La transplantation d'organe améliore durablement la qualité de vie de patients en défaillance organique terminale. Malheureusement le nombre de greffons disponibles est insuffisant pour traiter tous les patients inscrits en liste d'attente. En France, les organes greffés proviennent essentiellement de donneurs en mort encéphalique. En cas de maladie grave, incurable et rapidement mortelle, il est également possible dans certains pays (dont la France) d'arrêter les thérapeutiques qui maintiennent artificiellement un patient en vie et de prélever ses organes une fois le décès par arrêt circulatoire constaté. La loi n°2005-370 du 22 Avril 2005 (dite loi Léonetti) autorise l'arrêt des traitements lorsqu'ils apparaissent « inutiles, disproportionnés ou n'ayant d'autre effet que le seul maintien artificiel de la vie ». Pour certains, cette fin de vie médicalement planifiée devrait prendre en compte les souhaits du patient en matière de don d'organes et l'intérêt de la greffe pour la société. La position française était néanmoins jusqu'en 2014 de ne pas considérer le patient en fin de vie comme un donneur potentiel afin d'éviter toute confusion entre la décision d'arrêter les traitements curatifs et l'intention de prélever ses organes. Alors que ce type de prélèvement a débuté fin 2014 dans quelques sites pilotes français, nous avons examiné les aspects pratiques, juridiques et éthiques du prélèvement d'organe en situation de fin de vie médicalisée, en focalisant notre réflexion sur les droits du patient, la définition de la mort, la temporalité du processus de prélèvement, et les éléments qui déterminent les modalités d'arrêt des suppléances vitales. / Organ transplantation saves lives of many persons who otherwise would die from end-stage organ disease. In the past decades the need for transplants has grown faster than the number of available organs. This increasing requirement for donated organs has led to a renewed interest in donation after circulatory determination of death (DCDD). In some countries including France, terminally ill patients who die of cardiac arrest after a planned withdrawal of life support may be considered as organ donors (controlled DCDD). Before 2005 French rules were not designed for such practices. With regard to patients in final stage of incurable diseases, the law number 2005-370 of April 22, 2005 authorizes the withholding or withdrawal of treatments when they appear "useless, disproportionate or having no other effect than solely the artificial preservation of life". Advocates of the controlled DCDD argue that the end-of-life care plan should incorporate the patient's wishes concerning organ donation and the public interest of transplantation. Until 2014, most French medical academics regarded the perceived conflict of interest that would arise for clinicians treating potential donors as a major ethical question. As the French program started at the end of 2014 in a few pilot sites, we thus examine the practical, legal and ethical issues that arise in considering controlled DCDD, including determination of the donor's overall benefit, debates relating to the diagnosis and time of death, and factors determining how life-sustaining treatment is to be withdrawn.

No description available.

The study is focused on advanced life support (ALS) performed by rescue team physicians in an out-of-hospital setting. The first part of the study analyzes diagnostic possibilities and correctness of assumed aetiology of the sudden cardiac arrest during cardiopulmonary resuscitation (CPR) in the field. It introduces an original method of "Crosscheck Tables" and applies this method to 211 cases of CPR provided by physicians of the Emergency Care Service. The study demonstrates that significantly misleading conclusions can result from a global analysis of a set of cases. It stresses importance of diagnostic analyses applied to individual cases. The second part of the study concentrates on changes in PETCO2 level as related to the return of spontaneous circulation (ROSC - Return of Spontaneous Circulation) as opposed to the circulation fully dependent on chest compressions. The study demonstrates that in constantly ventilated patients undergoing CPR in an out-of-hospital setting, PETCO2 is significantly higher (about 10 mmHg) after ROSC than before ROSC. It demonstrates that a sudden increase in PETCO2 exceeding 10 mmHg is likely to indicate the moment of ROSC. The study also support a view that steadily low levels of PETCO2 values (<10 mmHg) indicate a low chance for a successful resuscitation outcome. Key...

Collision with orbital debris poses a serious threat to spacecraft and astronauts. Hypervelocity impacts resulting from collisions mean that objects with a mass less than 1g can cause mission-ending damage to spacecraft. A means of shielding spacecraft against collisions is necessary. A means of testing candidate shielding methods for their efficacy in mitigating hypervelocity impacts is therefore also necessary. Cal Poly’s Electromagnetic Railgun was designed with the goal of creating a laboratory system capable of simulating hypervelocity (≥ 3 km/s) impacts. Due to several factors, the system was not previously capable of high-velocity (≥ 1 km/s) tests. A deficient projectile design is revised, and a new design is tested. The new projectile design is demonstrated to enable far greater performance than the previous design, with a muzzle velocity ≥ 1 km/sbeing verified during testing, and an energy conversion efficiency of 2.7%. A method of improving contact and controlling wear at the projectile/rail interface using silver plating and conductive silver paste is validated. A mechanism explaining the problem of internal arcing within the railgun barrel is proposed, and design recommendations are made to eliminate arcing on the basis of the work done during testing. The primary structural members are found to be deficient for their application and a failure analysis of a failed member, loading analysis of the railgun barrel, and design of new structures is undertaken and presented.

