidas em tempo real pelo software Polycom PVX, o qual também foi utilizado para compartilhamento de aplicativos. Por meio desse compartilhamento a pesquisadora realizava as medidas diretamente no participante, com auxílio do fonoaudiólogo voluntário. Quatro repetições das medidas da REUR, REAR e REIG foram obtidas apenas para o grupo B. Correlações (Pearson) muito fortes e significativas foram obtidas entre as medidas realizadas face a face (F) e à distância (D). O teste t pareado revelou diferenças pequenas, porém significativas entre as medidas F e D para a REUR e REAR. A ANOVA mostrou diferenças significativas entre as repetições realizadas. Diferenças entre os métodos F e D foram obtidas apenas na freqüência de 2000 Hz. Os erros causais obtidos pelas medidas face a face e à distância foram muito semelhantes. As diferenças e variações encontradas entre as medidas face a face e à distância não foram maiores do que a magnitude de variabilidade do próprio procedimento de medidas com microfone sonda. É possível realizar medidas de microfone sonda confiáveis via teleconsulta / telessaúde baseada na internet. Outras investigações são necessárias para validar esse procedimento. / The efficacy of an internet based teleconsultation for hearing aid probe microphone measures in hearing impaired adults was evaluated. The amplitudes of face to face (F) and remote (R) real ear unaided response (REUR), real ear aided response (REAR) and real ear insertion gain (REIG) were compared. The measurement error for repeated measures of REUR, REAR and REIG was analyzed. Participated in this study: group A: 60 adults (mean age: 67 years), with unilateral (n=15) or bilateral (n=45) hearing loss, totalizing 105 ears; group B: 19 normal hearing adults (mean age: 28 years) totalizing 19 ears. Behind the ear hearing aids with no directional microphone, noise reduction and/or feedback cancellation were used. For group B these hearing aids were adjusted as to produce the least amount of gain and output. Five audiologists volunteers helped the data collection. The Unity PC Probe Mic (Siemens) coupled to a personal computer were used by the researcher to carry out face to face measures. For the remote measures this equipment was connected to a local area network (LAN 10 Mpbs). The volunteer and the participant were located in this room (test site). At the remote site the researcher used a notebook connected to the LAN. Webcams and headsets were used for audio and video capture which was transmitted in real time by the Polycom PVX software, which was also used for application sharing. By means of remote controlling of the PC Probe Mic equipment the researcher could perform the remote real ear measurements in the participants. Four repeated measures of REUR, REAR and REIG were obtained for group B only. Strong and significant correlations (Pearson) were obtained between face to face and remote real ear measures. Paired t tests revealed small but significant differences between face to face and remote REUR and REAR. Analysis of variance showed significant differences between repeated measures. Measurement errors for face to face and remote real ear measures were very similar. The differences as well as errors found between face to face and remote measures were never higher than the reported variability for probe microphone measures themselves. It is possible to carry out probe microphone measures by means of teleconsultation / telehealth. Further investigations to validate this procedure are necessary.

