Statistisk processtyrning, SPS, är ett välkänt verktyg som används för kvalitetsförbättringar inom organisationer världen över. De senaste åren har tillverkande organisationer tenderat att gå mot kortare serier, vilket medför en problematik när de vill tillämpa statistiska metoder som är utvecklade för traditionell masstillverkning. Framgångsfaktorer för implementering av SPS vid små serier är ett relativt outforskat område och kräver därför ytterligare forskning. Syftet med denna studie var att ta fram en modell över hur SPS framgångsrikt kan implementeras av organisationer med små serier och en stor detaljflora. För att besvara syftet genomfördes en fallstudie med både kvantitativ och kvalitativ metod. Deltagande observationer och en workshop med 15 deltagare utfördes för att identifiera existerande variationer samt definiera nuläget i det avgränsade produktionsflödet, vars processer studerades i studien. Tre produktfamiljer och kritiska parametrar som representerade produktkvalitén valdes ut för att följas upp i styrdiagram. En mätsystemanalys utfördes för att undersöka om de mätdon som i stor utsträckning användes för kvalitetskontroll i processen var tillförlitliga. Styrdiagram upprättades anpassade för små serier och statistiska analyser utfördes för att undersöka om SPS var en användbar metod för kvalitetsförbättringar i processer med små serier. En kvalitativ benchmark med fyra deltagande organisationer utfördes även för att ta del av deras erfarenheter relaterat till implementering och arbete med SPS.  Resultatet visade att den studerade organisationen behöver utföra förändringar gällande arbetsmetoder för kvalitetskontroll samt hantering av processer och mätsystem. Det finns även behov av ett omfattande förbättringsarbete, för att eliminera det flertalet orsaker till systematiska variationer som identifierades påverka processerna och produktkvalitén. Dessa förändringar krävs innan en implementering av SPS kan genomföras. Verktyg inom SPS visade sig med framgång kunna användas för att förbättra processer med små serier, vid användning av standardiserade styrdiagram som möjliggör analys av flera produkter i samma diagram. Processer med små serier och en stor detaljflora medför en utökad komplexitet vid statistiska analyser och visar tecken på ett flertal svårigheter som ökar risken för en fallerad implementering.  Utifrån analyser av det kvalitativa och kvantitativa resultatet skapades en modell med 15 framgångsfaktorer för implementering av SPS vid små serier. Faktorerna bör följas av organisationer med små serier som vill lyckas med att implementera SPS. Framgångsfaktorerna är följande: (1) Var beredd på en kulturförändring som kräver att SPS vävs in i hela organisationen, (2) Förmedla ett tydligt mål och hållbar strategi för arbetet med SPS, (3) Skapa ett utbrett engagemang i hela organisationen, (4) Utse en SPS-koordinator, (5) Inför utbildning och uppföljning från start, (6) Skapa tvärfunktionella team, (7) Främja samarbete och delaktighet under förbättringsarbetet, (8) Ställ krav på ett dugligt mätsystem, (9) Utför en pilotstudie där det finns intresse, (10) Identifiera kritiska processer, produktfamiljer och parametrar, (11) Börja med att lära känna processerna, (12) Upprätta standardiserade styrdiagram, (13) Tolkning och analys av styrdiagram utförs enligt Montgomerys metod för statistiska analyser, (14) Sträva efter stabila processer, (15) Utför kontinuerlig uppföljning. / Statistical process control, SPC, is a widely used technique for quality improvements by companies all over the world. The current trend in manufacturing organizations is directed towards shorter productions runs, which cause problems when applying traditional statistical methods developed for SPC on mass production runs. The critical factors for a successful implementation of SPC on short runs are still not fully explored and require further research. The main purpose of this study was to present a conceptual framework that illustrates the successful implementation of SPC in organizations with short runs and extensive product portfolio. In order to answer the research questions, a case study research methodology with both quantitative and qualitative methods was used. Participant observations and a workshop including 15 participators were performed in order to identify existing process variability’s and current state of the studied production processes.  Three product families and key quality characteristics of each product were chosen to be monitored in control charts, based on scrap costs and staff experiences of the production process.  A measurement system analysis was used to determine if the gauges, used to make measurement quality controls, were capable. Control charts were constructed and adjusted to short production runs. Statistical analysis was then made on the information gathered through the control charts to determine if statistical tools within SPC was useful for quality improvements on short production runs.  Also a qualitative benchmark was performed with four manufacturing companies to take part of their experiences and knowledge related to the implementation and application of SPC.  The findings indicate that the studied organization needs to improve working methods related to quality inspections and monitoring of the production processes. The organization also needs to improve the measurement system and make an extensive work of improvement to reduce the many identified special causes of variation that affects the processes and product quality, before implementing SPC in the organization. Findings showed that SPC tools and techniques successfully can be adopted to improve short run production processes when using standardized control charts for different product types. Short run production processes involve more complex statistical analysis which could inhibit the success of an implementation of SPC.   The analysis of the qualitative and quantitative findings resulted in a framework including 15 critical success factors for the implementation of SPC in short production runs. All the following critical success factors should be taken into account by organizations with short runs that aspire a successful implementation of SPC: (1) Be ready to make a cultural change including the recognition of the importance of SPC within the whole organization, (2) Communicate a clear goal and long-term strategy, (3) Create motivation and commitment from top management to operators on the shop floor, (4) Select a SPC coordinator, (5) Introduce a training programme with feedback from start, (6) Create cross-functional teams, (7) Stimulate cooperation and participation within the work of improvements, (8) Ensure a capable measurement system, (9) Perform a pilot project with enthusiastic employees, (10) Identify critical processes, product families and key quality characteristics, (11) Focus on exploring process behaviors, (12) Construct standardized control charts, (13) Interpret and analyze control charts according to Montgomery’s method for statistical analysis, (14) Attempt to obtain processes in control, (15) Perform continuous follow ups.