<div>Adsorbent technology is widely used in many industrial applications including waste heat recovery, water purification, and atmospheric revitalization in confined habitations. Astronauts depend on adsorbent-based systems to remove metabolic carbon dioxide (CO₂) from the cabin atmosphere; as NASA prepares for the journey to Mars, engineers are redesigning the adsorbent-based system for reduced weight and optimal efficiency. These efforts hinge upon the development of accurate, predictive models, as simulations are increasingly relied upon to save cost and time over the traditional design-build-test approach. Engineers rely on simplified models to reduce computational cost and enable parametric optimizations. Amongst these simplified models is the axially dispersed plug-flow model for predicting the adsorbate concentration during flow through an adsorbent bed. This model is ubiquitously used in designing fixed-bed adsorption systems. The current work aims to improve the accuracy of the axially dispersed plug-flow model because of its wide-spread use. This dissertation identifies the critical model inputs that drive the overall uncertainty in important output quantities then systematically improves the measurement and prediction of these input parameters. Limitations of the axially dispersed plug-flow model are also discussed, and recommendations made for identifying failure of the plug-flow assumption.</div><div><br></div><div>An uncertainty and sensitivity analysis of an axially disperse plug-flow model is first presented. Upper and lower uncertainty bounds for each of the model inputs are found by comparing empirical correlations against experimental data from the literature. Model uncertainty is then investigated by independently varying each model input between its individual upper and lower uncertainty bounds then observing the relative change in predicted effluent concentration and temperature (<i>e.g.</i>, breakthrough time, bed capacity, and effluent temperature). This analysis showed that the LDF mass transfer coefficient is the largest source of uncertainty. Furthermore, the uncertainty analysis reveals that ignoring the effect of wall-channeling on apparent axial dispersion can cause significant error in the predicted breakthrough times of small-diameter beds.</div><div><br></div><div>In addition to LDF mass transfer coefficient and axial-dispersion, equilibrium isotherms are known to be strong lever arms and a potentially dominant source of model error. As such, detailed analysis of the equilibrium adsorption isotherms for zeolite 13X was conducted to improve the fidelity of CO₂ and H₂O on equilibrium isotherms compared to extant data. These two adsorbent/adsorbate pairs are of great interest as NASA plans to use zeolite 13X in the next generation atmospheric revitalization system. Equilibrium isotherms describe a sorbent’s maximum capacity at a given temperature and adsorbate (<i>e.g.</i>, CO₂ or H₂O) partial pressure. New isotherm data from NASA Ames Research Center and NASA Marshall Space Flight Center for CO₂ and H₂O adsorption on zeolite 13X are presented. These measurements were carefully collected to eliminate sources of bias in previous data from the literature, where incomplete activation resulted in a reduced capacity. Several models are fit to the new equilibrium isotherm data and recommendations of the best model fit are made. The best-fit isotherm models from this analysis are used in all subsequent modeling efforts discussed in this dissertation.</div><div><br></div><div>The last two chapters examine the limitations of the axially disperse plug-flow model for predicting breakthrough in confined geometries. When a bed of pellets is confined in a rigid container, packing heterogeneities near the wall lead to faster flow around the periphery of the bed (<i>i.e.</i>, wall channeling). Wall-channeling effects have long been considered negligible for beds which hold more than 20 pellets across; however, the present work shows that neglecting wall-channeling effects on dispersion can yield significant errors in model predictions. There is a fundamental gap in understanding the mechanisms which control wall-channeling driven dispersion. Furthermore, there is currently no way to predict wall channeling effects a priori or even to identify what systems will be impacted by it. This dissertation aims to fill this gap using both experimental measurements and simulations to identify mechanisms which cause the plug-flow assumption to fail.</div><div><br></div><div>First, experimental evidence of wall-channeling in beds, even at large bed-to-pellet diameter ratios (<i>d</i>_bed/<i>d</i>_p=48) is presented. These experiments are then used to validate a method for accurately extracting mass transfer coefficients from data affected by significant wall channeling. The relative magnitudes of wall-channeling effects are shown to be a function of the adsorption/adsorbate pair and geometric confinement (<i>i.e.</i>, bed size). Ultimately, the axially disperse plug-flow model fails to capture the physics of breakthrough when nonplug-flow conditions prevail in the bed.</div><div><br></div><div>The final chapter of this dissertation develops a two-dimensional (2-D) adsorption model to examine the interplay of wall-channeling and adsorption kinetics and the adsorbent equilibrium capacity on breakthrough in confined geometries. The 2-D model incorporates the effect of radial variations in porosity on the velocity profile and is shown to accurately capture the effect of wall-channeling on adsorption behavior. The 2-D model is validated against experimental data, and then used to investigate whether capacity or adsorption kinetics cause certain adsorbates to exhibit more significant radial variations in concentration compared than others. This work explains channeling effects can vary for different adsorbate and/or adsorbent pairs—even under otherwise identical conditions—and highlights the importance of considering adsorption kinetics in addition to the traditional <i>d</i>_bed/<i>d</i>_p criteria.</div><div><br></div><div>This dissertation investigates key gaps in our understanding of fixed-bed adsorption. It will deliver insight into how these missing pieces impact the accuracy of predictive models and provide a means for reconciling these errors. The culmination of this work will be an accurate, predictive model that assists in the simulation-based design of the next-generation atmospheric revitalization system for humans’ journey to Mars.</div>

