A Doença de Alzheimer (DA) é a doença mais prevalente entre as demências, retratada por déficits progressivos da memória, funções cognitivas e funcionalidade. Apesar das evidências dos benefícios do exercício físico nas funções cognitivas e no declínio funcional, há poucos estudos com idosos com DA, que incluem efeitos de programas multimodais de exercícios físicos comparados com idosos sem DA. Os objetivos foram comparar os efeitos do programa multimodal de exercícios físicos na capacidade funcional, memória e atenção em idosos sem e com DA. Foram randomizados vinte idosos sem DA para grupo controle (NDA-C) ou grupo treinamento físico (NDA-T) e 18 idosos com DA no grupo controle (DA-C) ou treinamento físico (DA-T). Todos realizaram avaliação do nível sócio econômico, nível de atividade física (Questionário Internacional de Atividade física), e avaliação neuropsicológica (Miniexame do Estado Mental, Teste Breve de Desempenho Cognitivo, Escore Clínico de Demência e Escala de Depressão Geriátrica). A avaliação funcional incluiu testes de resistência muscular de membros inferiores (MMII) e superiores (MMSS) (Teste de Sentar e levantar e Teste de Flexão do cotovelo), capacidade aeróbia (Teste de Marcha estacionária), flexibilidade de MMII e MMSS (Teste de Sentar e alcançar e Teste de Alcançar atrás) e agilidade/equilíbrio dinâmico (Teste de Levantar e ir). A avaliação da amplitude de movimento de ombro e tornozelo foi realizada através do Flexímetro. Os grupos DA-T e NDA-T participaram do programa durante 6 meses, 2 vezes/semana com duração de 75 minutos cada sessão. A análise estatística para verificar diferenças entre os quatro grupos no período inicial foi realizada por Análise de variância (ANOVA) de 1 fator. E para verificar diferenças entre os grupos antes e depois de 6 meses foi realizada ANOVA de 2 fatores. No caso de significância foi realizado uma análise de pos-hoc com Tukey. Admitiu-se, em todas as análises, o nível de significância de 5% (P 0,05). O programa aumentou significativamente (P < 0,05) o nível de atividade física no lazer, a força muscular de MMSS, capacidade aeróbia, flexibilidade de MMII e amplitude de extensão de tornozelo e ombro nos grupos NDA-T e DA- T. Os grupos NDA-T e DA-T melhoraram a capacidade de agilidade e equilibro dinâmico em relação ao grupo DA-C. O programa proporcionou melhora significativa (P < 0,05) na força muscular de MMII do grupo NDA-T e, na flexibilidade de MMSS e amplitude de flexão de tornozelo e ombro no grupo DA-T. Após a intervenção houve melhora significativa (P < 0,05) da memória dos grupos NDA-T e DA-T, e da atenção no grupo NDA-T. Conclui-se que o programa foi efetivo para aumentar o nível de atividade física no lazer, capacidade aeróbia, força muscular de MMSS, flexibilidade de MMII e amplitude de extensão de tornozelo e ombro, bem como a memória dos idosos, independente da presença da DA. O declínio da agilidade/equilibro dinâmico e da atenção do DA-T foi atenuado em relação ao DA-C. Estes benefícios contribuem para um melhor desempenho nas atividades da vida diária melhorando a qualidade de vida dos idosos com e sem DA / The Alzheimer Disease (AD) is the most prevalent disease between all the dementia, and it is portrayed by progressive deficits of memory and cognition. Besides all the evidences of the benefits of the physical exercises to the cognitive function, there are a few studies that include the effects of the multimodal programs on the physical function and cognitive functions, comparing older adults with and without AD. The goals were compare the multimodal program effects in functional capacity, memory and attention on older adults with and without AD. Twenty older adults without AD were randomized on Control Group (NAD-C) or Physical Training Group (NAD-T) and eighteen elderly with AD were randomized on control group (AD-C) or physical training group (AD-T). All patients realized socioeconomic evaluation, physical activities level (International Physical Activities Questionary), and neuropsychological evaluation (Mental State Miniexam, Syndrom Kurztest, Clinical Dementia Rating and Geriatric Depression Screening Scale). On the period of 6 months, the NAD-T and AD-T groups, participated on the multimodal program, the exercise routine was 2 times a week and the duration of 75 minutes. A measuring functional fitness of older adults were applied, the tests evaluated the Inferior and Superior liths muscular Resistance/Strenght (30-second Chair Stand and Arm Curl), Aerobic Capacity (2-minute Step), the lower and upper body flexibility (Chair Sit-and-Reach, and Back Scratch tests) and agility/dynamic balance (8-foot Up and Go). The shoulder and ankle amplitude evaluation