The objective of this thesis is to evaluate the use of Doppler echocardiography markers ofglobal dyssynchrony [total isovolumic time (t-IVT)] in the following 6 studies: 1) Its prognostic role in predicting cardiac events in patients undergoing CABG surgery,compared with conventional global systolic and diastolic measurements. 2) Its additional value in predicting six minute walk test (6-MWT) in patients with leftventricular (LV) ejection fraction (EF) <45%. 3) Its prognostic value in comparison with other clinical, biochemical and echocardiographicvariables in patients with chronic systolic heart failure (HF). 4) The relationship between 6-MWT and cardiac function measurements in a consecutivegroup of patients, irrespective of EF and to identify predictors of exercise capacity. 5) To investigate the effect of age on LV t-IVT and Tei index compared with conventionalsystolic and diastolic parameters. 6) To assess potential additional value of markers of global LV dyssynchrony in predictingcardiac resynchronization therapy (CRT) response in HF patients. Study I Methods: This study included 74 patients before routine CABG who were followed up for18±12 months. Results: At follow-up, 29 patients were hospitalized for a cardiac event or died. LV-ESD wasgreater (P=0.003), fractional shortening (FS) lower (p<0.001), E:A ratio and Tei index higher(all P<0.001), and t-IVT longer (P<0.001) in patients with events. Low FS [0.66 (0.50–0.87),P<0.001], high E:A ratio [l4.13 (1.17–14.60), P=0.028], large LV-ESD [0.19 (0.05–0.84),P=0.029], and long t-IVT [1.37 (1.02–1.84), P=0.035] predicted events and deaths. Conclusion: Despite satisfactory surgical revascularization, long t-IVT and systolicdysfunction suggest persistent ventricular dyssynchrony that contributes to post-CABGcardiac events. Study II Methods: We studied 77 patients (60±12 year, and 33.3% females) with stable HF using 6-MWT.iii Results: E’ wave (r=0.61, p<0.001), E/e’ ratio (r=-0.49, p<0.001), t-IVT (r=-0.44, p<0.001),Tei index (r=-0.43, p<0.001) and NYHA class (r=-0.53, p<0.001) had the highest correlationwith the 6-MWT distance. In multivariate analysis, only E/e’ ratio [0.800 (0.665-0.961),p=0.017], and t-IVT [0.769 (0.619-0.955), p=0.018] independently predicted poor 6-MWTperformance (<300m). Conclusions: In HF, the higher the filling pressures and the more dyssynchronous the LV, thepoorer is the patient’s exercise capacity. Study III Methods: We studied 107 systolic HF patients; age 68±12 year, 25% females and measuredplasma NT-pro-BNP. Results: Over a follow-up period of 3718 months, t-IVT ≥12.3 sec/min, mean E/Em ratio≥10, log NT-pro-BNP levels ≥2.47 pg/ml and LV EF ≤32.5% predicted clinical events. Theaddition of t-IVT and NT-pro-BNP to conventional clinical and echocardiographic variablessignificantly improved the χ2 for the prediction of outcome from 33.1 to 38.0, (p<0.001). Conclusions: Prolonged t-IVT adds to the prognostic stratification of patients with systolicHF. Study IV Methods: We studied 147 HF patients (61±11 year, 50.3% male) with 6-MWT.Results: The 6-MWT correlated with t-IVT (r=-0.49, p<0.001) and Tei index (r=-0.43,p<0.001) but not with any of the other clinical or echocardiographic parameters. Group Ipatients (<300m) had lower Hb (p=0.02), lower EF (p=0.003), larger left atrium (p=0.02),thicker septum (p=0.02), lower A wave (p=0.01) and lateral wall a’ (p=0.047), longerisovolumic relaxation time (r=0.003) and longer t-IVT (p= 0.03), compared with Group II(>300m). Only t-IVT ratio [1.257 (1.071-1.476), p=0.005], LV EF [0.947 (0.903-0.993),p=0.02], and E/A ratio [0.553 (0.315-0.972), p=0.04] independently predicted poor 6-MWTperformance. Conclusion: In HF, the limited 6-MWT is related mostly to severity of global LVdyssynchrony, more than EF or raised filling pressures. Study V Methods: We studied 47 healthy individuals (age 62±12 year, 24 female), arbitrarilyclassified into: M (middle age), S (seniors), and E (elderly). Results: Age strongly correlated with t-IVT (r=0.8, p<0.001) and with Tei index (r=0.7,p<0.001), E/A ratio (r=-0.6, p<0.001), but not with global or segmental systolic function measurements or QRS duration. The normal upper limit of the t-IVT (95% CI) for the three groups was 8.3 s/min, 10.5 s/min and 14.5 s/min, respectively, being shorter in the S compared with the E group (p=0.001). T-IVT correlated with A wave (r=0.66, p<0.001), E/Aratio (r=-0.56, p<0.001), septal e’ (r=-0.49, p=0.001) and septal a’ (r=0.4, p=0.006), but notwith QRS. Conclusions: In normals, age is associated with exaggerated LV global dyssynchrony anddiastolic function disturbances, but systolic function remains unaffected. Study VI Methods: We studied 103 HF patients (67±12 year, 82.5% male) recruited for CRTtreatment. Results: Prolonged t-IVT [0.878 (0.802-0.962), p=0.005], long QRS duration [0.978 (0.960-0.996), p=0.02] and high tricuspid regurgitation pressure drop (TRPD) [1.047 (1.001-1.096),p=0.046] independently predicted response to CRT. A t-IVT ≥11.6 s/min was 67% sensitiveand 62% specific (AUC 0.69, p=0.001) in predicting CRT response. Respective values for aQRS ≥ 151ms were 66% and 62% (AUC 0.65, p=0.01). Combining the two variables had asensitivity of 67% but higher specificity of 88% in predicting CRT response. In atrialfibrillation (AF) patients, only prolonged t-IVT ≥11 s/min [0.690 (0.509-0.937), p=0.03]independently predicted CRT response with a sensitivity of 69% and specificity of 79% (AUC0.78, p=0.015). Conclusion: Combining prolonged t-IVT and broad QRS had higher specificity in predictingresponse to CRT, with the former the sole predictor of response in AF patients.