O objetivo do presente estudo foi verificar a acurácia diagnóstica da imagem clínica obtida pela câmera acoplada ao telefone celular, comparada ao diagnóstico clínico presencial e ao diagnóstico histopatológico em tumores palpebrais. Métodos: Pacientes sob demanda espontânea, foram recrutados. Foram incluídos pacientes encaminhados para avaliação e exérese de tumor palpebral benigno ou maligno. Avaliação presencial foi realizada constando de anamnese, avaliação externa macroscópica e biomicroscópica com estabelecimento de diagnóstico clínico. Todos os pacientes tiveram as lesões palpebrais documentadas com um smartphone Samsung S4 (imagens de 4128x 3096 pixels), salvas em formato JPEG. Todas as lesões foram ressecadas e submetidas à exame histopatológico. Três especialistas em Plástica Ocular em outro país fizeram a teleavaliação das imagens na tela de um laptop (2366x768 pixels). Verificou-se a concordância entre o padrão-ouro (histologia) e os diagnósticos presencial e à distância. Resultados: Foram avaliados 75 casos por exame presencial e por imagem. A idade média dos pacientes foi de 66,6 anos com predominância do sexo feminino (44 mulheres). As lesões ocorreram com maior frequência nas pálpebras inferiores (57 casos - 76%). O tamanho médio das lesões foi de 9,36 mm (DP 7,37). Trinta e quatro (45,33%) eram benignas e 41 (54,67%) malignas. O diagnóstico anatomopatológico maligno mais comum foi o carcinoma basocelular com 27 casos (36%) e o benigno mais comum foi o nevus com 10 casos (13,33%). Os examinadores virtuais acertaram cerca de 50% do diagnóstico histológico enquanto o presencial foi de 76%. Quanto ao diagnóstico de malignidade, o estudo mostrou alta concordância da teleavaliação (sensibilidade de 85-90%) - praticamente igual ao exame presencial - 88%. Nas lesões benignas, por telemedicina houve 74-88% de acertos (alta concordância), contra 100% de acertos no exame presencial. A acurácia média via telemedicina do diagnóstico de malignidade de lesão foi de 83% contra 93% do exame presencial. O tamanho da lesão também se relacionou positivamente com diagnóstico de malignidade tanto no exame presencial quanto na teleavaliação. Conclusões: A avaliação de lesões palpebrais usando smartphone e Telemedicina nas condições deste estudo, é viável, sendo alta a concordância para o reconhecimento de tumores palpebrais malignos. Quanto ao diagnóstico histopatológico, o exame à distância foi menos acurado que o exame presencial. Os resultados deste estudo sugerem que a avaliação de tumores palpebrais através da Telemedicina é um bom método que pode ter aplicações práticas em populações com acesso restrito a médicos especialistas, com grandes vantagens para fins de saúde pública / The objective of this study was to check the diagnostic precision of clinical image obtained by the phone camera of smartphones compared to face-toface clinical diagnosis and histopathological diagnosis of eyelid tumors. Methods Patients on spontaneous demand were recruited. We included patients referred to evaluation and resection of benign or malignant eyelid tumors. The face-to-face evaluation was done to establish the clinical diagnosis: anamnesis, external macroscopic evaluation and biomicroscopic exam. Every patient had pictures of eyelid lesions taken with a smartphone Samsung S4 (images of 4128x 3096 pixels) and saved in jpeg format. All lesions were resected and had the histologic evaluation. Three Oculoplastics experts in another city abroad performed images tele evaluation at the laptop screen with a resolution of 2366x768 pixels. We investigated concordance between the gold standard (histology) and the face-to-face and telemedicine diagnosis. Results Seventy-five lesions were evaluated face-to-face and by images. The mean age was 66.6 years, with the predominance of women (44). The lesions were more frequent at lower eyelid (57 cases- 76%). The mean size was 9.36 mm (DP 7.37). Thirty-four (45.33%) were benign and 41 (54.67) malignant. The most frequent malignant histopathological diagnosis was basal cell carcinoma with 27 cases (36%), and the benign was nevus with 10 cases (13.33%). Tele examiners answered correctly 50% of histological diagnosis, and face-to-face examiner matched 76%. The study showed a high correlation between tele evaluation and face- to- face exam at malignity diagnosis (sensibility= 85-90%, mean accuracy = 83.3% against 88% and 93%). At benign lesions, with Telemedicine, there are 74-88% of correct answers against face- to - face 100% hits. Lesion size correlated positively with malignity diagnosis at face - to- face and by telemedicine exam. Conclusions Eyelid lesion evaluation by telemedicine in this study conditions was viable. It showed high concordance to recognize malignant eyelid tumors. However, histological diagnosis was less accurate at telemedicine when compared to face - to- face exam. These results indicate that eyelid tumors evaluation by telemedicine is a suitable method. It can have practical applications in communities where experts are few, so providing advantages at public health