Les challenges posés par les missions d’exploration du système solaire sont très différents de ceux de la Station Spatiale Internationale, puisque les distances sont beaucoup plus importantes, limitant la possibilité de ravitaillements réguliers. Les systèmes support-vie basés sur des plantes supérieures et des micro-organismes, comme le projet de l’Agence Spatiale Européenne (ESA) MELiSSA (Micro Ecological Life Support System Alternative) permettront aux équipages d’être autonomes en termes de production de nourriture, revitalisation de l’air et de recyclage d’eau, tout en fermant les cycles de l’eau, de l’oxygène, de l’azote et du carbone, pendant les missions longue durée, et deviendront donc essentiels.La croissance et le développement des plantes et autres organismes biologiques sont fortement influencés par les conditions environnementales (par exemple la gravité, la pression, la température, l’humidité relative, les pressions partielles en O2 et CO2). Pour prédire la croissance des plantes dans ces conditions non-standard, il est crucial de développer des modèles de croissance mécanistiques, permettant une étude multi-échelle des différents phénomènes, ainsi que d’acquérir une compréhension approfondie de tous les processus impliqués dans le développement des plantes en environnement de gravité réduite et d’identifier les lacunes de connaissance.En particulier, les échanges gazeux à la surface de la feuille sont altérés en gravité réduite, ce qui pourrait diminuer la croissance des plantes dans l’espace. Ainsi, nous avons étudié les relations complexes entre convection forcée, niveau de gravité et production de biomasse et avons trouvé que l’inclusion de la gravité comme paramètre dans les modèles d’échanges gazeux des plantes nécessite une description précise des transferts de matière et d’énergie dans la couche limite. Nous avons ajouté un bilan d’énergie au bilan de masse du modèle de croissance de plante déjà existant et cela a ajouté des variations temporelles sur la température de surface des feuilles.Cette variable peut être mesurée à l’aide de caméras infra-rouges et nous avons réalisé une expérience en vol parabolique et cela nous a permis de valider des modèles de transferts gazeux locaux en 0g et 2g, sans ventilation.Enfin, le transport de sève, la croissance racinaire et la sénescence des feuilles doivent être étudiés en conditions de gravité réduite. Cela permettrait de lier notre modèle d’échanges gazeux à la morphologie des plantes et aux allocations de ressources dans une plante et ainsi arriver à un modèle mécanistique complet de la croissance des plantes en environnement de gravité réduite. / Challenges triggered by human space exploration of the solar system are different from those of the International Space Station because distances and time frames are of a different scale, preventing frequent resupplies. Bioregenerative life-support systems based on higher plants and microorganisms, such as the ESA Micro-Ecological Life Support System Alternative (MELiSSA) project will enable crews to be autonomous in food production, air revitalization, and water recycling, while closing cycles for water, oxygen, nitrogen, and carbon, during long-duration missions and will thus become necessary.The growth and development of higher plants and other biological organisms are strongly influenced by environmental conditions (e.g. gravity, pressure, temperature, relative humidity, partial pressure of O2 or CO2). To predict plant growth in these non-standard conditions, it is crucial to develop mechanistic models of plant growth, enabling multi-scale study of different phenomena, as well as gaining thorough understanding on all processes involved in plant development in low gravity environment and identifying knowledge gaps.Especially gas exchanges at the leaf surface are altered in reduced gravity, which could reduce plant growth in space. Thus, we studied the intricate relationships between forced convection, gravity levels and biomass production and found that the inclusion of gravity as a parameter in plant gas exchanges models requires accurate mass and heat transfer descriptions in the boundary layer. We introduced an energy coupling to the already existing mass balance model of plant growth and this introduced time-dependent variations of the leaf surface temperature.This variable can be measured using infra-red cameras and we implemented a parabolic flight experiment, which enabled us to validate local gas transfer models in 0g and 2g without ventilation.Finally, sap transport needs to be studied in reduced gravity environments, along with root absorption and leaf senescence. This would enable to link our gas exchanges model to plant morphology and resources allocations, and achieve a complete mechanistic model of plant growth in low gravity environments.

