The first part of this work focuses on control experiments performed on an unstable kerosene-fueled turbulent combustor. Using a phase shift controller and primary fuel modulation stability is successfully gained for a wide band of global equivalence ratios allowing the limitations of the control scheme to be characterized. It is shown that control signal saturation can significantly impact the ability of the control scheme to stabilize the system. Three different regions of controllability are defined based on the degree of saturation. A hysteresis behavior is also found to exist for the controller settings depending on whether stability is being maintained or realized for an unstable system. The second part of this work focuses on the impact that primary fuel modulation has on the fuel spray. Measurements for a simplex nozzle and an air-assist nozzle are taken under both static and dynamic operating conditions with a Phase Doppler Anemometry system. The dynamic modulation is found to significantly impact the spray properties of both nozzles. / Master of Science

Vehicle platooning is an advanced vehicle maneuver that allows for the simultaneous control of several vehicles traveling on the roadway cite{al2010experimental}. Automated platoons, when activated in tractor trailer convoys, have a high potential of increasing the fuel efficiency and improving the utilization of roadways by allowing more vehicles to share the road at the same time. The increased fuel efficiency translates to lower cost on goods and motivates a more environmentally friendly and sustainable economy. In order to achieve the promised fuel savings from vehicle platooning, the vehicles need to follow each other at shorter headways than in typical driving scenarios. The reduced separation distance between the lead and follow vehicle reduces visibility and the reaction time available for the follow vehicle; this renders most modern Active Driver Assist Systems (ADAS) ineffective since they are not designed for operation in such short headway conditions. The focus of this work is related to understanding and improving the failures of Lane Keep Assist (LKA) systems in the follow vehicles of a platoon. In this work, the source of lane detection degradation when using a monocular forward facing camera in short headway platooning is identified. Furthermore, a novel lane augmentation algorithm is proposed to improve the lane detection capability of follow vehicles in a platoon. The lane augmentation process utilizes a longitudinal transformation of lane parameters from the lead to the follow vehicles. The transformation utilizes an accurate understanding of the relative spatial position and orientation of the two vehicles. The transformation also requires a reliable communication system between the two vehicles such as a Vehicle-to-Vehicle (V2V) module. The work presented in this thesis develops theory, simulation and verification using real world data of the proposed cooperative lane augmentation. The results of this work indicate that it is possible to improve vehicle platooning performance by distributing the required sensing across multiple agents of the platoon. / Master of Science / Vehicle platooning is an advanced vehicle maneuver that allows for the simultaneous control of several vehicles traveling on the roadway cite{al2010experimental}. Automated platoons, when activated in tractor trailer convoys, have a high potential of increasing the fuel efficiency and improving the utilization of our roadways by allowing more vehicles to share the road at the same time. The increased fuel efficiency translates to lower cost on goods and motivates a more environmentally friendly and sustainable economy. In order to achieve the promised fuel savings from vehicle platooning, the vehicles need to follow each other at closer distances (headway) than in typical driving scenarios. The reduced separation distance between the lead and follow vehicle reduces visibility and the reaction time available for the follow vehicle; this renders most modern Active Driver Assist Systems (ADAS) ineffective since they are not designed for operation in such short headway conditions. The focus of this work is related to understanding and improving the failures of Lane Keep Assist (LKA) systems - the automated system used to keep the vehicle in the center of the lane - in the follow vehicles of a platoon. In the proposed scenario, the LKA uses a single forward facing camera to detect the lane lines ahead of the vehicle. The detected lanes serve as inputs to the lateral position (steering) controller in order to keep the vehicle in the center of the lane. In this work, the source of lane detection degradation in a follow vehicle of a short headway platoon is identified. Furthermore, a novel cooperative lane detection algorithm is proposed to improve the lane detection capability of the follow vehicles. The proposed algorithm utilizes lane information transformed from the lead to follow vehicle frame. The transformation utilizes the relative spatial position and orientation of the two vehicles. Additionally, a reliable communication protocol between the vehicles is required to transport the lane information. The work presented in this thesis develops theory, simulation and verification using real world data of the proposed algorithm. The results of this work indicate that lane keeping performance in a platoon can be improved using cooperative lane detection.