tests were realized using a Fleximeter. The statistical analysis to verify if there was any difference between the four groups (NAD-C, NAD-T, AD-C and AD-T) on the initial period were realized using the Variance Analysis (ANOVA) 1way. The statistical analysis to verify the difference between the groups before and after the six months period was realized using the ANOVA 2way. In the case of significance, were used the Tukey Pos-Hoc analysis. In all analysis the level of significance was 5% (P 0.05). The multimodal exercise program was effective to increase the leisure time physical activity level of older adults with or without AD. The program, also contributed to increase the physical conditioning, getting a significant improvement (P<0.05) on the upper body muscular strength, aerobic capacity, upper and lower body flexibility, and, on the Shoulder and Ankle extension amplitude, in the NAD-T and AD-T groups. The NAD-T and AD-T groups improved agility/dynamic balance in relation to the AD-C group. Concerning the cognition, after exercise program, the groups NAD-T and AD-T showed an improvement on the memory (P<0.05). However, the attention only improved in the NAD-T group (P<0.05). Independent of multimodal physical exercise program was improve the leisure time physical activity level, aerobic capacity, upper body muscular strength, lower body flexibility shoulder and ankle extension, and memory in the older adults. The program attenuated the decline in agility/dynamic balance, and attention in DA-T group. These benefits contribute to a better performance in daily living activities which contributes to improve the quality of life of the older adults with and without AD

Este trabalho está voltado à avaliação dos problemas do transporte intermodal sob efeito de restrições sazonais que, usualmente, não são consideradas na fase de planejamento e dimensionamento da frota. E, considerando a sobreposição de dois fatores sazonais restritivos ao longo da cadeia de transportes - a variação na produção de grãos ao longo do ano e a sazonalidade das cotas de nível d\'água nas hidrovias -, um modelo de simulação de eventos discretos mostra as impedâncias sofridas no sistema pela junção de fatores restritivos bem fortes. É possível avaliar o impacto dessas restrições não só no nível de utilização dos silos intermediários e silagem do porto, mas também no número de veículos necessários para fazer o transporte de commodities na região Centro-Oeste do Brasil. Em um sistema de transporte composto pelos modais rodoviário, hidroviário e marítimo, no qual o modelo de simulação abrange desde a produção nas fazendas, passando pelo transporte de caminhão até os armazéns intermediários, posteriormente com o transporte fluvial com destino ao porto para exportação. O presente estudo traz uma série de comparações entre cenários para avaliação dos gargalos existentes neste sistema de transporte intermodal, especialmente avaliando cenários com e sem as restrições sazonais, assim como análises de sensibilidade de performance de equipamentos de carregamento e descarregamento, nos quais a frota e os estoques necessários são substancialmente diferentes se a sazonalidade não for considerada. / This work focuses on the evaluation of the intermodal transport problems under the influence of seasonal constraints that are not usually considered on the phase of planning and sizing the fleet. Considering the superposition of two different seasonal factors along the transportation chain - first one the variation on grain production and the second one the level of water in the waterways throughout the year -, a discrete event simulation model was built to show the real effects of those constraints in the grain supply chain. So, it is possible to evaluate the impact of those constraints not only on the usage level of storages in this system, but also the number of vehicles required to transport this commodities from the Midwest of Brazil to the port. In a complex multimodal transportation system, the simulation model in this work includes roadways, waterways and seaways to transport all the cargo from farms to the final costumer. This study is composed by a number of scenarios to evaluate the bottlenecks in this intermodal transportation system, specially analyzing scenarios with and without seasonal constraints, as well as analysis of sensitivity of performance of equipment of loading and unloading, in which the fleet and the required stocks are substantially different if seasonality is not considered. In other words, it is possible to evaluate the risks involved when managers are making decisions if they do not take in consideration any of those seasonal constraints.

