Orientador: Prof. Dr. Gustavo Sousa Pavani / Dissertação (mestrado) - Universidade Federal do ABC, Programa de Pós-Graduação em Ciência da Computação, 2017. / Algoritmos baseados em Otimização por Colonia de Formigas (Ant Colony Optimization { ACO) vem sendo usados com bastante sucesso no metaescalonamento distribuído e integrado dos recursos de computação e de comunicação em ambientes de grade computacional baseadas em redes opticas (lambda grid ). Nesse ambiente sao utilizados infraestruturas de comunicações compostas por enlaces de fibras opticas e nós opticos, que são elementos sujeitos aos mais variados tipos de falhas. Com efeito, problemas decorrentes dos equipamentos ou meios de transmissão podem interromper o trafego de informações e, consequentemente, causam a indisponibilidade de recursos na grade. A arquitetura proposta em [1] é capaz de gerenciar dinamicamente e de forma conjunta os recursos de rede e processamento no ambiente de lambda grid, além de prover agendamento e reserva futura desses recursos. Neste trabalho, considerar-se-à tambem a capacidade de sobrevivencia da grade sob condições adversas de falhas. Para tanto, a grade computacional deve prover mecanismos de restauração de forma a se recuperar em caso de falhas de enlace ou nó. Simulações foram realizadas com os diversos algoritmos de metaescalonamento propostos originalmente em [1], demonstrando o respectivo desempenho em termos de capacidade de restauração e de atraso de execução das tarefas restauradas. / Algorithms based on Ant Colony Optimization (ACO) have been successfully used in distributed and integrated meta-scheduling of computing and networking resources in lambda grids. The lambda grid environment is composed by optical fiber links and optical nodes, which are susceptible to diferent types of failure. In eect, problems due to equipment or transmission outages may interrupt the information trac and, consequently, cause unavailability of grid resources. The architecture proposed in [1] is capable of the dynamic, joint management of networking and processing resources at the lambda grid. It can also provide scheduling and advance reservation of those resources. In this work, we also consider the survivability capacity of the lambda grid when a failure occurs. Therefore, the lambda grid has to provide a restoration mechanism in order to recover from link and node failures. Simulations carried with the meta-scheduling algorithms originally proposed in [1] demonstrate their performance in terms of restorability and delay in scheduling the restored tasks.

A população idosa possui alta prevalência de edentulismo e, conseqüentemente, é afetada pelos problemas a ele associados. A perda da dimensão vertical de oclusão (DVO) é um destes problemas que compromete, entre outros fatores, o desempenho do sistema estomatognático. Logo, doenças relacionadas ao colapso da musculatura da via aérea superior (VAS), como a síndrome da apnéia obstrutiva do sono (SAOS), tornam-se enfermidades relevantes para pacientes nesta faixa etária. Sendo assim, medidas terapêuticas eficazes e de baixo custo, como a utilização de aparelhos intraorais (AIOs) para liberação do fluxo aéreo, podem ser empregadas contribuindo para a qualidade do sono destes pacientes. O objetivo deste estudo foi avaliar parâmetros subjetivos e objetivos do sono, em 10 pacientes idosos portadores de Próteses totais (PTs) bimaxilares, após a utilização de novas PTs confeccionadas no Programa Envelhecer Sorrindo e após o uso de dois AIOs: um dispositivo intraoral (DIO), especialmente desenvolvido para aumentar a DVO sem provocar avanço mandibular, e um aparelho de avanço mandibular (AAM). Para isso, questionários de rastreamento da qualidade do sono e polissonografias (PSGs) foram realizados, em quatro momentos distintos: sem as PTs, com as PTs, com o DIO e com o AAM. Foram realizadas, também, telerradiografias em norma lateral (TNL) dos pacientes com as PTs, com o DIO e com o AAM a fim de avaliar alterações no diâmetro da VAS e o posicionamento mandibular nesses três momentos. Concluiu-se que, o AAM testado promove maior porcentagem de sono no estágio 1, podendo contribuir para a melhora na qualidade subjetiva do sono dos pacientes, uma vez que ajudou a diminuir o tempo necessário para iniciar o sono, além de facilitar a manutenção do estado de vigília. / There is a high prevalence of edentulism and problems associated to it in the elderly population. A decrease in vertical dimension of occlusion (VDO) is one of these problems that may compromise the stomatognathic system. Therefore, it is important to investigate diseases related to upper airway (UA) musculature collapse, such as the syndrome of obstructive sleep apnea (OSAS). Therapeutic measures of low cost and high efficacy, such as intraoral appliances (IAs) to release the air flow may be employed, contributing to