In all coating applications, a liquid film displaces air in contact with a dry solid substrate. At a low substrate speed a thin uniform wetting line is formed on the substrates surface, but at a high speed the wetting line becomes segmented and unsteady as air becomes entrained between the substrate and the liquid. These air bubbles affect the quality of the coated product and any means to postpone this at higher speeds without changing the specifications of the coating liquid is desirable. This research assesses the validity of a theoretically based concept developed by Blake and Rushack [1] and exploited by Cohu and Benkreira [2] for dip coating. The concept suggests that angling the wetting line by an angle ß would increase the speed at which air is entrained by a factor 1/cos ß. In practice, if achieved this is a significant increase that would result in more economical operation. This concept was tested in a fast coating operation that of curtain coating which is already enhanced by what is known as hydrodynamic assistance [2]. Here we are effectively checking an additional assistance to wetting. The work, performed on a purposed built curtain coater and a rotating die, with a range of fluids showed the concept to hold but provided the data are processed in a way that separate the effect of curtain impingement from the slanting of the wetting line.

Various congenital heart defects (CHDs) are characterized by the existence of a single functional ventricle, which perfuses both the systemic and pulmonary circulation in parallel. A three-stage palliation procedure, including the final Fontan Completion, is often adopted by surgeons to treat patients with such CHDs. However, the most common outcome of this surgery, an extra-cardiac total cavopulmonary connection (TCPC), formed by suturing the inferior vena cava (IVC) and superior vena cava (SVC) to the pulmonary arteries (PAs), results in non-physiological flow conditions, systemic venous hypertension, reduced cardiac output, and pressure losses, which ultimately calls for a heart transplantation. A modest pressure rise of 5-6 mm Hg would correct the abnormal flow dynamics in these patients. To achieve this, a novel conceptual design of a percutaneous dual propeller pump inserted and mounted inside the TCPC is developed and studied. The designed blood pump is percutaneously inserted via the Femoral vein and deployed at the center of Total Cavopulmonary Connection (TCPC). The two propellers, each placed in the Superior Vena Cava (SVC) and the Inferior Vena Cava (IVC) are connected by a single shaft and motor, and thus rotate at same speed. The device is supported with the help of a self-expanding stent which would be anchored to the walls of the IVC and the SVC. An inverse design methodology implementing Blade Element Momentum theory and Goldstein's radial momentum loss theory was employed to generate the blade profiles for the studied propeller pumps. The propeller blade profiles generated from the inverse design optimization code were examined for hydraulic performance, blood flow pattern and potential for hemolysis inside the TCPC using 3-D computational fluid dynamics (CFD) analysis. The Lagrangian particle tracking approach in conjunction with a non-linear mathematical power law model was used for predicting the blood damage potential of the analysed blood pump designs by calculating the scalar shear stress history sustained by the red blood cells (RBC). The study demonstrated that the IVC and SVC propeller pumps could provide a pressure rise of 1-20 mm Hg at flow rates ranging from 0.5 to 5 lpm while rotating at speeds of 6,000-12,000 rpm. Moreover, the average Blood Damage Index (BDI), quantifying the level of blood trauma sustained by the RBCs for the analyzed propeller pump designs, was found to be around 3e-04% to 4e-04% which is within the acceptable limits for an axial flow heart assist device. Thus, such a dual propeller blood pump configuration could potentially provide assistance to Fontan patients by unloading the single functional ventricle thereby acting as a bridge to transplantation and recovery until a donor heart is available. / Master of Science / A single functional ventricle is a type of congenital heart defect, where either left or right ventricle is underdeveloped, resulting in a single ventricular chamber to pump blood to both the body as well as lungs. A three-stage surgical procedure called the Fontan procedure, is often adopted by the surgeons to treat this defect by disconnecting the inferior(IVC) and superior vena cava(SVC), the two main veins carrying de-oxygenated blood from the body to the heart, and connecting them to the pulmonary arteries(PAs), the vessels carrying de-oxygenated blood from heart to the lungs. This helps to bypass the underdeveloped ventricle and allows blood to flow directly from the body to the lungs. However, the absence of a pumping chamber in the newly developed blood portal system causes an increase in pressure inside the vena cava and pressure losses inside the pulmonary arteries, which results in vena cava hypertension, reduced cardiac output. A modest pressure rise of 5-6 mm Hg across the vena cava or pulmonary artery should correct the abnormal flow dynamics and should bring the cardiac output of such patients back to normal. To achieve this, a conceptual design of a dual propeller mechanical circulatory support device has been designed and developed in this thesis.