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No. of bitstreams: 1 Tese- Patrícia Correia Saraiva.pdf: 5471120 bytes, checksum: faed3fa950294e70e5e4750ea26d9538 (MD5) Previous issue date: 2014-02-28 / FAPEAM - Fundação de Amparo à Pesquisa do Estado do Amazonas / The volume of information encoded in the form of images has increased significantly in the last decades. Contributing to this scenario, the wide-spread use of mobile devices, such as tablets and smartphones, and even notebooks, which not only can take photos, but also easily send them to connected applications, such as web services and social networks. Nowadays, images are used in several applications, such as to record personal moments of people’s life or showing products in e-commerce online stores. As a consequence, not only does the volume of images increase, but also the interest in solutions able to retrieve these images. The main goal of this thesis is to investigate the impact of using genetic programming (GP) as a tool for combining different sources of evidence available when retrieving images. As case studies, we considered the application of GP in two different contexts: image retrieval on the Web using textual information automatically extracted from Web pages, and visual search by expanding the image query using information derived from different types of data, such as text and visual content. We evaluate the proposed expansion strategies in an application of visual search for products focused on e-commerce stores for the fashion domain. Experiments performed in the context of image retrieval on the Web showed that the evolutionary approach outperformed the best baseline with gains of 22.36% in terms of MAP. In the context of visual search for e-commerce applications, experimental results indicated that automatic expansion based on genetic programming is an effective alternative for improving the quality of image search results. When compared to a genetic programming system based only on visual information, the multimodal expansion achieved gains of at least 19% in all scenarios considered. When compared to a similar approach, but completely ad hoc, the GP framework achieved gains of up to 54% in terms of MAP. / O volume de informação codificada sob a forma de imagens tem aumentado de forma significativa nas últimas décadas. O uso cada vez mais frequente de tablets, smartphones, câmeras digitais e notebooks com suporte à aquisição de imagens e a facilidade para tornar essas imagens disponíveis publicamente em repositórios compartilhados, são fatores que contribuem ainda mais para este cenário. Atualmente, imagens são usadas nas mais diversas aplicações, seja para registrar momentos e ações em jornais e revistas eletrônicas, ou redes sociais, ou ainda para divulgar produtos em aplicações de comércio eletrônico. Na medida em que cresce o volume de imagens, cresce também o interesse por sistemas capazes de realizar busca em bases de dados de imagem. O objetivo principal desta tese é investigar o impacto do uso de programação genética (GP - Genetic Progamming) como ferramenta para combinar diferentes fontes de informação disponíveis durante a busca de imagens. Mais especificamente, foram abordados dois contextos distintos como estudos de caso: a busca de imagens na Web utilizando informação textual extraída automaticamente das páginas Web e, a busca visual por meio da expansão da imagem de consulta utilizando informação derivadas de diferentes modalidades de dados, como texto e conteúdo visual. Para avaliar as estratégias propostas para o contexto de busca visual, escolheu-se como estudo de caso a busca visual de produtos em lojas de comércio eletrônico voltadas para o segmento de moda. Os experimentos realizados no contexto de busca de imagens na Web mostraram que a abordagem evolucionária superou a melhor abordagem utilizada como baseline, com ganhos de 22,36% em termos de MAP. No cenário de busca visual de produtos em lojas de comércio eletrônico, os resultados experimentais mostraram que a expansão automática baseada em GP é uma alternativa efetiva para melhorar a qualidade dos resultados de um sistema de busca de imagens. Quando comparado a uma abordagem baseada somente em propriedades visuais, a expansão multimodal obteve ganhos de pelo menos 19% em todos os cenários de busca considerados. Quando comparado a uma abordagem similar, mas completamente ad hoc, o arcabouço baseado em GP obteve ganhos de até 54% em termos de MAP.