Esse estudo tem, por objetivo, descrever a organização do atendimento pré-hospitalar, prestado pelas equipes de suporte básico do Serviço de Atendimento Móvel de Urgência – SAMU 192 de Porto Alegre, em relação ao fluxo, encaminhamento e recepção nos serviços de saúde, identificando como se articulam as ações entre o médico regulador de urgência e as equipes de suporte básico. Trata-se de um estudo de caso, com abordagem qualitativa. A coleta de dados foi realizada por meio de observação e entrevistas semi-dirigidas. O foco da observação foi sobre o trabalho das equipes de suporte básico do SAMU em relação à comunicação com o médico regulador de urgência, referente à passagem dos casos, às orientações de condutas no atendimento e no encaminhamento, aos serviços de saúde, dos pacientes atendidos por essas equipes. Os entrevistados foram os profissionais, que compõem as equipes de suporte básico (auxiliares e técnicos de enfermagem e condutores de veículos de urgência), e médicos da central de regulação de urgência. Os dados obtidos foram classificados em estruturas de relevância e, posteriormente, agrupados em dois núcleos: a articulação do trabalho entre a regulação médica e as equipes de suporte básico do SAMU e o trabalho das equipes para além do APH móvel. No primeiro núcleo, aborda-se como a regulação se comunica com as equipes na passagem dos casos às quais estes são enviadas para atendimento, assim como em relação às orientações dadas às equipes na cena dos eventos e aos contatos com os serviços de urgência que recebem os pacientes encaminhados pelo SAMU. Constatou-se que as informações, dadas pelo médico regulador, carecem de detalhamento sobre as condições dos pacientes que serão atendidos pelas equipes de suporte básico, fazendo com que as equipes trabalhem com pouca preparação prévia ao evento. A recepção, nas portas de urgência, evidencia as dificuldades encontradas pela superlotação dos serviços. Nesse cenário, as equipes de suporte básico usam de suas relações interpessoais para garantir a acolhida dos pacientes. No segundo núcleo, abordam-se a articulação do trabalho em equipe e o desempenho dos profissionais do suporte básico em tratar situações que, a priori, fogem da classificação de risco iminente à vida. Os dados analisados revelam a importância do trabalho das equipes de suporte básico do SAMU, constituindo-se num dos pilares do serviço. Evidenciam, também, a estreita relação com a regulação médica, numa combinação de ações para o cuidado dos usuários que demandam o SAMU. Conclui-se pela necessidade de aprofundar as discussões sobre os processos de trabalho, tanto na relação interna do serviço quanto nas relações interinstitucionais com os serviços de saúde da cidade, na perspectiva de desenvolver um trabalho em rede, articulado e solidário. / This study aims at describing the organization of the pre-hospital care delivered by the basic support crew of the Emergency Mobile Care Service (Serviço de Atendimento Móvel de Urgência – SAMU - 192) of Porto Alegre, in relation to the flow, delivery and reception within the healthcare services, by identifying how actions between the emergency coordinator physician and the basic support crews are articulated. This is a case study with qualitative approach. Data collection was performed by means of observation and semi-oriented interviews. The focus of observation was the work of the basic support crews of SAMU regarding communication with the emergency coordinator physician, concerning information about addressing the cases, guidelines about attendance management, and patient delivery to the health services rendered by these crews. Interviews were carried out with the professionals that compose the basic support crews (nursing assistants and technicians and drivers of emergency vehicles) and the coordinator physicians from the urgency regulation center. The obtained data were classified into structures of relevance and, afterwards, grouped in two nuclei: the articulation of the work between coordinator physicians and basic support crews of SAMU and, the work of the crews beyond the mobile Pre-Hospital Care (PHC). The first nucleus approaches communication ways between the medical regulation and the basic crews which the cases are addressed to as well as regarding the guidelines given to the crews in the site of events besides the contacts with the emergency services received by the patients delivered by SAMU. It was found out that the information given by the medical regulation lacks details about the condition of the patients that will be cared by the basic support crews resulting that the crews work without enough previous preparation when attending an event. The reception, at the emergency services, evidences the difficulties met due to overcrowded facilities. Within this scenario, the basic support crews use their interpersonal relations to guarantee the patient reception. The second nucleus approaches the articulation of crew work and the performance of the basic support professionals in managing situations that, a priori, are not classified as an eminent life threat. The analyzed data reveal the importance of the work by SAMU basic support crews who constitute one of the pillars of the service. They also evidence a close relation with the medical regulation in a combination of actions towards the care rendered to the users that call for SAMU. The conclusion drawn appoints to the need of further discussions about the work processes concerning to internal relations of the service and inter-institutional relations with other healthcare services from the city, in the perspective of developing an articulated and humanized healthcare network. / Ese estudio tiene el objetivo de describir la organización del atendimiento pre-hospitalario prestado por los equipos de soporte