Esta pesquisa tem como objetivo desenvolver e avaliar um website com informações na área de Fonoaudiologia com enfoque no processo de envelhecimento. Foi elaborado um website contendo informações com linguagem simples, objetivo claro e conteúdo conciso, baseado em evidências científicas Utilizou-se o índice de Flesch para verificar a legibilidade do material, encontrando-se em 50% do conteúdo o correspondente a fácil e em 50% do conteúdo o correspondente a difícil. A elaboração do website seguiu as etapas: análise e planejamento, modelagem, implementação e avaliação. Foram convidados avaliadores que fizeram parte das categorias: idoso (I), cuidador de idoso (CI) e fonoaudiólogo (F). A amostra foi composta por 10 idosos (média etária de 63,60 anos), 8 cuidadores de idosos (média etária de 42,63 anos) e 10 fonoaudiólogos (média etária de 27,70 anos). A maioria dos indivíduos é (89,28%) do sexo feminino, que frequentemente acessavam a Internet (78,57%) e de diferentes níveis educacionais. A análise estatística foi realizada por meio do teste Kruskal-Wallis e Coeficiente de Correlação de Spearman. O conteúdo do website foi avaliado como adequado com maior classificação no submenu 6 (91,9%) e menor no submenu 2 (80,8%). Ao comparar o escore geral do questionário de avaliação do conteúdo entre as categorias encontrou-se diferença estatisticamente significativa entre CI x F de acordo com o teste Kruskal-Wallis, sendo p=0,017. Ao analisar cada submenu de acordo com as categorias, encontrou-se diferença estatística nos submenus 1 e 5 também entre as categorias CI x F, com as melhores avaliações realizadas pela categoria F. A avaliação da qualidade técnica do website apresentou-se como excelente, cuja subescala com maior classificação foi o Precisão (100%) e a menor foi Autoria (94,4%). Não houve diferença estatisticamente significativa entre as categorias e as subescalas ou o escore geral. Conclui-se que o website e seu conteúdo sobre o Processo de Envelhecimento compõem uma fonte de consulta ou de complementação de informações fidedignas. / This research aims to develop and evaluate a website with information on Speech-Language Pathology area with focus on the aging process. A website containing information with simple language, clear purpose and concise content was designed, based on scientific evidence. The Flesch index was used to check the material readability, being 50% of the content corresponding to \"easy\" and 50% of the content corresponding to \"difficult\". The website development followed the steps: analysis and planning, modeling, implementation and evaluation. Evaluators who were part of the following categories had been asked to participate: elderly (E), elderly caregiver (EC) and speech-language pathologists (SLP). The sample consisted of 10 elderly (average age of 63.60 years), 8 elderly caregivers (average age of 42.63 years) and 10 speech-language pathologists (average age of 27.70 years). Most individuals (89.28%) were females, which often accessed the Internet (78.57%) and of different educational levels. Statistical analysis was performed using the Kruskal-Wallis test and Spearman correlation coefficient. The website\'s content was rated as \"adequate\" with highest ranking in subsection 6 (91.9%) and lowest ranking in subsection 2 (80.8%). Comparing the overall score from the questionnaire of content evaluation between the categories there was a statistically significant difference between EC x SLP according to the Kruskal-Wallis test, in which p=0.017. Analyzing each subsection according to categories, a statistical difference in subsections 1 and 5 was found, also among the EC x SLP categories, with the best ratings by SLP category. The evaluation of the websites technical quality was presented as \"excellent\", which subscale with the highest rating was \"Accuracy\" (100%) and the lowest rating was \"Authorship\" (94.4%). There was no statistically significant difference between the categories and subscales or the overall score. It was concluded that the website and its contents on the Aging Process compose a source of consultation or complementation of reliable information.