<p>Research shows that there is a literacy crisis in many South African primary schools, especially in the Foundation and Intermediate Phases (Grades 1 &ndash / &nbsp / ). The latest Annual National Assessments (ANA) results released in 2011 indicate that learners performed below the acceptable literacy levels as&nbsp / the national pass rate for Grade 3 learners was 35% and was 28% for Grade 6 learners (ANA, 2011:6). Research on literacy focuses on reading and&nbsp / there is little known about how young learners develop writing skills. This qualitative ethnographic study investigated how writing skills are developed in Grade 1 learners by looking at the writing processes as well as the teaching methods used by teachers to develop learners&rsquo / writing skills. The research also&nbsp / analyzed the texts produced by Grade 1 learners and the languages used in their written texts. The sample group in this research was the Grade 1 learners&nbsp / to a multicultural school in Cape Town. Data were collected by means of classroom observations, interviews and document analysis. The thematic&nbsp / arrative approach was used to analyze data and the analysis was informed by the Writing Developmental Continuum model and the Multimodal&nbsp / Approach to literacy in order to gain a better understanding of how young learners use language and other forms of writing such as visuals and gestures to&nbsp / onstruct and convey meaning.&nbsp / The findings of this research show that Grade 1 learners make use of semiotic resources including the language(s)&nbsp / &nbsp / &nbsp / available in their immediate context to create multimodal texts that incorporate both visual and written features. This shows that young learners represent&nbsp / their world experiences through interpersonal and experiential meanings in language(s) exposed to them. The teacher has a big role to play in developing&nbsp / learners&rsquo / writing skills and has to employ a variety of pedagogical strategies that support learners to move through the different writing phases before they develop into early writers. The study concludes that writing is not a linear process but it is a gradual process which depends on a variety of resources and&nbsp / factors which build on learners&rsquo / prior experiences and creativity.</p>

Background: Chronic pain is a condition that approximately 18% of the Swedish population suffers from. This condition affects many aspects of a person´s life and causes psychological, physiological and social suffering. Multimodal treatment is considered the most effective treatment for patients with chronic pain. Patient participation and motivation are very important to treatment. Aim: The aim of this study was to explore patients´ experience of a multimodal chronic pain treatment program regarding their experience of patient participation and interaction with the rehabilitation team. Method: An exploratory qualitative interview study with inductive approach. The data was collected through interviews with nine former outpatients at a pain clinic who underwent the multimodal rehabilitation program for patients with chronic pain. Data was analysed by using manifest content analysis. Results: The participants experienced that they had received a very good treatment from the team as a whole. They also had experienced participation during the rehabilitation program. The experience was built on some requirements being fulfilled, which directly or indirectly contributed to the feeling and experience of receiving help. Human, professional, external and inner conditions contributed to a positive experience regarding patient participation in the program and the good treatment and interaction with the rehabilitation team as a whole. Conclusions: There seem to be a connection between the participants´ experience of good treatment and the help they experience they have received. Apparently, for patients, there is no clear border between rehabilitation and feeling of receiving a good treatment. Participation in the program seems to be based on receiving a good treatment. / Bakgrund: Långvarig smärta är ett tillstånd som cirka 18 % av befolkningen i Sverige är drabbat av. Detta tillstånd påverkar många aspekter i patientens liv och medför stort lidande såväl fysiskt, psykiskt och socialt. Multimodal rehabilitering har visat sig vara den mest effektiva behandlingen för patienter med långvarig smärta. Delaktighet och motivation är grundstenar i behandlingen. Syfte: Syftet med den här studien var att undersöka patienters upplevelse av multimodal smärtrehabilitering avseende bemötande och känsla av delaktighet i behandlingen. Metod: En explorativ intervjustudie med kvalitativ induktiv ansats. Datainsamling skedde genom intervjuer med nio människor som genomgått multimodal rehabilitering. Intervjuerna analyserades med hjälp av manifest innehållsanalys. Resultat: Deltagarna har upplevt genomgående ett mycket gott bemötande och en känsla av delaktighet i behandlingen på smärtrehabiliteringen. Upplevelsen bygger på att vissa förutsättningar uppfylls som direkt och indirekt bidrar till upplevelse av att man får hjälp. Mellanmänskliga, professionella, yttre och inre förutsättningar bidrar till en positiv upplevelse avseende bemötande och känsla av delaktighet. Slutsats: Det tycks finnas en tydlig koppling mellan upplevelse av ett gott bemötande och upplevelsen att ha fått hjälpt. Det tycks inte finnas, i deltagarnas livsvärld, en tydlig skiljelinje mellan rehabilitering och upplevelse av bemötande. Delaktighet tycks bygga på att man upplever ett gott bemötande.