Falls in people aged over 65 years account for the largest proportion of all injury-related deaths and hospitalisations within Australia. Falls contributed to 1,000 deaths and 50,000 hospitalisations in older people during 1998 (Commonwealth Department of Health and Aged Care 2001). It has been predicted that by 2016, 16% of the Australian population will be aged over 65 years (Australian Bureau of Statistics 1999) placing considerable pressure on the health care system. Furthermore, prospective studies have shown that 30-50% of people aged 65 years and over, will experience a fall (Tinetti et al. 1988b; Campbell et al. 1989; Lord et al. 1994b; Hill 1999; Brauer et al. 2000; Stalenhoef et al. 2002) and this figure increases exponentially with age (Lord et al. 1994b). Many physiological falls risk factors have been established including reduced leg strength, poor balance, impaired vision, slowed reaction time and proprioception deficits. However, little research has been conducted to determine whether performance on aerobic fitness tasks is also a physiological falls risk factor. Aerobic fitness has previously been related to an individual's ability to perform activities of daily living, which in turn has been linked to falls. It was therefore proposed that aerobic fitness might also be a risk factor for falls among community dwelling older people. This research aimed to provide clinical evidence to inform public health practice. This thesis comprised of four objectives: the first to find suitable measures of aerobic fitness for older people; the second investigated relationships between existing clinical tests and future falls; the third explored relationships between aerobic fitness tests and future falls; the final objective was to examine the independent relationships between falls and clinical and physiological characteristics. The participants were recruited through a random sample from the local electoral roll, with an average age of 73 ±6 years. Of the 87 participants who completed the prospective component of the study, 37% were male and 63% were female. Sixty-three participants (65%) reported no previous falls, 19 (20%) reported a single fall, and 16 (15%) reported two or more falls in the previous 12 months. The first objective required participants recruited from the community to take part in submaximal and maximal fitness tests in order to find suitable measures of aerobic fitness. A further objective was to determine whether older people were able to fulfil the 'standard' criteria for completion of a maximum oxygen consumption test. The measures used in this research included: maximum oxygen consumption, peak oxygen consumption, ventilatory threshold, oxygen uptake kinetics, oxygen deficit, efficiencies, oxygen consumption at zero, 30 and 50 watts, predicted max and Six-Minute Walk Test distance. Only weak relationships were observed between submaximal aerobic measures and peak oxygen consumption. Furthermore, only 54% of participants were able to fulfil the criteria to complete a test of maximum oxygen consumption, indicating it was not a suitable measure for use among a sample of community dwelling older people. Therefore submaximal aerobic variables were used in the following chapters. The second objective investigated the relationship between clinical measures and falls among older people and was carried out to enable comparisons between the population in this study and those described in the literature. This research found that the Timed Up and Go (TUG) test was the most sensitive of all clinical tests (including the Berg Balance Scale, Function Reach, Performance Oriented Mobility Assessment and Physiological Profile Assessment) for the assessment of future falls. The TUG requires participants to stand up, walk 3m, turn, walk back, and sit down. Time taken to complete the test is the recorded value. For this study, a cut-off value of 7-seconds was established, above which individuals were at increased risk of falls. Previous research suggested cut-off times of over 10s were appropriate for older people. However, this is the first study to assess falls prospectively and definitively find that the TUG can discriminate between future fallers and non-fallers. This research also investigated the differences in falls risk factors for functionally different subsamples, as defined by their ability to undertake and complete the cycle test. The participants who could complete the test had significantly better balance ability and strength than those unable to undertake or complete the cycle test. However, this inability to undertake or complete the cycle test was not itself a predictor of future falls. These two groups also differed in the relationships between clinical test results and falls risk. Participants in the no-cycle group had very similar results to that of the entire cohort. Even after adjustment for age, the TUG, foot and hand reaction times and knee flexion strength were all performed better by non-fallers than fallers. However, none of these differed between fallers and non-fallers for participants in the cycle group. This group had better balance ability and strength than the no-cycle group. These results indicated that the cycle group differed from the no-cycle group and the entire sample, further indicating that factors other than the physiological variables measured in this research influence falls risk in strong participants with good balance ability. Similar results were reported when aerobic tests and falls were investigated in the third objective. In the whole sample, the fallers walked significantly less distance than non-fallers for the 6-MWT. Similar results were found for participants in the no-cycle group but not the cycle group. All participants were able to complete the Six-Minute Walk Test (6-MWT) although only 74% were able to undertake and complete the cycle test. The fourth objective was to consider all measures from the previous chapters as potential predictors of falls. The variables most predictive of future falls were the TUG and having experienced one or more falls in the previous 12 months. As a result they could be used as screening tools for the identification of high-risk fallers who require referral for further assessment. This could be completed by a General Practitioner or Practice Nurse, which would ensure that screening is being undertaken in the wider population. If the patient is at high risk they should be referred for falls risk factor assessment to determine an optimal tailored intervention to reduce future falls. Low risk patients should be referred for preventive evidence-based activities. These steps can potentially improve quality of life for individuals, and if effective in preventing future falls, will result in reduced costs to the individual and the Australian public. The results of this work demonstrate that the best screening tests are simple tasks like the TUG and asking an individual if they have experienced a fall in the last 12 months. This research also found that strong, mobile older people who could undertake and complete a submaximal cycle ergometer test, still experienced falls in the following 12 months, although the causes of this are currently unknown. This research showed that physiological falls risk factors are less relevant as these highly functional older people do not have physiological deficits. However, this research found that the 6-MWT showed promise as a predictor of falls in a group who could not complete a submaximal cycle ergometer test, who had lower strength, balance and functional fitness scores than a group who could complete this cycle test. The results showed that physiological falls risk factors are still very important for older people with lower physical abilities, and this is where aerobic fitness may still be related to falls. While the association between aerobic fitness and falls remains unclear, these are novel and provocative findings highlighting the need for future falls risk investigations to consider aerobic fitness as a contributing factor.