As medidas com microfone sonda constituem o método preferencial para a verificação do Aparelho de Amplificação Sonora Individual in situ. No Brasil apenas uma pequena parcela dos fonoaudiólogos que atuam em serviços públicos realiza esse procedimento devido, principalmente, à fragilidade de treinamento profissional. O treinamento profissional continuado, aliado a um processo de preceptorado, tem potencial para modificar esta realidade. O uso da teleconsulta como forma de preceptorado clínico vem sendo sugerido na literatura e pode representar uma oportunidade importante de integração entre ensino e serviço. O objetivo do estudo foi avaliar a eficácia de um treinamento online e da teleconsulta síncrona para preceptorado clínico na realização de procedimentos de verificação do aparelho de amplificação sonora individual in situ. Participaram do estudo 50 fonoaudiólogos que atuavam no processo de seleção e verificação do AASI nos serviços públicos de Reabilitação Auditiva sendo divididos de maneira aleatória em grupos controle (n=25) e experimental (n=25). Todos os participantes tiveram acesso a um material educacional online (plataforma Moodle) sobre as medidas com microfone e sonda. No decorrer do curso realizaram procedimentos de avaliação formativa e somativa. Posteriormente, o grupo experimental participou de teleconsultas síncronas. A inabilidade para interpretação de resultados, manuseio dos equipamentos e fragilidade do treinamento profissional foram fatores que interferiram na adoção ou dificultaram o uso das MMS na prática clínica, anteriormente ao treinamento. Não foram observadas diferenças estaticamente significativas (teste U de Mann-Whitney) entre os grupos no acesso aos conteúdos do curso, nas reações ao desempenho do instrutor, a interface gráfica e ao treinamento e no benefício do treinamento online. Ocorreu diferença significativa (teste de Friedman) para análise dos acessos intragrupo. Houve correlação (Spearman) significativa e positiva entre os resultados de reação e o instrutor e com a interface gráfica. A teleconsulta foi mais utilizada com o propósito de equiparar as respostas obtidas com AASI ao target de prescrição e, ao longo do tempo, a frequência de solicitação de teleconsultas para o grupo experimental foi sendo reduzida. Concluiu-se de um modo geral que o treinamento online foi bem avaliado em todos os quesitos pelos participantes, assim como as teleconsultas e que houve benefício do treinamento nas habilidades dos participantes em interpretar os resultados das medidas com microfone sonda e tomar condutas clinicas compatíveis. Ambos os grupos apresentaram melhora para resoluções de casos clínicos após o treinamento realizado. Combinar a teleconsulta ao treinamento online não impactou estes resultados do benefício. / The microphone probe measurements are the preferred method for the verification of individual sound amplification device in situ. In Brazil only a small portion of the audiologists who work in public services does so mainly due to the fragility of professional training. Continued professional training, coupled with a preceptorship process, has the potential to change this reality. The use of teleconsultation as a form of clinical preceptorship has been suggested in the literature and may represent an important opportunity for integration between teaching and service. The objective of the study was to evaluate the effectiveness of an online training and synchronous teleconsultation for clinical preceptorship in procedures for verification of individual hearing aid in situ. The study included 50 audiologists who worked in the selection and verification of hearing aids in public service of Auditory Rehabilitation, divided randomly into control group (n=25) and experimental group (n=25). All participants had access to an online educational material (Moodle platform) on measures with microphone and probe. During the course they conducted formative and summative assessment procedures. Subsequently, the experimental group participated in synchronous teleconsultation. The inability to interpretation of results, handling equipment and fragility of professional training were factors that interfered in the adoption or hindered the use of MMS in clinical practice, prior to the training. Statically significant differences weren\'t observed (Mann-Whitney U test) between groups in access to course content, in response to instructor performance, the graphics and the training and efficiency of online training interface. Significant differences (Friedman test) occured for analysis of intra-group access. There was a significant and positive correlation (Spearman) between results of the reaction and the instructor and with the graphical interface. The teleconsultation was more used in order to match the responses obtained with HA to target prescription and over time, the frequency of teleconsultation request to the experimental group was reduced. It was concluded, in general, that online training was well rated in all aspects by the participants, as well as telconsultas and that the training was beneficial on the skills of the participants in interpreting the microphone probe measurements and take compatible clinical behavior. Both groups showed improvement in clinical cases resolutions after the training conducted. Combining teleconsultation with the online training did not affect these results the benefit.