Utgångspunkten i uppsatsen är, att om en kommunikation av ett budskap inom en organisation skall ha förutsättningar att lyckas, måste budskapet: 1. först och främst bli mottaget, d v s uppfattas av en tänkt mottagare. 2. därefter tolkas korrekt, d v s avsändarens och mottagarens förståelse måste stämma överens. 3. sist, men inte minst, väcka engagemang, d v s vilja att ta till sig budskapet, samt skapa självförtroende, d v s tro att kunna omsätta budskapet i praktiken. Tre metoder analyseras utifrån ett lärandeperspektiv vilket bygger på fenomenografiska principer om att förmedla lärande samt erfarande av lärande genom att skapa variationens arkitektur och bygga relevansstruktur. De tre metoderna som analyseras är: 1. Ifråga om att mottagande - den duala annonseringsmodellen. 2. Ifråga om förståelse - Ongstads triadiska positioneringsmodell. 3. Ifråga om att väcka engagemang och självförtroende att formulera en aktivitet - Palmers multimodala coachningsmodell. Det visar sig att samtliga metoder bör kunna användas för att förmedla lärande enligt det i denna uppsats valda fenomenografiska lärandeperspektivet. En slutsats som dras är, att en möjlig brist och förklaring till att kommunikation inte alltid fungerar, är att mottagaren som en människa med personliga egenskaper och problem glöms bort. Om fokus istället läggs på att utforma kommunikationen så den stämmer överens med hurdan människan (mottagaren) är, är det tänkbart att chansen ökar att få fler åhörare vilka förstår och tar till sig ett förmedlat budskap. Eftersom de tre analyserade metoderna rör olika aspekter av människan, bör användning av samtliga tre tillsammans bidra till att underlätta ett budskaps passage genom de barriärer som hindrar mottagande, förståelse och formulering av aktivitet. / The premise of this thesis is that a successful communication of a message throughout an organisation requires that the message: - first and foremost is received, i e perceived by an intended recipient. - is properly interpreted, i e the sender’s and the receiver's understanding of the message must match. - last, but not least, stimulates involvement, i e stimulates the willingness to take in the message and gives the self-confidence to translate the message into practice. Three methods are analyzed from a learning perspective based on phenomenographic principles. The principles are about facilitating learning by creating the architecture of variation and by building a relevance structure. The three methods analyzed are: 1. In terms of receiving messages – the dual advertising model. 2. In terms of understanding – Ongstad’s triadic positioning model. 3. In terms of commitment and confidence to formulate a task – Palmer’s multimodal coaching model. From the chosen phenomenographic learning perspective, all methods turn out to be useful. One conclusion that may be drawn from the study is, that a possible reason behind unsuccessful communication of a message, is that the receiver as a human being with personal characteristics and problems is not taken into account. Therefore, if focus is placed on designing communication so it matches the receiver, the chance increases to get more listeners who understand and take in the conveyed message. As the three analyzed methods relate to various aspects of the human being, the use of all three together may facilitate the message through the barriers that prevent the message from being received, understood and applied.

<p>Research shows that there is a literacy crisis in many South African primary schools, especially in the Foundation and Intermediate Phases (Grades 1 &ndash / &nbsp / ). The latest Annual National Assessments (ANA) results released in 2011 indicate that learners performed below the acceptable literacy levels as&nbsp / the national pass rate for Grade 3 learners was 35% and was 28% for Grade 6 learners (ANA, 2011:6). Research on literacy focuses on reading and&nbsp / there is little known about how young learners develop writing skills. This qualitative ethnographic study investigated how writing skills are developed in Grade 1 learners by looking at the writing processes as well as the teaching methods used by teachers to develop learners&rsquo / writing skills. The research also&nbsp / analyzed the texts produced by Grade 1 learners and the languages used in their written texts. The sample group in this research was the Grade 1 learners&nbsp / to a multicultural school in Cape Town. Data were collected by means of classroom observations, interviews and document analysis. The thematic&nbsp / arrative approach was used to analyze data and the analysis was informed by the Writing Developmental Continuum model and the Multimodal&nbsp / Approach to literacy in order to gain a better understanding of how young learners use language and other forms of writing such as visuals and gestures to&nbsp / onstruct and convey meaning.&nbsp / The findings of this research show that Grade 1 learners make use of semiotic resources including the language(s)&nbsp / &nbsp / &nbsp / available in their immediate context to create multimodal texts that incorporate both visual and written features. This shows that young learners represent&nbsp / their world experiences through interpersonal and experiential meanings in language(s) exposed to them. The teacher has a big role to play in developing&nbsp / learners&rsquo / writing skills and has to employ a variety of pedagogical strategies that support learners to move through the different writing phases before they develop into early writers. The study concludes that writing is not a linear process but it is a gradual process which depends on a variety of resources and&nbsp / factors which build on learners&rsquo / prior experiences and creativity.</p>