Thesis (MScEng)--University of Stellenbosch, 2005. / ENGLISH ABSTRACT: This report presents the application of the six sigma quality concept in solving a true business problem. Six sigma is a quality improvement and business strategy/tool developed by Motorola in the mid 1980s. It aims at delivering products and services that approach levels of near perfection. To achieve this objective a six sigma process must not produce more than 3.4 defects per million opportunities, meaning the process should be at least 99.9997% perfect [Berdebes, 2003]. Motorola's success with six sigma popularised the concept and it has now been adopted by many of the world's top compames e.g. General Electric, Allied Signal-Honeywell, etc. All the six sigma companies report big financial returns as a result of increased quality levels due to the reduction in the number of defects. 'General Electric reports annual benefits of over $2.5 billion across the organisation from six sigma' [Huag, 2003]. The six sigma concept follows a five step problem-solving methodology known as DMAIC (Define, Measure, Analyse, Improve, Control) to improve existing processes. Each of these steps makes use of a range of tools, which include quality, statistical, engineering, and business tools. This report first gives a theoretical presentation on quality and six sigma, attempting to answer the question 'What is six sigma'. A step-by-step guide on how to go through the DMAIC problem solving cycle is also presented. The six sigma concept was demonstrated by application to the colour removal process of a continuous processing plant manufacturing refined sugar. Colour removal is a very important process in sugar refining since the purpose of a refinery is to remove colour and other impurities from the raw sugar crystals. The colour removal process consists of three unit operations; liming, carbonation and sulphitation. Liming involves the addition of lime (calcium hydroxide) required for the formation of a calcium precipitate in the next unit operations. Carbonation is carried out in two stages; primary and secondary carbonation. Both stages involve the formation of a calcium carbonate precipitate, which traps colour bodies and other impurities. Sulphitation occurs in a single step and involve the formation of a calcium sulphite precipitate which also traps impurities. The pH and colour are the main variables that are being monitored throughout the colour removal process. Colour removal process Raw sugar Melting Carbonation Crystalli ~ Liming ~ c::J Secondary f+ Sulphitation .. Sugar sation Figure 1: Colour removal process The pH control of the two colour removal unit operations; carbonation and sulphitation, is very poor and as a result the colour removal achieved is below expectation. This compromises the final refined sugar quality since colour not removed in the colour removal processes ends up in the sugar. The first carbonation stage (primary) fails to lower the pH to the required specification and the second carbonation stage (secondary) is highly erratic, the pH fluctuating between too high and too low. The sulphitation process adds more sulphur dioxide than required and hence the pH is lowered below the lower specification limit. The six sigma DMAIC cycle was implemented in order to solve the problem of poor pH control. The Define phase defined the project and identified the process to be improved. The Measure phase measured the current performance of the process by collecting past laboratory data with the corresponding field instruments data. The data was used to draw frequency distribution plots that displayed the actual variation of the process relative to the natural variation of the process (specification width) and to calculate process capability indices. The Analyse phase analysed the data so as to determine the key sources of variation. The Improve phase used the findings of the analyse phase to propose solutions to improve the colour removal processes. The Control phase proposed a control plan so as to monitor and sustain the improvement gained. The key findings of the study are presented below: • Failure of the first carbonation stage to lower the pH to the required level is due to insufficient carbon dioxide gas supply. • The second carbonation reaction occurs very fast hence poor control will result in high variability. • The amount of colour removed is dependent on the input raw melt colour. • The histograms of the colour removal unit operations are off-centered and display a process variation greater than the specification width and hence a large proportion of the data falls outside the specification limits. • The % CaO and CO2 gas addition were found to be the key variables that control the processes centering on target. The % CaO having a stronger effect in the liming process and CO2 gas addition on the carbonation process. • The variation between the field instrument's pH and laboratory pH is the key variable that control the processes spread (standard deviation of the processes). • The processes Cpk values are less than C, (Cpk<Cp) meaning the processes can be improved by controlling the key variables that control centering (% CaO, CO2 gas addition). The processes capability indices are low, Cp<l meamng the processes are not statistically capable of meeting the required specifications at the current conditions. • Based on the findings of the study, the following deductions are made for the improvement of the colour removal processes in better meeting the required specifications. • Increase the CO2 gas supply to at least 4900 m31hr, calculated based on the fact that at least 140 rrr' gas is required per ton of solids in melt [Sugar Milling Research Institute Course Notes, 2002]. • Control the key variables identified to be the key sources of variation; % CaO, CO2 gas addition and variation between the field instrument's pH and laboratory pH. Reducing variation in the % CaO and increasing CO2 gas supply will improve the processes ability to maintain centering at the target specification. Maintaining a consistent correlation between the two pH readings; field instruments pH and laboratory pH will reduce the processes standard deviation and hence the processes spread. Reduction in the processes spread will minimize the total losses outside the specification limits. This will allow better control of the pH by getting rid of high fluctuations. • Control of the input raw melt colour is essential since it has an impact on the degree of decolourisation. The higher the input colour, the more work required in removing the colour. In improving the colour removal processes the starting point should be in ensunng process stability. Only once this is achieved, the above adjustments may be made to improve the processes capability. The processes capability will only improve to a certain extent since from the capability studies it is evident that the processes are not capable of meeting specifications. To provide better control and to ensure continuous improvement of the processes the following recommendations are made: • Statistical process control charts The colour removal processes are highly unstable, the use of control charts will help in detecting any out of control conditions. Once an out of control condition has been detected, necessary investigations may be made to determine the source of instability so as to remove its influence. Being able to monitor the processes for out of control situations will help in rectifying any problems before they affect the processes outputs. • Evaluation of capability indices- ISO 9000 internal audits Consider incorporating the assessment of the capability indices as part of the ISO 9000 internal audits so as to measure process improvement. It is good practice to set a target for Cp, the six sigma standard is Cp=2, this however does not mean the goal should be Cp=2 since this depends on the robustness of the process against variation. For instance the colour removal processes at the current operating conditions can never reach Cp=2. This however is not a constraint since for the colour removal processes to better meet pH specifications it is not critical that they achieve six sigma quality. A visible improvement may be seen in aiming for Cp=I. On studying the effects of CO2 gas addition the total data points outside specification limits reduced from 84 % to 33 % and by reducing the variation between field instruments pH and laboratory pH for the secondary pH the total data points out of specification reduced from 55 % to 48 %. These results indicate that by improving C, to be at least equal to one (Cp=l) the total data points outside specification can reduce significantly, indicating a high ability of the processes to meet specifications. Thus even if six sigma quality is not achieved, by focussing on process improvement using six sigma tools visible benefits can be achieved. / AFRIKAANSE OPSOMMING: Hierdie tesis kyk na die toepassing van die ses sigma kwaliteitskonsep om 'n praktiese probleem op te los. Ses sigma soos dit algemeen bekend staan is nie slegs 'n kwaliteitverbeteringstegniek nie maar ook 'n strategiese besigheidsbenadering wat in die middel 1980s deur Motorolla ontwikkel en bekend gestel is. Die doelstellings is om produkte en dienste perfek af te lewer. Om die doelwit te kan bereik poog die tegniek om die proses so te ontwerp dat daar nie meer as 3.4 defekte per miljoen mag wees nie - dit wil se die proses is 99,9997% perfek [Berdebes, 2003]. As gevolg van die sukses wat Motorolla met die konsep behaal het, het dit algemene bekendheid verwerf, en word dit intussen deur baie van die wereld se voorste maatskappy gebruik, o.a. General Electric, Allied Signal-Honeywell, ens. Al die maatskappye toon groot finansele voordele as gevolg van die vermindering in defekte wat teweeg gebring is. So by. beloop die jaarlikse voordele vir General Electric meer as $2.5 biljoen [Huag, 2003]. Die ses sigma konsep volg 'n vyf-stap probleem oplossings proses (in Engels bekend as DMAIC: Define, Measure, Analyse, Improve, Control), naamlik definieer, meet, analiseer, verbeter, en beheer om bestaande prosesse te verbeter. In elkeen van die stappe is daar spesifieke gereedskap oftegnieke wat aangewend kan word, soos by. kwaliteits-, statistiese--, ingenicurs-cn besigheids tegnieke. Die verslag begin met 'n teoretiese oorsig oor kwaliteit en die ses sigma proses, waardeur die vraag "wat is ses sigma" beantwoord word. Daama volg 'n gedetailleerde stap-virstap beskrywing van die DMAIC probleem oplossingsiklus. Die toepassing van die ses sigma konsep word dan gedoen aan die hand van 'n spesifieke proses in die kontinue suiker