京都大学 / 新制・論文博士 / 博士(医学) / 乙第13633号 / 論医博第2324号 / (主査)教授 江木 盛時, 教授 湊谷 謙司, 教授 森田 智視 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DFAM

京都大学 / 新制・課程博士 / 博士(人間健康科学) / 甲第25502号 / 人健博第122号 / 京都大学大学院医学研究科人間健康科学系専攻 / (主査)教授 木下 彩栄, 教授 千葉 理恵, 教授 湊谷 謙司 / 学位規則第4条第1項該当 / Doctor of Human Health Sciences / Kyoto University / DFAM

The thesis discusses the education of patients with left ventricular support HeartMate II. Theoretical part is focused on education and its ethical and legal aspects, on the description of the educational process. Furthermore it focuses on heart supports, especially on left ventricular assist device HeartMate II. To provide a comprehensive overview, I have included also information about the anatomy and physiology of the cardiovascular system and the section on heart failure. I described the specifics of nursing care for patients with implanted HeartMate II system and the educational topics that should be part of the education of these patients. The empirical part was prepared as a quantitative research, where research sample was 47 respondents. Respondents consisted of nurses who educate patients after implantation of the HeartMate II at the cardiovascular surgical intensive care unit. To create the feedback I complemented a quantitative research with structured interviews with patients after implantation of the HeartMate II. The aim of the research was to determine the status and range of education of patients with left ventricular assist device HeartMate II. This thesis further maps the topics on which is placed the emphasis in education and vice versa topics that would need to focus more on....

Hintergrund: Elastischer Ohrknorpel ist eine potentielle Quelle fuer autologe Zellen um die luminalen Oberflaechen von links ventrikularen assist systemen (LVAD''s) zu besiedeln zu dem Zweck die Biokompatibilitaet dieser Systeme zu verbessern. Wir prueften dieses Potential der Ohrknorpelzellen in vitro und in vivo in einem Tiermodel (Kalb). Methoden: In vitro, Elastischer Knorpel wurde von dem Ohr eines Kalbes unter Lokalanaesthesie gewonnen, isoliert, und in Gewebekultur gezuechtet. Chondrocytes wurden immunocytochemisch analysiert, transferriert in Zellkulturmedium, zweimal umgesetzt, und auf die blutkontaktierenden, luminalen Oberflaechen von vier LVAD''s (HeartMate(R); Thermo Cardiosystems, Inc., Woburn, MA) gesiedelt. Die beschichteten Zelloberflaechen wurden preconditioniert unter Flussbedingungen in vitro, um die Zellhaftung an den luminalen Oberflaechen der LVAD''s zu beguenstigen. Die Effiezienz der Zellbesiedelung und der kumulative Zellverlust unter Flussbedingungen in vitro wurden quantifiziert. In vivo, eine der vier chondrocyte-beschichteten und preconditionierten LVAD''s wurde in das Kalb implantiert, welches urspruenglich Ohrknorpelspender diente. Das LVAD wurde fuer sieben Tage betrieben, dann explantiert und pathologisch und histologisch evaluiert unter der Benutzung eines Scanningelektronenmikroskopes und eines Transmissionelektronenmikroskopes. Resultate: Die luminalen Oberflaechen von vier LVAD''s wurden mit autologen Ohrknorpelzellen besiedelt. Die Effiezienz der Zellbesiedelung betrug 95.11± 4.23% (n = 4). Der kumulative Zellverlust unter Flussbedingungen in vitro war geringer als 12% (n = 4). Nach sieben Tagen der in vivo Implantation zeigten die luminalen Oberflaechen des implantierten LVAD eine intakte, fest haftende Zellbesiedelung. Es wurden keine Thromboembolien waehrend der Nekropsie festgestellt. Schlussfolgerungen: Ohrknorpel stellt eine einfach und schnell erreichbare Quelle fuer autologe Ohrknorpelzellen dar, dessen Collagen Typ II und andere wichtige Bestandteile der extrazellulaeren Matrix sie dazu befaehigt, fest an den luminalen Oberflaechen der LVAD''s zu haften. Die hier beschriebene einfache Methode der Knorpelgewinnung und der Zellisolierung kann benutzt werden, um eine autologe Zellbeschichtung von LVAD''s und anderen implantierbaren kardiovaskulaeren Systemen vorzunehmen mit dem Ziel die Biokompatibilitaet dieser zu verbessern. Unsere erfolgreiche Feasibilitystudie in einem Kalbmodel fordert weitere in vivo Studien. / Background: Auricular elastic cartilage is a potential source of autologous cells for lining the luminal surfaces of left