Methadone and ketamine have been used in neuropathic pain management, but the benefits of the association of both drugs are uncertain. Aiming to enhance the analgesic efficacy and to reduce the occurrence of adverse-effects, an oral solutionof methadone plus ketamine was tested in patients suffering of neuropathic pain of different etiologies and resistant to other analgesics. All patients were treated in the Clinical Care & Pain Management of Santa Maria University Hospital (HUSM) between October 2006 and March 2008. Pain (primary aim) was analyzed before and several times after starting the treatment, through the visual analogical scale (VAS), allodynia and burning or shooting pain evaluation. The development of adverse-effects (secondary aim), such as somnolence, nausea, vomit, dizziness, hallucination, constipation and headache, was also investigated. The first part of this thesis presented the case report of 18 neuropathic pain patients treated with the oral solution of methadone plus ketamine during 6 months.Except for one patient that discontinued the treatment due to intolerable adverse effect, all patients reported pain relief and lowprevalence of adverse effects throughout the treatment. The second part of this thesis presents arandomized, double-blind study conducted with 37 neuropathic patients. Patients were randomly assigned in three treatment groups: methadone group (n=13), ketamine group (n=11) and methadone plus ketaminegroup (n=13). All patients received the designated treatment by oral route, during 3 months. Methadone, ketamine or methadone plus ketamine treatmentgradually (better effect in 30 than in 7 days) and largely (inhibition of about 70% at the end of treatment) reduced the level of neuropathic pain (VAS) with nodifference between the treatment groups.The proportion of patients presenting burning or shooting pain was similarly reduced in all treatmentgroups, but the prevalence of allodynia was significantly reduced only in ketamine group. Excepted for the somnolence that was more prevalent in methadone and methadone plus ketamine groups, the prevalence of the adverse effects was very similar in all treatment groups. All together, the present data show that the combination of methadone plus ketamine was effective to reliefneuropathic pain resistant to other analgesics, though the combination of the two drugs did not show superior efficacy than those reached by methadone or ketamine alone. This study strengthens the use of methadone or ketamine as alternatives to treat neuropathic pain. The drug of choice, however, should be based on the patient background. / Metadona e cetamina têm sido usados no tratamento da dor neuropática, mas os benefícios da associação das duas drogas são desconhecidos. Com o objetivo de melhorar a eficácia analgésica e reduzir a ocorrência de efeitos adversos, uma solução oral de metadona mais cetamina foi testada em pacientes que sofrem de dor neuropática de diferentes etiologias e resistentes a outros tipos de tratamento. Todos os pacientes foram tratados no ambulatório da dor do Hospital Universitário de Santa Maria (HUSM) entre outubro de 2006 e março de 2008. A dor foi analisada antes e várias vezes depois de iniciar o tratamento, através da escala visual analógica (EVA), bem como alodinia, dor em queimação e/ou em choque. Efeitos adversos, como sonolência, náuseas, vômitos, tontura, alucinação, constipação e dor de cabeça, também foram investigados. A primeira parte desta tese apresenta um relato de caso de 18 pacientes com dor neuropática, submetidos ao tratamento com a solução oral de metadona mais cetamina durante seis meses. Exceto para um paciente que descontinuou o tratamento devido a efeitos adversos intoleráveis, todos os pacientes relataram alívio da dor e de baixa prevalência de efeitos adversos ao longo do tratamento. A segunda parte desta tese apresenta um estudo duplo-cego randomizado, realizado com 37 pacientes apresentando dor neuropática de diferentes etiologias. Os pacientes foram divididos aleatoriamente em três grupos de tratamento: grupo metadona (n = 13), grupo cetamina (n = 11) e grupo metadona mais cetamina (n = 13). Todos os pacientes receberam o tratamento designado por via oral, durante 3 meses. O tratamento com metadona, cetamina ou metadona mais cetamina, gradualmente (melhor efeito em 30 do que em 7 dias) e em grande parte (inibição de cerca de 70% no final do tratamento) reduziu o nível de dor neuropática sem apresentar diferença significativa entre os grupos. A dor em queimação ou em choque apresentada pelos pacientes foi igualmente reduzida em todos os grupos de tratamento, mas a prevalência de alodinia foi significativamente reduzida apenas no grupo cetamina. A sonolência foi mais prevalente nos grupos da metadona e metadona mais cetamina, a manifestação dos demais efeitos adversos foi muito semelhante em todos os grupos de tratamento.