patients sleep quality. The aim of this study was to evaluate subjective and objective sleep parameters in 10 elderly patients who wore maxilar and mandibular complete dentures (CD). The analyses were performed after the use of a new pair of CD and after using two IAs: an intraoral device (ID), especially developed to increase the VDO without causing mandibular advance, and a mandibular advance device (MAD). For this purpose, questionnaires and polysomnography (PSG) were performed in four distinct stages: patients not wearing CD, wearing CD, wearing ID and wearing MAD. In addition, lateral cephalograms (LC) of patients wearing FD, wearing ID and wearing MAD were performed to assess changes in UAs diameter and in the mandibular positioning. It was concluded that the MAD tested promotes higher percentage of stage 1 sleep and and may contribute to the improvement in patients subjective sleep quality, as it helped to decrease the time needed to fall asleep, and facilitate the maintenance of wakefulness.

Introdução As Diretivas Antecipadas de Vontade, também denominadas Testamento Vital constituem um documento com o registro expresso do desejo de um cidadão de recusar tratamento, caso venha a sofrer de alguma enfermidade terminal. Dessa forma, busca desconstruir uma cultura centrada no paternalismo que reduz o indivíduo doente a um paciente que deve aguardar, resignado e submissamente, que deliberações acerca de sua vida sejam tomadas por outros, sem que possa se manifestar ou decidir, autonomamente, como quer ser tratado ou que tipo de práticas de intervenção está disposto a aceitar. Objetivo - O presente trabalho objetivou conhecer a representação do Testamento Vital para os enfermeiros que atuam na assistência à pacientes em situação de terminalidade. Método - Trata-se de pesquisa de natureza qualitativa realizada com quinze enfermeiros que atuam na assistência à pacientes terminais, por meio de entrevistas norteadas pela seguinte questão Fale a respeito do Testamento Vital. Após a aprovação do Comitê de Ética em Pesquisa, houve a obtenção dos depoimentos que foram analisados de acordo com o método do Discurso do Sujeito Coletivo com fundamentação na Teoria das Representações Sociais de Serge Moscovici. Resultados - A pesquisa identificou três categorias que compõem o Discurso do Sujeito Coletivo: o enfermeiro frente às diretivas antecipadas de vontade; o enfermeiro frente à família contrária à vontade do paciente e o enfermeiro frente ao médico contrário à vontade do paciente. Conclusão - O testamento vital representa, na perspectiva dos enfermeiros, a autonomia e o direito do paciente pelas decisões nas situações de terminalidade que devem ser compartilhadas com seus familiares e profissionais de saúde. Não obstante, o enfermeiro pode vivenciar conflitos éticos nas situações em que o desejo manifestado por meio desse documento não é respeitado por familiares e/ou médicos. Diante dessa situação, o enfermeiro pode perceber a própria ação como limitada e sentir-se frustrado com a impossibidade de atender o desejo do paciente. / Introduction: Advance Directives also known as the Living Will Declaration constitute a manifestation of will by means of a document written by a person fully healthy of his mental faculties in order to dispose of the care, treatment and procedures that whether or not he or she wants to be submitted in case of a disease that is beyond therapeutic possibilities and incapable of manifesting his or her will freely. Objective - To know the representation of Living Will Declaration for nurses who work with terminally ill patients. Method - This is a qualitative research carried out with fifteen nurses who work in the care of terminal patients, through interviews guided by the following question \"Talk about the Living Will Declaration\". After the approval of the Committee of Ethics in Research, the interviews were obtained, which were analyzed according to the Collective Subject Discourse method based on Serge Moscovici\'s Theory of Social Representations. Results - The research identified three categories that make up the Discourse of the Collective Subject: \"the nurse in front of the advance directives \"; \"The nurse facing the family contrary to the will of the patient\" and \"the nurse facing the doctor contrary to the will of the patient\". Conclusion - The living will declaration represents, from the perspective of nurses, the autonomy and the right of the patient for decisions in terminal situations that should be shared with family members and health professionals. Nonetheless, nurses may experience ethical conflicts in situations where the desire expressed through this document is not respected by family members and / or doctors. Faced with this situation, the nurse can perceive the action as limited and feel frustrated with the impossibility of fulfilling the patient\'s desire.