prosesserings aanleg, naamlik die kleurverwyderingsproses. Hierdie proses is baie belangrik omdat die doelstellings daarvan juis draai rondom die verwydering van nie net kleur nie maar ook alle ander vreemde bestanddele van die rou suiker kristalle. Die proses bestaan uit drie onafhanklike maar sekwensiele aktiwiteite waardeur verseker word dat die regte gehalte suiker uiteindelik verkry word. Tydens die eerste twee stappe is veral die pH-beheer onder verdenking, sodat die kleur verwydering nie die gewenste kwaliteit lewer nie. Dit bemvloed op sy beurt die gehalte van die finale produk, omdat die ongewenste kleur uiteindelik deel is van die suiker. Die pH inhoud is nie net nie laag genoeg nie, maar ook hoogs veranderlik - in beginsel dus buite beheer. Die DMAIC siklus is toegepas ten einde die pH beter te kan beheer. Tydens die definisiefase is die projek beskryf en die proses wat verbeter moet word identifiseer. In die meetfase IS die nodige data versamel om sodoende die inherente prosesveranderlikheid te bepaal. Die belangrikste bronne of veranderlikes wat bydra tot die prosesveranderlikheid is in die derde-- of analisefase bepaal. Hierdie bevindings is gebruik tydens die verbeteringsfase om voorstelle ter verbetering van die proses te maak. Die voorstelle is implementeer en in die laaste fase, naamlik die beheerfase, is 'n plan opgestel ten einde te verseker dat die proses deurentyd gemonitor word sodat die verbeterings volhoubaar bly. 'n Hele aantal veranderlikes wat elk bygedra het tot die prosesvariasie is identifiseer, en word in detail in die verslag beskryf. Gebaseer op die analise en bevindings van die ondersoek kon logiese aanbevelings gemaak word sodat die proses 'n groot verbetering in kleurverwydering getoon het. Die belangrikste bevinding was dat die huidige proses nie die vermoee het om 100% te voldoen aan die spesifikasies of vereistes nie. Die hoofdoel van die voorstelle is dus om te begin om die prosesveranderlikheid te minimeer of ten minste te stabiliseer - eers nadat die doel bereik is kan daar voortgegaan word om verbeteringe te implementeer wat die prosesvermoee aanspreek. Ten einde hierdie beheer te kan uitoefen en vanasie te verminder IS die volgende voorstelle gemaak: Statistiese beheer kaarte Die kleurverwyderingsproses is hoogs onstabiel. Met behulp van statistiese beheer kaarte is daar 'n vroegtydige waarskuwing van moontlike buite beheer situasies. Die proses kan dus ondersoek en aangepas word voordat die finale produkkwaliteit te swak word. • Evaluering van proses vermoee - ISO 9000 interne oudit Die assesering van die prosesvermoee behoort deel te word van die interne ISO oudit proses, om sodoende prosesverbeteringe gereeld en amptelik te meet. Die standaard gestel vir C, behoort gedurig aandag te kry - dit is nie goeie praktyk om bv. slegs 'n doelwit van C, = 2 soos voorgestel in ses sigma te gebruik nie, maar om dit aan te pas na gelang van die robuustheid van die proses wat bereik is. Daar is beduidende voordele bereik deur die toepassing van die DMAIC siklus. So het byvoorbeeld die persentasie datapunte buite spesifikasie verminder van 84% tot 33%, bloot deur te kyk na die effek wat die toevoeging van C02 gas tydens die proses het. Dit toon dus duidelik dat, alhoewel die proses huidiglik nie die vermoee het om te voldoen aan die vereistes van ses sigma nie, dit wel die moeite werd is om die beginsels en tegnieke toe te pas.

Thesis (MPhil)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: Volatility, globalisation, turbulence and constant change are some of the challenges facing the business environment today. Companies have proposed and tested many strategies to cope with the unpredictable world of business. In this thesis, a project by an anonymous South African company (The Company) to respond by improving organisational excellence is analysed and evaluated against its success in fostering organisational learning. The Company initiated a project in which Lean Manufacturing, Six Sigma and Clear Leadership Engagement were combined in search of operational excellence. In Chapter 1, the context is set out. The research question is formulated as follows: to what extent does organisational learning depend on organisational excellence? Chapter 2 discusses and defines key process concepts. These are: Lean Manufacturing, Six Sigma, Lean Six Sigma and Clear Leadership Engagement Models. The chapter also outlines the key practices and the shortcomings of each process. Chapter 3 discusses and defines the conceptual building blocks of the thesis. These are the notions of organisational learning and learning organisation. Tools used to diagnose whether an organisation is learning are introduced together with an Organisational Learning model to be used to assess the relationship between Organisational Learning and Operational Excellence. Chapter 4 focuses on the project of the Company – the Operational Excellence “journey”. How the journey was conceived, the players were involved and steps taken to drive it are described. In Chapter 5, the combination of Lean Six Sigma, Lean Manufacturing and the engagement models that the Company used, is assessed. The chapter attempts to unravel the reasons behind this combination and determine how this combination worked in practice. It is through this chapter that an attempt is made to explain the logic of this unusual combination. Other businesses have implemented different forms of improvement in isolation, but it is rare to find a company that combines operational improvement methodologies with an engagement model. In Chapter 6, all the theories and empirical evidence come together. In this chapter, the relationship between Pursuing Operational Excellence (POE) and Organisational Learning is tested. The author uses the seven salient characteristics of learning organisations, distilled by the researcher, to prove the positive relationship between Organisational Learning and Operational Excellence. Through this chapter, the researcher answers the question whether a positive link exists between POE and Organisational Learning. It was clear from the research that there is indeed a positive link between POE and Organisational Learning. What the research could not determine is the degree or the rate of learning linked to POE, or what percentage of learning the organisation achieved over a period of time. / AFRIKAANSE OPSOMMING: Volatiliteit, globalisering, turbulensie en konstante verandering is ‘n uitdaging waarmee die sake-omgewing deesdae te doen kry. Baie strategieë is voorgestel en getoets deur maatskappye ten einde by te bly in die onvoorspelbare sake-wêreld. In hierdie tesis word ‘n projek wat in ‘n anonieme Suid-Afrikaanse maatskappy (The Company) uitgevoer is om op die uitdagings te reageer, by wyse van ‘n dryf na operasionele uitnemendheid, geanaliseer en geëvalueer aan die hand van die mate waarin sodanige aksies organisatoriese leer bevorder het. The Company het ‘n projek geloods waarin Lean Manufacturing, Six Sigma en Clear Leadership Engagement gekombineer is op soek na operasionele uitnemendheid. In Hoofstuk 1 word die konteks uiteengesit en die navorsingsvraag geformuleer as die vraag in watter mate organisatoriese leer deur operasionele uitnemendheid bepaal word. In Hoofstuk 2 word die kern prosesbegrippe bespreek en gedefinieer. Dit is: Lean Manufacturing, Six Sigma, Lean Six Sigma en Clear Leadership Engagement models. Die hoofstuk gee ook ’n oorsig oor die hoofpraktyke en tekortkominge van elke model. Hoofstuk 3 bespreek die konseptuele basis van die navorsing. Dit is die konsepte: Organisatoriese Leer en Lerende Organisasie. Instrumente om te diagnoseer of ’n organisasie leer, word voorgestel, asook ’n model van Organisatoriese Leer wat gebruik sal word om die verband tussen Organisatoriese Leer en Operasionele Uitmuntendheid te bepaal. Hoofstuk 4 fokus op die projek wat The Company onderneem het. In hierdie hoofstuk word die “reis” na operasionele uitnemendheid beskryf; hoe dit ontstaan het, die rolspelers wat betrokke was en die stappe wat op die reis geneem is. In Hoofstuk 5 beoordeel die kombinasie van Lean Six Sigma, Lean Manufacturing en die engagement modelle wat deur die Company gebruik is. Die hoofstuk probeer ontrafel wat die motivering vir hierdie kombinasie is en hoe dit in die praktyk uitgewerk het. In die hoofstuk word gepoog om die logika van hierdie ongewone kombinasie te peil. Ander ondernemings het verskillende vorms van verbetering in isolasie geïmplementeer, maar dit is selde dat ’n mens ’n maatskappy vind wat operasionele verbeteringsmetodologieë kombineer met ’n engagement model. In Hoofstuk 6 kom al die teorieë en empiriese gegewens bymekaar. Dit is in hierdie hoofstuk waar die verhouding tussen die nastrewing van Operasionele Uitnemendheid en Organisatoriese Leer getoets word. Die navorser gebruik die sewe kenmerke van Lerende Organisasies wat tevore geïdentifiseer is om ’n positiewe verband tussen Organisatoriese Leer en Operasionele Uitnemendheid aan te toon. Uit die navorsing was dit duidelik dat daar ’n positiewe verband is tussen die nastrewing van Operasionele Uitnemendheid en Organisatoriese Leer. Maar, wat die navorsing nie kon beantwoord nie, is die graad of spoed van leer wat met die nastrewing van Operasionele Uitnemendheid verbind kan word, of watter persentasie leer die organisasie oor ’n gegewe tydperk bereik het.