básico del Servicio de Atendimiento Móvil de Urgencia – SAMU 192 de Porto Alegre, en relación al flujo, encaminamiento y recepción en los servicios de salud, identificando como se articulan las acciones entre el médico regulador de urgencia y los equipos de soporte básico. Se trata de un estudio de caso, con abordaje cualitativo. La recolección de datos fue realizada por medio de observación y entrevistas semi-dirigidas. El foco de la observación fue acerca del trabajo de los equipos de soporte básico del SAMU en relación a la comunicación con el médico regulador de urgencia, referente al pasaje de los casos, a las orientaciones de conductas en el atendimiento y en el encaminamiento a los servicios de salud de los pacientes atendidos por eses equipos. Los entrevistados fueron los profesionales, que componen los equipos de soporte básico (auxiliares y técnicos de enfermería y conductores de vehículos de urgencia), y los médicos de la central de regulación de urgencia. Los datos obtenidos fueron clasificados en estructuras de relevancia y, luego, agrupados en dos núcleos: la articulación del trabajo entre la regulación médica y los equipos de soporte básico del SAMU y el trabajo de los equipos más allá del APH – Atendimiento Pre-Hospitalario móvil. El primer núcleo aborda las formas de comunicación entre la regulación y los equipos en el pasaje de casos que les son encaminados para atendimiento así como en relación a las orientaciones dadas a los equipos en el sitio de los eventos además de los contactos con los servicios de emergencia que reciben los pacientes encaminados por el SAMU. Se constató que las informaciones dadas por el médico regulador carecen de detalles acerca de las condiciones de los pacientes, que serán atendidos por los equipos de soporte básico, de manera que los equipos trabajan con poca preparación previa al evento. La recepción, en las puertas de emergencia, evidencia las dificultades encontradas por la superpoblación de los servicios. En tal escenario, los equipos de soporte básico usan de sus relaciones interpersonales para garantizar la acojida de los pacientes. El segundo núcleo aborda la articulación del trabajo en equipo y el desempeño de los profesionales de soporte básico al tratar situaciones que, a priori, huyen de la clasificación de riesgo inminente a la vida. Los datos analizados revelan la importancia del trabajo de los equipos de soporte básico del SAMU, uno de los pilares del servicio. Evidencian, además, la estrecha relación con la regulación médica en una combinación de acciones para la atención a los usuarios que demandan el SAMU. Se concluye por la necesidad de profundizar las discusiones acerca de los procesos de trabajo tanto en la relación interna del servicio cuanto en las relaciones interinstitucionales con los servicios de salud de la ciudad, en la perspectiva de desarrollar un trabajo en red, articulado y solidario.

Esse estudo tem, por objetivo, descrever a organização do atendimento pré-hospitalar, prestado pelas equipes de suporte básico do Serviço de Atendimento Móvel de Urgência – SAMU 192 de Porto Alegre, em relação ao fluxo, encaminhamento e recepção nos serviços de saúde, identificando como se articulam as ações entre o médico regulador de urgência e as equipes de suporte básico. Trata-se de um estudo de caso, com abordagem qualitativa. A coleta de dados foi realizada por meio de observação e entrevistas semi-dirigidas. O foco da observação foi sobre o trabalho das equipes de suporte básico do SAMU em relação à comunicação com o médico regulador de urgência, referente à passagem dos casos, às orientações de condutas no atendimento e no encaminhamento, aos serviços de saúde, dos pacientes atendidos por essas equipes. Os entrevistados foram os profissionais, que compõem as equipes de suporte básico (auxiliares e técnicos de enfermagem e condutores de veículos de urgência), e médicos da central de regulação de urgência. Os dados obtidos foram classificados em estruturas de relevância e, posteriormente, agrupados em dois núcleos: a articulação do trabalho entre a regulação médica e as equipes de suporte básico do SAMU e o trabalho das equipes para além do APH móvel. No primeiro núcleo, aborda-se como a regulação se comunica com as equipes na passagem dos casos às quais estes são enviadas para atendimento, assim como em relação às orientações dadas às equipes na cena dos eventos e aos contatos com os serviços de urgência que recebem os pacientes encaminhados pelo SAMU. Constatou-se que as informações, dadas pelo médico regulador, carecem de detalhamento sobre as condições dos pacientes que serão atendidos pelas equipes de suporte básico, fazendo com que as equipes trabalhem com pouca preparação prévia ao evento. A recepção, nas portas de urgência, evidencia as dificuldades encontradas pela superlotação dos serviços. Nesse cenário, as equipes de suporte básico usam de suas relações interpessoais para garantir a acolhida dos pacientes. No segundo núcleo, abordam-se a articulação do trabalho em equipe e o desempenho dos profissionais do suporte básico em tratar situações que, a priori, fogem da classificação de risco iminente à vida. Os dados analisados revelam a importância do trabalho das equipes de suporte básico do SAMU, constituindo-se num dos pilares do serviço. Evidenciam, também, a estreita relação com a regulação médica, numa combinação de ações para o cuidado dos usuários que demandam o SAMU. Conclui-se pela necessidade de aprofundar as discussões sobre os processos de trabalho, tanto na relação interna do serviço quanto nas relações interinstitucionais com os serviços de saúde da cidade, na perspectiva de desenvolver um trabalho em rede, articulado e solidário. / This study aims at describing the organization of the pre-hospital care delivered by the basic support