Civil Liability in the Case of Disrespecting a Patient's Advance Directives The aim of this thesis is to analyse and describe the problematic of Civil Liability in the specific case of disrespecting a patient's advance directives by a medical. The institute of Advance Directives was first introduced in the Czech law by the Convention on Human Rights and Biomedicine in 2001 and later by the Law No. 372/2011 Coll., Act on Health Care Provision. Thought the Advance Directives cannot be considered as a new institute in the Czech law, it is hardly ever used in practice. There is no judicature and practical knowledge on the topic of civil liability in this case, and the insecurity causes that doctors do not feel like willing to respect the exceptionally occurring advance directives, because they fear the criminal liability they think that could arise if they did not provide the health care necessary for saving life of their patient. This thesis is trying to highline the importance of a patient's will. Meanwhile, it is pointing to the fact that even saving a patient's life can cause legal liability of a doctor. The thesis is primarily analysing and describing such liability within the general provisions on liability in the Czech Law and is also trying to give an insight to the problematic of potential...

Les systèmes de recherche ont facilité l’accès à l’information disponible sur le web à l’aide de mécanismes de collecte, d’indexation et de stockage de contenus hétérogènes.Ils génèrent des traces résultant de l’activité des internautes. Il s’agit ensuite d’analyser ces données à l’aide d’outils de data mining afin d’améliorer la qualité de réponse de ces systèmes ou de la personnaliser en fonction des profils des utilisateurs. Certains acteurs, comme la société Marketshot, se positionnent comme intermédiaires entre les consommateurs et les professionnels. Ils mettent en relation les acheteurs potentiels avec les grandes marques et leurs réseaux de distribution à travers leurs sites Internet d’aide à l’achat. Pour cela, ces intermédiaires ont développé des portails efficaces et stockent de gros volumes de données liées à l’activité des internautes sur leurs sites. Ces gisements de données sont exploités pour répondre favorablement aux besoins des internautes, ainsi qu’à ceux des professionnels qui cherchent à comprendre le comportement de leurs clients et anticiper leurs actes d’achats. C’est dans ce contexte, où on cherche à fouiller les données collectées du web, que se placent mes travaux de recherche. L’idée est de construire des modèles qui permettent d’expliciter une corrélation entre les activités des internautes sur les sites d’aide à l’achat et les tendances de ventes de produits dans la « vraie vie ». En effet, ma thèse se place dans le cadre de l’apprentissage probabiliste et plus particulièrement des modèles graphiques « Topic Models ». Elle consiste à modéliser les comportements des internautes à partir des données d’usages de sites web. / Research systems have facilitated access to information available on the web using mechanisms for collecting, indexing and storage of heterogeneous content. They generate data resulting from the activity of users on Internet (queries, logfile). The next step is to analyze the data using data mining tools in order to improve the response’s quality of these systems, or to customize the response based on users’ profiles. Some actors, such as the company Marketshot, are positioned as intermediaries between consumers and professionals. Indeed, they link potential buyers with the leading brands and distribution networks through their websites. For such purposes, these intermediaries have developed effective portals, and have stored large volumes of data related to the activity of users on their websites. These data repositories are exploited to respond positively to the needs of users as well as those of professionals who seek to understand the behavior of their customers and anticipate their purchasing actions. My thesis comes within the framework of searching through the data collected from the web. The idea is to build models that explain the correlation between the activities of users on websites of aid for the purchase, and sales trends of products in « real life ». In fact, my research concerns probabilistic learning, in particular Topic Models. It involves modeling the users’ behavior from uses of trader websites.