Depuis les vingt dernières années, l'industrie a développé plusieurs produits commerciaux dotés de capacités auditives et visuelles. La grand majorité de ces produits est composée d'un caméscope et d'un microphone embarqué (téléphones portables, tablettes, etc). D'autres, comme la Kinect, sont équipés de capteurs de profondeur et/ou de petits réseaux de microphones. On trouve également des téléphones portables dotés d'un système de vision stéréo. En même temps, plusieurs systèmes orientés recherche sont apparus (par exemple, le robot humanoïde NAO). Du fait que ces systèmes sont compacts, leurs capteurs sont positionnés près les uns des autres. En conséquence, ils ne peuvent pas capturer la scène complète, mais qu'un point de vue très particulier de l'interaction sociale en cours. On appelle cela "Analyse Égocentrique de Scènes Audio-Visuelles''.Cette thèse contribue à cette thématique de plusieurs façons. D'abord, en fournissant une base de données publique qui cible des applications comme la reconnaissance d'actions et de gestes, localisation et suivi d'interlocuteurs, analyse du tour de parole, localisation de sources auditives, etc. Cette base a été utilisé en dedans et en dehors de cette thèse. Nous avons aussi travaillé le problème de la détection d'événements audio-visuels. Nous avons montré comme la confiance en une des modalités (issue de la vision en l'occurrence), peut être modélisée pour biaiser la méthode, en donnant lieu à un algorithme d'espérance-maximisation visuellement supervisé. Ensuite, nous avons modifié l'approche pour cibler la détection audio-visuelle d'interlocuteurs en utilisant le robot humanoïde NAO. En parallèle aux travaux en détection audio-visuelle d'interlocuteurs, nous avons développé une nouvelle approche pour la reconnaissance audio-visuelle de commandes. Nous avons évalué la qualité de plusieurs indices et classeurs, et confirmé que l'utilisation des données auditives et visuelles favorise la reconnaissance, en comparaison aux méthodes qui n'utilisent que l'audio ou que la vidéo. Plus tard, nous avons cherché la meilleure méthode pour des ensembles d'entraînement minuscules (5-10 observations par catégorie). Il s'agit d'un problème intéressant, car les systèmes réels ont besoin de s'adapter très rapidement et d'apprendre de nouvelles commandes. Ces systèmes doivent être opérationnels avec très peu d'échantillons pour l'usage publique. Pour finir, nous avons contribué au champ de la localisation de sources sonores, dans le cas particulier des réseaux coplanaires de microphones. C'est une problématique importante, car la géométrie du réseau est arbitraire et inconnue. En conséquence, cela ouvre la voie pour travailler avec des réseaux de microphones dynamiques, qui peuvent adapter leur géométrie pour mieux répondre à certaines tâches. De plus, la conception des produits commerciaux peut être contrainte de façon que les réseaux linéaires ou circulaires ne sont pas bien adaptés. / Along the past two decades, the industry has developed several commercial products with audio-visual sensing capabilities. Most of them consists on a videocamera with an embedded microphone (mobile phones, tablets, etc). Other, such as Kinect, include depth sensors and/or small microphone arrays. Also, there are some mobile phones equipped with a stereo camera pair. At the same time, many research-oriented systems became available (e.g., humanoid robots such as NAO). Since all these systems are small in volume, their sensors are close to each other. Therefore, they are not able to capture de global scene, but one point of view of the ongoing social interplay. We refer to this as "Egocentric Audio-Visual Scene Analysis''.This thesis contributes to this field in several aspects. Firstly, by providing a publicly available data set targeting applications such as action/gesture recognition, speaker localization, tracking and diarisation, sound source localization, dialogue modelling, etc. This work has been used later on inside and outside the thesis. We also investigated the problem of AV event detection. We showed how the trust on one of the modalities (visual to be precise) can be modeled and used to bias the method, leading to a visually-supervised EM algorithm (ViSEM). Afterwards we modified the approach to target audio-visual speaker detection yielding to an on-line method working in the humanoid robot NAO. In parallel to the work on audio-visual speaker detection, we developed a new approach for audio-visual command recognition. We explored different features and classifiers and confirmed that the use of audio-visual data increases the performance when compared to auditory-only and to video-only classifiers. Later, we sought for the best method using tiny training sets (5-10 samples per class). This is interesting because real systems need to adapt and learn new commands from the user. Such systems need to be operational with a few examples for the general public usage. Finally, we contributed to the field of sound source localization, in the particular case of non-coplanar microphone arrays. This is interesting because the geometry of the microphone can be any. Consequently, this opens the door to dynamic microphone arrays that would adapt their geometry to fit some particular tasks. Also, because the design of commercial systems may be subject to certain constraints for which circular or linear arrays are not suited.