This research is inserted in Curriculum, Teaching and School Practices line at Postgraduate Program in Education from UFSM. It had as purpose to know the ideas from teachers about admission of children, aged six, to obligatory school and its implications in the organization of beginning reading and writing teaching process. Studies from Ferreiro and Teberosky (1999), Ferreiro (1993, 2001, 2002), Bolzan (2001, 2002, 2007), Vygotski (1994, 1995), among others, were utilized as theoretical basis to develop this investigation. This research was carried out in Municipal System of Teaching from Santa Maria/RS, between April and December, 2007. The participants were twelve teachers, who developed their profession at first grade groups of Elementary School. The investigation was done through a qualitative narrative study, which focused on the teachers speeches/voices/narratives. The data search was carried out through some semi-structured interviews. The teachers, expressing their understanding about the children admission to school, allowed the construction of three categories: conceptions of childhood and children, conceptions of reading and writing and conceptions of pedagogical organization. In the elaboration of these categories, two movements arose: a retrospective movement and a prospective movement. In the retrospective movement, the teaching enlargement is thought in a retrospective view, from what the students do not know, and, thus, the teaching processes are organized, not considering the childhood as a period of development, what makes occur, in this way, the educational formalization. In the prospective movement, it was noticed that the organization of this first grade addresses to think of producing the childhood and of formalizing the education processes in a prospective way. We realized, thus, an educational construction movement directed to the students possibilities. In this way, it was pointed out that there are two realities being produced inside schools; on the one hand, the practice has been the motivator for of a wide children development and, on the other hand, the practice addresses to the existence of activities which ignore the children sociocultural nature. At last, the research allowed to perceive that to think, prospective or retrospectively, makes part of the own school production movement, which needs to be, constantly, reviewed and questioned in the institution as a whole. / Esta pesquisa insere-se na linha de Currículo, Ensino e Práticas Escolares do Programa de Pós-Graduação em Educação da UFSM. O estudo teve como objetivo conhecer as idéias de professoras sobre o ingresso da criança, aos seis anos de idade, na escolaridade obrigatória e sua implicação na organização do processo de ensino da leitura e da escrita iniciais. Os estudos de Ferreiro e Teberosky (1999), Ferreiro (1993, 2001, 2002), Bolzan (2001, 2002, 2007); Vygotski (1994, 1995), entre outros, foram utilizados como aportes teóricos para o desenvolvimento dessa investigação. A pesquisa foi realizada no Sistema Municipal de Ensino de Santa Maria/RS, entre abril e dezembro de 2007. As participantes foram doze professoras que desenvolviam seus trabalhos com turmas do primeiro ano do Ensino Fundamental. A investigação foi feita através de um estudo qualitativo narrativo, tendo por foco as falas/vozes/narrativas das professoras. A busca dos dados foi realizada por meio de entrevistas semi-estruturadas. As professoras, ao expressarem seus entendimentos sobre o ingresso da criança na escola, permitiram a construção de três categorias: concepções sobre infância e criança, concepções sobre leitura e escrita e concepção sobre organização pedagógica. Nesse processo de elaboração das categorias, emergiram dois movimentos: um movimento retrospectivo e um movimento prospectivo. No movimento retrospectivo, a ampliação do ensino é pensada a partir daquilo que os sujeitos não sabem, pois precisam ser lapidados e completados, pois lhes faltam habilidades e competências para aprender, assim, o processo de escolarização é organizado abandonando-se a visão de infância como período de desenvolvimento. No movimento prospectivo, percebeu-se que a organização desse primeiro ano remete a um pensar os processos de produzir a infância e de formalizar o ensino de maneira a valorizar as possibilidades de avançar de cada sujeito, notando-se, assim, um movimento de construção de uma escolarização voltado às capacidades do sujeito. Dessa maneira, evidenciou-se que existem duas realidades sendo produzidas nos espaços escolares; de um lado, as narrativas sobre a prática têm se constituído como motivadora de um amplo desenvolvimento das crianças, e de outro, essas mesmas narrativas remetem a existência de atividades que desconsideram a natureza sociocultural das crianças. Enfim, evidencia-se que pensar e implementar a escolarização de nove anos gerou a concomitância desses dois movimentos: o prospectivo e o retrospectivo, levando-se a afirmar que ambos fazem parte do próprio movimento de produção da escola, o qual precisa ser, constantemente, revisto e problematizado no conjunto da instituição.