This dissertation aims to examine and analyse the current South African position with regard to voluntary euthanasia. An examination is made from constitutional law, common law, case law and statutory law perspectives, including the legislation proposed by the South African Law Commission (project 86). The writings of prominent authors are considered. Once the South African position is examined, a comparative study is undertaken concerning relevant aspects in the Dutch law. The most important findings are that the South African Constitution may allow, and perhaps even demand, the legalization of voluntary euthanasia in South Africa, provided that sufficient safeguards can be established to effectively and sufficiently minimize the risk of abuse. Should this be impossible, the proscription of euthanasia may be reasonable and justifiable in an open and democratic society based on human dignity, equality and freedom. Finally, some recommendations are made for changes to the South African Law Commission’s Final Draft Bill. / Dissertation (LLM (Medical Law))--University of Pretoria, 2008. / Public Law / unrestricted

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Die Arbeit beschäftigt sich mit der im Jahr 2009 in Kraft getretenen Regelung der Patientenverfügung des §1901 a BGB, insbesondere den Anwendungsproblemen der Erstellung einer Verfügung sowie den Schwierigkeiten bei Ihrer Umsetzung. Dabei liegt ein Schwerpunkt bei der Frage, inwieweit Patientenverfügungen in der Notfallsituation aufgrund der spezifischen Besonderheiten beachtet werden können bzw. müssen. Die Ausarbeitung unterbreitet Vorschläge für die Abfassung von Patientenverfügungen und bietet im Anhang eine auf der Musterverfügung des BMJuV basierende überarbeitete Textbausteinversion zur Erstellung einer individuellen Patientenverfügung an. Literatur, Rechtsprechung und Gesetze sind bis zum 01.06.2016 berücksichtigt.:Inhaltsverzeichnis 1 EINFÜHRUNG 1 2 HISTORIE 2 2.1 Die wegweisenden Urteile 2 2.2 Das Gesetzgebungsverfahren 4 2.2.1 Bosbach-Entwurf 5 2.2.2 Zöller-Entwurf 5 2.2.3 Stünker-Entwurf 6 2.2.4 Beschluss des Bundestags 6 3 DIE AKTUELLE GESETZLICHE REGELUNG IM ÜBERBLICK 7 3.1 Abgrenzung von Patientenverfügung im engeren Sinn, Patientenwunschund mutmaßlicher Einwilligung 7 3.2 Formvorschriften 9 3.3 Geltungsbereich und Reichweite 11 3.4 Rolle von Behandlern und Vertretern 15 3.5 Der Konfliktfall, § 1904 BGB 17 4 DIE REGELUNGSINHALTE 19 4.1 Patientenverfügung im Sinne des § 1901 BGB 19 4.1.1 Bestimmtheit der Verfügung 19 4.1.2 Die einzelnen Anordnungen: Untersuchung, Behandlung, Behandlungsabbruch, Behandlungsverbot 21 4.1.3 Postmortale Organspende 23 4.1.4 Entnahme technischer Apparate 26 4.1.5 Delegation der Entscheidung auf den Vertreter 27 4.2 Ergänzende Regelungen zur Patientenverfügung 28 4.3 Sonderfragen 31 4.3.1 Assistierter Suizid und Tötung auf Verlangen 31 4.3.2 Beschränkung auf Volljährige 33 4.3.3 Pflegerische Maßnahmen 34 4.3.4 Vergütung der Beratung und Hilfe bei der Abfassung einer Patientenverfügung 35 4.3.5 Versicherungsrechtliche Konsequenzen bei Umsetzung einer Patientenverfügung 38 5 ANWENDUNG DER PATIENTENVERFÜGUNG IN DER PRAXIS 40 5.1 Überprüfungspflichten 40 5.1.1 Auslegung und Validitätsprüfung 40 5.1.2 Widerruf 41 5.1.3 Dialog 42 5.2 Akzeptanzproblem 43 5.2.1 Vorbemerkung 43 5.2.2 Qualität der Patientenverfügung 45 5.2.3 Zielkonflikte 46 6 ANWENDBARKEIT IN DER NOTSITUATION 47 6.1 Grundsatz 47 6.2 Besonderheiten der Notsituation 48 6.3 Differenzierung zwischen „normalem“ Notarzteinsatz und dem palliativmedizinisch begründeten Notfall 51 6.4 Lösungsansätze 54 7 DIE PATIENTENVERFÜGUNG AUF DEM PRÜFSTAND 56 7.1.1 Muster des Bundesministeriums für Justiz und Verbraucherschutz 57 7.1.2 Musterformular der Christlichen Patientenvorsorge 59 7.1.3 Musterformular der Sächsischen Landesärztekammer 59 7.1.4 Musterformular des Humanistischen Verbands Deutschlands 60 7.1.5 Musterformular von Monuta Versicherungen 61 7.1.6 Formular der Stiftung Schlaganfallhilfe 62 7.2 Verbesserungsvorschläge 62 7.2.1 Formales 62 7.2.2 Bevollmächtigung 63 7.2.3 Inhaltsfragen 63 7.2.4 Sprachwahl und Kommunikation 64 7.2.5 Notfallverfügung 66 7.3 Mustervorschlag 67 8 FAZIT 68 9 LITERATURVERZEICHNIS V 10 ANLAGEN XI 10.1 Anlage 1: Muster eines Statusabfragebogens XI 10.2 Anlage 2: Hausärztliche Anordnung einer hausärztlich internistischen Praxis XII 10.3 Anlage 3: Muster Patientenverfügung (SLAEK) XIII 10.4 Anlage 4: Musterbausteine einer Patientenverfügung XIV