ventricular assist devices (LVAD''s) to improve long-term biocompatibility. We evaluated this potential in vitro and in vivo in a calf model. Methods: In vitro, auricular cartilage was harvested from the anesthetized ear of a calf, isolated, and cultured on tissue culture dishes. Primary chondrocytes were typed by immunocytochemistry, transferred into culture media, passaged twice, and seeded onto the blood-contacting luminal surfaces of four LVAD''s (HeartMate(R); Thermo Cardiosystems, Inc., Woburn, MA). The seeded cell linings were preconditioned under flow conditions in vitro to promote cell adhesion to the luminal surfaces. Seeding efficiency and cumulative cell loss under flow conditions in vitro were quantitated. In vivo, one of the four preconditioned, autologous chondrocyte-lined LVAD''s was implanted into the tissue-donor calf; run for 7 days; explanted; and finally evaluated grossly, by scanning electron microscopy, and by transmission electron microscopy. Results: Autologous chondrocytes were seeded onto the luminal surfaces of the four LVAD''s. The seeding efficiency was 95.11± 4.23% (n = 4). Cumulative cell loss during preconditioning under flow conditions in vitro did not exceed 12% (n = 4). After 7 days of in vivo implantation, the luminal surfaces of the implanted LVAD demonstrated an intact, strongly adherent cellular lining. There was no evidence of thromboembolic events at necropsy. Conclusions: Auricular elastic cartilage is a ready and easily accessible source of chondrocytes whose ability to produce collagen II and other important extracellular matrix constituents allows them to adhere strongly to the luminal surfaces of LVAD''s. The simple method of isolating and expanding auricular chondrocytes presented here could be used to provide autologous cell linings for LVAD''s and other cardiovascular devices to improve their long-term biocompatibility. Our successful short-term feasibility study in a calf model warrants further study in vivo.

Apesar dos crescentes avanços no controle e tratamento da insuficiência cardíaca, sejam eles na área clinica ou cirúrgica, o tratamento definitivo permanece sendo o transplante cardíaco. No entanto, o transplante cardíaco tem enfrentado o grave problema da escassez de doadores. Atualmente, estima-se que entre 20% e 40% dos pacientes selecionados falecem na fila de espera em todo o mundo sendo que a maioria, por falência circulatória progressiva. Para esses pacientes, a utilização de dispositivos de assistência circulatória mecânica é, muitas vezes, a única possibilidade de sobrevivência durante a espera do doador. No Brasil, a experiência com o emprego de métodos de assistência circulatória mecânica no tratamento do choque cardiogênico é pequena. Paralelamente, a expectativa de vida dos pacientes nesta situação, em particular os de etiologia chagásica, é muito limitada, e nenhum programa regular foi ainda introduzido com a finalidade de utilizar estes dispositivos no tratamento do choque cardiogênico refratário, especialmente como ponte para o transplante cardíaco. Objetivos: O objetivo deste estudo é determinar a viabilidade e segurança do implante do DAV-InCor como ponte para o transplante cardíaco, avaliando o seu desempenho hemodinâmico, a evolução clínica e as alterações da resposta inflamatória dos pacientes submetidos a este procedimento. Métodos: Este estudo foi realizado em pacientes que estavam na fila de espera para o transplante cardíaco, no período de outubro de 2003 a abril de 2006, e se apresentavam em quadro clínico de choque cardiogênico refratário. Durante os primeiros dias, foram analisadas as medidas de pressão capilar pulmonar (PCP), pressão de artéria pulmonar (PAP), pressão venosa central (PVC), débito cardíaco e índice cardíaco (IC). O cálculo do fluxo indexado era obtido pela divisão entre o fluxo do dispositivo pela superfície corpórea. Durante o seguimento pós-operatório imediato, a saturação venosa central de oxigênio (SVO2), os níveis de lactato sérico, uréia, creatinina, bilirrubinas e desidrogenase lática foram dosados diariamente. Os níveis séricos do peptídeo natriurético central (BNP), das interleucinas (IL6 e IL8), do fator de necrose tumoral alfa (TNF alfa) e da proteína C reativa (PCR) foram dosados nos três primeiros