Orientador: Otávio José de Oliveira / Banca: Messias Borges Silva / Banca: José Antônio Perrella Balestieri / Banca: Márcio Cardoso Machado / Banca: Eduardo Ferro dos Santos / Resumo: Lean Six Sigma (LSS) é uma estratégia de melhoria contínua usada para aumentar a eficiência e eficácia dos processos produtivos a partir da eliminação de desperdícios e redução da sua variabilidade. Embora existam pesquisas sobre esta metodologia em empresas do setor manufatureiro, poucos estudos são direcionados para a sua aplicação no setor calçadista. Pelo exposto, o objetivo deste trabalho consiste em diretrizes para implementação do LSS em Micro, Pequenas e Médias Empresas (MPME's) de calçados. Para direcionar a realização de oito estudos de casos em MPME's calçadistas foram identificados na literatura cientifica os princípios do LSS e verificada a sua aplicação na realidade das empresas estudadas. Os instrumentos de coleta de dados para estes estudos de caso foram entrevistas semiestruturadas com gestores e colaboradores, análise documental e visita in loco. Na análise dos casos foi identificado que as empresas, embora não utilizem o LSS, possuem práticas que podem facilitar sua implementação, assim como há dificuldades que precisam ser superadas para que implementação possa ocorrer de forma eficaz. Tais possibilidades e dificuldades se constituíram como a base das diretrizes elaboradas para implementação do LSS em MPME's. Os princípios do LSS verificados nas MPME's de calçados foram: desenvolver e manter uma filosofia de longo prazo, focar no cliente, desenvolver líderes, desenvolver pessoas e equipes profissionais, desafiar e respeitar a rede de parceiros e fornecedor... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Lean Six Sigma (LSS) is a continuous improvement methodology used to increase the efficiency and effectiveness of production processes by eliminating waste and reducing its variability. Although there are researches on this methodology in companies of the manufacturing sector, few studies are directed to its application in the footwear sector. Therefore, the objective of this paper is to propose guidelines for the implementation of LSS in micro, small and medium enterprises of footwear. In order to direct the accomplishment of eight case studies in footwear MSMEs, the principles of LSS were identified in the scientific literature, verified in the reality of the companies studied. The instruments of data collection for these case studies were semi-structured interviews with managers and collaborators, documentary analysis and on-site visit. In the analysis of the cases it was identified that the companies, although they do not use the LSS, have practices that can facilitate their implementation. As well as there are difficulties that need to be overcome so that implementation can take place effectively. These possibilities and difficulties were the basis of the guidelines developed for the implementation of LSS in MSMEs. The LSS principles found in MSMEs for footwear were: to develop and maintain a long-term philosophy, focus on the customer, develop leaders, develop people and professional teams, challenge and respect the network of partners and suppliers, create a culture of continuous improvement, Use LSS tools, pull systems (JIT), focus on the perfection of products, processes and services, eliminate waste and reduce variability. This research contributes to fill the gap in the literature regarding the lack of proposals for the implementation of LSS in MSMEs of footwear (scientific contribution) and allows ... (Complete abstract click electronic access below) / Doutor

Orientador: Silvia Regina Ricco Lucato Sigolo / Banca: Maria Regina Guarnieri / Banca: Márcia Cristina Argenti Perez / Resumo: Partindo da aprovação da Lei nº 11.114, sancionada em 16/05/2005 - que estabeleceu que crianças de seis anos fossem então matriculadas no ensino fundamental e da Lei nº 11.274, sancionada em 06/02/2006 que amplia a duração do ensino fundamental para nove anos - e considerando que família e escola são os contextos mais relevantes da vida de uma criança - esse trabalho teve por objetivo constatar como se configura o 1º ano do ensino fundamental de nove anos e como os principais envolvidos - crianças, pais e professoras percebem este processo. O estudo, de caráter qualitativo, se fundamenta na abordagem bioecológica de desenvolvimento humano de Bronfenbrenner (1996), cuja ênfase está na interconexão entre vários níveis do sistema ecológico. É uma abordagem que privilegia estudos em ambientes naturais que contemplem a realidade cotidiana vivenciada pelos sujeitos envolvidos - considerando estes em suas particularidades, bem como os ambientes nos quais estão inseridos. Dessa forma, a presente pesquisa possibilitou a inserção da pesquisadora no campo para coletar informações e poder dar ênfase ao olhar de crianças matriculadas no primeiro ano do ensino fundamental, para além da visão de seus pais e professores. Sendo assim, foram realizadas observações e entrevistas semi-estruturadas, com o objetivo principal de constatar situações de práticas e apreender as percepções dos sujeitos envolvidos com o ingresso no ensino fundamental. A pesquisa foi desenvolvida em uma escola municipal de uma cidade do interior paulista, que atende estudantes do ensino fundamental. A coleta de dados ocorreu no período de março a agosto de 2008. Somaram-se trinta e três o número de sujeitos deste estudo: três professoras atuantes no 1º ano do ensino fundamental, quinze crianças deste mesmo ano e quinze responsáveis destas (pais e/ou mães, neste caso). As observações... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: From the approval of the Law 11.114, released in 05/16/05, which established that the sixyear- old children were enrolled in fundamental school - and considering that the family and the school are the most relevant contexts in a child's life - the aim of this work was to notice how the first year of the nine-year fundamental teaching takes place, and also, how the main involved - children, parents and teachers - notice the procedure. The quality study is based in the bioecological approach of Bronfenbrenner's human development, which emphasizes the interconnection among several levels of the ecological system. It's a kind of approach that privileges studies in natural atmospheres that contemplate the daily reality lived by the involved characters - considering them in their features, as well as the atmospheres in which they're inserted. This way, the present research enabled the researcher's inset to get information and be able to emphasize the look at the children who were enrolled in the first year of the fundamental reaching, for a further vision of their parents and teachers. So, remarks and semi-structured interviews were carried out, with the main goal of noticing practical situations and learning the perceiving of the characters involved in the entrance in the fundamental teaching. The research was carried out at a Town hall school in a city in the countryside of São Paulo state, which deals with fundamental teaching students. The data collection happened from March to August in the year 2008. The number of characters in this study was thirty-six: three teachers of the first year of fundamental teaching, fifteen children at the same course, and their fifteen fathers and mothers. The observations inside the classroom were carried out during the research time, and focused the situations in regular classes and other moments that surround the school... (Complete abstract click electronic access below) / Mestre