A emergência de resistências bacterianas, principalmente quando associadas ao ambiente hospitalar, representa, mundialmente, um problema de saúde pública. A diversidade de mecanismos de resistências configura um desafio terapêutico e a escolha de antibióticos deve ser individualizada e baseada em antibiogramas locais. O laboratório de microbiologia representa um apoio estratégico para o rápido diagnóstico das doenças infecciosas e deve funcionar com sistemas de alerta para informar a comunidade médica sobre novos mecanismos de resistência bacteriana. O objetivo deste estudo foi estruturar e aplicar um curso de extensão universitária em microbiologia clínica por meio de teleducação interativa para capacitação de profissionais. O conteúdo científico foi definido em função das competências associadas à prática laboratorial. O curso foi estruturado em onze módulos divididos em três semestres, sendo 70% a distância, 22% presencial e 8% do tempo dedicado a monografia, como modelo misto, com ambientes de aprendizagem a distância e presencial integrados. Em todos os módulos foram propostos estudo a distância, tarefas para o estímulo à pesquisa bibliográfica (revisão de artigos e questionários) e aulas presenciais, teóricas e práticas. O grupo de alunos foi composto por 28 participantes com perfil diversificado, médicos e microbiologistas, originários de vinte cidades brasileiras diferentes. Dois dos motivos para a participação dos alunos foi a flexibilidade do tempo e local de estudo, reduzindo a ausência do seu local de trabalho. O desempenho demonstrado pelo grupo durante o curso foi satisfatório. Após um ano do término do curso foi realizada uma visita ao ambiente de trabalho dos alunos para correlação do seu desempenho no curso com as mudanças realizadas na prática da rotina microbiológica. Houve uma diferença significativa entre os índices de mudanças nas práticas microbiológicas realizadas nos locais de trabalho dos alunos, antes e depois da sua participação no curso, sendo que 76,9% dos procedimentos verificados foram modificados. Na avaliação subjetiva, os participantes informaram que o curso promoveu mudanças comportamentais e que voltariam a se matricular em um modelo educacional semelhante. A qualificação profissional estimulou a autonomia profissional. O uso de tecnologias interativas permitiu a participação de profissionais de diversas regiões do país, representando uma alternativa para inovação do processo de ensino em microbiologia clínica. O resultado deste estudo indica perspectivas para a consolidação do uso da teleducação interativa para criação de programas de educação continuada / The emergence of bacterial resistance, especially when associated with the hospital environment, represents a worldwide public health problem. The diversity of resistance mechanisms forms an important therapeutic challenge, and the selection of antibiotics should be individualized and based on local and institutional antibiograms. Microbiology laboratories represent a strategic support for a fast diagnosis of infectious disease to notify the medical community about new mechanisms of resistance. This study aimed to design and implement an academic extension course in clinical microbiology via interactive tele-education for training of professionals. The scientific content was defined according to competencies associated with laboratory practices. The course was structured in eleven modules divided into three semesters: 70% distance learning, 22% on campus (mixed model with distance learning environments and integrated presence) and 8% monographs. All the modules have been proposed for remote study, to present tasks for the investigation of the literature (review articles and questionnaires), as well as for the on-campus classroom, from both a theoretical and practical perspective. The group of students was composed of 28 physicians and microbiologists with diverse profiles from 20 Brazilian cities. Two reasons students gave for their participation were the need for scheduling flexibility and the need for a place to learn that would not require absence from their place of work. The performance demonstrated by the group during the course was satisfactory. A year after finishing the course, visits were made to the students work environments to correlate performance with the changes