Por intermédio deste procurou-se identificar nexos que evidenciassem adesão ao tratamento da hipertensão arterial nos modos de vida dos usuários portadores de hipertensão arterial; compreender as relações dialéticas da assistência prestada pela Unidade de Saúde da Família expressa por contradições e congruências no modo de vida destes e elaborar um programa educativo segundo pedagogia emancipatória fundada nos pressupostos teóricos de Paulo Freire, com temas referentes às necessidades evidenciadas pelos usuários portadores de hipertensão arterial. O fenômeno modo de vida foi apreendido sob o referencial teórico-metodológico do materialismo histórico e dialético. As entrevistas realizadas com 11 usuários portadores de hipertensão arterial foram submetidas ao procedimento de análise de discurso, que revelou o modo de vida destes usuários representado pelos temas: crenças, sentimentos, para além do individual, controle pressórico, descontrole pressórico e causa da hipertensão arterial. Estes temas foram analisados frente às categorias dialéticas o subjetivo e o objetivo e processo saúde-doença-cuidado. Para estes usuários portadores de hipertensão arterial a vida cotidiana se apresenta com inúmeras contradições referentes ao tratamento necessário e a doença que não é assumida como doença; necessidade de modificações em hábitos e valores humanos que se contrapõem às essas modificações; impossibilidade concreta de controle dos níveis pressóricos decorrente de situações do modo de vida como o nervosismo, problemas familiares e financeiros. Ao identificar contradições do modo de vida destes usuários, este estudo apresenta uma proposta de melhoria da adesão ao tratamento da hipertensão arterial por meio da educação emancipatória nos pressupostos de Paulo Freire. É necessário que a enfermagem reconheça e se aproxime desta realidade e de modo ético transforme sua prática profissional no sentido de propiciar caminhos de maior autonomia aos usuários portadores de hipertensão arterial assistidos pelas enfermeiras. / This study intended to identify, in the way of life of hypertensive patients, connections which could clarify their compliance of hypertension treatment, to understand dialectical relationship of the assistance offered by a Family Healthcare Program expressed through contradictions and coincidences in the patients\' way of life, and to create an educative program according to the emancipatory pedagogy based on Paulo Freire\'s conception of emancipatory education, with themes related to hypertensive patients\' required needs. The phenomenon \"way of life\" was grasped on the grounds of the theoretical and methodological aspects of the historical and dialectical materialism. The interviews, held with 11 hypertensive patients, were submitted to the analysis of the speech procedures, which showed the way of life of these patients. It can be represented by the following: beliefs, feelings, beyond-individual, under-control pressure, out-of-control pressure and hypertension causes These categories were analyzed according to dialectical categories - the subjective and the objective - and the health-illness-care process. Hypertensive patients\' daily life shows many contradictions related to the treatment needed and the illness not assumed as it is; the need of changing habits and human values which oppose to these changes; the real impossibility of controlling pressure levels due to daily life conditions such as nervousness and financial and familiar problems. Once many contradictions in these patients\' way of life have been identified, this study sugests the improvement of the acceptance of hypertension treatment by means of emancipatory education, according to Paulo Freire\'s theory. Nursing has to accept this reality, approach to it, and ethically change its own practice in order to show hypertensive patients under the care of nurses a better way towards their autonomy.

Por intermédio deste procurou-se identificar nexos que evidenciassem adesão ao tratamento da hipertensão arterial nos modos de vida dos usuários portadores de hipertensão arterial; compreender as relações dialéticas da assistência prestada pela Unidade de Saúde da Família expressa por contradições e congruências no modo de vida destes e elaborar um programa educativo segundo pedagogia emancipatória fundada nos pressupostos teóricos de Paulo Freire, com temas referentes às necessidades evidenciadas pelos usuários portadores de hipertensão arterial. O fenômeno modo de vida foi apreendido sob o referencial teórico-metodológico do materialismo histórico e dialético. As entrevistas realizadas com 11 usuários portadores de hipertensão arterial foram submetidas ao procedimento de análise de discurso, que revelou o modo de vida destes usuários representado pelos temas: crenças, sentimentos, para além do individual, controle pressórico, descontrole pressórico e causa da hipertensão arterial. Estes temas foram analisados frente às categorias dialéticas o subjetivo e o objetivo e processo saúde-doença-cuidado. Para estes usuários portadores de hipertensão arterial a vida cotidiana se apresenta com inúmeras contradições referentes ao tratamento necessário e a doença que não é assumida como doença; necessidade de modificações em hábitos e valores humanos que se contrapõem às essas modificações; impossibilidade concreta de controle dos níveis pressóricos decorrente de situações do modo de vida como o nervosismo, problemas familiares e financeiros. Ao identificar contradições do modo de vida destes usuários, este estudo apresenta uma proposta de melhoria da adesão ao tratamento da hipertensão arterial por meio da educação emancipatória nos pressupostos de Paulo Freire. É necessário que a enfermagem reconheça e se aproxime desta realidade e de modo ético transforme sua prática profissional no sentido de propiciar caminhos de maior autonomia aos usuários portadores de hipertensão arterial assistidos pelas enfermeiras. / This study intended to identify, in the way of life of hypertensive patients, connections which could clarify their compliance of hypertension treatment, to understand dialectical relationship of the assistance offered by a Family Healthcare Program expressed through contradictions and coincidences in the patients\' way of life, and to create an educative program according to the emancipatory pedagogy based on Paulo Freire\'s conception of emancipatory education, with themes related to hypertensive patients\' required needs. The phenomenon \"way of life\" was grasped on the grounds of the theoretical and methodological aspects of the historical and dialectical materialism. The interviews, held with 11 hypertensive patients, were submitted to the analysis of the speech procedures, which showed the way of life of these patients. It can be represented by the following: beliefs, feelings, beyond-individual, under-control pressure, out-of-control pressure and hypertension causes These categories were analyzed according to dialectical categories - the subjective and the objective - and the health-illness-care process. Hypertensive patients\' daily life shows many contradictions related to the treatment needed and the illness not assumed as it is; the need of changing habits and human values which oppose to these changes; the real impossibility of controlling pressure levels due to daily life conditions such as nervousness and financial and familiar problems. Once many contradictions in these patients\' way of life have been identified, this study sugests the improvement of the acceptance of hypertension treatment by means of emancipatory education, according to Paulo Freire\'s theory. Nursing has to accept this reality, approach to it, and ethically change its own practice in order to show hypertensive patients under the care of nurses a better way towards their autonomy.