crew of the Emergency Mobile Care Service (Serviço de Atendimento Móvel de Urgência – SAMU - 192) of Porto Alegre, in relation to the flow, delivery and reception within the healthcare services, by identifying how actions between the emergency coordinator physician and the basic support crews are articulated. This is a case study with qualitative approach. Data collection was performed by means of observation and semi-oriented interviews. The focus of observation was the work of the basic support crews of SAMU regarding communication with the emergency coordinator physician, concerning information about addressing the cases, guidelines about attendance management, and patient delivery to the health services rendered by these crews. Interviews were carried out with the professionals that compose the basic support crews (nursing assistants and technicians and drivers of emergency vehicles) and the coordinator physicians from the urgency regulation center. The obtained data were classified into structures of relevance and, afterwards, grouped in two nuclei: the articulation of the work between coordinator physicians and basic support crews of SAMU and, the work of the crews beyond the mobile Pre-Hospital Care (PHC). The first nucleus approaches communication ways between the medical regulation and the basic crews which the cases are addressed to as well as regarding the guidelines given to the crews in the site of events besides the contacts with the emergency services received by the patients delivered by SAMU. It was found out that the information given by the medical regulation lacks details about the condition of the patients that will be cared by the basic support crews resulting that the crews work without enough previous preparation when attending an event. The reception, at the emergency services, evidences the difficulties met due to overcrowded facilities. Within this scenario, the basic support crews use their interpersonal relations to guarantee the patient reception. The second nucleus approaches the articulation of crew work and the performance of the basic support professionals in managing situations that, a priori, are not classified as an eminent life threat. The analyzed data reveal the importance of the work by SAMU basic support crews who constitute one of the pillars of the service. They also evidence a close relation with the medical regulation in a combination of actions towards the care rendered to the users that call for SAMU. The conclusion drawn appoints to the need of further discussions about the work processes concerning to internal relations of the service and inter-institutional relations with other healthcare services from the city, in the perspective of developing an articulated and humanized healthcare network. / Ese estudio tiene el objetivo de describir la organización del atendimiento pre-hospitalario prestado por los equipos de soporte básico del Servicio de Atendimiento Móvil de Urgencia – SAMU 192 de Porto Alegre, en relación al flujo, encaminamiento y recepción en los servicios de salud, identificando como se articulan las acciones entre el médico regulador de urgencia y los equipos de soporte básico. Se trata de un estudio de caso, con abordaje cualitativo. La recolección de datos fue realizada por medio de observación y entrevistas semi-dirigidas. El foco de la observación fue acerca del trabajo de los equipos de soporte básico del SAMU en relación a la comunicación con el médico regulador de urgencia, referente al pasaje de los casos, a las orientaciones de conductas en el atendimiento y en el encaminamiento a los servicios de salud de los pacientes atendidos por eses equipos. Los entrevistados fueron los profesionales, que componen los equipos de soporte básico (auxiliares y técnicos de enfermería y conductores de vehículos de urgencia), y los médicos de la central de regulación de urgencia. Los datos obtenidos fueron clasificados en estructuras de relevancia y, luego, agrupados en dos núcleos: la articulación del trabajo entre la regulación médica y los equipos de soporte básico del SAMU y el trabajo de los equipos más allá del APH – Atendimiento Pre-Hospitalario móvil. El primer núcleo aborda las formas de comunicación entre la regulación y los equipos en el pasaje de casos que les son encaminados para atendimiento así como en relación a las orientaciones dadas a los equipos en el sitio de los eventos además de los contactos con los servicios de emergencia que reciben los pacientes encaminados por el SAMU. Se constató que las informaciones dadas por el médico regulador carecen de detalles acerca de las condiciones de los pacientes, que serán atendidos por los equipos de soporte básico, de manera que los equipos trabajan con poca preparación previa al evento. La recepción, en las puertas de emergencia, evidencia las dificultades encontradas por la superpoblación de los servicios. En tal escenario, los equipos de soporte básico usan de sus relaciones interpersonales para garantizar la acojida de los pacientes. El segundo núcleo aborda la articulación del trabajo en equipo y el desempeño de los profesionales de soporte básico al tratar situaciones que, a priori, huyen de la clasificación de riesgo inminente a la vida. Los datos analizados revelan la importancia del trabajo de los equipos de soporte básico del SAMU, uno de los pilares del servicio. Evidencian, además, la estrecha relación con la regulación médica en una combinación de acciones para la atención a los usuarios que demandan el SAMU. Se concluye por la necesidad de profundizar las discusiones acerca de los procesos de trabajo tanto en la relación interna del servicio cuanto en las relaciones interinstitucionales con los servicios de salud de la ciudad, en la perspectiva de desarrollar un trabajo en red, articulado y solidario.