Individuals who are facing death today are doing so in an environment that is significantly different than it was in the past. Medical technology is increasingly able to keep people alive even with multiple complex chronic conditions. While these advances in medicine are beneficial to many, it can also unnecessarily prolong inevitable deaths. Concerns over the ability to have a death that is in alignment with personal values has increased the interest in the use of formal end-of-life planning including writing an advance instructional directive and assigning a durable power of attorney for health care. Although research has indicated that the use of these formal planning strategies is beneficial, not everyone completes them. Using a current nationally representative sample, the three specific aims of this study were to examine whether there are racial and ethnic differences in formal end-of-life planning done by older African American, Hispanic, and White adults; to examine socioeconomic factors including education and income in formal end-of-life planning as well as assess the contribution of these factors in explaining racial and ethnic differences in formal end-of-life planning; and to examine the role of religiosity in formal end-of-life planning and to assess its influence on racial and ethnic differences in explaining formal end-of-life planning. Logistic regression was run on data from the Health and Retirement Study (HRS) in order to analyze the completion of formal end-of-life plans by African American, Hispanic, and White decedents. Exit interviews conducted with knowledgeable proxies in 2008 or 2010 were combined with data from earlier waves of the HRS survey in order to analyze the completion of formal end-of-life plans, race and ethnicity, socioeconomic status, and religion. Both Blacks and Hispanics were less likely to complete a written advance directive, assign a proxy, or complete both forms of formal planning than were Whites. Group differences remained after controlling for region of death and cause of death. Both Blacks and Hispanics were less likely to complete any form of formal planning than Whites. Group differences remained after additionally controlling for gender, age, marital status, whether the decedent had children, income, education, religious preference, importance of religion, and frequency of attending religious services. Higher levels of income and education both increased the odds that formal advance planning would take place. Religious preference was not significant, but decedents who had stated that religion was very important were less likely to plan while those that attended services frequently were more likely to plan. I speculate that the role of cultural capital may partially explain the persistent racial and ethnic disparities and the importance of income and education. Additionally the dominant religious doctrines of Christianity may have a greater influence than the different religious teachings of Protestant and Catholics around end-of-life medical care. Contrary to expected findings, reference groups of those who attend religious services frequently may assist in formal planning. These finding may help guide interventions that can diminish disparities in the end-of-life experience. Understanding who are completing formal plans can help ensure end-of-life care that is in alignment with personal beliefs and values.

Walkers provided stability to the elderly but cannot assist a person from sitting to standing. The objective of this project is to present the design and analysis of a lift assist walker. This report discusses the design and analysis of a collapsible lift assist walker capable of lifting a patient up to 250 lbs. from seated to standing in under 10 seconds. The designed walker utilized a two stage scissor mechanism with a gas spring assisted embedded linear actuator.