La fiabilité des microcontrôleurs est cruciale compte tenu de leur utilisation massive dans de nombreux domaines, surtout dans des environnements sévères. De ce fait, la robustesse aux perturbations électromagnétiques, en particulier à propos des alimentations, est un axe de développement majeur, que ce soit pour acquérir un avantage comparatif sur le marché, ou simplement pour assurer la sécurité des biens et des personnes. En ce sens, nous avons étudié le test de ces circuits soumis à des agressions transitoires rapides en salve définies par la norme IEC 61000-4-4. Les mécanismes spécifiques de propagation de la perturbation en mode commun sont mis en évidence, ainsi que leur conversion en mode différentiel. Plusieurs méthodes de mesure, dont certaines originales, ont été développées pour valider cette conversion, ainsi que les modes de propagation. Sur cette base, le réseau de distribution des alimentations a été particulièrement étudié et son influence sur la robustesse du circuit a été mise en évidence. Enfin, cette thèse ouvre de nouvelles perspectives d’amélioration de la robustesse des microcontrôleurs, pour ce type d’agression, et donc de leur fiabilité. / The reliability of the microcontrollers is crucial considering their massive use in numerous domains, especially in severe environments. Therefore, the robustness in the electromagnetic disturbances, in particular for the power supply network, is a major development, whether it is to acquire a comparative advantage on the market, or simply to assure the goods and people safety. Therefore, we studied the Fast Transient Burst test of integrated circuits, as defined by the IEC 61000-4-4 standard. The specific propagation mechanisms of the disturbance in common mode are highlighted, as well as their conversion in differential mode. Several measurements methods, among which certain novel, were developed to validate this conversion, as well as the propagation modes. Based on this, the power distribution network was particularly studied and its influence on the robustness of the circuit was highlighted. Finally, this work opens new perspectives of improvement of the microcontrollers’ robustness, for this kind of aggression, and thus their reliability.

O momento ideal para a extubação de crianças graves é ainda difícil de ser avaliado. A razão entre espaço morto e volume corrente (Vd/Vt), como valor preditiva de extubação bem sucedida, já foi testada em adultos e crianças. O objetivo deste trabalho foi avaliar a eficácia do Vd/Vt, como preditivo do sucesso da extubação, em crianças de uma UTI pediátrica geral. Após aplicação dos critérios de inclusão e exclusão, testou-se o Vd/Vt em 86 pacientes extubados num período de 16 meses. Nos estudos estatísticos o índice Vd/Vt médio não discriminou os grupos de falha e sucesso na extubação nas análises uni e multivariada. O valor do índice, com corte em 0,65, foi limitado na sensibilidade e especificidade e mediano na razão de verossimilhança. O estudo sugere que o índice Vd/Vt, pode ser considerado como complementar aos dados de avaliação clínica no momento da extubação. / The ideal moment for extubation of critically ill children is still difficult to determine. The dead-space : tidal volume ratio (Vd/Vt) has been tested as predictor of extubation failure in adults and children. The purpose of this study was to evaluate the efficacy of the Vd/Vt as a predictor of the success of extubation in children admitted to a pediatric intensive care unit. After the inclusion and exclusion criteria, 86 patients were studied during 16 months. The statistical study revealed that the mean Vd/Vt was not able to discriminate between failure and success of extubation in the multivariate analysis. The utility of the Vd/Vt was limited, in terms of sensibility and specificity, using a cutoff of 0,65, but was medially satisfactory in the likelihood ratio. This study suggests that the Vd/Vt can only be considered as complementary to the routine clinical evaluation prior to extubation.