Esse estudo tem, por objetivo, descrever a organização do atendimento pré-hospitalar, prestado pelas equipes de suporte básico do Serviço de Atendimento Móvel de Urgência – SAMU 192 de Porto Alegre, em relação ao fluxo, encaminhamento e recepção nos serviços de saúde, identificando como se articulam as ações entre o médico regulador de urgência e as equipes de suporte básico. Trata-se de um estudo de caso, com abordagem qualitativa. A coleta de dados foi realizada por meio de observação e entrevistas semi-dirigidas. O foco da observação foi sobre o trabalho das equipes de suporte básico do SAMU em relação à comunicação com o médico regulador de urgência, referente à passagem dos casos, às orientações de condutas no atendimento e no encaminhamento, aos serviços de saúde, dos pacientes atendidos por essas equipes. Os entrevistados foram os profissionais, que compõem as equipes de suporte básico (auxiliares e técnicos de enfermagem e condutores de veículos de urgência), e médicos da central de regulação de urgência. Os dados obtidos foram classificados em estruturas de relevância e, posteriormente, agrupados em dois núcleos: a articulação do trabalho entre a regulação médica e as equipes de suporte básico do SAMU e o trabalho das equipes para além do APH móvel. No primeiro núcleo, aborda-se como a regulação se comunica com as equipes na passagem dos casos às quais estes são enviadas para atendimento, assim como em relação às orientações dadas às equipes na cena dos eventos e aos contatos com os serviços de urgência que recebem os pacientes encaminhados pelo SAMU. Constatou-se que as informações, dadas pelo médico regulador, carecem de detalhamento sobre as condições dos pacientes que serão atendidos pelas equipes de suporte básico, fazendo com que as equipes trabalhem com pouca preparação prévia ao evento. A recepção, nas portas de urgência, evidencia as dificuldades encontradas pela superlotação dos serviços. Nesse cenário, as equipes de suporte básico usam de suas relações interpessoais para garantir a acolhida dos pacientes. No segundo núcleo, abordam-se a articulação do trabalho em equipe e o desempenho dos profissionais do suporte básico em tratar situações que, a priori, fogem da classificação de risco iminente à vida. Os dados analisados revelam a importância do trabalho das equipes de suporte básico do SAMU, constituindo-se num dos pilares do serviço. Evidenciam, também, a estreita relação com a regulação médica, numa combinação de ações para o cuidado dos usuários que demandam o SAMU. Conclui-se pela necessidade de aprofundar as discussões sobre os processos de trabalho, tanto na relação interna do serviço quanto nas relações interinstitucionais com os serviços de saúde da cidade, na perspectiva de desenvolver um trabalho em rede, articulado e solidário. / This study aims at describing the organization of the pre-hospital care delivered by the basic support crew of the Emergency Mobile Care Service (Serviço de Atendimento Móvel de Urgência – SAMU - 192) of Porto Alegre, in relation to the flow, delivery and reception within the healthcare services, by identifying how actions between the emergency coordinator physician and the basic support crews are articulated. This is a case study with qualitative approach. Data collection was performed by means of observation and semi-oriented interviews. The focus of observation was the work of the basic support crews of SAMU regarding communication with the emergency coordinator physician, concerning information about addressing the cases, guidelines about attendance management, and patient delivery to the health services rendered by these crews. Interviews were carried out with the professionals that compose the basic support crews (nursing assistants and technicians and drivers of emergency vehicles) and the coordinator physicians from the urgency regulation center. The obtained data were classified into structures of relevance and, afterwards, grouped in two nuclei: the articulation of the work between coordinator physicians and basic support crews of SAMU and, the work of the crews beyond the mobile Pre-Hospital Care (PHC). The first nucleus approaches communication ways between the medical regulation and the basic crews which the cases are addressed to as well as regarding the guidelines given to the crews in the site of events besides the contacts with the emergency services received by the patients delivered by SAMU. It was found out that the information given by the medical regulation lacks details about the condition of the patients that will be cared by the basic support crews resulting that the crews work without enough previous preparation when attending an event. The reception, at the emergency services, evidences