dias de seguimento e posteriormente a cada semana. Resultados: No período do estudo, 29 pacientes foram indicados em caráter de prioridade para o transplante cardíaco. Destes pacientes, 11 evoluíram em choque cardiogênico refratário à terapêutica farmacológica e ao implante de balão intra-aórtico. O implante do DAV-Incor foi realizado em sete destes pacientes. O diagnóstico etiológico foi cardiopatia chagásica em cinco (71%) e cardiomiopatia dilatada idiopática em dois (29%) dos sete pacientes estudados. Cinco pacientes eram do sexo masculino. A idade variou entre 34 e 54 anos (média de 39,5 anos). A assistência circulatória mecânica ao ventrículo esquerdo foi mantida nos 7 pacientes por períodos que variaram de 14 a 42 dias, com média de 26,2 dias. Neste período, o desempenho hemodinâmico foi adequado, sendo observada a normalização do índice cardíaco, das pressões em território pulmonar, da SVO2 e do lactato sérico. A avaliação da resposta inflamatória sistêmica demonstrou a elevação do TNF e das interleucinas, principalmente nos pacientes que evoluíram com alterações infecciosas. O transplante cardíaco foi realizado em 2 pacientes e os outros 5 faleceram em uso do DAV Incor por infecção sistêmica ou falência de múltiplos órgãos. Não ocorreram complicações relacionadas ao DAV em 6 pacientes nos primeiros 30 dias de seguimento. Um paciente apresentou episódio de acidente vascular cerebral extenso aos 26 dias de pós-operatório. Conclusões: Os resultados deste estudo demonstram que, apesar do alto índice de complicações apresentado pelos pacientes, a assistência circulatória mecânica ao ventrículo esquerdo pode ser realizada como ponte para transplante cardíaco em nosso meio. / Cardiac transplantation faces a serious problem of lack of donation. Between 20 and 40% of the listed patients died while waiting for heart transplantation, most of them because of progressive heart failure. For these patients, the use of mechanical circulatory assist devices is the only choice of surviving during that time. In Brazil, the experience with mechanical circulatory support is limited and there is no regular program of the use of these devices as bridge to heart transplantation. Objectives: To evaluate the hemodynamic performance and the systemic inflammatory response during the clinical application of the ventricular assist device type InCor (DAV-InCor) as bridge to heart transplantation. Methods: Between October 2003 and April 2006, 11 patients on the waiting list for heart transplantation have hemodynamic deterioration to refractory cardiogenic shock. Hemodinamic profile (cardiac index, capilar pressure, pulmonary artery pressure and central venous pressure) was analised during early post-operative days. Serum levels of central venous saturation, lactate, urea, creatinin, bilirrubin and lacti desidrogenase were measured every day Blood drawn from patients for 3 days and once a week was assayed for levels of BNP, interleukin 6, interleukin 8, and tumor necrosis factor-alfa. Results: During the study, 11 patients listed for cardiac transplantation as urgent status have deteriorated to refractory cardiogenic shock. Seven of these patients were submitted to DAV-InCor implantation for left ventricular assistance. The etiologic diagnosis was Chagas\' disease in 5 patients (71%) and idiopathic dilated cardiomyopathy in 2 (29%). There were 5 male and 2 female. The age ranged from 34 and 54 years (mean 39,5). Duration of left ventricular assistance ranged from 14 to 42 days (mean 26.2 days). During this period, the hemodynamic performance of the DAV-InCor was adequate to support a normal hemodynamic condition. There was normalization of cardiac index, central venous oxygen saturation and serum lactate. The systemic inflammatory response showed elevated TNF-alfa, Interleukin-6 and interleukin-8 concentrations. Two patients were submitted to heart transplantation, while the other 5 patients died under assistance due to infection and multiple organ failure. There were no complications related to the device in 6 patients. One patient had a stroke by the 26st day Conclusions: Mechanical circulatory support can be performed as bridge to heart transplantation with the DAV-InCor, in spite of the high incidence of complications.