O teste de exercício cardiopulmonar incremental (TECP) tem sido utilizado para avaliar o impacto global da doença em pacientes com DPOC. Considerando que as avaliações de exercício em laboratório são demoradas, caras e muitas vezes indisponíveis, o teste de caminhada de seis minutos (TC6min) não exige equipamentos caros e sofisticados, e pode ser facilmente realizado. Embora, a principal medida comumente utilizada no teste de caminhada seja a distância percorrida durante os 6 minutos (D), esta medida não leva em conta as diferenças de peso corpóreo, que podem influenciar o desempenho do exercício. Além disso, estudos anteriores correlacionaram o trabalho realizado durante o TC6min com TECP incremental pedalando, modalidade de exercício comumente associada a fadiga de quadríceps e menor consumo de oxigênio de pico ( O2) do que o TECP caminhando. O principal objetivo desse estudo foi avaliar a correlação entre a distância percorrida no TC6min (D) e o produto distância percorrida - peso corporal (DxP), uma estimativa do trabalho realizado durante o TC6min, com o O2 de pico obtido durante o TECP incremental em esteira ergométrica. Foram estudados trinta pacientes (19 homens), apresentando média (± DP) de idade de 66,3 ± 7,5 anos, com DPOC estável de moderada a grave intensidade (VEF1 médio de 1,1 ± 0,4L e 39 ± 13% predito) que realizaram TECP incremental em esteira ergométrica até o limite máximo de tolerância e o TC6min. Os testes foram realizados com pelo menos 48 horas de intervalo. A correlação de Pearson foi utilizada para avaliar o nível de associação entre o O2 pico, a distância e o trabalho executado durante o TC6min. Os pacientes percorreram 425,1 ± 78,6 m e realizaram um trabalho de 28166,4 ± 8368,4 Kg-m durante o TC6min, enquanto que o O2 de pico atingido foi 965,6 ± 370,1 mL/min (68,7 ± 17,4% do previsto) no TCPE. Ao final do exercício, em ambos os testes, a dispnéia foi a principal queixa e maior percepção de dispnéia e maior frequência cardíaca foi observado ao final do TECP comparativamente ao TC6min. O trabalho da caminhada (DxP) durante o TC6min demonstrou maior correlação com o O2 pico do que a distância (D) isoladamente. O mesmo ocorreu para VEF1, CVF, CI, DLCO, CO2, E e duplo produto (uma estimativa do trabalho do miocárdio), (r = 0,57; r = 0,57; r = 0,73; r = 0,7; r = 0,75; r = 0,65; r = 0,51; r = 0,4 respectivamente, todos com p <0,05). Dessa forma, esse estudo corrobora a melhor associação entre o trabalho estimado a partir da TC6min e o O2 pico atingido durante TECP, neste caso em esteira ergométrica, em comparação à distância isoladamente. / Incremental cardiopulmonary exercise testing (CPET) is increasingly used to evaluate the overall impact of the illness in patients with COPD. Whereas laboratory tests of exercise performance are often time-consuming, costly and frequently unavailable, the six-minute walk test (6MWT) does not require expensive or sophisticated equipments, and can be easily performed. Although, the main outcome measure commonly used in this field test is the distance walked during the predetermined 6 minutes (6MWD), this measure does not account for differences in body weight that are known to influence exercise performance. Furthermore, previous studies correlated the working performed during 6MWT with incremental cycling CPET, an exercise modality more associated with quadriceps fatigability and lower peak oxygen consumption ( O2) than incremental walking tests. The main objective of this study is to evaluate the correlation between 6MWD and its derivative walking distance-body weight product, an estimation of the work performed during 6MWT, with peak O2 obtained during a treadmill incremental CPET. The study enrolled thirty patients (19 males), with a mean (± SD) age of 66.3 ± 7.5 years and a stable moderate-to-severe COPD (ie, mean FEV1 1.1 ± 0.4L and 39 ± 13 % predicted) performed a ramp incremental CPET to the limit of tolerance on a treadmill and 6MWT. Tests were performed at least 48 h apart. Pearson´s correlation was used to assess the level of association between peak O2 and the distance and work executed during 6MWT. The patients walked 425.1 ± 78.6 m and performed a work of 28,166.4 ± 8368.4 (Kg-m) during the 6MWT while achieved a peak O2 of 965.6 ± 370.1 mL/min (68.7 ± 17.4% of predicted) in the treadmill CPET. They mainly stopped exercise due to dyspnea in both tests and reported a greater perception of dyspnea and higher heart rate was observed at the end of the CPET. The work of walking during the 6-MWT (DxW) provided greater and more frequent significant correlation with peak O2 than that observed with 6MWD.This was the case for FEV1, FVC, IC, DLCO, CO2, E, and double product (an estimate of myocardial work) (r=0.57; r=0.57; r=0.73; r=0.7; r=0.75; r=0.65; r=0.51 and r= 0.4, respectively; all p<0.05). This study provides evidence to corroborate the better association between the work estimated from the 6MWT and peak O2 achieved during CPET, in this case with a treadmill, than the 6MWD on isolation.

Introdução: A tolerância ao exercício e os níveis de atividade física tendem a ser reduzidos em pacientes com fibrose cística (FC). Estudos trazem que o nível de atividade física pode estar associado com melhor estado nutricional e com um maiordeclínio da função pulmonar. Com a evolução da doença,o declínio da função pulmonar associado a distúrbios metabólicos e desnutrição, provocam alterações na mecânica respiratória, distúrbios musculoesqueléticos e deformidades torácicas, trazendo prejuízos na qualidade de vida destes indivíduos. Objetivo: Verificar a associação entre gravidade funcional pulmonar, nível de atividade física e variáveis de avaliação postural em adultos com FC. Secundariamente, verificar a correlação entre os parâmetros de atividade física observados pelo acelerômetro e pelo questionário internacional de atividade física (IPAQ) e, verificar a correlação entre os parâmetros de atividade física observados pelos dois instrumentos com a distância percorrida no teste de caminhada de seis minutos (DTC6M) e os parâmetros de avaliação postural.Métodos: Estudo de caráter transversal, aprovado pelo Comitê de Ética em Pesquisa do Hospital de Clínicas de Porto Alegre. Para a verificação de parâmetros de função pulmonar foi utilizado o exame de espirometria, para a verificação do nível de atividade física foi utilizado o questionário IPAQ e um acelerômetro, para avaliação postural foi utilizada a fotogrametria com auxílio do Software de avaliação postural (SAPO) e, para comparações complementares foi utilizado o teste de caminhada de seis minutos (TC6M). Resultados: Participaram do estudo 28 indivíduos adultos com FC, idade média de 25,1 anos e VEF1 (%) com média de 47,1. O VEF1 se associou com os parâmetros obtidos pelo acelerômetro, avaliação postural e TC6M, porém, não houve associação com os dados obtidos pelo IPAQ. Conclusão: Este estudo demonstrou que o declínio da função pulmonar dos pacientes adultos com FC está associado com maior cifose torácica, menor tempo em atividade física moderada e vigorosa e menor distância percorrida no TC6M. O acelerômetro demonstrou-se ser o melhor instrumento para avaliação da atividade física neste público. / Introduction: Exercise tolerance and levels of physical activity tend to be reduced in patients with cystic fibrosis (CF). Studies suggest that the level of physical activity may be associated with better nutritional status and with larger decline in lung function. With the evolution of the disease, the decline of lung function associated with metabolic disorders and malnutrition, causes alterations in respiratory mechanics, musculoskeletal disorders and thoracic deformities, bringing injury to the individual’s quality of life.Objective: To verify the association between pulmonary functional severity, physical activity level and postural evaluation variables in adults with CF. Secondly, to verify the correlation between the physical activity parameters observed by the accelerometer and the international physical activity questionnaire (IPAQ) and to verify the correlation between the parameters of physical activity observed by the two instruments with the six-minute walking distance (6MWD) and the parameters of postural evaluation. Methods:Cross-sectional study, approved by the Research Ethics Committee of the Hospital de Clínicas, Porto Alegre.The spirometry test was used to verify pulmonary function parameters. The IPAQ questionnaire and an accelerometer were used to assess the level of physical activity, for postural evaluation the photogrammetry was used with the aid of the Postural Evaluation Software (SAPO) and, for further comparisons, the six-minute walk test (6MWT) was used. Results: 28 adult subjects with CF, mean age of 25.1 years and FEV1 (%) with a mean of 47.1 participated in the study. FEV1 was associated with the parameters obtained by the accelerometer, postural evaluation and 6MWT, but there was no association with the data obtained by IPAQ. Conclusion: This study demonstrated that the decline in lung function in adult patients with CF is associated with higher thoracic kyphosis, shorter time in moderate and vigorous physical activity, and shorter distance walked on 6MWT. The accelerometer has been shown to be the best instrument for assessing physical activity in this public.