the difficulties met due to overcrowded facilities. Within this scenario, the basic support crews use their interpersonal relations to guarantee the patient reception. The second nucleus approaches the articulation of crew work and the performance of the basic support professionals in managing situations that, a priori, are not classified as an eminent life threat. The analyzed data reveal the importance of the work by SAMU basic support crews who constitute one of the pillars of the service. They also evidence a close relation with the medical regulation in a combination of actions towards the care rendered to the users that call for SAMU. The conclusion drawn appoints to the need of further discussions about the work processes concerning to internal relations of the service and inter-institutional relations with other healthcare services from the city, in the perspective of developing an articulated and humanized healthcare network. / Ese estudio tiene el objetivo de describir la organización del atendimiento pre-hospitalario prestado por los equipos de soporte básico del Servicio de Atendimiento Móvil de Urgencia – SAMU 192 de Porto Alegre, en relación al flujo, encaminamiento y recepción en los servicios de salud, identificando como se articulan las acciones entre el médico regulador de urgencia y los equipos de soporte básico. Se trata de un estudio de caso, con abordaje cualitativo. La recolección de datos fue realizada por medio de observación y entrevistas semi-dirigidas. El foco de la observación fue acerca del trabajo de los equipos de soporte básico del SAMU en relación a la comunicación con el médico regulador de urgencia, referente al pasaje de los casos, a las orientaciones de conductas en el atendimiento y en el encaminamiento a los servicios de salud de los pacientes atendidos por eses equipos. Los entrevistados fueron los profesionales, que componen los equipos de soporte básico (auxiliares y técnicos de enfermería y conductores de vehículos de urgencia), y los médicos de la central de regulación de urgencia. Los datos obtenidos fueron clasificados en estructuras de relevancia y, luego, agrupados en dos núcleos: la articulación del trabajo entre la regulación médica y los equipos de soporte básico del SAMU y el trabajo de los equipos más allá del APH – Atendimiento Pre-Hospitalario móvil. El primer núcleo aborda las formas de comunicación entre la regulación y los equipos en el pasaje de casos que les son encaminados para atendimiento así como en relación a las orientaciones dadas a los equipos en el sitio de los eventos además de los contactos con los servicios de emergencia que reciben los pacientes encaminados por el SAMU. Se constató que las informaciones dadas por el médico regulador carecen de detalles acerca de las condiciones de los pacientes, que serán atendidos por los equipos de soporte básico, de manera que los equipos trabajan con poca preparación previa al evento. La recepción, en las puertas de emergencia, evidencia las dificultades encontradas por la superpoblación de los servicios. En tal escenario, los equipos de soporte básico usan de sus relaciones interpersonales para garantizar la acojida de los pacientes. El segundo núcleo aborda la articulación del trabajo en equipo y el desempeño de los profesionales de soporte básico al tratar situaciones que, a priori, huyen de la clasificación de riesgo inminente a la vida. Los datos analizados revelan la importancia del trabajo de los equipos de soporte básico del SAMU, uno de los pilares del servicio. Evidencian, además, la estrecha relación con la regulación médica en una combinación de acciones para la atención a los usuarios que demandan el SAMU. Se concluye por la necesidad de profundizar las discusiones acerca de los procesos de trabajo tanto en la relación interna del servicio cuanto en las relaciones interinstitucionales con los servicios de salud de la ciudad, en la perspectiva de desarrollar un trabajo en red, articulado y solidario.

Master of Visual Arts / This Dissertation explores the metaphor of Ariadne’s thread in terms of interconnection, when an element from the everyday is used as a locus linking broader concepts of time and space. Such experiences and associations are reflected in the work of Louise Bourgeois, Eva Hesse, Doris Salcedo, Lucio Fontana, Richard Tuttle, Mona Hatoum, Simone Mangos, Anya Gallaccio and Yoshihiro Suda. In relation to my own work, the metaphor of interconnecting thread allows a sense of freedom and journey of discovery. My studio and related research are closely aligned in developing my understanding of interconnection, through my studio process of making and continuing experiences of looking at and interpreting others artists’ work.