Bakgrund: Långvarig smärta har konsekvenser på såväl individ- som samhällsnivå och är ett stort folkhälsoproblem. Forskning har visat måttligt till starkt vetenskapligt stöd för multimodal rehabilitering (MMR) vid komplex smärtproblematik. Vad fysioterapeuten använder för åtgärder inom MMR och hur samarbetet med andra yrkeskategorier ser ut finns dåligt beskrivet. Syfte: Att kartlägga fysioterapeutens arbete inom ramen för multimodal smärtrehabilitering inom specialistvården (MMR2). Metod: Webbenkätstudie där data samlades in från 71 fysioterapeuter som arbetade på enheter anslutna till Nationella registret över smärtrehabilitering (NRS). Resultat: Fysioterapeuternas arbete bestod framförallt av undervisning/råd och olika former av träning. Strategier för beteendeförändring, övningar i medveten närvaro/kroppsmedvetenhet och hemövningar var andra vanliga åtgärder. Acceptance and Commitment Therapy (ACT) och Kognitiv beteendeterapi (KBT) användes i flera moment av rehabiliteringen på många enheter. Rehabilitering i grupp var vanligast med aktiva åtgärder som till exempel träning. Rehabiliteringsperioden var vanligen 8-11 veckor, under vilken patienten träffade en fysioterapeut flera gånger i veckan. Teamen hade ett tätt samarbete med regelbundna teamträffar, uppföljningar och gemensamma åtgärder. Slutsats: Fysioterapeutens arbete inom MMR2 utgår från ett biopsykosocialt perspektiv där tyngdpunkten ligger i att återställa och/eller förbättra kroppsfunktion. Fysioterapeuterna har bred kompetens och lång erfarenhet vilket möjliggör att deras kunskaper om kroppen och rörelsesystemet kan integreras med åtgärder för beteendeförändring. Tillsammans med övriga yrkeskategorier täcker fysioterapeutens arbete in alla domäner i Klassifikation av funktionstillstånd, funktionshinder och hälsa (ICF). För en ökad förståelse kring vad som styr valet av fysioterapeutiska åtgärder inom MMR2 och hur arbetet med dessa åtgärder ser ut i den kliniska vardagen behövs fortsatt forskning. / Background: Chronic pain is a common cause for patients seeking care. The consequences of chronic pain can be seen at both individual and social level. Research has shown moderate to strong scientific support for multimodal rehabilitation (MMR) in complex pain problems. What the physiotherapist uses for interventions within MMR and how the collaboration with other occupational categories works is poorly described. Aim: To study what interventions physiotherapist’s use in multimodal pain rehabilitation in specialist care settings (MMR2) in Sweden. Methods: Web survey study where data was collected from 71 physiotherapists working at units connected to the Swedish Quality Registry for Pain Rehabilitation (SQRP). Results: The most common interventions were teaching/counseling and various forms of exercise. Strategies for behavioral change, mindfulness/body awareness and homework exercises are other commonly used interventions. Acceptance and Commitment Therapy (ACT) and Cognitive Behavioral Therapy (CBT) were used in several stages of rehabilitation on many units. Rehabilitation in group were the most common form of work and the interventions are primarily patient active as physical activity. The rehabilitation period were usually 8-11 weeks, where the patient saw a physiotherapist several times a week. The teams worked closely with regular team meetings, follow-ups and sometimes joint actions such as patient education and group training. Conclusion: The physiotherapist's work in MMR2 is based on a biopsychosocial perspective where the focus lies in restoring and/or improving body function. Physiotherapists have broad competence and long experience, enabling their knowledge about the body and the movement system to be integrated with behavioral change technics. Together with other occupational categories, the physiotherapist's work covers all domains in the Functional Classification, Disability and Health Classification (ICF). For increased understanding of the choice of physiotherapeutic interventions within MMR2, and how these interverventions works in the clinical setting, further research is needed.