made in routine microbiological practice. A significant difference was found between the rates of change in microbiological practices conducted in the workplaces of the students before and after their participation in the course; 76.9% of modified procedures were verified. In subjective evaluation, the participants reported that the course promoted behavioral changes and that they would return to enroll in a similar educational model. The qualification stimulated professional autonomy. The use of interactive technologies allowed the participation of professionals from various regions of the country, representing an alternative to the innovation of teaching in clinical microbiology. The results indicate prospects for the consolidation of the use of interactive tele-education to create programs of continuing education

近年來感測器、集成電路及無線通信的科技迅速發展，促使IEEE802.15工作小組6（TG6）致力硏究一個新的無線通信標準─人體區域網路（BAN）。這個新標準特別考量在人體上、人體內或人體周邊的應用。雖然BAN至今還未達成最後定案，不同類型的應用方案已被廣泛提出。這些方案可分為醫療應用（例如：生命徵象感測和植入式治療）及非醫療應用（例如：消費性電子、個人娛樂和遙遠控制）。無線感測節點〈WSN）的基本要求包括輕巧、廉價及低耗電量。因此，本論文提出了一個符合以上要求的注入式鎖態發射機。此外，我們設計了三個發射機的內部模組。由於BAN的物理層例如調變方式和頻譜配置還未完全製訂，本文的電路設計將基於IEEE802.15 TG6的初步建議。 / 第一個模組是一個利用同相位雙路輸入及電流再使用技術的次毫瓦、第一次諧波LC注入式鎖態振盪器〈ILO）。該振盪器操作範圍在醫療植入式通訊服務〈MICS）頻段，並已採用了0.13-μm CMOS工藝實現而僅佔有200 m x 380 m芯片面積。實驗結果表明，在輸入動力0 dBm時，其鎖定範圍可達800 MHz (150 950 MHz) 。最重要的是，該ILO擁有-30 dBm的高輸入靈敏度，同時在1-V供電下只消耗660 A靜態電流。超低的靜態電流使WSN能從人體收集能量而變得完全自主。 / 第二個模組是一個低功耗MICS非整數型頻率合成器，其目的在於選擇信道。雖然整數鎖相環由於其低複雜性而被廣泛使用，對MICS頻段而言並不是一項良好方案。主要原因在於其信道寬只有300 kHz，速度、頻率解析度和相位雜訊變得很難平衡。為此，我們採用0.13-μm CMOS製程設計了一個4階第二型和差積分〈Σ-）調變器分數鎖相環。為了抑制混附單頻信號，二階單迴路數字Σ-調變器加入了抖動。仿真結果顯示該頻率合成器能在15 s內鎖定，同時在1.5-V供電下只消耗4 mW功耗。 / 第三個模組是一個高效能、完全集成的E類功率放大器〈PA）。該PA採用了自給偏壓反相器作為前置放大器，操作範圍在MICS頻段及工業、科學和醫學〈ISM）頻段。在0.18-m CMOS工藝下實現的該PA佔有0.9 mm x 0.7 mm芯片面積。實驗結果表明，在1.2-V供電下及操作頻率是433 MHz時，該PA的漏極效率及輸出功率分別可達40.2 %和14.7 dBm。當操作頻率從380 MHz 到460 MHz，該PA仍能保侍最少34.7 %的漏極效率。此設計適用於低數據傳輸率、固定振幅調變，例如：QPSK、OQPSK等。 / Recent technological advances in sensors, integrated circuits and wireless communication enable miniature devices located on, in or around the human body to form a new wireless communication standard called wireless Body Area Network (BAN). Although BAN is still being investigated by the IEEE 802.15 Task Group 6 (TG6), a vast variety of applications has been proposed which can be categorized into medical applications (e.g. vital signs monitoring and implantable therapeutic treatment) and non-medical applications (e.g. consumer electronics and remote control). The basic requirements of each Wireless Sensor Node (WSN) include light weight, small form-factor, low cost and low power consumption. This thesis proposes an injection-locked transmitter which is a potential candidate to minimize the power consumption of the RF transmitter in WSNs. Three circuit blocks in the proposed injection-locked transmitter are designed and implemented. Since the physical layer of BAN, such as modulation scheme and frequency allocation, has still not been finalized yet, the prototypes in this thesis are designed based on the preliminary suggestions made by the IEEE 802.15 TG6. / The first circuit block is a sub-mW, current-reused first-harmonic LC injection-locked oscillator (ILO) using in-phase dual-input injection technique, operating in the Medical Implantable Communications Service (MICS) band from 402MHz to 405 MHz for medical implants. It has been fabricated in a standard 0.13-m CMOS technology; occupying 200 m x 380 m. Measurement results show that the proposed ILO features a wide locking range of 800 MHz (150-950 MHz) at input power of 0 dBm. More importantly, it has a high input sensitivity of -30 dBm to lock the 3-MHz bandwidth of the MICS band, while consuming only 660 W at 1-V supply. This ultra-low power consumption enables autonomous WSNs by energy harvested from the human body. / The second circuit block is a low power MICS fractional-N frequency synthesizer for channel selection. Although integer-N phase-locked loop (PLL) is widely used due to its low circuit complexity, it is not considered as a good solution for MICS band where the channel spacing is just 300 kHz, due to the severe trade-off between speed, frequency resolution and phase noise performance. To solve this issue, a 4th-order type-II Σ- fractional-N PLL is designed using a standard 0.18-m CMOS technology. A 2nd-order single-loop digital Σ- modulator