Submitted by Setor de Tratamento da Informa??o - BC/PUCRS (tede2@pucrs.br) on 2015-09-29T12:57:03Z No. of bitstreams: 1 475285 Texto Completo.pdf: 2201401 bytes, checksum: 17c76eaa304cc4d0792fee5adb40252c (MD5) / Made available in DSpace on 2015-09-29T12:57:03Z (GMT). No. of bitstreams: 1 475285 Texto Completo.pdf: 2201401 bytes, checksum: 17c76eaa304cc4d0792fee5adb40252c (MD5) Previous issue date: 2015-08-13 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPES / This doctoral thesis aims to analyze from the State of Tocantins reality, as the Social Assistance Policy's, through the actions of Specialized Social Assistance Reference Centers (CREAS), has been setting for the promotion of the rights of children, adolescents and their families in situations of sexual violence. In this sense, the research sought mainly to contribute to the production of knowledge about sexual violence against children and adolescents in Tocantins, since there is no significant research and studies on this subject in the State. The specific objectives sought to identify characteristics of sexual violence; unravel how teams of CREAS has been acting in the interdisciplinary framework to guarantee the rights of children and adolescents and their families; analyze how the Social Assistance Policy's has sought to materialize the intersectoral approach to confronting sexual violence against children and adolescents and investigate how has been guaranteed the protection of rights and access to the medium complexity services to children, adolescents and families living in rural or to access difficult the municipalities. In view of the objectives proposed in this research, the kind of research used was the qualitative approach, in which they sought to apprehend these aspects of reality: the particularities of sexual violence, the perception of the subjects about the phenomenon, challenges and possibilities for realization of completeness of care for children and adolescents in situations of sexual violence.To collect data, there were 17 interviews with families, professionals and coordinators of CREAS beyond the desk review of 40 medical records of attendance of CREAS. To analyze the data collected in the survey, we opted for the content analysis technique and the systematization method of Practice. Data analysis allowed to grasp that construction of comprehensiveness of care to children, adolescents and families in situation of sexual violence requires a movement that promotes the break with revictimization of answers. The reports of the subjects reveal the presence of subscribers values in a culture based on socioeconomic inequality, ethnic-racial, gender and generation, thus asserting the presence of symmetry between unequal relations and reproduction of sexual violence. Thus, the analysis of the data confirms the thesis that the interdisciplinary and intersectoral approach are elements that support for the effectiveness of integrality of interventional processes to enable the CREAS and the protection network overcome fragmented actions, superficial and immediate. / A presente tese de doutorado tem como mote analisar a partir da realidade do Estado do Tocantins, como a Pol?tica de Assist?ncia Social, por meio das a??es dos Centros de Refer?ncia Especializado de Assist?ncia Social (CREAS), vem se configurando para a promo??o dos direitos das crian?as, adolescentes e suas fam?lias em situa??o de viol?ncia sexual. Nesse sentido, a pesquisa buscou primordialmente contribuir para a produ??o de conhecimentos acerca da viol?ncia sexual contra crian?as e adolescentes no Tocantins, uma vez que n?o h? pesquisas e estudos significativos sobre essa tem?tica no Estado. Os objetivos espec?ficos buscaram identificar as particularidades da viol?ncia sexual; desvendar como as equipes dos CREAS v?m atuando no ?mbito interdisciplinar para a garantia dos direitos das crian?as e adolescentes e suas fam?lias; analisar como a Pol?tica de Assist?ncia Social vem buscando materializar a intersetorialidade para o enfrentamento ? viol?ncia sexual contra crian?as e adolescentes e investigar de que forma vem sendo garantida a prote??o aos direitos e o acesso aos servi?os da m?dia complexidade ?s crian?as, adolescentes e fam?lias residentes nas ?reas rurais ou de dif?cil acesso dos munic?pios. Tendo em vista os objetivos propostos nesta investiga??o, o tipo de pesquisa utilizada foi a de enfoque qualitativo, em que se buscou apreender tais aspectos da realidade: as particularidades da viol?ncia sexual, a percep??o dos sujeitos acerca do fen?meno, os desafios e possibilidades para a efetiva??o da integralidade do atendimento ?s crian?as e adolescentes em situa??o de viol?ncia sexual.Para a coleta de dados, realizaram-se 17 entrevistas com fam?lias, profissionais e coordenadores/as do CREAS al?m da an?lise documental de 40 prontu?rios de atendimento dos CREAS. Para analisar os dados coletados na pesquisa, optou-se pela t?cnica de an?lise de conte?do e pelo m?todo de Sistematiza??o da Pr?tica. A an?lise dos dados permitiu apreender que a constru??o da integralidade do atendimento ?s crian?as, adolescentes e fam?lias em situa??o de viol?ncia sexual requer um movimento que promova o rompimento com respostas revitimizantes. Os relatos dos sujeitos revelam a presen?a de valores calcados em uma cultura baseada na desigualdade socioecon?mica, ?tnico-racial, de g?nero e gera??o, asseverando assim a presen?a da simetria entre rela??es desiguais e reprodu??o da viol?ncia sexual. Desse modo, a an?lise dos dados confirma a tese de que a interdisciplinaridade e intersetorialidade s?o elementos que corroboram para a efetiva??o de processos interventivos integralizados ao possibilitar ao CREAS e a rede de prote??o superar a??es fragmentadas, superficiais e imediatistas.