O momento ideal para a extubação de crianças graves é ainda difícil de ser avaliado. A razão entre espaço morto e volume corrente (Vd/Vt), como valor preditiva de extubação bem sucedida, já foi testada em adultos e crianças. O objetivo deste trabalho foi avaliar a eficácia do Vd/Vt, como preditivo do sucesso da extubação, em crianças de uma UTI pediátrica geral. Após aplicação dos critérios de inclusão e exclusão, testou-se o Vd/Vt em 86 pacientes extubados num período de 16 meses. Nos estudos estatísticos o índice Vd/Vt médio não discriminou os grupos de falha e sucesso na extubação nas análises uni e multivariada. O valor do índice, com corte em 0,65, foi limitado na sensibilidade e especificidade e mediano na razão de verossimilhança. O estudo sugere que o índice Vd/Vt, pode ser considerado como complementar aos dados de avaliação clínica no momento da extubação. / The ideal moment for extubation of critically ill children is still difficult to determine. The dead-space : tidal volume ratio (Vd/Vt) has been tested as predictor of extubation failure in adults and children. The purpose of this study was to evaluate the efficacy of the Vd/Vt as a predictor of the success of extubation in children admitted to a pediatric intensive care unit. After the inclusion and exclusion criteria, 86 patients were studied during 16 months. The statistical study revealed that the mean Vd/Vt was not able to discriminate between failure and success of extubation in the multivariate analysis. The utility of the Vd/Vt was limited, in terms of sensibility and specificity, using a cutoff of 0,65, but was medially satisfactory in the likelihood ratio. This study suggests that the Vd/Vt can only be considered as complementary to the routine clinical evaluation prior to extubation.

Indiana University-Purdue University Indianapolis (IUPUI) Indiana University School of Dentistry Master Degree Thesis. / Detection of caries at an early stage is unequivocally essential for early preventive intervention. Longitudinal assessment of caries lesions, especially under the opaque preventive sealant, would be of utmost importance to the dental community. OBJECTIVES: The aim of this two-part in-vitro study is to evaluate the performance of multiple detection methods: The International Caries Detection and Assessment System (ICDAS); two quantitative light-induced fluorescence systems QLF; Inspektor™ Pro and QLF-D Biluminator™2 (Inspektor Research Systems B.V.; Amsterdam, The Netherlands); and photothermal radiometry and modulated luminescence (PTR/LUM) of The Canary System® (Quantum Dental Technologies; Toronto, Canada). All these are to be evaluated on their detection of caries on posterior human permanent teeth for 1) of primary occlusal lesions, and 2) under the sealant of primary occlusal lesions. METHODS: One hundred and twenty (N = 120) human posterior permanent teeth, selected in compliance with IU-IRB “Institutional Review Board” standards, with non-cavitated occlusal lesions ICDAS (scores 0 to 4) were divided into two equal groups. The second group (N = 60) received an opaque resin dental sealant (Delton® Light-Curing Pit and Fissure Sealant Opaque, Dentsply, York, PA). All lesions were assessed with each detection method twice in a random order except for ICDAS, which was not used following the placement of the sealant. Histological validation was used to compare methods in regard to sensitivity, specificity, % correct, and the area under receiver- operating characteristic curve (AUC). Intra-examiner repeatability and inter-examiner agreement were measured using intraclass correlation coefficient (ICC). RESULTS: 1) Of primary occlusal lesions, sensitivity, specificity, and AUC values were respectively: 0.82, 0.86 and 0.87 (ICDAS); 0.89, 0.60 and 0.90 (Inspektor Pro); 0.96, 0.57 and 0.94 (QLF-D Biluminator 2); and 0.85, 0.43 and 0.79 (The Canary System). Intra-examiner repeatability and inter-examiner agreement were respectively: 0.81 to 0.87: 0.72 (ICDAS); 0.49 to 0.97: 0.73 (Inspektor Pro); 0.96 to 0.99: 0.96 (QLF-D Biluminator 2); and 0.33 to 0.63: 0.48 (The Canary System). 2) Of primary occlusal lesions under the opaque dental sealants, sensitivity, specificity, and AUC values were respectively: 0.99, 0.03 and 0.67 (Inspektor Pro); 1.00, 0.00 and 0.70 (QLF-D Biluminator 2); and 0.54, 0.50 and 0.58 (The Canary System). Intra-examiner repeatability and inter-examiner agreement were respectively: 0.24 to 0.37: 0.29 (Inspektor Pro); 0.80 to 0.84: 0.74 (QLF-D Biluminator 2); and 0.22 to 0.47: 0.01 (The Canary System). CONCLUSION: Limited to these in-vitro conditions, 1) ICDAS remains the method of choice for detection of early caries lesion due to its adequately high accuracy and repeatability. QLF systems demonstrate potential in longitudinal monitoring due to an almost perfect repeatability of QLF-D Biluminator 2. The Canary System performance and repeatability were not acceptable as a valid method of early caries detection. 2) None of the methods demonstrated acceptable ability in detecting of occlusal caries under the opaque sealant. However, QLF-D Biluminator 2, with limitation to these in-vitro conditions and Delton opaque sealant, demonstrated a fair accuracy AUC (0.70) in detecting of caries under sealants at an experimental threshold of 12.5% ΔF.