with dither is designed to eliminate the spurious tones. Simulation results verify that the synthesizer achieves 15 s locking time and consumes 4 mW at a power supply of 1.5 V. / Finally, a power-efficient fully-integrated class-E power amplifier with a self-biased inverter used as a preamplifier stage has been implemented in a standard 0.18-m CMOS process, with 0.9 mm x 0.7 mm active area. It operates in both MICS band for implantable devices and Industrial, Scientific and Medical (ISM) band for wearable devices. Experimental results shows that it achieves 40.2 % drain efficiency while output power is 14.7 dBm at 433 MHz under 1.2-V supply. Moreover, the drain efficiency maintains at least 34.7 % over the frequency range from 380 MHz to 460 MHz. This design is suitable for low data-rate, constant envelope modulation, such as QPSK, OQPSK, etc. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Li, Kwan Wai. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2012. / Includes bibliographical references. / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese. / Abstract of thesis entitled: --- p.I / 摘要 --- p.IV / Contents --- p.VI / List of Figures --- p.XI / List of Tables --- p.XVII / Acknowledgement --- p.XVIII / Chapter CHAPTER 1. --- Introduction --- p.1 / Chapter 1.1 --- Motivation for body area network (BAN) --- p.1 / Chapter 1.2 --- Standardization of BAN and its positioning between different communication technologies --- p.3 / Chapter 1.3 --- Classification of BAN and its potential applications --- p.5 / Chapter 1.4 --- Requirements and challenges of BAN --- p.7 / Chapter 1.5 --- Research objectives and organization of this dissertation --- p.9 / References --- p.11 / Chapter CHAPTER 2. --- Background information of biomedical transceivers --- p.12 / Chapter 2.1 --- MICS band --- p.12 / Chapter 2.1.1 --- Frequency allocation --- p.12 / Chapter 2.1.2 --- Output power --- p.13 / Chapter 2.1.3 --- Transmit spectral mask --- p.14 / Chapter 2.1.4 --- Transmit center frequency tolerance --- p.14 / Chapter 2.1.5 --- Channel model --- p.15 / Chapter 2.1.6 --- Link budget --- p.17 / Chapter 2.2 --- Fundamental figure of merits for transceivers --- p.18 / Chapter 2.2.1 --- Noise figure, noise floor and receiver sensitivity --- p.18 / Chapter 2.2.2 --- Transmitter energy efficiency --- p.19 / References --- p.20 / Chapter CHAPTER 3. --- Review of transmitter architectures --- p.21 / Chapter 3.1 --- Overview --- p.21 / Chapter 3.2 --- Architectures --- p.22 / Chapter 3.2.1 --- Quadrature --- p.22 / Chapter 3.2.2 --- Polar --- p.23 / Chapter 3.2.3 --- PLL-based --- p.24 / Chapter 3.2.4 --- Injection-locked --- p.26 / Chapter 3.3 --- Radio architecture selection for biomedical systems in BAN --- p.27 / Chapter 3.3.1 --- Data-rate --- p.27 / Chapter 3.3.2 --- Modulation scheme --- p.28 / Chapter 3.3.3 --- Proposed transmitter architecture --- p.28 / References --- p.31 / Chapter CHAPTER 4. --- Design of sub-mW injection-locked oscillator --- p.33 / Chapter 4.1 --- Introduction --- p.34 / Chapter 4.2 --- Circuit design and analysis --- p.34 / Chapter 4.3 --- Experimental results --- p.47 / Chapter 4.4 --- Summary --- p.55 / References --- p.56 / Chapter CHAPTER 5. --- Design of low-power fractional-N frequency synthesizer --- p.58 / Chapter 5.1 --- Synthesizer architectures --- p.59 / Chapter 5.2 --- PLL design fundamentals --- p.63 / Chapter 5.2.1 --- Stability --- p.63 / Chapter 5.2.2 --- Phase noise --- p.65 / Chapter 5.3 --- Proposed architecture --- p.67 / Chapter 5.4 --- System design --- p.68 / Chapter 5.4.1 --- Stability --- p.68 / Chapter 5.4.2 --- Phase noise --- p.73 / Chapter 5.5 --- Σ modulation in fractional-N synthesis --- p.75 / Chapter 5.5.1 --- Basic operating principles --- p.76 / Chapter 5.5.2 --- An accumulator as a first-order Σ- modulator --- p.78 / Chapter 5.5.3 --- Noise analysis --- p.80 / Chapter 5.5.4 --- Architectures --- p.84 / Chapter 5.5.5 --- Design and modeling --- p.87 / Chapter 5.5.6 --- Digital circuit implementation --- p.99 / Chapter 5.5.7 --- Measurement results --- p.104 / Chapter 5.6 --- Time domain behavioral modeling --- p.104 / Chapter 5.7 --- Design of building blocks --- p.106 / Chapter 5.7.1 --- VCO --- p.107 / Chapter 5.7.1.1 --- Principles --- p.107 / Chapter 5.7.1.2 --- Circuit design --- p.111 / Chapter 5.7.2 --- PFD --- p.131 / Chapter 5.7.2.1 --- Principles --- p.131 / Chapter 5.7.2.2 --- Circuit design --- p.133 / Chapter 5.7.3 --- CP --- p.136 / Chapter 5.7.3.1 --- Principles --- p.136 / Chapter 5.7.3.2 --- Circuit design --- p.137 / Chapter 5.7.4 --- Frequency divider --- p.138 / Chapter 5.7.4.1 --- Principles --- p.138 / Chapter 5.7.4.2 --- Circuit design --- p.145 / Chapter 5.7.5 --- Loop filter --- p.148 / Chapter 5.8 --- Layout issues --- p.149 / Chapter 5.9 --- Overall simulation results --- p.150 / Chapter 5.1 --- Summary --- p.152 / References --- p.153 / Chapter CHAPTER 6. --- Design of high-efficient power amplifier --- p.154 / Chapter 6.1 --- Classification of PAs --- p.154 / Chapter 6.2 --- Circuit design considerations --- p.158 / Chapter 6.3 --- Experimental results --- p.160 / Chapter 6.4 --- Summary --- p.164 / References --- p.166 / Chapter CHAPTER 7. --- Conclusions and future work --- p.167 / Chapter 7.1 --- Conclusions --- p.167 / Chapter 7.2 --- Future work --- p.168 / References --- p.171

Noninvasive pulse oximetry represents an area of potential interest to the army, because it could provide cost-effective, safe, fast and real-time physiological assessment in a combat injured soldier. Consequently, there is a need to develop a reliable, battery-powered, wearable pulse oximeter to acquire and process photoplethysmographic (PPG) signals using an optimized sensor configuration. A key requirement in the optimal design of a wearable wireless pulse oximeter is low power management without compromising signal quality. This research investigated the advantage gained by increasing the area of the photodetector and decreasing the light emitting diode (LED) driving currents to reduce the overall power requirement of a reflectance mode pulse oximeter sensor. In vitro and preliminary in vivo experiments were conducted to evaluate a multiple photodetector reflectance sensor setup to simulate a varying detection area. It was concluded that a reflection pulse oximeter sensor employing a large area photodetector is preferred over a similar transmission type sensor for extending the battery life of a wireless pulse oximeter intended for future telemedicine applications.

"A mobile ultrasound system has been developed, which makes ultrasound examinations possible in harsh environments without reliable power sources, such as ambulances, helicopters, war zones, and disaster sites. The goal of this project was to analyze three different wireless communication technologies that could be integrated into the ultrasound system for possible utilization in remote data applications where medical information may be transmitted from the mobile unit to some centralized base station, such as an emergency room or field hospital. By incorporating wireless telecommunication technology into the design, on site medical personnel can be assisted in diagnostic decisions by remote medical experts. The wireless options that have been tested include the IEEE 802.11g standard, mobile broadband cards on a 3G cellular network, and a mobile satellite terminal. Each technology was tested in two phases. In the first phase, a client/server application was developed to measure and record general information about the quality of each link. Four different types of tests were developed to measure channel properties such as data rate, latency, inter-arrival jitter, and packet loss using various signal strengths, packet sizes, network protocols, and traffic loads. In the second phase of testing, the H.264 Scalable Video Codec (SVC) was used to transmit real-time ultrasound video streams over each of the wireless links to observe the image quality as well as the diagnostic value of the received video stream. The information gathered during both testing phases revealed the abilities and limitations of the different wireless technologies. The results from the performance testing will be valuable in the future for those trying to develop network applications for telemedicine procedures over these wireless telecommunication options. Additionally, the testing demonstrated that the system is currently capable of using H.264 SVC compression to transmit VGA quality ultrasound video at 30 frames per second (fps) over 802.11g while QVGA resolution at frame rates between 10 and 15 fps is possible over 3G and satellite networks."